Inspection on 27/09/06 for Ridgwell House

This inspection was carried out on 27th September 2006.

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 but made no statutory requirements on the home.

Other inspections for this house

Ridgwell House 14/04/09

Ridgwell House 07/05/08

Ridgwell House 26/04/07

Ridgwell House 17/02/06

Ridgwell House 30/10/05

Ridgwell House 04/02/05

Ridgwell House 08/09/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Ridgwell House 95 Dulwich Road Holland on Sea Essex CO15 5LZ Lead Inspector Sara Naylor-Wild Key Unannounced Inspection 27th September 2006 14:00 X10015.doc Version 1.40 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 Ridgwell House DS0000060997.V311696.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 Older People. 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. Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ridgwell House Address 95 Dulwich Road Holland on Sea Essex CO15 5LZ 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) 01255 815633 01255 815633 Prestige International (EC) Ltd Vacant Care Home 16 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (16) of places Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, falling only within the category of Old Age (not exceeding 16 persons) Four persons, over the age of 65 years, falling only within the category of Dementia, whose names were made known to the Commission in February 2003 The total number of service users accommodated in the home must not exceed 16 persons 17th February 2006 Date of last inspection Brief Description of the Service: Ridgwell House is an established care home for older people in the village of Holland on Sea, near the town of Clacton on Sea. The home has been open since 1985, and was registered to the present owners Prestige International (EC) Ltd in July 2004. The accommodation offers care for 16 service users on the ground and first floors. At the time of the inspection a double bedroom was used to accommodate a single person and therefore all accommodation is in single rooms for 15 service users. There is a stair lift to the first floor. The majority of the accommodation is on the ground floor, with 4 service users on the first floor. There are 3 bathrooms and 1 shower room, all with toilets. In addition, there are 3 separate toilets around the home. Catering and laundering facilities are found in the centre of the home. Communal areas consist of a front and rear lounge and a large dining room. The rear lounge overlooks the rear garden, which is laid to lawn with flowers, shrubs, fruit trees and vegetable beds. In the garden there is a summerhouse, a green house and shed. Seating is provided during the summer in the garden. The front garden has a semi-circular driveway offering some off-road parking. Flowerbeds, plant pots, flowering shrubs and trees bring colour and interest to this area. The range of fees charged by the service are between £367 and £400 per week. There are additional charges for hairdressing, chiropody and staff escort fees. This information was provided to the Commission by the provider in August 2006. Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report represents the information gathered in respect of Ridgwell House and culminated in the key unannounced inspection visit carried out on 27th September 2006. The inspector considered a variety of information including service users and relatives’ surveys, discussions with staff and service users, examination of documents and records provided to the Commission by the service provider. In the period since the last inspection the registered manager Geraldine Chalk had resigned. The service was being managed part time by Ms Duna Abrahim, the General Manager and a director of the company. She was assisted in this by the senior staff at the home. What the service does well: What has improved since the last inspection? What they could do better: There was little progress in the demonstration of the service moving forward with documentation that meets the requirements of the Care Homes Regulations and the National Minimum Standards. This was particularly reflected in the assessment and care planning records, which were inadequate. Additionally in order to support staff in providing a quality service delivery the development of a training plan and how the courses meet the development Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 6 needs of the service by increasing the skill mix of staff should be considered. Regular line management supervision should also be considered. 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. Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a lack of knowledge of proposed service users needs prior to admission. The service does not provide intermediate care. EVIDENCE: The files of service users sampled during the inspection visit, did not contain a thorough assessment format that the service used to gather information about the service users needs prior to their admission. The lack of this documentation does not prohibit the service from admitting and providing a level of care to the service user, however it does not indicate how their individual needs were considered and how these would be met within the home or impact on the existing service user group. Although some service users have stayed on a short-term basis for respite care the service does not provide intermediate care. Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The way in which service users needs are to be met is not documented to provide consistent support. EVIDENCE: The care plans of four service users were sampled during the inspection in order to gain insight into how the staff understands the service users needs and the agreed plan to support these. The previous inspection reports have commented on the poor quality of care planning in the home and at the last inspection the then manager had made inroads into addressing these issues. However, It was disappointing that at this visit there had not been any progress in developing the care plans. Those available contained some references to the service users needs, but these were not consistently completed and did not provide the full detail of information required to provide a quality care delivery. The plans were not regularly reviewed and an example included where a service user had recently undergone an operation on their eyes that had resulted in a serious affect on their independence and abilities. Here was no