Inspection on 07/06/07 for Ridgmont

This inspection was carried out on 7th June 2007.

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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ridgmont 28/02/06

Ridgmont 03/09/05

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 Yoke-Lan Jackson Unannounced Inspection 7 and 13th June 2007 10:00 th Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 Page 1 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 Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 Page 2 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 Stationery 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 DS0000019510.V342495.R01.S.doc Version 5.2 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 Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.pentahact.org.uk Adepta Ian Frederick Head Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th October 2006 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 autistic spectrum disorder (ASD) and associated challenging behaviour. The home was opened in 1991. The provider of the service is Adepta (formerly known as PentaHact), a charitable organisation. The semi-detached, three storey Victorian building is owned and managed by Stoneham Housing Association. It is located in a residential area south of St Albans city centre. All the community services are within easy reach. There are good transport links nearby for the city centre, other Hertfordshire towns and London. The home has its own minibus service. All the bedrooms are for single occupancy. The bathroom and toilet facilities are nearby. The home does not have a lift and would not be suitable for service users with restricted mobility. There is one bedroom on the ground floor and four bedrooms on the first floor. The administrative office and the sixth bedroom are on the second floor. The laundry is in the basement. The home has an enclosed garden with a patio, garden furniture and a summerhouse. The fees range from £1490 - £2962 per week. Further information can be obtained from the home’s Statement of Purpose and the Service User Guide. A copy of the CSCI inspection report should be available in the home. Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on 07/06/2007. The registered manager was present. The home has 6 residents. The inspection included a tour of the premises and general observation of staff performance and their interaction with residents. Documents and care plans were examined. There were no visitors at the time but telephone interviews with relatives were conducted. The inspection included a detailed discussion with the management team of Adepta. (See below for details of the inspection findings). What the service does well: What has improved since the last inspection? The format of the care plans has been revised and now includes an individual learning plan, which is an accreditation requirement of the National Autistic Society (NAS). The home has a yearly accreditation assessment by NAS. Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective clients have the information they need to make an informed choice. A full assessment will be carried out before a prospective client is admitted to ensure that all their care needs can be met. EVIDENCE: There has been no new admission and no change in the number of residents since the last inspection. The registered manager would carry out a full assessment prior to admitting a prospective service user. The revised Service Users’ Guide is in laminated form and it is designed to be easy to read by residents with learning difficulties. It included pictures, photographs and information on the staff working in the home. Each resident is given a copy. Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are given the opportunity to participate in the daily routine in the home. They are supported in taking risks as part of an independent lifestyle. Each resident has a written care plan. Confidentiality is maintained in accordance with legislation. EVIDENCE: The home has a key-working system to ensure that each resident is consulted on all aspects of life in the home and that they are supported in the choices made. All the residents have learning difficulties and staff are trained to assist and support them to lead a reasonably independent lifestyle. On the day of the inspection, apart from the home manager, there was one other member of staff present and a resident. The resident appeared content Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 Page 10 and happy. Feedback from relatives was generally positive in regard to the individual care given. The revised care plans examined were comprehensive and reflected the assessed and changing needs of the residents. Each care plan includes an individual learning plan, which is an accreditation requirement of the National Autistic Society (NAS). The home has a yearly accreditation assessment by NAS. The relatives interviewed confirmed that they were informed of any change in the care needs of the resident. The relatives are involved in the annual review together with the resident, the respective social worker and healthcare professionals. Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to integrate into the community through an outdoor activity programme and to adopt a healthy living lifestyle. They have close contact with their relatives. EVIDENCE: A full weekly activity programme for each resident is displayed on the notice board. The social activities are planned to suit individual needs. Each resident has an activity and learning plan and their participation in therapeutic and recreation activities is monitored and recorded on a monitoring form. However, not all the forms were updated consistently. The home adopts the guidelines from the National Autistic Society and is working towards accreditation this year by the NAS. Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 Page 12 On the day of the inspection, it was noted that the majority of the residents are able to attend the day care centre and to participate in outdoor activities with staff supervision. However, there is one resident who requires one-to-one supervision and who is cared for in the home throughout the day. It was noted that he requires at least two carers when he goes out. The registered manager ensures that there are sufficient staff on duty so that this resident’s outdoor activities can be carried out daily and regularly. Each member of staff takes turns to prepare the meals. Sometimes residents prefer take-away food and they are supported to do so. The registered manager ensures that the food provided, are nutritious and balanced. Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Medication is not always administered in accordance with the home’s own policy and procedure. Therefore residents are exposed to risk to their safety. EVIDENCE: Residents are well supported by members of staff. Any health and behavioural concerns are referred to the doctor or the psychiatric team for assessment and review. It was noted that the home’s written policies and procedures for the safe use and administration of medicines were not being followed when medicines were ordered and delivered. The medicines that were delivered by the pharmacist on the evening of 07/06/07 were not checked until the next morning, during which time an incident took place. An investigation highlighted poor practices by both management and staff. Although staff have training to enable them to administer medicines safely and effectively, not all the staff were trained to order and check medication delivered into the home. The defined procedure for obtaining medicines means that staff must have sight of the original signed Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 Page 14 prescription from the GP. A copy should be retained in order to validate the prescribed instructions. On this occasion, it was not retained. Medicines are stored in a drug trolley that is attached to the wall in the dining room. None of the residents are prescribed controlled drugs. If the need arises, a controlled drug cupboard will be installed. It was noted that containers of medication that are in use have no opening date and time written on the container itself. This means that their use is difficult to audit since a fully accountable audit trail is not available. Since the inspection, an action plan has been implemented to ensure that all staff adhere to the home’s policies and procedures to ensure that such incidents do not happen again. The management is meeting with the supplying pharmacist to rearrange the day and time of delivery to minimise the risk of medication incidents and to safeguard vulnerable residents from harm. (See Statutory Requirements and Recommendations) Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a robust Complaints Policy and Procedure. EVIDENCE: The home follows the Hertfordshire Adult Protection Procedure. Staff have had training on abuse issues. An alleged abuse incident has been reported since the last inspection. The incident is being investigated by the police and the carer has been suspended pending this investigation. Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents and staff are living in a building that has fallen into disrepair. The premises have not being kept in a good state of repair externally and internally for some time. EVIDENCE: The building appeared dilapidated and is in need of urgent repair externally and internally. The residents’ bedrooms are in need of redecoration. The plastering in the dining room is falling off in places. Both management and staff continue to use manual wedges to keep all fire doors open even though this was highlighted at the last inspection by the CSCI inspector and by the Hertfordshire Fire & Rescue Service. The management has confirmed that all doors will be fitted with automatic hold-open door devices this month. Since the inspection, the provider, Adepta and Stoneham Housing (who own the building), have begun working closely together to arrange for repair and redecoration work to be carried out as soon as possible. The management is Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 Page 17 making appropriate plans to ensure that residents are not affected too much while repair work is being carried out. (See Statutory Requirements) Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have the experience to care and support the residents, who are safeguarded by the home’s recruitment policy and procedure. Regular agency workers are deployed to assist in the home. EVIDENCE: The home is recruiting two more staff and they will commence work once the Criminal Record Bureau (CRB) checks and the Protection of Vulnerable Adult (POVA) Register checks are cleared. Meanwhile, regular agency workers are deployed to assist in the home. All new staff will have induction training that is in line with Skills for Care guidance. There is a rolling training programme for all staff. However, a member of staff felt that they need more training on Autism and Communication. Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42, 43. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of management could improve. Although the home has sound policies and procedures to safeguard the health, safety and welfare of residents, not all members of staff adhere to the Medication Policy and Procedures. EVIDENCE: The standard of administration and record keeping is being maintained. However, in view of the recent medication incident, the registered manager should give more supervision to staff to ensure consistency in the way the service is being delivered. The home is not involved in the residents’ finances but the registered manager oversees the personal allowance for each resident and has signing authority to access the resident’s own account. Accounting records are kept. However, a Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 Page 20 recent financial transaction for a resident’s own account suggested that there is a need for the provider to review its policy and procedures in this area to safeguard not only the residents but the staff themselves so that any such transaction is not misconstrued. Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 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 Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 3 26 2 27 3 28 2 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X X 2 3 3 2 2 2 Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 Page 22 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 YA20 Regulation 13(2) Requirement The registered manager must ensure that all medicines in the care home are handled in accordance with the Medicines Act 1968, Guidelines from the Royal Pharmaceutical Society and the Requirements of the Misuse of Drugs Act 1971. (i) Clear and accurate records must be kept of the date of receipt of medicines from the pharmacy. (ii) The opening date must be recorded on the front of the medicine container when it is first open. (iii) A copy should be retained of the original signed prescription from the General Practitioner in order to validate the prescribed instructions. 3. YA24 23(4)(c) (Subsequently rectified) All doors must be held open with automatic hold-open door devices approved by the Fire & Rescue Service. 31/07/07 Timescale for action 08/06/07 2. YA20 13(2) 08/06/07 Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 Page 23 4. YA24 23 (2) (b) & (d) This was a requirement at the previous inspection. Failure to meet this extended deadline could lead to the issuing of a statutory enforcement Notice. The premises must be of sound construction and kept in a good state of repair externally and internally. All parts of the care home must be kept clean and reasonably decorated. All repair and redecoration work must be carried out as soon as possible and be completed within a reasonable period. Failure to meet this requirement could lead to the issuing of a statutory enforcement Notice. 30/09/07 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 YA20 Good Practice Recommendations It is recommended that all management staff and carers have accredited training (through an approved source) on the administration of medicines. Ridgmont DS0000019510.V342495.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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