Inspection on 27/06/07 for Ringstead House

This inspection was carried out on 27th 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

CARE HOME ADULTS 18-65 Ringstead House Ringstead House 62 Ringstead Road Catford London SE6 2BS Lead Inspector Wendy Owen Unannounced Inspection 27th June 2007 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ringstead House DS0000068744.V343949.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. Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ringstead House Address Ringstead House 62 Ringstead Road Catford London SE6 2BS 020 8860 0233 020 8314 1082 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) Right Support Management Ltd Edith Eneanya-Bonito Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A Brief Description of the Service: Ringstead is a home that was registered by the Commission in February 2007 to support and care for three individuals with learning disabilities. The premises have been adapted from a private residential home located in a residential area close to Catford town centre. There is a lounge, dining room and office on the ground floor. Bedrooms and bathrooms are located over the first and second floors. People using the service are supported 24 hours a day by a team of support workers and the manager. Information is provided to prospective users of the service in the form of a Service Users Guide and Statement of Purpose. Information on fees is included in the Service Users Guide with a minimum fee of £1500 per week. Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Ringstead House was registered in February 2007 and therefore a report on the registration was completed at this time. This information was used as part of the inspection process. This inspection included reviewing of information held by the Commission, including the AQUAA and a visit to the home for one day. The manager was not in the home on the day of the inspection but I had discussions with her at the local CSCI office the next day when she was required to provide information relevant to the inspection. This was complied with. I was unable to meet with the one resident living in the home as he was out for most of the day but I did have the opportunity to speak the spoke to the one staff member on duty and a Care Co-ordinator. With one resident currently residing in the home it is difficult to make a full judgement on the quality of care provided, particularly around systems for involving residents, quality assurance and continuous improvement of the service. These will be inspected more fully in future inspections. What the service does well: Ringstead offers people a comfortable, homely and well-maintained place to live that is situated close to amenities, the town centre and travel links. The manager also ensures that information is available for people wanting to use the service and prospective residents are assessed prior to admission. This includes visits to the home meet with staff and other residents to ensure the home is suitable for the individual. A care plan has been developed together with risk assessments for the resident currently residing in the home, giving staff information about the needs of the person and how they can meet their needs. A complaints procedure has been developed that enables those wishing to raise concerns can do so. The majority of staff are NVQ trained to ensure they have some of the skills and knowledge to meet the needs those living in the home. Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 6 The manager has ensured the health and safety of staff and residents through regular checks on equipment and services. The manager is qualified and experienced to run the home and is committd to improving the quality of care so that it meets individual needs. What has improved since the last inspection? What they could do better: Care plans have been developed but they must be elaborated on to ensure all areas of identified needs are recorded and individualised to the person so staff are aware of these needs and can support them. Not all areas of risk had been identified and, where risk assessments have been developed to minimise risks to the resident, these must be elaborated further to ensure staff have full details of the action to take to ensure the risks are minimised. Activities have been developed for the person living there, although it has not been made clear how difficult it is for staff to motivate the individual in this area. A record of the activities undertaken must be clearly recorded. There are concerns about the what the individual eats despite the attempts of the staff to encourage a healthy and varied diet. This must be made clear in the risk assessment process to show how the home is managing this aspect of care and the choices and decisions made by the individual. The manager must also ensure that the medication procedures and practices are improved to ensure any risks to the resident’s health are reduced. Adult protection procedures are in place, however they must provide the full information needed for staff to fully protect individuals using the service. Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 7 Staff rosters must detail the actual hours worked by staff and management and all checks must be made on new staff to ensure vulnerable residents are protected. There is evidence of training taking place and staff qualified to NVQ level. However, there are gaps in the current training, including induction to LDAF specifications and recording, training of staff in core areas and those specifically with mental health and learning disability. It would be beneficial to undertake regular audits on the current systems to ensure procedures are implanted in practice and for the manager to investigate an external quality assurance system to improve the care through identifying good practice and where there may be shortfalls. 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. Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 8 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 Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 9 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): Standards 1,2,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre-admission information and procedures provide the prospective individual with information on what they can expect from the service, although further clarity is needed in respect of the terms and conditions. EVIDENCE: A Statement of Purpose and Service Users Guide have been developed to provide information to those people who wish to use the service and are currently living in the home. This includes much of the information required by the Regulations and a copy of the “Guide” is kept in the individual resident’s file. The Statement of Purpose stated that the home is to care for those with autism and Aspergers syndrome, whilst the “Guide” stated that the home provides support to those with “severe enduring mental health problems” that would aim to improve life skills and enable the individual to live independently in the community. The information contained in these documents was different and since the inspection has been changed to ensure they are consistent. Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 10 I was unable to discuss the information provided to the current resident or the way in which the home managed the admission as the resident was out all day. However, it is clear from the home’s records that the resident did have an opportunity to visit the home prior to the trial period and that the manager confirmed in writing that they were able to meet his needs, provided there was one to one input. The “Guide” contains information on the terms and conditions of residency with an individual contract. However, the information provided in the “Guide” and contract contained different information on notice periods. In the “Guide” it stated eight weeks notice and, in the contract, four weeks. The contract had been completed and signed with information on fees and what is included in the fees. (See requirement) There was, at that time, no placement agreement from the Local Authority. This was because the individual was still on a trial period. There is evidence of the home obtaining information relevant to the individual’s needs before agreeing admission to the home. This included the mental health team assessment and the home’s assessment. The home’s assessment did not fully identify some of the issues identified in the professional assessment and other documentation eg aggression, alcohol abuse and self-neglect. This should be made clear in the home’s assessment. (See recommendation) Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 11 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): Standards 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are provided with some good information on how they can care for and support the needs of the people using the service, although there are gaps in the information that means there is potential for some needs to be left unmet. EVIDENCE: The person living in the home was admitted in May 2007 and is on a trial period. A care plan has been developed relating to the individual’s needs. It details how the staff are to support the person in their identified areas including, core areas, although the information relating to some of these could be more specific. This relates particularly to risks such as absconding, selfneglect, nutrition and finances. The care plan must clearly show how finances are managed and by whom and the system in place for providing the resident with monies and where there may be restrictions on this such as reducing expenditure on gambling or alcohol. The care plan should also include the Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 12 actions the home is taking to support the individual in the “rehabilitative” nature of the service. (See requirement) It is clear from the fact that the current resident has funding for 1:1 care that there are identified risks and although these risk assessments would benefit from being clear as to the identified risk, under what circumstances there is a likelihood of this occurring and the full action the home is taking to reduce the risk, whilst maintaining a level of independence. (See requirement) The AQUAA and Statement of Purpose detail the procedures and systems in place for including individuals in the decision-making and management of the home. These are yet to be implemented as there is only one resident who has only been recently admitted. Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 13 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): Standards 12,13,14,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has arranged activities that are important to the individual, although it is difficult to ascertain how much the individual participates. There are difficulties for the staff to ensure the person receives a well-balanced and healthy diet. EVIDENCE: The assessment, care planning information (together with the Statement of Purpose information and AQUAA) states that people using the service will be able to access various activities and will be supported in daily activities to live independently. The manager told the inspector of the resident not only making daily visits to the bookmakers and pub but also of their attempts to encourage him in other activities. This has proved to be very difficult with the resident rejecting such attempts. It is positive that his interest in gardening has been encouraged and he currently looks after the home’s vegetable patch in the Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 14 back garden. The care plan detailed finding a day centre, allotment, playing ping-pong and community activities, as part of the recreational likes and dislikes. The assessment also detailed that the residents enjoyed snooker, visiting the bookmakers (gambling) and watching games on TV. The records however, do not reflect inclusion in other activities except visits to the bookmakers and therefore do not give an accurate reflection of his participation in other activities. If the home is setting itself as a rehabilitation service, where they improve the life and daily living skills of others, then this should be included in the care planning of the individual along with continued relationships. (See requirement) The resident maintains contact with family through agreed visits. The Service Users Guide states that the home provides good home cooking and that menus will be varied. The AQUAA also states that the home provides three cooked meals a day. There is however little evidence of the resident receiving a balanced diet. This is due to the resident preferring foodstuffs such as pizzas etc. This was confirmed by the