Inspection on 07/05/08 for Ridgwell House

This inspection was carried out on 7th May 2008.

CSCI found this care home to be providing an Adequate service.

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 26/04/07

Ridgwell House 27/09/06

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Ridgwell House 95 Dulwich Road Holland on Sea Essex CO15 5LZ Lead Inspector Sara Naylor-Wild Unannounced Inspection 7th May 2008 08:30 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.V364014.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.V364014.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 F/P 01255 815633 dunaibrahim@aol.com Prestige International (EC) Ltd Manager post vacant Care Home 16 Category(ies) of Dementia (16), Old age, not falling within any registration, with number other category (16) of places Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of service users accommodated in the home must not exceed 16 persons 26th April 2007 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 residents on the ground and first floor. 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 residents. There is a stair lift to the first floor. The majority of the accommodation is on the ground floor, with 4 residents 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.V364014.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection was carried out over two days on the 7th and 25th May 2008. During the second visit the inspector conducted an observation of people living at the service using the Short Observational Framework for Inspection tool or SOFI. This tool was specifically designed to be used to consider how people with dementia experience the delivery of the service. Each year the Commission conducts an annual thematic inspection study from which we produce a public report. This year we looked at how well services makes sure people are protected from abuse. We looked at whether services have good procedures and training for safeguarding; how they work with other organisations to make sure people are safe; how they recognise abuse and respond to allegations to protect the people who use their service. We call this ‘safeguarding systems’. We gather this information by carrying out either a thematic inspection, a short, focused inspection that looks in detail at a specific theme in some services or we carry out a thematic probe where we gather additional information on a particular theme from a key inspection. During this key inspection visit we included the thematic probe to consider the documents relating to safe guarding and interviewed staff about their understanding of safe guarding. In addition we also undertook a tour of the premises spoke to staff and looked at documents relating to care, staff, and medication. We sent surveys to people living in the home and their relatives. There was a good response and the information contained in these was used to inform us on some of the outcomes for people using the service. The service did not send us their AQAA when we asked for it. The deputy manager assisted the inspector at the first site visit. Feedback on findings was given during the visit with the opportunity for discussion or clarification. The inspector would like to thank the general manager Mrs Ibrahim and the staff team, residents and their relatives for their help throughout the inspection process. Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The service did not submit the Annual Quality Assurance Assessment (AQAA) to the Commission when it was required. This is a breach of the Care Homes Regulations 2001 and does not support the service in informing us about how it understands where it does and does not meet the expectations of the Care Homes Regulations 2001. Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 7 Although the views of people are sought through surveys there is not evidence of how the service is using this information to improve the quality of its provision as set out in an action plan as part of the internal quality assurance system. Staff and manager’s work in close proximity and engage in regular discussions on an informal basis. However staff do not benefit from regular feedback on their performance through formal one to one discussions with their line manager that includes consideration of how their roles support the services aims and objectives as set out in the statement of purpose. Whilst training was readily available for staff and the providers have demonstrated a commitment to ongoing training, there is not an annual training programme that sets out how the skill deficits identified in supervision of staff will be addressed or how the assessed needs of people who are admitted to the service will be supported. This document underpins the way the service sets out to consolidate the staff’s development and the improving quality of the service delivery. The attention to consistently completed documentary evidence of how people are supported in the service is not good. Gaps in the assessment process, care planning details and monitoring tools do not support a well informed and quality measured provision of care. 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. Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 8 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.V364014.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most people can be confident that the home will understand their needs prior to their admission, however this is not always documented fully. EVIDENCE: The service Statement of Purpose says that all admission new residents are planned and decisions taken in relation to admission following and assessment of their age, their level of dependency, any special needs they may have, their emotional needs and their mobility needs. This information is then weighted against the current resident groups needs to achieve a balance of needs. The document states that the service does not have unplanned admissions. Prospective residents are offered two trial visits to the home. The admission documents of three people who had recently been admitted to the home were case tracked. The format of the assessment form contained all the elements required to assess needs from the standards. Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 10 However it was not always completed for each person, and a variety of completed information was found from none at all to a full and informative document. The completed form would allow the reader to consider how the person would fit into the group of people already living at the home and ensure that any skills required by staff or equipment needed to meet the assessed needs was in place prior to the person’s admission. One person who had used the service said “The information given in advance of the weeks’ respite care was excellent. Very informative and clear both written and verbal” and “The manager and staff always keep us updated with any changes or costs”. The service does not admit people for intermediate care. Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the service can be confident that staff will understand how to support them in their daily lives. The detail of this could be improved to ensure a consistent delivery of their support. EVIDENCE: The care plans of the same people identified in the earlier case tracking exercise were sampled to understand how care planning informs the staff. In all three files the care planning element starts with a daily routine sheet that sets out an overview of the persons normal routine and their preferences in this. This is written in the first person and aims to give the reader an “at a glance” understanding of the way in which people spend their day. There is a sectioned care-planning tool that follows this overview. This gives an opportunity for staff to identify individual elements of the person’s daily routine and ‘need’ heading and the action they propose to take in meeting these. Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 12 The statements in these are more detailed than those found at the last inspection, however they tend to be generally advisory rather than specific steps for staff to follow. In the case of one person whose assessment states that they experience difficulties with their digestion and have a deficiency in a vitamin the action for staff was to encourage the person to eat a well balanced diet high in fibre rich roods and food high in vitamin B12, and to offer a choice at all times. Because there were not examples of the foods that contain these elements or direction as to where staff can source the information it is unclear whether these directions would give staff sufficient information to meet this need. The care plans did not contain many indications of mental health interventions or specific strategies for supporting people with dementia. This is particularly relevant where the behaviour of individuals is challenging to staff and other people living at the service. The social care assessment of one person who had been admitted to the service in the previous twelve months stated that there should be ongoing support from the older people’s mental health team, but no further reference was found to their involvement either in the persons plan of care or the daily records and medical interventions sheets. Overall care plans have improved considerably since previous inspections and this progress is positive and will improve the consistency in the way staff provide support. They contain indications of how staff should set out to meet each person’s basic needs. They would benefit from refinement to reflect all the detail known about the person’s preferences and the specialist approaches adopted by a dementia trained staff group to enhance the individual’s quality of life. Risk assessments were in place for activities undertaken by individuals and generic issues of risk such as using the kitchen equipment and using the garden. The format asks a series of questions about who is at risk, what is nature of risk and finishes with how to reduce the risk. Those sampled were completed and gave the reader indications of what the issues were and how these had been reduced. One assessment said that the risk to the person in the kitchen was due to a risk of cutting/burning themselves in kitchen and a risk of cross infection to the wider resident group, suggestion is to support resident whilst helping in kitchen make sure their hands are washed. They are not to be left alone in the kitchen and to be asked to leave when the ovens are on. The care plan files contained medical visit monitoring sheets for GP, district nurse and other health professional’s visits. These informed the reader what the health issue was and the outcome of the professionals visit. It is important that the persons changing health needs and the outcomes of consultations with health professionals where they are provided are incorporated into the person’s care plan, and those examples seen did not always fulfil this. Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 13 There were gaps in other monitoring tools used to understand a person’s physical wellbeing. This included records of fluid intake, food intake and body weight. This information should be used to understand according to the persons assessed needs, if there are changes in their physical health. People who used the service and their supporters told us that “I am confident that good medical support was available if required” and “I have been kept advised of medical appointments.” Daily records sheets completed by staff reflected the activities of day for each individual for example “sat in garden enjoyed and ate all meals, had a shave and assisted with washing and dressing”. These statements are repeated on a daily basis and do not reflect on whether all items in care plan were addressed or if there are changes to the plans to be made. Records and practice relating to medication administration was considered at the inspection visit. There were good records of medication administration and dispensing practice. The service uses a monitored dosage system and is provided with MAR sheets to sign out medication by the pharmacist. The records for receipt and dispensing medication were in good order, and demonstrated that staff understood the best practice in this area. Feedback from people who have used the service and relatives in respect of how they rated the support provided included “Always make my (relative) feel the centre of attention and they always put (them) at ease this is very important with some one who has dementia (sic)”, “My (relative) even though (They) has severe dementia is happy there. (They) is well looked after fed well and kept clean and smells clean, the way (they) would be when at home (sic)”, “ Provides a high quality service”, “Very warm and caring to all of us”,” Nothing is too much trouble”, “The care staff have always treated (my relation) with dignity and respect (sic)”, “Promotes a caring attitude to residents that is genuine”, “ Staff were most helpful in providing good support and care as and when needed”, “Provides a warm and friendly environment with a nice feeling of ‘being in ones own home” and “Staff provide a caring service meeting the wide variety of needs of each individual”. Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the service can expect staff to be aware of their interests and preferences for activity. However they cannot expect these to always be individually provided as there is a greater emphasis on group activities. EVIDENCE: The care plans of those people identified in the case tracking activity included details of their interests and preferences in relation to their social time. These are useful in helping staff identify what activity they should aim to the meet the individuals preferences and abilities. The sample seen did give general direction to staff about the person, but as with other elements of the care plan could give greater details in how staff should engage people in stimulating activity as part of their day. There is an ‘activity book’ in which staff maintain a record of the activities on offer and which people took part. The entries for these are sporadic with none made from 18/12/07 to 07/05/08. Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 15 However the entries made for November 2007 detail evidence of sessions for group activity in bingo, guess the object games, dominoes, manicure, flower arranging, bread making, armchair exercise and cards. During the first visit to the home people living there were observed attending to the garden, chatting, sitting in the kitchen working on the meal preparation and sunbathing in the garden. On the second day’s visit to the home the inspector was able to use the (SOFI) Short Observational Framework for Inspection methodology to assess the way in which residents with dementia received the service. The observations were centred on the care of the people sitting in the main lounge of the home for a period of two hours. The observations assist inspectors, where individuals are unable to give answers to direct questions about how they feel about the service, to identify how their interactions with others enhances or detracts from their sense of wellbeing. During the period observed there were three care staff on duty, one of which was in charge of the shift, a housekeeper and the cook. The session started midmorning and included periods where people were still getting up and coming into the communal rooms, as well as the morning activity session. Overall the observations indicated that 85 of the time staff spent with people living at the service was done in a way that enhanced their sense of wellbeing and which they enjoyed. The majority of this result is derived from the activity that the staff undertook with the people in the lounge and demonstrates how important staffs time spent with residents of care homes is in their day. The exchanges during the session of bingo were lively and humorous, and for some people observed the only time they were animated during the whole observation. The session was inclusive where possible and visitors attending were invited to join their relative and take part in the session. The small percentage of negative or neutral experiences of people observed were primarily linked to when staff were passing through the lounge and gave short acknowledgments to the individuals as they passed. People often looked disappointed or confused by the exchange, and this was recorded as a neutral or negative outcome for their wellbeing. These were few in number and staff were obviously not intending to give a less than positive experience to the individuals. Overall the observation and the feedback received from other people living at the home and relatives who said things like, “this is an excellent place to live, and I wouldn’t say that if I didn’t mean it”, “Provides a homely environment that encourages residents to be involved” and “Provides a warm and friendly Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 16 environment with a nice feeling of ‘being in ones own home’”, confirmed that people living at the home like their experience. The observations and the feedback from people also identified areas where the service should develop their delivery of activity and occupation further. In particular the way people who do not enjoy group activity are offered activity and how the staff work on a one to one basis throughout the day in involving and stimulating less social people. One comment received was “Could provide more activities to residents where appropriate and in particular enabling people to participate in local community activities.” People’s contact with their relatives or friends is maintained and documented in their plans of care. Visitors were welcomed during the inspection visits and encouraged to take their visit where they preferred, or join in activities taking place. People said, “As far as we are aware if (our relative) wanted to contact us (they) has been encouraged and offered use of the phone. Equally the staff have also been very helpful in providing every opportunity for (them) to talk with us when we ring (sic) “ The Commission also received positive feedback about the meal provision, with statements such as “The food was excellent and the dining room very nicely set out”, “The food is homemade and looks appetising. The dining room always looks welcoming” and “Excellent home cooking and alternative available”. The service has a menu that offers varied choices from a balanced nutritious diet. The observation of the midday meal during the inspection indicated that people enjoyed the meal on offer and were supported by staff in deciding their choice and in eating the meal itself. Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living at the service can be confident that staff generally understands it is important to listen and protect them. However they cannot be assured that this will be consistently upheld as this depends on the individual staffs knowledge of how this should be done. EVIDENCE: The thematic probe conducted during this inspection included discussions with staff demonstrated. These indicated that they generally recognised that they should report abuse they witnessed, but in some cases they struggled to identify the areas that constituted abuse. They did believe that the report would be taken seriously by the management of the home but were not always aware of the involvement of other agencies outside of the service in responding to reports of abuse. This is important as the way in which information is gathered for evidence could be at risk if the staff are not aware of correct procedures. All the staff had received training in Safeguarding and abuse but this had not been followed up with discussion and review