This inspection was carried out on 30th November 2005.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.
CARE HOME ADULTS 18-65
Rivendell 19 Lynton Crescent Christchurch Dorset BH23 2SD Lead Inspector
Tracey Cockburn Unannounced Inspection 11:10 30 November 2005
th Rivendell DS0000030576.V252275.R01.S.doc Version 5.0 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.V252275.R01.S.doc Version 5.0 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.V252275.R01.S.doc Version 5.0 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.V252275.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th May 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. Rivendell DS0000030576.V252275.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place unannounced over 2 hours. The registered manager was present throughout. The purpose of this inspection was to review the requirements and recommendations from the previous inspection. Care files were examined and a tour of the premises took place. The resident who lives there permanently was not in at the time of the inspection. The home does not employ any staff. What the service does well: What has improved since the last inspection? What they could do better:
At the conclusion of this inspection there are 5 requirements and 2 recommendations. The resident who is now living in the home long term has a higher level of physical care needs than the previous resident, they are less independent and require more support. This means that the registered provider must be more specific in risk management strategies specifically around their health care needs and in relation to activities both inside and outside the home. Mrs Ridyard is supporting the resident to take risks but lacks the details in writing to support her action, which could put both the provider and the resident at risk. The home has a policy on medication but further guidance must be sought to ensure that it is correctly stored. This is important in safeguarding both the resident and the provider. The registered provider must look into training, which will keep her updated on current good practice and develop her management skills. Work is still needed on the homes quality
Rivendell DS0000030576.V252275.R01.S.doc Version 5.0 Page 6 assurance system and this requirement is being repeated for the 3rd time. It is important that the provider is able to demonstrate to interested parties that the home is run in the best interests of the residents. The provider must also be up to date with training in regard to safe working practices such as first aid, food hygiene and infection control. The registered provider needs to develop a policy on ageing, illness and death; she also needs to develop a policy in relation to resident’s finances. 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.V252275.R01.S.doc Version 5.0 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.V252275.R01.S.doc Version 5.0 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): None of these standards were assessed at this inspection EVIDENCE: Rivendell DS0000030576.V252275.R01.S.doc Version 5.0 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): 9 The home supports people to take risks as part of an independent lifestyle however risk management strategies are not clear and could leave the resident vulnerable. EVIDENCE: The manager does not have a risk assessment in place regarding the residents medical condition and what action to take if they are out in the local community. There are risk assessments in place regarding scalding form radiator. The manager said that the resident is not able to go out without considerable support. Some activities the resident is participating in for the first time and enjoying. Rivendell DS0000030576.V252275.R01.S.doc Version 5.0 Page 10 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): 12,16 Residents participate in activities, which are appropriate to their age, culture and peer group. Resident’s rights are respected. EVIDENCE: The manager explained that the resident who has recently moved into the home long term has not had the opportunity to participate in many activities outside the day centre which she attends 5 days a week. The manager has therefore arranged a t weekends to take the resident out to a variety of different activities, giving her the opportunity to experience new things. The manager is clear that the resident is able to have individual choice and she is able to understand the non-verbal prompts and cues which the resident uses to express her views. Rivendell DS0000030576.V252275.R01.S.doc Version 5.0 Page 11 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): 18,20,21 Care documentation details how service users prefer and require to be supported enabling care staff to meet resident’s needs the way they need, want and like. The home has a policy and procedure for dealing with medicines, which protects the resident. The manager talks about sensitive subjects such as illness and death openly and honestly however there is no documentation to support this. EVIDENCE: The manager demonstrated during the course of the inspection that she has a very clear understanding of the way the residents prefers to be guided and supported. This is not fully reflected in the care plan. Much of the information Mrs Ridyard has in her head, as she has known the resident for a long time. Mrs Ridyard explained that routines are flexible to suit the needs of the individual. Mrs Ridyard also explained that she is working with the resident in learning how to choose what she wants to wear. An occupational therapist has completed an assessment and technical aids and equipment have been supplied to maximise the resident’s independence. Specialist advice has also been sought from staff at the day centre the residents attend. As the registered provider is the only person who provides support and guidance the residents has no choice in who supports her. All the residents’ medication is