inspector, noting some eggs in the fridge, bread, 2 pizzas and oven chips in freezer. The staff have difficulty in promoting a healthy diet with the individual throwing food away that is often prepared for him and food that is stored in the kitchen that he does not like. He also refuses at times to prepare his meals. The records regarding nutrition also show that the resident mainly eats foods such as pizzas and chips. It is positive that since the inspection the home records fully food offered, prepared and when refused. However, these issues must be identified as a risk and interventions recorded. (See requirement) Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 15 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): Standard 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has gone some way to ensuring any risks to the resident are identified and minimised, although the poor medication practices and procedures and lack of information relevant to the individual mental health lead to potential health and safety issues. EVIDENCE: The care plan and risk assessment did not identify any issues with personal support required, as the resident is ambulant and physically able to undertake personal care tasks. However, there are risks to the individual of self-neglect and this is detailed, to some degree, in the care plan. The individual assessment details mental health problems but the care plan does not record any interventions that the home is taking to ensure his continued emotional well-being. (See recommendation) Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 16 There are also issues around trying to register the resident with a local GP making it difficult to obtain repeat scripts for prescribed medication. The resident has medication prescribed, although when viewed this was kept in an envelope with no label with dosage, numbers etc and no evidence of a GP script. The staff member stated that the hospital pharmacist had provided the medication in this way. Staff must be clear that any prescribed medication entering the home must be labelled. The medication is recorded on a printed sheet produced by the home for each individual prescribed medication. However, there is no record of this medication being recorded in. Discussions with the member of staff showed that they were not clear on how to record refusal of meds etc. I viewed the Lewisham policy for control of medication in residential home dated Feb 1994. This is well out of date and should be replaced by the Royal Pharmaceutical Guidelines for Care Homes. The member of staff could not locate the home’s procedures relating to medication but these were later provided and were satisfactory. The records supplied by the manager at a later date showed that the staff are trained in medication procedures. However, in light of the findings regarding current practice the inspector requires further training to ensure staff are aware of the correct procedures in ordering, obtaining and recording of prescribed medication to ensure the health and well-being of the individual is not compromised and that risks are reduced. (See requirement) Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 17 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): Standard 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 policy and procedure relating to complaints and the safeguarding of adults. The procedures in relation to protecting adults from abuse do not provide enough information for staff to ensure vulnerable people are protected. EVIDENCE: A copy of the complaints procedure is contained in the Service Users Guide, a copy of which is included in the individual’s file. The procedure is appropriate with timescales for investigation and CSCI address and telephone number. A complaint form has also been developed that states complainants name, nature of complaint action taken and “signed off” by the manager. There was no space for detailing whether the complainant is satisfied with the outcome or recording the route of the investigation. The Inspector suggested that this is added to the information and was subsequently completed Ringstead has only just started operating with one resident admitted in May 2007. The Commission has received no complaints or any other allegations and none have been reported in the information sent to the Commission. Adult protection procedures have also been developed that include Whistleblowing. The adult protection procedure is titled “allegation of ill treatment” Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 18 and gives guidance on types of abuse and how any such incidents will be investigated. The procedure does not detail the need to make a referral to the Local Authority Adult Protection Co-ordinator or the role of the Local Authority in safeguarding adults and co-ordinating adult abuse allegations. Nor does it give details of referring to POVA where allegations have been substantiated. The recruitment procedures do not give specific information regarding the checks required by the Regulations except in the form of a checklist. The home’s records identified at least three staff having received training in protection of adults from abuse although the procedures must be elaborated and staff trained in these. (See requirement) I also checked the personal monies of the one individual living in the home. It is not clear from the records or care plans that the finances are managed through a guardianship and how this actually works. For example, the restriction on monies each day. The care plan needs to identify this and how money is restricted each day and why. When auditing the monies it was clear the home keep records with receipts for monies coming in and going out of the home with the residents and staff signature confirming this. Staff must remember to ensure these records are clear and up to date. (See requirement) Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 19 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): Standard 24,25,27,28, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Ringstead House provides those using the service with a comfortable and homely environment that is clean and well maintained. EVIDENCE: Ringstead House has only been registered since February 2007 and a visit to the home took place prior to the application being successful. A tour of the home was undertaken and was found it to be as stated in the registration report. It is comfortable, homely, well-decorated and well- furnished. The bedrooms are of a good size with some nice personal touches in place and residents area able to bring in their own personal belongings. The bathrooms are also of a good standard. The back garden is quite long and has a wooden shed, good garden furniture and a BBQ for residents to use. There is also a vegetable patch for the resident to potter about as part of their preferred activities. Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 20 The home is within a short walking distance of the shops, leisure activities and local transport links, making it easier for the people living there to access community activities. I found no concerns with the environment, with the exception of a window restrictor missing from the current resident’s room. This is because, staff stated, the resident had removed it. The risk of falling is minimal because of the flat roof just below. However, the manager may need to look at other ways of minimising the risk of the resident absconding particularly as the flat roof makes this somewhat easier. The inspector also noted that the front and back doors (the only two exits in the event of a fire) are locked with keys with two locks on the front door. The manager should discuss the risks regarding this to ensure they meet Fire Regulations. The home was found to be clean and fresh with laundry equipment located in the kitchen towards one end away from the food preparation area. Handwashing facilities had been placed in the kitchen minimising the risk of cross infection. This is reasonable for small care environments where resident involvement in daily activities core to their support. Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 21 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): Standards 32,34,35,36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The staffing levels are appropriate with the current number of residents and whilst staff recive adequate training this could be further improved to ensure staff have a good understanding and knowledge of how to support people using the service. Records do not accurtely reflect staffing levels and together with recruitment procedures and practices do not fully ensure that residents are fully protected. EVIDENCE: Two support workers were on duty during the visit with the manager on personal business for the day. When I viewed the roster it did not match with the staff who were actually working, including the manager. The roster is a working document and must accurately reflect the staff working in the home each day. (See requirement) The AQUAA and other records show that over 50 of staff are qualified to NVQ 2 or above (or the equivalent). The member of staff spoken to also said that Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 22 they are encouraged to obtain further qualifications. For example those with NVQ 2 are now undertaking NVQ 3. This is good practice. The manager has not yet developed a system for recording all staff training to monitor when updates are required. This would be beneficial. Viewing of individual staff records and discussions with one staff member showed there to be a variety of training provided, although there is a need to provide training on mental health and autism and Aspergers syndrome. The manager must also ensure that medication training is followed up after procedures have been changed and to ensure training is also provided in challenging behaviour. (See requirement) There was also some evidence of formal supervision taking place although it is difficult to determine how regular this is likely to be with the staff only recently in post. The inspection also included viewing of staff files to determine the quality of the recruitment procedures. However, these could not be located on the day of the visit and therefore the manager was required to bring the relevant files to the Commission’s local office. This was complied with and many of the checks required, together with the documentation, was in place. However, there were gaps in the information. There was not always two references; verification of references where there was previous care employment had not been made with the exception of one telephone call; not all application forms had a full ten year employment history and there was no written explanation of gaps. Not all files contained certificates of qualification. The inspector did note that there were records of interviews; offer of employment letters; Criminal records Bureau checks (CRB) and POVA. (See requirement) The Statement of Purpose and records provided some evidence of induction training taking place in the form of an induction checklist. There was little evidence of how the induction meets Skills Sector specifications or LDAF or the requirements of Regulation 18. (See requirement) Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 23 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): Standards 37,39,40,41,42,43 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Due to the current level of service and the short length of time in which the home has been providing a service to individuals it is difficult to make a judgement on the quality of the service provided. Whilst further work is required to ensure records and procedures fully meet with the current Regulations and standards the manager has the capacity and commitment to ensure any improvements are made. EVIDENCE: The manager, has together with the home, been recently registered with the Commission. She has the required qualifications and experience to manage a home of this size. However, the home has only recently admitted a resident Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 24 and it is therefore difficult to make a judgement at this stage on how well the service is being run. There are areas that require improvement, including accurate roster records, organisation of documentation, further development of procedures and ensuring records are in the home that have been identified in the relevant outcome groups. However, I am confident, after discussion with the manager that these will be addressed by the timescales required. The Statement of Purpose states that, “there are various systems which ensure close monitoring is maintained on all the home’s services and procedures”. These systems are not