of the policy after their training. The difficulty that people had in identifying the elements of abuse and the steps taken by authorities in responding to allegations would be identified in these discussions either in staff meetings or individual supervision and would Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 18 support their understanding of theirs and others responsibilities in preventing abuse. The service’s safeguarding policy was dated 2003 and does not appear to have been reviewed to reflect the current agreements for reporting and steps taken. The service does have a copy of the Essex Social Services Safeguarding guidance although the staff had problems locating the current policy on the day of inspection. There have not been any reported safeguarding issues related to the service. The service has a complaints policy and maintains a complaints log. The entries were all made by staff in relation to difficulties in dealing with the behaviour of a particular person who lived at the home. These are not appropriate entries and should instead have been documented as a care management issue in the resident’s file. The layout of the entries made do not contain all the information required by the Care Homes Regulations 2001, in particular they do not set out what investigation was made into the complaints and the outcome and action taken in response to the issues raised. People told the Commission that “I would speak to the deputy manager if I wanted to make a complaint”, “I would have no problem in raising issues direct in the event of any problem”, “When we have raised concerns the response has been very good and appropriate” and “The complaints procedure was explained”. This indicates that people feel confident in the complaints procedures and the home’s integrity in dealing with concerns raised with them. Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the service can expect the premises to be clean and well maintained, but which could be developed to better support service users rights to independence and privacy. EVIDENCE: The tour of the premises identified areas of the home where improvements had been made to the environment and equipment. This included the widening of some doorways to provide better access to people who use wheelchairs, new furnishings in lounges and dining rooms and ramp access to the garden. The Commission has not been made aware of any considerations the providers have made in addressing how successfully the environment supports people living there. Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 20 The layout of the service has been raised at previous inspections and observations at this inspection confirm that the access issues in communal areas have an impact on the day-to-day life of people living there. The premises were clean and free from any offensive odour. People’s bedrooms are individually decorated with personal items. Feedback from relatives and people who have used the service included, “The home was very comfortable”, “… a number of specific improvements have been made over recent months to make (their) stay more comfortable – doorways widened for wheelchair access, new hygienic floor, and new hospital style bed (sic)” and “…found Ridgwell house to be the best in cleanliness (sic)” Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the service can expect their support to be delivered by a staff group with sufficient skills to meet most of their assessed needs. EVIDENCE: Staffing levels have not changed since the last inspection, although the numbers of people living at the home have increased. The calculation tool used to determine how many staff were required to meet the needs of people living at the home was not available at this inspection. During the period observed at the inspection there were not long periods where staff were noticeably absent from communal areas during the day, and the provision of activity sessions during the day indicated that staff were not predominantly taken up with physical tasks. From discussions with staff and reading of documentation there was evidence of a good level of training available to staff. This was evidenced in the training matrix for 2007 that included items such as first aid, infection control, Stoke awareness, diabetes, Safeguarding, Fire safety and dementia all completed in 2007. There was not a training plan commenced for 2008, although staff were aware of further training planned. Certificates held on individual staff’s files demonstrated a variety of sources that training is provided from. Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 22 Staff spoken with were confident that training would be provided for any subject that they identified, although in general it was the proprietor who advised of the training available and asked staff to attend, as supervision had not taken place. Recruitment records held on staff files demonstrated a robust system to underpin the appointment of staff to work in the service. This includes the completion of a full application from, gaining of two written references and CRB checks prior to commencement. People who used the service and their supporters told the Commission that they were confident in staff’s skills and abilities. Their feedback included “Staff are very attentive sympathetic and caring”, “The caring and sympathetic staff suggest that training is first class, suitable staff who know what they are doing and by far”, “The care staff have always treated (my relative) with dignity and respect”, “we do recognise the huge challenge presented and the very caring and dignified care provided”, “The care staff are always professional in the way they present themselves i.e. dress and manner to both us and (our relative)” and “Staff were most helpful in providing good support and care as and when needed” Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are confident in the leadership of the service will deliver good outcomes for them. They are listened to but the information they cannot be assured that this information will influence the way the service operates. EVIDENCE: The service continues to operate without a registered manager, but with the co-management arrangement shared between the general manager Duna Ibrahim and the deputy manager. They have both undertaken the NVQ Level 4 Registered Managers Award. Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 24 In general this arrangement has supported an improvement in the outcomes for people living at the service and positive feedback has been received in respect of the operation of the service and specifically the leadership of Ms Ibrahim and her deputy manager. This included “Staff seemed to have an excellent ‘team spirit’ due to the excellent leadership by Duna and her assistant manager.” However in other respects there has not been a consistent approach to the requirements of a registered service. In particular the provision of an Annual Quality Assurance Assessment to the Commission when requested to do so. The primary purpose of the AQAA is to inform the Commission about how the registered persons understood the strengths and weaknesses of the service in meeting its regulatory obligations and how they were seeking to address these In not completing the document the proprietors had not only missed an opportunity to tell us how the service was improving, but also acted in breach of Regulation 24 of the Care Homes Regulations 2001. The service does carry out some aspects of a quality assurance system in that they distribute surveys to people who use the service and their families. However the surveys were not anonymous and whilst an immediate response was made by the general manager to any issues raised, the feedback given in them was not audited and responded to in an action plan. Quality assurance systems are intended to gain information anonymously in order to understand the difference between expected and actual performance of a services processes to identify opportunities for improvement. In the case of residential care services the statement of purpose sets out how people should expect the service to perform, and the surveys ask for people’s actual experience of the performance. Finally the service responds to what had been said and sets out how it plans to improve. It is not the aim to deal with individual issues, these would be more appropriately responded to under the complaints procedures. One to one formal supervision had not been consistently carried out since the previous inspection. Although staff felt they had access to the general manager and were able to discuss issues openly. Both the quality assurance and staff supervision are requirements of the Care Homes Regulations 2001. They are viewed as important because they underpin the way in which the service assures people are listened to and supports staff in developing their skills and understanding of their practice. The shortfalls in these documents appear to indicate that the management arrangements are not supporting the services movement forward in meeting its regulatory requirements. Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 25 Records required to ensure that the service complies with health and safety risks were present. These included fire safety systems checks, fire risk assessments, annual safety certificates for gas and electrical equipment and moving and handling equipment. Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 26 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 1 X 3 Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 27 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(1) Requirement People who are admitted to the service must be assured that their needs have been fully assessed and that the service is prepared to meet their needs. Residents’ plans of care must contain all the information gathered about them and is updated when additional information is provided. This will assist staff to support residents consistently in a way that provides the best benefits to the individual. This is a repeat requirement. 3. OP16 22(8) People who use the service must 30/06/08 be confident that their complaints, their investigation and their outcomes are recorded. A quality assurance system must be operating in the home, whose findings are audited and an action plan produced. This will assist the proprietors in understanding what is important DS0000060997.V364014.R01.S.doc Timescale for action 31/07/08 2. OP7 OP8 15 31/08/08 4. OP33 24 30/09/08 Ridgwell House Version 5.2 Page 28 to people involved with the service and how they can improve their experience. This is a repeat requirement. 5. OP36 18 Staff supervision must be consistently carried out. This will support staffs’ development and practice in meeting residents’ needs. This is a repeat requirement. 6. OP37 24(2)(3) (4) The service must review and develop the service to improve the outcomes for people living there. Specifically the registered person must provide the Commission with an Annual Quality Assurance Assessment when requested to do so. Failure to comply with this request is an offence. 31/05/09 31/08/08 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 OP7 OP8 Good Practice Recommendations Staff should be encouraged to share information about how they support individuals. This will help them to provide a consistent approach to the individuals care and improve the residents’ experiences of care. The People who live at the service should be provided with activity that suits their abilities and personal preferences. Specifically staff should provide opportunities for people to enjoy individual activity as well as in groups. 2. OP12 Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 29 3. OP12 OP14 Residents’ choices and preferences in relation to daily living, activity, social emotional and spiritual needs should be recorded and staff should have sufficient skills to be able to provide opportunities to exercise these choices. Staff should be supported in understanding their role in protecting people from abuse, and how this is carried forward by other agencies outside the home. An environment that maximises their abilities and independence should support people who live at the home. Where this is not so, the responsible person should ensure there are assessments that determine how the impact of this can be reduced. People who live at the home should be supported by staff in numbers sufficient to meet their assessed needs. This assessment should be documented and kept under review. People living at the home should be supported staff who are in receipt of a training programme that equips them to meet people’s assessed needs. People who live at the service should be consulted on an annual basis about the way in which the service operates and the outcomes from this exercise used to identify how the service will improve the quality of its delivery. A manager with appropriate skills and experience to lead the service should be recruited. 4. OP18 5. OP19 6. OP27 7. OP30 8. OP33 9. OP31 Ridgwell House DS0000060997.V364014.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact 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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