reference to this in the care plan. This also relates to the record of Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 10 health needs that should be held on the care plan, providing details of how service users health needs should be met. From discussions with service users and staff it was clear that care staff clearly understood the individuals needs and provided a level of care that service users appreciated. However the absence of care planning does not demonstrate a level of consistency that service users can rely on in receiving support from staff. Medication management and records were in place and satisfactory, and those staff who had responsibility for administration of medication to service users, had undertaken training. Service users spoken with were definite in their view that the staff were capable and considerate in delivery of their care. They stated that they always knocked on doors and addressed them respectfully. They felt that staff would respond to any reasonable request without hesitation and found Ms Abrahim always approachable and interested in them Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service The service does not enhance the daily lives of service users through the provision of stimulation and occupation. EVIDENCE: The previous inspection noted plans in place to address the service users social needs through the provision of activities both internal and external to the home. Unfortunately both staff and service users reported that this initiative had not been fulfilled and following some initial opportunities there was not a regular programme of activity offered on a daily basis. Service users reported to the inspector that they were able to keep in touch with family and friends in a variety of way, including visits, phone calls and writing. They felt the service welcomed visitors and ensured they were received in a manner that supported their visits . Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users cannot expect to be protected by the service’s policy in respect of vulnerable adults. There are procedures in place for service users to make their concerns known, but this needs to be in a format that is accessible to all service users. EVIDENCE: The service users spoken with during the inspection were confident about how their complaints would be dealt with. They all stated that they would approach Ms Abrahim and that they had no doubt in her ability to listen and to ensure that their issues were appropriately dealt with. The service also accommodates service users who have developed dementia since living at the home, but staff were not aware of any means by which these service users would access a complaints system. The service has a complaints policy and this required the updates noted in previous inspections since the registered manager was not any longer in post. The protection of vulnerable adults (POVA) policy was generally satisfactory with some minor amendments still required in respect of investigation of an allegation and reporting procedures. The staff had not had updated training in POVA and whistle blowing. This training is provided on a rolling programme by the local authority and it is disappointing to note that this requirement remains Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 13 outstanding. This and the home’s recruitment procedures do not reduce the risk of service users suffering from abuse. Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can expect to live in premises that are clean and maintained, but which could be developed to better support service users rights to independence and privacy. EVIDENCE: The service is provided in a building situated in a residential street close to the seafront. The building was originally a residential house with additional extensions added at later dates. The layout of the building is therefore not always obviously flowing with the two lounges and dining room providing access to other parts of the home. This presents a challenge to the service in considering how they can best support service users independent movement around the building, particularly those service users with dementia. Overall the premises are well maintained and provide a homely environment. Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 15 Service users rooms were appropriately furnished and were personalised with the individuals’ belongings. Service users were free to use their room whenever they wished and a number had comfortable seating for day time use. There has not been a review of the provision of lockable cupboards facilities for service users to use for secure storage or the number of bedrooms provided with locks and care plans did not include risk assessments to demonstrate why it would not be appropriate for this provision. Although there is not a passenger lift to the first floor, there is a stair lift to provide access to this area. From discussions with the staff and service users it was clear that they considered the individual service users ability to mobilise independently when determining where their bedroom accommodation should be situated in the home, and some service users had been offered ground floor accommodation when to support their continued independence. During a tour of the premises the rooms appeared clean and there was not any noticeable odour. The service has a contract with a hygiene collection company for the removal of clinical waste. Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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. The recruitment and development of staff is insufficient to ensure a safe and effective delivery of support to service users. EVIDENCE: The documentation provided to the commission in respect of staffing numbers and arrangements for 2006 did not contain reference to a staffing calculation based on the assessed needs of service users. The staff on duty on the day of inspection were not aware of how the numbers of staff were arrived at, but stated that the proprietor agrees to additional cover when required i.e. illness of a service user etc. On the day of inspection there were three care staff on shift with additional hours provided for cooks and housekeeping. The a sample of documentation held on staff files were considered in respect of a robust recruitment system that protects service users. The files sampled contained omissions in documents listed in Regulation 19, Schedule 2. Specifically they did not contain CRB statements, two references or