Rivendell DS0000030576.V252275.R01.S.doc Version 5.0 Page 12 kept in a locked cupboard in the resident’s bedroom. The manager said that the resident would be unable to reach the medicine and take it due to restricted mobility. The registered provider keeps a record of the medication taken. There is no information available on the resident’s files about how the home will deal with issues of ageing and illness. Rivendell DS0000030576.V252275.R01.S.doc Version 5.0 Page 13 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): These standards were not assessed at this inspection. EVIDENCE: Rivendell DS0000030576.V252275.R01.S.doc Version 5.0 Page 14 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 Residents live in a comfortable home and their private space is decorated in a style of their choosing. The home provides specialist equipment to maximise the resident’s independence. The home is clean giving a good impression to visitors. EVIDENCE: The home is suitable for its stated purpose; all communal areas are accessible to the resident. The home is comfortable and homely. The registered provider does take people on respite into the 2nd bedroom. She said that they are all people the long term residents knows as gets on well with. The home is bright and airy and free from offensive odours. There is easy access to local amenities. The home is the same as the others in the street. The new resident who will live in the home long term has the equipment she needs; this has been individually assessed by an occupational therapist. There was concern that the resident had a significant eyesight problem but following an eye test and new glasses her eyesight has considerably improved. The laundry facilities in the home are domestic as in any other ordinary home.
Rivendell DS0000030576.V252275.R01.S.doc Version 5.0 Page 15 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 apart from the registered provider. EVIDENCE: Rivendell DS0000030576.V252275.R01.S.doc Version 5.0 Page 16 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 The home is run by an experienced provider who understands the needs of people with a learning disability very well, however the home would be benefit from the provider undertaking management training. The quality assurance system is not fully implemented which means that residents cannot be confident that their views underpin the homes development. The home has systems in place to ensure that the residents are promoted and protected however work is needed to evidence this. EVIDENCE: The registered provider has not been on any training courses recently and said that she is having difficulty with the Registered managers Award as the college have withdrawn her name from the course. The registered provider needs to find a suitable provider, which will enable her to complete the award. She should also keep up to date with current good practice. The registered provider seeks the views of residents, families and other interested parties however this information has not been collated into a report which can then be made
Rivendell DS0000030576.V252275.R01.S.doc Version 5.0 Page 17 available to people. The registered provider does not have all the appropriate safety information available. She has put some stickers on the glass patio door as she discovered that it could be dangerous if someone walked into them. The outside pathways and steps were clear and well maintained. Because the provider admitted that she had not completed any training recently she should ensure that she has up to date training on safe working practice issues such as first aid, moving and handling, food hygiene and infection control. Rivendell DS0000030576.V252275.R01.S.doc Version 5.0 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 Score x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x x x 2 x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x 3 3 LIFESTYLES Standard No Score 11 x 12 3 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Rivendell Score 3 x 1 1 Standard No 37 38 39 40 41 42 43 Score 1 x 1 x x 1 x DS0000030576.V252275.R01.S.doc Version 5.0 Page 19 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. Standard Regulation Requirement Timescale for action 31/01/06 1 YA9 2 YA20 3 YA37 4 YA39 5 YA42 The registered provider must ensure that unnecessary risks to 13(4)(b)(c) the health or safety of service users are identified and so far as possible eliminated. The registered provider must arrange for the proper storage 13(2) and safe keeping of medicines in the home. The registered provider must undertake training regularly to 10(3) ensure that they have the skills necessary to manage a care home. The registered provider must collate information from any reviews of the quality of the service and write a report which is available to service users and 24 other interested parties including the Commission. The previous timescale of 31/08/05 and 30/09/04 have not been met. The registered provider must ensure that they undertake 18(c)(i)(ii) training appropriate to the work they do. 31/01/06 31/03/06 31/01/06 31/03/06 Rivendell DS0000030576.V252275.R01.S.doc Version 5.0 Page 20 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 Refer to Standard YA21 YA23 Good Practice Recommendations The registered provider should develop a policy on death and dying. Discussions should be recorded in the resident’s personal file. The registered person should develop a policy in relation to residents finances detailing how money is kept safe. Rivendell DS0000030576.V252275.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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