detailed as such and should be. It also states that “an important part of the our quality programme is to involve the Service Users and their relatives. We regularly ask for comments on the home, the staff and services e provide. We also quarterly circulate a service user’s questionnaire, which assists in assuring that place we continue to provide a quality service. The service is only just “up and running” and there has not been the opportunity to implement these. The AQUAA states that the manager hopes to implement a ISO quality assurance system. This would be good practice. (See recommendation). The manager must also ensure that there is an annual review as required by the Regulations with a report detailing the outcome sent to the Commission. This will be inspected in future inspections when the home has more residents and there has been reasonable time undertake a review of the service. It is evident from findings on various procedures and systems that there is a need for checks to be made even at this stage and, particularly in areas relating to the health, safety and well-being of the resident. (See recommendation) The registration report from February 2007 also details the health and safety requirements that had to be met prior to agreeing registration. This visit included a check on a small sample of these. On the day the inspector viewed the record of fire drills, fire alarm weekly checks, portable appliance testing (visual tests only), insurance and the certificate of registration. The evidence required in respect of others could not be located on the day and therefore the manager was required to bring the documents to the local office two days later. The inspector viewed the gas, fire, Landlords gas certificate and fixed wiring. These were all satisfactory. The fire risk assessment was also brought into the office. There was also some evidence of the staff receiving fire training during induction. The manager is reminded that all staff must received fire instruction every twelve months and this must be recorded and should detail what is included in the fire training and signed by staff. The front and back doors are both locked with a key and in one case two keys. The Manager was requested to liase with the fire officer to ensure this meets Fire Regulations. The inspector has previously commented on the risks relevant to the current resident. The home has not made the Commission aware of notifications as required by the Regulations. For example, the resident absconding on three, Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 25 separate occasions. Since the last inspection the manager has ensured the Commission has been made aware of these events. There is evidence that some staff have received core training, such as First Aid, infection control, food hygiene and moving and handling. The manager must ensure that all staff receive these (with the exception of moving and handling if the risk assessment determines otherwise). The AQUAA does not detail any staff training other than NVQ. (See requirement) Ringstead House DS0000068744.V343949.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 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 X 4 3 5 2 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 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 x 2 X 2 2 2 3 x Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 27 N/A 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 2 Standard YA5 YA9 Regulation 5 13 Requirement The notice period must be made clear in the information provided. Risk assessments must provide staff with clear information on all risks and how they are to be minimised. Specifically, around behaviour, nutrition, activities and mental health. Care plans must reflect the physical, health, personal, financial and social care needs of the individual to ensure staff have the information to provide the support required. There must be a record of activities undertaken by the resident to ensure they are provided with a stimulating and active lifestyle. Medication procedures and practices must be reviewed to ensure those using the service are fully protected from harm. Adult protection procedures must be reviewed to ensure staff have the information and guidance to protect vulnerable individual who are using the service. Rosters produced must be accurate and reflect the staffing DS0000068744.V343949.R01.S.doc Timescale for action 01/10/07 01/10/07 3 YA6 15 01/10/07 5 YA14 12 01/10/07 6 YA20 13 01/09/07 7 YA23 13 01/10/07 8 YA33 17 01/09/07 Ringstead House Version 5.2 Page 28 9 YA35 18 10 YA34 17 & 19 11 YA35 18 in the home at the time to ensure there are adequate staffing levels to support residents. Training must be provided to staff on core areas and those specific to the needs of the individual living in the home to ensure staff have the knowledge and understanding to support the individual. Please provide an action plan of the training that you are to provide with timescales. Recruitment checks must be robust by ensuring all the checks required are completed to protect those people using the service. Induction training as specified by the Common Induction Standards or LDAF must be provided to all staff with an accurate record of the training undertaken to ensure it meets the Regulations. Please provide an action plan of the training that you are to provide with timescales. 01/10/07 01/09/07 01/10/07 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 2 3 Refer to Standard YA2 YA6 YA39 Good Practice Recommendations The manager should obtain more information on the individual’s need prior to assessment. Care plans should be improved to ensure all needs are detailed to ensure staff are aware of all the individual’s needs and the way in which they want to live. The manager should develop a system for reviewing the quality of care and ensuring a review of the service takes place each year. DS0000068744.V343949.R01.S.doc Version 5.2 Page 29 Ringstead House 4 YA39 Regular audits should take place on the implementation on the policies and procedures. Ringstead House DS0000068744.V343949.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH 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. Extracts may not be used or reproduced without the express permission of CSCI - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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