CARE HOME ADULTS 18-65
Rivendell 19 Lynton Crescent Christchurch Dorset BH23 2SD Lead Inspector
Tracey Cockburn Unannounced Inspection 2 & 4th May 2007 10:00
nd Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rivendell DS0000030576.V338029.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. Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Rivendell Address 19 Lynton Crescent Christchurch Dorset BH23 2SD 01202 476663 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.V338029.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th June 2006 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 a communal lounge and dining area. 1 bedroom is en-suite. There is also a separate bathroom with shower. There is public transport into the centre of Christchurch. The home provides care in a family context and environment. The weekly fees range from £400 - £650. For further information on fee levels and fair terms of contracts you are advised to refer to the Office of Fair Trading website: www.oft.gov.uk Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over several days. This inspection was a key inspection and was initially unannounced. However on the first day no one was home. The registered provider was contacted and a further visit to the service was made. Mrs Ridyard was present throughout. The inspection lasted 2.5 hours. 2 survey forms were returned, a care plan and file of the person who lives in the service long term was looked at. No staff work in the home. Policies were looked at and discussion with the registered provider took place. A tour of the premises was also part of the inspection. The registered provider also completed the annual Quality Assurance Assessment, which helped inform the inspection process. What the service does well: What has improved since the last inspection?
At the conclusion of the inspection in June 2006 there were 4 requirements and 2 recommendations. Care Plans have been reviewed this means that people who use the service know that their changing needs and goals are reflected in their own care plans. The home has a clearer audit trail of people’s finances. This should include people who use the service for respite. The home now has a policy on ageing, death and dying. Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People have their needs assessed before they move into the service. EVIDENCE: There have been no new service users since the last inspection. This standard has not been assessed. However in previous inspections this standard has been met. Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 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 have individual plans of care, which reflect their needs and risks in their daily lives and support them to have an ordinary life. EVIDENCE: The 1 person who lives in the home long term has their care needs detailed in an individual plan of care. Their daily routine is clear, as are their likes and dislikes including how they prefer to be supported. There is also information on non-verbal sings, which indicate how the person is feeling. The registered provider has stated that she has known the person for a very long time and understands their needs well. The plan is not in an accessible format for the service user. The registered provider says staff at the day centre supports her and a communication book is used to good effect. The registered provider encourages people who use the service to make their own choices about such activities as what to wear, what to eat, where to go at the weekend. What
Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 10 programmes they might enjoy on TV and what clubs they might want to go to. Risk assessments are in place for both the people who use the service short term and those who use the service long term. Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 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 take part in activities, which interest them and are part of the local community. They are able to lead the lives they want to with the people they want to. EVIDENCE: People who use the service participate in a variety of activities. Mrs Ridyard keeps a record of all the activities undertaken. These include, meals out, day trips and short breaks. Mrs Ridyard explained that they had taken a service user on a trip abroad. They had made a photo album of the trip. People who use the service attend day services such as a local authority day centre. 1 comment card returned said that the service only sometimes helped them keep in touch with friends. As there are few comments about daily routines from the people who use the service. It is difficult to know if people feel respected. However Mrs Ridyard is clear that she only enters peoples bedrooms once she
Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 12 has knocked. She uses their preferred form of address and they have unrestricted access to the home. Mrs Ridyard says that people who use the service participate in the cooking of meals when they want to or feel able. She also said they are involved in the choosing of what to eat and in shopping. Meals are flexible to suit peoples individual preference and in accordance with their schedule. Such as the time they leave for the day centre. Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use the service are supported in the way they prefer, their physical and emotional health needs are met and the homes policy and procedures on medication keep them safe. EVIDENCE: The registered provider, who provides all the care and support to both the long term resident and those who come for respite, has a very good understanding of the way people who use her service prefer to be guided and supported. In the past this has not been fully reflected in the care plans. The care plans are now much better at detailing the preferred routines of the people she supports. There is equipment in the home to enable the people who use the service to maximise their independence. The medication is stored in a locked cabinet in the bathroom of the resident. A detailed record of all medication is kept. This was seen and found to be accurate and up to date. Mrs Ridyard has sought advice about the management of medication in the home. She also has an up to date medication policy.
Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People are unsure if their concerns are listened to and acted upon as they are unsure of the process of how to raise a concern or complaint. EVIDENCE: There have been no concerns or complaints since the last inspection. There is a complaint policy and procedure in place in an accessible format. There were 2 survey forms returned and both said that they would not know who to complain to if they were not happy with the service. The home has an adult protection policy and procedure and the registered provider has undertaken training. There have been no allegations of adult protection concerns. Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home is comfortable but not as clean as it needs to be. EVIDENCE: A tour of the premises took place. The home is comfortable. There is sufficient light, heat and ventilation. The long-term resident’s room was seen and this is very personalised. A comment card was concerned that the home is not as clean as they would like. On the day of the inspection, there was some clutter in the lounge area. The bathroom and the en-suite were both clean. The home is in keeping with the community and is accessible to the people who use it. The equipment used is of good quality. There has been some updating in the home and an extension has been added to the side of the building. This is an office space. There has also been some building work in a third bedroom with the addition of an en-suite.
Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 16 This is a small care home and the laundry facilities are the same as any small domestic home. Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home does not employ any members of staff. EVIDENCE: These standards are not assessed, as the registered provider does not employ any staff other than herself. Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The people who use the service would benefit from the manager undertaking management training. This would ensure that their health, safety and welfare was protected. EVIDENCE: The registered provider was able to evidence during the inspection that she is trying to secure a place on a management training course. The course has not yet started. She must also update her training on safe working practice such as moving and handling, first aid, infection control and food hygiene. The home has a quality assurance system. Each year the registered provider sends out survey forms to a variety of people including health care professionals, staff at the day centre, people who use the service and their
Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 19 relatives. The registered provider needs to make sure that the information collated is reported on and becomes part of the annual development plan. Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 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 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 3 2 X 2 X X 2 X Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA22 Regulation 22 (5) Requirement The registered provider must ensure that people who use the service and their representatives have a copy of the home complaints procedure. The registered provider must undertake/commence the Registered Managers award to ensure the consolidation of the skills necessary to manage a care home. Previous timescale of 31/3/06 not met 3. YA39 24 (2) The Registered provider must 31/08/07 produce a report based on the results of the surveys. This report must be made available to people who use the service and other interested parties. 18(c)(i)(ii) The registered provider must 30/09/07 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 Timescale for action 31/08/07 2. YA37 10(3) 30/09/07 4. YA42 Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 22 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. Rivendell DS0000030576.V338029.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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
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