CARE HOME ADULTS 18-65 Rivendell 19 Lynton Crescent Christchurch Dorset BH23 2SD
Lead Inspector Tracey Cockburn Unannounced 06 May 2005 14:30 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 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 Stationary 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 Version 1.10 Page 3 SERVICE INFORMATION
Name of service Rivendell Address 19 Lynton Crescent, Christchurch, Dorset, BH23 2SD Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 396677 Mrs Dyanne Margaret Ridyard Mrs Dyanne Margaret Ridyard CRH (PC) - Care Home Only 2 Category(ies) of LD - Learning Disibility (2) registration, with number of places Rivendell Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 09 December 2004 Brief Description of the Service: Rivendell is a small care home in Christchurch. It is run and owned by Mrs Ridyard, who also lives in the home with her husband. Her son lives in an annex attached to the house. It is registered for 2 service users who have a learning disability. One service user lives there permanently. The other bed is used as a short-term care bed. The service users live as part of the family, and share the kitchen, lounge, dining room, bathroom and conservatory. There is a large rear garden with a patio area. The home has 2 cats. The property is a bungalow in a residential area, near to the main town of Christchurch. Christchurch has a variety of shops, post office, banks, public houses and leisure facilities. Mrs Ridyard is the main carer, and supports the service users with their personal, social and emotional care. Service users are encouraged to attend day activities away from the home during the week, as Mrs Ridyard has other employment in a day centre for people who have learning disabilities. Rivendell Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 3 hours in the afternoon and early evening. The reason for this inspection was to ensure that the resident who was not seen at the last inspection had a chance to see and talk to the inspector about their experience of living in the home. The resident was seen in private. The manager was seen as was care documentation and policies and the progress in meeting the requirements and recommendations from the last inspection were discussed. There have been no additional visits to the home since the last inspection. What the service does well: What has improved since the last inspection?
At the previous inspection in December 2004 there were 6 requirements and 15 recommendations. Mrs. Ridyard has produced information and policies in a format that her residents would find easy to use. At previous inspections Mrs Ridyard has not always been able to evidence what she says she has done, this has improved however there is not yet a policy on ageing and illness and Mrs. Ridyard said she has not documented all the conversations that have occurred around these sensitive issues. There is more involvement of the residents in decision making in the running of the home. Residents now keep copies of their care plans in their own rooms. Rivendell Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rivendell Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Rivendell Version 1.10 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 standard(s) 1,2,5 The home provides information which enables prospective residents to make informed decisions about whether or not the home is somewhere they want to live. The manager has clear criteria for ensuring that the home can meet the needs and aspirations of any prospective resident. Written contracts are in plain English and enable the resident to understand the terms and conditions of the home. EVIDENCE: The service user guide has been updated since the last inspection in December 2004 to include more detail of the facilities and services provided in the home. There have been no new admissions to the home since the last inspection however the manager explained that should she admit another resident she would ensure that the assessment was detailed and that the prospective resident was able to participate fully in determining whether or not the home was suitable. The current resident said they would be involved in the decision making with the manager of another resident moving into the home. The manager also explained that she would be considering any prospective resident unless they had an assessment from a Social Services care management team and that the prospective resident had been fully involved in the assessment
Rivendell Version 1.10 Page 9 process. The current resident has a copy of his individual care plan which is kept in his room. The manager explains the contract to each service user and believes it is in an appropriate format and language for residents to understand. The resident currently living in the home long term said he had had his contract read to him. Rivendell Version 1.10 Page 10 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 standard(s) 6,7,8,10 Individual plans of care reflect changing needs and goals ensuring that residents have the care they need. Residents make decisions about their own lives. Residents make decisions about life in the home. The manager makes residents aware of information and services, which encourages independence in making decisions about their own lives. EVIDENCE: A recommendation at the last inspection was for care plans to be in a format suitable to their needs. The current resident feels that his care plan is easy to understand and that he is fully involved in its development. The owner says that she has fully involved the long term resident in future plans for the home, the resident confirmed this. The manager said that the resident is responsible for his own finances, she supports him when she is asked to and goes with him to the bank when he asks. The manager said that the resident keeps receipts and looks after his own money in the home. Rivendell Version 1.10 Page 11 The resident said that he enjoys looking after his own money and being able to buy things that he wants to. The resident says that he has friends and is able to invite them to visit him when he wishes. Rivendell Version 1.10 Page 12 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 standard(s) 13,15,17 Residents live ordinary lives in the community seeing family