Inspection on 03/09/05 for Ridgmont

This inspection was carried out on 3rd September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ridgmont 07/06/07

Ridgmont 28/02/06

Ridgmont 28/02/05

Ridgmont 23/09/04

Ridgmont 24/02/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Ridgmont 8 Ridgmont Road St Albans Hertfordshire AL1 3AF Lead Inspector Claire Farrier Unannounced 03 September 2005 at 13:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ridgmont Address 8 Ridgmont Road St Albans Hertfordshire AL1 3AF 01727 811159 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) ihead@pentahact.org.uk PentaHact Ian Head Care Home 6 Category(ies) of LD Learning Disability - 6 registration, with number of places Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: There are no additional conditions of registration. Date of last inspection 28th February 2005 Brief Description of the Service: Ridgmont is a care home providing personal care and accommodation for six younger adults with learning disabilities. It provides a specialist environment for people with ASD (autistic spectrum disorder) and associated challenging behaviour. The home was opened in 1991 and consists of a semi-detached Victorian family house with three storeys and a basement that houses the laundry. It is run by PentaHact, which is a voluntary organisation. The building is owned and managed by Stoneham Housing Association. PentaHact provides the care and employs the staff. The home is located in a residential area south of St Albans city centre. All the community services are within easy reach. The home has a minibus and there are good transport links nearby for the city centre, other Hertfordshire towns and London. All the home’s bedrooms are single and none have en-suite facilities. The home does not have a lift and would not be suitable for service users with mobility difficulties. The home has an enclosed garden with lawn, flower beds, summerhouse, brick built barbeque and garden furniture. Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of the inspection year and took place over one Saturday. The majority of time was spent observing and talking to residents and staff, and some time was also spent looking at care plans, records, complaints and staff training. Five residents and two members of staff were met and observed or spoken to during the inspection, and feedback was given to the manager. This was generally a positive inspection, and the majority of the standards were met. New requirements were made in relation to medication and health and safety in the garden. Requirements were repeated from the previous inspection report on refurbishment of the bathroom and repairs to the front drive. It was reported that Stoneham Housing Association has now agreed to repair the driveway, refurbish both the bathrooms in the home and convert the downstairs toilet into a wet room with a shower. Following this inspection a copy of the schedule of works was sent to CSCI. The requirements have been repeated, but it is accepted that there is an intention to complete the required repairs and refurbishment. What the service does well: What has improved since the last inspection? There has been little change since the last inspection. Ridgmont continues to provide a good quality of care for the residents. A new Statement of Purpose has been completed and a copy was sent to CSCI. It includes all the required information, including a schedule of room sizes, and has updated information on the staff team. The recording of medication has improved, but there was an unfortunate error in the administration of medication, which needs to be addressed. Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 and 3 The home has sufficient information on residents’ needs and access to appropriate services to enable their needs to be met. EVIDENCE: Pentahact specialises in services for people with ASD, and the company provides training in autism for all the staff of the homes. The home is accredited by the National Autistic Society for provision of services to people with ASD. Ridgmont provides a domestic environment for the residents, and the interior design, decoration and furnishing meet the needs of the individual residents, some of whom may not be able to cope with too much furniture or pictures on the wall. Behaviour programmes are in place for each resident, and the staff showed good understanding of the communication and behavioural needs of each person. No residents have been admitted to the home since the last inspection. The care plans contain full details of all the residents’ needs, which show that their needs are assessed and understood (See Standard 6). Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 The good quality of information in the residents’ files has been maintained. The residents’ care plans contain detailed information on all their personal care and health care needs. The staff were observed to treat the residents with respect and to assist them to make choices about their lives. EVIDENCE: Detailed case tracking was carried out through the files of two residents, which showed what care is provided for the residents and how it is recorded. The care plans seen contained comprehensive information on all the service users’ assessed needs, including detailed guidelines for individual service users for procedures such as the administration of medication and managing behaviour. Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 10 PentaHact is introducing a new care plan format to incorporate the principles of PCP (person centred planning), which focus on the person being totally at the centre of all planning, including how the process is carried out. The PCP process has been started with one resident. He has been involved in meetings with the people closest to him, and he is creating a visual diary using photographs of his activities, which he will be able to use to communicate with his parents. It was reported that care plans will be transferred to the new format one at a time, and the details will be kept on the computer so that they can be constantly reviewed and updated. The format will provide a clearer indication of how the residents are involved in making decisions about their lives. It was clear from observing the residents and their relationship with the staff that they are encouraged to make choices and decisions about their lives in the home. This is reflected in the daily recording completed for each resident, which include details of communication, socialisation, flexibility of thought, activities and daily living skills. Risk assessments for each resident are kept in a separate file. The risk assessments cover all aspects of each person’s behaviour, including leaving the home, travelling and tidying their bedroom. The risk assessments that were seen were dated 1998 and 2000, and there was no indication of any review since then. The care plans contain good details and procedures for behaviour management, but there is no reference in the care plan to the appropriate risk assessments. Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15, 16 and 17 The ethos of the home is that the residents are living in their own home, supported by the staff. The residents are encouraged to make choices for their activities, and to be involved according to their abilities in developing their skills for independence. This ensures good relationships with their families and with the local community, and that individual rights and responsibilities are recognised and supported. EVIDENCE: It is evident from observing the residents and their relationship with the staff that Ridgmont is the home of the residents, and the staff have the role of assisting them to live as independently as possible. Residents are encouraged to be involved in choosing and preparing their meals, and tidying and cleaning their rooms. This includes being present in the room while the activities are going on, which can be an achievement for some of the residents who find a lot of activity disturbing. Most of the residents attend the Queen Elizabeth the Queen Mother day centre, which is part of the PentaHact organisation, and continues the same behaviour programmes as Ridgmont. Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 12 One person has a structured timetable of activities with the staff at Ridgmont, and his behaviour has been observed to improve with this change in his routine. All the residents are encouraged to take part in activities in the home and in the community. The summerhouse in the garden has been converted into a sensory room, and it provides a quiet space for individual residents. One resident was seen listening to music in the summerhouse during the afternoon. The home has its own transport, and staffing levels ensure that all the residents are enabled to go out each day. Two residents went swimming during the morning, and one then chose to stay in her room during the afternoon, with assurance that she could stay there and relax. All the residents have families who remain very involved in their care. One resident was visiting his parents for the day, and another was going to visit his family later in the day. The staff cook meals from fresh ingredients, and the residents are involved as far as possible in choosing and preparing the food (see above). Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 The staff provide good quality personal care and treat the residents with sensitivity and respect. There is good recording of all the residents’ health care needs. All personal and health care support is well maintained within the home ensuring that individual needs, choices and preferences are met at all times EVIDENCE: The care plans that were inspected provide comprehensive details of the residents’ personal care and health care needs (see Standard 6), and a good relationship was observed between the staff and the residents. All the residents of Ridgmont have behaviour difficulties related to ASD, and most have limited communication. This makes them highly dependent on the staff to monitor and understand their needs. A behaviour change in one resident indicated that he was in pain, and after several consultations with the GP he was admitted to hospital where an operation was needed. The hospital admission took place following this inspection, but evidence was seen that the progress of the concerns about the resident’s health was well recorded. When a resident is admitted to hospital staff stay with them constantly, so that they have a familiar person with them who can communicate with the hospital staff on their behalf. Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 14 The home administers the medication for all the residents. It is stored in a locked cupboard attached to the wall in the dining room and accurate recording was seen for the administration. Medication is supplied in nomad monitored dosage boxes for each service user. PRN (when required) medications are supplied in separate containers. Notifications had been submitted to CSCI concerning an error when one resident was given another resident’s medication. The staff contacted NHS Direct and the GP immediately, and they confirmed that they was no risk to the resident concerned. The error had happened because it was not sufficiently clear which Nomad box belonged to which resident, and the two residents concerned have the same medication. Measures must be taken to ensure that Nomad boxes are clearly marked with the name of each resident, to ensure that there is no risk of a similar error. The home is considering changing to a new pharmacy supplier who will supply the medication in individual blister packs and provide training and support for the staff. Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Residents and their families are encouraged and enabled to make their views and concerns known. EVIDENCE: The home has a comprehensive complaints policy, which has been provided to the residents’ families. None of the residents have sufficient communication skills to understand and use the complaints policy without assistance. They all have involved families who would raise any concerns they may have, and the staff have the skills and experience to understand them if any resident is not happy. No complaints have been recorded since the last inspection. Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 The home provides a comfortable and well maintained environment for the residents, and the staff maintain a good standard of cleanliness and hygiene. EVIDENCE: The home is a semi-detached Victorian family house with three storeys and a basement. It is in keeping with the surroundings and the accommodation meets the standards for younger adults. Ridgmont provides a domestic environment for the residents, and the interior design, decoration and furnishing meet the needs of the individual residents, some of whom may not be able to cope with too much furniture or pictures on the wall. Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 17 The premises are owned by Stoneham Housing Association, which is responsible for maintenance, repairs and redecorations. There is a history of Stoneham taking a long time to carry out required repairs and refurbishments, such as the kitchen, which was refurbished only after several years of waiting. Requirements were made in the two previous inspection reports concerning essential maintenance, refurbishment of the first floor bathroom and repair of the front driveway. • The bathroom has a shabby appearance; the tiles on the wall need replacing and the enamel in the bath is worn and scuffed. The bath has a shower attachment, but it cannot be used as a shower as there is no wall fixing and no shower screen. There are now signs of damp and mould on the walls, and there is a distinctive smell in the room. Ridgmont Road is close to St Albans station and parking is very restricted. The area in front of the house is necessarily used for staff parking. The surface is cracked and broken in several places and there is no identified safe pathway from the gateway to the door. This is a health and safety risk for residents, staff and visitors to the home. • It was reported that Stoneham Housing Association has now agreed to repair the driveway, refurbish both the bathrooms in the home and convert the downstairs toilet into a wet room with a shower. Following this inspection a copy of the schedule of works was sent to CSCI. The requirements have been repeated, but it is accepted that there is an intention to complete the required repairs and refurbishment. The home appeared to be clean and hygienic. A new washing machine and tumble drier have been installed, that meet all the requirements for the hygienic handling of laundry. Staff spoken to confirmed that they follow the policies and procedures for maintenance of hygiene and control of infection. Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 35 The home is staffed by experienced support workers who are appropriately trained to meet the needs of the residents. The staff spoken to are confident of their knowledge of the needs of the residents and feel well supported in their work. EVIDENCE: The staffing levels have been maintained, and due to one resident having one to one support, the staffing levels are currently above the normal establishment. There were four members of staff in the home during the afternoon of the inspection. Two members of staff are in the home during the night, one sleeping in and one awake. PentaHact provides a comprehensive training programme that covers induction and ongoing mandatory training, and specific training on autistic spectrum disorder and behaviour management. Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The management within the home is secure and effective ensuring that changing needs of service users are met and that the home is meeting its aims and objectives. The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the home’s policies and procedures. EVIDENCE: The home has appropriate procedures for monitoring health and safety, including regular fire drills. However two potential hazards were noticed during the inspection. 1. The driveway in front of the house is cracked and broken (see Standard 24). It was reported that Stoneham Housing Association has now agreed to repair the driveway, and following this inspection a copy of the schedule of works was sent to CSCI. The requirement from the two previous two reports has been repeated, but it is accepted that there is an intention to complete the required repairs. 2. The rotary clothes drier in the garden is situated very close to the garden table and chairs, where several residents choose to eat their meals in the Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 20 warm weather. The drier is at head height, and it is not possible to reach the table and chairs without passing so close to the drier that there may be a risk of injury. Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ridgmont Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 20 Regulation 13(2) Requirement An incident was reported when one resident was given another resident’s medication. Measures must be taken to ensure that Nomad boxes are clearly marked with the name of each resident, to ensure that there is no risk of a similar error. The first floor bathroom is in need of refurbishment. Stonham Housing Association is responsible for maintenance of the building, and must provide a programme for carrying out the required work. Timescale of 31.8.05 not met. A schedule of planned works has been submitted, but the work has not yet been carried out. The driveway is uneven and a risk for service users, staff and visitors to the home. Access to the home must be made safe. Timescale of 31.8.05 not met. A schedule of planned works has been submitted, but the work has not yet been carried out. Measures must be taken to avoid the risk of injury to residents from the rotary clothes drier in the garden. Timescale for action 30 November 2005 2. YA24 23(2)(b) 31 December 2005 3. YA24YA42 23(2)(o) 13(4)(a)& (c) 31 December 2005 4. YA42 13(4)(c) 30 November 2005 Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 9 Good Practice Recommendations Appropriate risk assessments are in place, but they have not been reviewed. The care plans contain good details and procedures for behaviour management, but there is no reference in the care plan to the appropriate risk assessments. Risk asessments should be reviewed on a regular basis and at least annually on order to ensure that they are relevant and up to date. Care plans should make reference to the risk assessments where appropriate. Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ridgmont I52 s19510 ridgmont v243289 030905 stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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