Inspection on 12/06/06 for Rivendell [Christchurch]

This inspection was carried out on 12th June 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rivendell [Christchurch] 23/05/08

Rivendell [Christchurch] 02/05/07

Rivendell [Christchurch] 30/11/05

Rivendell [Christchurch] 06/05/05

Rivendell [Christchurch] 09/12/04

Rivendell [Christchurch] 29/06/04

Rivendell [Christchurch] 17/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Rivendell 19 Lynton Crescent Christchurch Dorset BH23 2SD Lead Inspector Maxine Martin Unannounced Inspection 12th June 2006 16:00 Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 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 Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 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. Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Rivendell Address 19 Lynton Crescent Christchurch Dorset BH23 2SD 01202 396677 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) Mrs Dyanne Margaret Ridyard Mrs Dyanne Margaret Ridyard Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th November 2005 Brief Description of the Service: Rivendell is a small care home registered to accommodate 2 people with a learning disability. The home is a detached bungalow in a quiet residential area. There is public transport into the centre of Christchurch. The home provides care in a family context and environment. Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was undertaken by Maxine Martin and lasted for three hours forty-five minutes. During the inspection the resident who lives there permanently was present as was the responsible individual, Mrs. Dyanne Ridyard. The purpose of the inspection was to review requirements from the last report and undertake a Key inspection in line with Inspecting for Better Lives. A tour of the premises was undertaken, files, relevant documentation was viewed and practice observed. The residents from Rivendell 2 were also present during the inspection, discussions were held with them, the records of which will be reflected in Rivendell 2’s report. For the purposes of this report the term resident and service user are interchangeable. What the service does well: What has improved since the last inspection? Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 6 Since the last inspection three requirements have been addressed and progress made. The resident continues to have their needs met and appears settled in this family care environment. New documentation has been purchased and is in the process of being implemented to support positive care practice. The focus of other developments for this provider had been around Rivendell 2. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Not applicable at this inspection as no new residents since the last inspection. EVIDENCE: Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this area is adequate. The judgement made is using available evidence including a visit to the service. Service users know that their needs are supported, however assessments and care plans need be up dated. Documentation must be dated and signed to ensure all records are appropriately kept, so that the needs of the service users can be meet. Service users are involved in planning their care as far as possible, so that they can make choices about their lives. Service users are supported in daily life to take risk to support their choice. These are enabled by a risk taking process. However due to the complex needs of the individuals risk assessment and planning must be reviewed regularly. Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 10 EVIDENCE: Files relating to service users living there permanently and individuals coming for respite were inspected. Mrs. Ridyard advised that she knows the resident’s needs and routines of care as they are well established. This was evidenced during observation of their interaction, however the records do not currently reflect this sufficiently to meet the requirements and support best practice. There were no up to date care plans on the file by either the provider or social worker. Mrs. Ridyard advised that she does have a detailed sheet of information relating to the care of the resident should there ever be a situation where this would be required. A copy of this was submitted to the inspector after the inspection, this would still need to be supported by up to date care plan/review documentation. Files viewed showed plans for introductions to the care environment and liaison with appropriate agencies. Documentation was not fully completed and dates and signatures were missing from some records. Files had individual likes and dislike sheets. Files relating to individuals coming on respite had more detailed records of activities. Respite files also evidenced Mrs. Ridyard providing positive care for the individuals as there were records of thanks and appreciation for the level of care provided. Mrs. Ridyard showed the inspector new documentation that she had just received which she hopes to implement into the home to ensure all needs are recorded, care and risk plans regularly reviewed and up dated. A requirement at the last inspection was relating to risk assessments in particular when out in the community. This is now in place, there has also been an Occupational Therapy assessment undertaken on 25/4/06 – documentation evidenced. As a result of this a new multi-position bed is being used and a chair to support bathing. The new documentation should provide the structure for ongoing risk assessments, which will need to be regularly reviewed in line with the care plans. Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this area is good. The judgement made is using available evidence including a visit to the service. Service users are involved in available activities appropriate to their needs. Service users are involved in the local community, which supports their needs. Service users are supported to maintain and develop appropriate relationships of their choice. Service users rights are supported within the context of a family care environment. Service users have healthy diets and are supported in the planning process. Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 12 EVIDENCE: Files viewed recorded activities such as trips to pubs, local shops. Most of the service users, who stay at Rivendell for respite, as well as the permanent resident, also attend day provision within the local community, where they also access a range of social and appropriate activities. Positive practice was observed of giving choice and respect to individuals. Some service users have complex communication needs, however files indicated ways to address these needs, practice observed also evidenced good interaction to support individuals with complex communication differences. Family and carer involvement is encouraged and was evidenced in the files. Dietary needs are met through menus at Rivendell as well as meals at the day centre service. As a result of the inspection it was discussed with Mrs. Ridyard the possibility of needing a speech and language therapist assessment of eating and drinking. Mrs. Ridyard has been in contact with the appropriate parties and this is being progressed. The resident lives as part of a family and as such is involved in general daily living activities. Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this area is adequate. The judgement made is using available evidence including a visit to the service. Service users receive personal support so that their needs are met. However up dated care plans and increased detail in plans would ensure this is maintained. Service users emotional needs are met so that they experience positive care. Service users medication is managed by the home and there is a policy in place. EVIDENCE: Mrs. Ridyard demonstrated and described during the inspection her detailed knowledge of the particular needs of the resident/s. This is not always reflected in the care records (Please cross reference to Requirement 1 – Standard 6) Mrs. Ridyard is the main person to provide care to the resident except for day care staff. Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 14 Records detailed relevant health professionals involved to meet a range of needs. Physiotherapy and other multi-disciplinary support are provided through the day care provision. Since the last inspection Mrs. Ridyard has tried to amend the storage and dispensing process of the medication. However there have been some complications relating to the particular type of medication and Mrs.Ridyard was told by a dispensing chemist that it could not be dispensed into a blister pack. This was confirmed with the Pharmacy Inspector following the inspection and that the current practice is adequate. Discussions were held that a review of the resident’s medication might be appropriate. Current developments in different types of medication are such that a slow releasing version of one of the particular medications may prevent the need for medication being sent into the day centre, if it is appropriate. Mrs. Ridyard advised this is an area she would follow through. The new documentation evidenced at the inspection contains policies relating to ageing and Mrs. Ridyard advised she would be revising these to use appropriately within this service. Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this area is adequate. The judgement made is using available evidence including a visit to the service. Service users experience care that is based on knowledge of the individual and recognises likes and dislikes. A policy relating to adult protection is in place, however further training in this would support this. New systems need to be established to ensure protection in relation to the resident’s finances. EVIDENCE: Services users complex communication differences are recognised and responded to. Interaction observed was positive and demonstrated knowledge and communication between the resident and the provider. There have been no complaints since the last inspection. Mrs. Ridyard has considerable experience in care and is aware of protection issues, however up dated training would ensure ongoing professional development of the skills and knowledge required. (Please cross-reference standard 37 and the related requirement). There have been some current difficulties outside of the control of the provider, which have created financial management issues. Mrs. Ridyard described where she was up to in resolving this matter and plans to ensure individuals have separate accounts. Financial record sheets were seen. Mrs. Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 16 Ridyard is dealing with this as a matter of urgency as she is aware of the need to set up appropriate systems as soon as possible. Mrs. Ridyard is awaiting contact from the benefits agency in relation to being an appointee, she is aware that is not a recommended situation, however currently there would appear to be no other option. Advised to get written confirmation form the social worker or their agreement to this, to be viewed at the next inspection. Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29, 30 Quality in this area is good. The judgement made is using available evidence including a visit to the service. Service users live in a comfortable homely environment. Service users have specialised equipment, which supports their identified needs and independence. Service users live in an appropriate environment for their current care needs. EVIDENCE: This accommodation provides a suitable environment for the residents, in the context of a family home. Residents have access to all communal areas of the home. The home is in easy access to local facilities. Risk assessments have been or are being completed where necessary. As a result of the inspection consideration was given to a risk assessment related to Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 18 the resident falling out of bed. Follow on conversations with Mrs. Ridyard have confirmed this matter is being dealt with. An occupational therapist has undertaken an assessment of the bedroom accommodation for the permanent resident. A specialist bed has been obtained and other equipment is used to support the needs of the individual. Positive interaction was observed between resident/s and family members. The home is maintained to an appropriate standard. Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these apply, as there are no members of staff that provide care apart from the registered provider. However in the future there are plans for the staff from Rivendell 2 to provide support during holidays. Files relating to staff from Rivendell 2 will be inspected in the next month and judgements made. (Please cross-reference to Rivendell 2 report) EVIDENCE: Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this area is adequate. The judgement made is using available evidence including a visit to the service. The home is run by an experienced provider who is aware of the needs of individuals with learning difficulties. However the home would benefit from the manager completing management and other appropriate training. Service users, carers and advocate views are now being taken into account to ensure service users views are valued in the home’s development. The home advocates for the needs of the service users, however documentation and process needs to evidence this further. EVIDENCE: Mrs. Ridyard has not yet been able to address the issue of completing the Registered Managers award, although she has recently had discussions to start this. Mrs. Ridyard needs to undertake other training to ensure her experience Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 21 and skills are developed to keep up with current good practice, including safe working practices. Included below are details of web links for organisation that have social care training as their focus and may be of use. Mrs. Ridyard has now developed a questionnaire to send out to individuals, carers and advocates enabling service user views to be recognised in the homes development. The result of this should be available by the end of July 2006. Respite care files viewed also demonstrated positive feedback from individuals and carers. The smoke detectors within the home are checked weekly along with fridge and freezer temperatures, records were viewed. Mrs. Ridyard has obtained a new range of documents to support the running of the homes. She is currently in the process of introducing these and adapting them accordingly to the needs of this small family care home. Training Web Links: www.Picbdp.co.uk www.Skillsforcare.org.uk www.traintogain.gov.uk www.Isc.gov.uk/bdp/employer/eggt_intro.htm Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 22 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 x 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 3 30 3 STAFFING Standard No Score 31 x 32 x 33 x 34 x 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 1 x 3 x x 2 x Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 23 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 YA6 Regulation 15 (2) (b) (c) Requirement To review care plans in consultation with appropriate parties. Ensure files contain up to date, specific care plans, which are signed and dated. To ensure risk plans reflect the complex needs of the residents. Financial management systems need to be finalised for service users monies to ensure a clear audit trail, protection and accountability. The registered provider must undertake/commence the Registered Managers award to ensure the consolidation of the skills necessary to manage a care home. Timescale for action 31/08/06 2. YA23 20 31/08/06 3. YA37 10(3) 30/09/06 4. YA42 Previous timescale of 31/3/06 not met 18(c)(i)(ii) The registered provider must ensure that they undertake training appropriate to the work they do, to ensure up to date current safe care practice is implemented Previous time scale of 31/3/06 not met 30/09/06 Rivendell DS0000030576.V293539.R01.S.doc Version 5.1 Page 24 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 YA19 Good Practice Recommendations Where individuals have complex health needs, written assessments should be obtained from specialists such as speech and language therapist relating to eating and drinking guidance, physiotherapist for mobility and exercise guidance. The registered provider should finalise work started on the policy relating to ageing, death and dying. Plans should be recorded in the care records. 2. 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