full employment histories. Without this information the service cannot determine that the applicants they propose to employ are suitable candidates to care for vulnerable adults. The staff files did not contain reference to a training profile and programme, although individual training certificates were available, these were not all in date. Staff spoken with during the inspection were clear that opportunities to Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 17 participate in training were always available and that the proprietors were generous in funding any sessions that the staff identified an interest in. In discussions with the General Manager, Ms Abrahim she confirmed that a number of training sessions had been supported, including dementia care, fire safety, and moving and handling, but that this occurred on an ad-hoc basis rather that a planned programme in response to identified needs in service users and the staff skills mix. Induction training was provided and the service used the Skills for Care model of induction standards to carry this out. This includes a competency-based element to the training that ensures new staff fully understand the way in which the service supports service users. Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The policies, procedures and records required to operate a safe and effective service are generally present. EVIDENCE: The registered manager had resigned prior to this inspection, and the service was operated on a day-to-day basis by one of the directors Duna Abrahim and the deputy manager. Ms Abrahim was working in the home on two days a week and available to the home by telephone at other times. The loss of a the manager was attributed for some of the shortfalls in addressing the outstanding requirements identified in previous reports, although Ms Abrahim stated that the managers capacity to move the service forward had been a concern prior to her resignation. Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 19 The atmosphere and ethos of the service did not appear to have been affected by the vacant managers post, and although all service users and staff spoken with were sorry that the manager had left they were not concerned about the future of the service. There is not a quality assurance system operated in the home. If this were in operation this would provide a useful insight into the service users views of the service they receive and how the quality of the provision could be improved. The staff spoken with during inspection confirmed that consistent recorded supervision had not taken place. The opportunity to discuss staff performance, training needs and to share information about developments in practice and policy significantly enhances the quality of how staff deliver support to service users and this omission The service presently is responsible for the management of one service user’s monies. Details of the banking system were shared with the inspector as part of the pre inspection information sent by the General Manager. The records relating to this were not available on the day of inspection, however previous assessments of the system operated by the home were appropriate and ensured the service users financial interests were protected. Documents related to the maintenance of equipment, supplies and safety systems were examined during the inspection visit. These included electrical and gas safety certificates, maintenance of hoists and stair lift and fire systems checks. These were present and within the recommended timescales. Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 1 X 3 1 2 3 Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14 Requirement The registered person must ensure that a comprehensive assessment is carried out for each service user using an appropriate holistic assessment tool. This is a repeat requirement The registered person must ensure that a service user plan of care generated from a comprehensive assessment is drawn up with each service user to provide the basis for the care to be delivered. This is a repeat requirement The registered person must ensure that risks to the welfare of each service user are assessed and steps taken to minimise these. This is a repeat requirement The registered person must ensure that the staffing numbers and mix of skills are sufficient to meet the assessed needs of service users and demonstrate DS0000060997.V311696.R01.S.doc Timescale for action 31/12/06 2. OP7 15 31/12/06 3. OP8 13(4) 31/12/06 4. OP27 18 31/12/06 Ridgwell House Version 5.2 Page 22 this through the recommended calculation tool. This is a repeat requirement 5. OP30 18 The registered person must ensure that the training provided for staff meets the expectations of the Skills for Care standards. This is a repeat requirement. The registered person must ensure there is a quality assurance system operating in the home, the findings of which are audited and an action plan produced. This is a repeat requirement The registered person must ensure that staff supervision is consistently carried out. This is a repeat requirement. The registered person must ensure that records required by regulation for the protection of service users and the effective and efficient running of the business are maintained, up to date and accurate. This is a repeat requirement 31/12/06 6. OP33 24 31/12/06 7. OP36 18 31/12/06 8. OP37 17 Schedule 3&4 31/12/06 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 OP11 Good Practice Recommendations The registered person should ensure that individuals’ wishes concerning their spiritual needs, rights and function in relation to death and dying are recorded and observed DS0000060997.V311696.R01.S.doc Version 5.2 Page 23 Ridgwell House through care planning. 2. OP12 The registered person should ensure that service users’ choices and preferences in relation to daily living, activity, social emotional and spiritual needs are recorded and opportunities to exercise these are further developed. The registered person should ensure that service users’ choices and preferences in relation to daily living, activity, social emotional and spiritual needs are recorded and opportunities to exercise these are further developed. The registered person should progress their plans to ensure that a minimum of 50 of staff are trained to NVQ 2 or equivalent. 3. OP13 4. OP28 Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Ridgwell House DS0000060997.V311696.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!