and friends as they wish. Meals are healthy and mealtimes flexible to suit residents lives. EVIDENCE: The resident said that he goes out and about in the community as he wishes, he visits family and friends and enjoys going to the pub, cinema and bowling. He said he also goes shopping, food shopping once a week and clothes shopping when he needs to. He said he is supported by the manager in any activities he does. The manager said that she is involved in supporting the resident to plan menus and prepare shopping lists, she said she encourages healthy eating and the resident confirmed this and said that he had lost some weight. The resident said he is able to choose who he sees and who he invites to the home. He said that he would ask the managers permission before bringing someone to the home. The resident joined in the discussion between the manager and the inspector. A very positive relationship was observed. Rivendell Version 1.10 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 standard(s) 19,21 A philosophy of open communication means that problems are identified early and acted upon. This means that any physical or emotional health needs are addressed as soon as the manager is aware of them and by appropriately qualified individuals. The manager talks about sensitive subjects such as illness and death openly and honestly however there is no documentation to support this. EVIDENCE: The resident explained that he is able to discuss any problems or concerns he has with the manager, he says she always has time to listen and that he is supported with any decisions. There was evidence in care information that the resident has regular checks with health care professionals such as opticians. The resident said that he is able to discuss any problems or worries that he has with the manager and he knows that she will give him good advice and support him. The manager said that she has not had a chance to develop a policy on ageing, illness and death but that she has had an opportunity to discuss these topics when they crop up in conversation with the resident. These conversations and their outcome are not recorded in the resident’s personal record.
Rivendell Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Good relationships between resident and manager mean that any concerns are listened to seriously and action taken to sort out the problem. An adult protection policy is in place but lacks information to ensure the resident is protected from financial abuse. EVIDENCE: The resident said he has never had any reason to complain, he said he does talk through problems with the manager and has always felt listened to. There are no complaints recorded for the home either by the home or by the commission. The manager has said that if there have been issues which have cropped up with relatives her approach is to discuss situations openly to seek a positive solution. The long term resident is responsible for his own finances, but the owner has not developed a policy to ensure he is protected from financial abuse. The resident explained that he keeps receipts for all his financial transactions and that he meets with the owner to discuss how he is spending his money and to make sure he is paying his bills. He says he is happy with this system. Rivendell Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,29 Residents live in a comfortable home and their private space is decorated in a style of their choosing. The home does not have any specialist equipment. EVIDENCE: The manager said that she will be arranging for an occupational therapist to come to the home probably on the 9th May 2005. A prospective resident has a need for specialist equipment, which will need to be in place if they move in long term. Rivendell Version 1.10 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed at this inspection. EVIDENCE: Rivendell Version 1.10 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 The quality assurance system is not fully implemented which means that residents cannot be confident that their views underpin the homes development. EVIDENCE: The manager has developed questions to ask both the resident who lives in the home fulltime and the residents who have short breaks, not all the questions relate to the aims and objectives of the home. The manager said that she has symbols and pictures, which she will be using in conjunction with the questions. The resident told the inspector that the manager has sat down with him and asked him about how the home is run, any changes he would like to make and about the care he receives. Rivendell Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 x x 3 Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 x 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x 2 x Standard No 11 12 13 14 15
Rivendell x x 3 x 3 Standard No 31 32 33 34 35 36 Score x x x x x x Version 1.10 Page 19 16 17 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 x 2 Standard No 37 38 39 40 41 42 43 Score x x 1 3 3 x x Rivendell Version 1.10 Page 20 YES 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 24 Regulation 23 Requirement the registerd provider must consult with a suitably qualified person in relation to whether the premises are suitable for meeting the needs of service users who have physical/mobility problems. the previous timescale of 30/09/04 was not met. 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 other interested parties including the Commission. The previous timescale of 30/09/04 was not met. Timescale for action 31/08/05 2. 39 24 31/08/05 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.
Rivendell Refer to Standard 21 23 Good Practice Recommendations The registered provider should develop a policy on death and dying. The registered provider should record any discussions and the action taken. The registered provider should develop a policy in relation
Version 1.10 Page 21 3. 29 to service users finances, detailing how money is kept safe. The provision of aids,adaptations and equiopment follows an assessment and meets the recommendations of an occupational therapist or other suitably qualified specialist. Rivendell Version 1.10 Page 22 Commission for Social Care Inspection 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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