CARE HOME ADULTS 18-65
Rivendell Woodway Street Chudleigh Newton Abbot Devon TQ13 0NE Lead Inspector
Mark Sharman Unannounced Inspection 17th January 2006 11:00 Rivendell DS0000003790.V267669.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 DS0000003790.V267669.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 DS0000003790.V267669.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Rivendell Address Woodway Street Chudleigh Newton Abbot Devon TQ13 0NE 01626 853943 01626 854621 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) HFT Margaret Lesley Wick Care Home 36 Category(ies) of Learning disability (36) registration, with number of places Rivendell DS0000003790.V267669.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 19 and 20/07/05 Brief Description of the Service: Rivendell is one of a number of homes provided by HFT (formerly Home Farm Trust), and is registered to accommodate up to 36 adults (aged 18 to 65) with a learning disability. The home is located just outside the small town of Chudleigh, and comprises three residential units (each of two houses) around a core building. Most of these houses were built about 22 years ago and are domestic in style. In addition there are three more modern day services buildings and some offices. Three former residents also live on site as tenants of HFT (under the Supporting People arrangements). A wide range of day services is offered on site for the residents, and for the residents of a smaller satellite home in Kingsteignton also run by HFT. The Rivendell site has very extensive grounds and is in a rural location with attractive views of the surrounding countryside. There is ample car parking available on site. Rivendell DS0000003790.V267669.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection and about six hours were spent at the home. The registered manager was away on holiday but time was spent with the overall service manager. About ten of the residents were spoken with, plus seven staff (including two team managers). A small sample of residents’ care records was examined, and most of the residents’ houses and the day activities rooms were visited. What the service does well: What has improved since the last inspection?
One requirement was made at the last inspection relating to fire safety training for all staff. This has been arranged in four separate sessions, one of which has now taken place with the rest to follow soon. This should help to ensure an appropriate response from staff in the event of a fire. Rivendell DS0000003790.V267669.R01.S.doc Version 5.1 Page 6 One recommendation was also made that there should be a centrally kept record for any complaints which might be made, which should help to identify any pattern of complaints. This has been done. 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 DS0000003790.V267669.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 DS0000003790.V267669.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): None of these Standards was considered on this occasion. EVIDENCE: Rivendell DS0000003790.V267669.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 and 9. There is a thorough care planning system which provides staff with the information required to meet residents’ needs and work towards their personal goals. The residents are consistently helped to make decisions for themselves and to take part in activities involving an element of risk. EVIDENCE: A small sample of residents’ personal files was examined, which clearly described their health/personal care and social needs, preferred routines, likes and dislikes. They are fully involved in the formulation of their care plan and in regular reviews, and in fact a review meeting including the resident and his parents took place on the afternoon of this inspection. Staff on duty said that a key worker is allocated for each resident from among the staff group. They also said that a personal risk assessment is carried out for each resident (some were seen), and risk assessments are carried out in respect of activities which residents take part in. This includes activities which take place outside the home in the local community, many of which may carry an element of risk. For example residents said they go swimming, horse riding, to college etc. and a few are able to go out on their own. One resident walked into Chudleigh on his own to have a haircut during the afternoon.
Rivendell DS0000003790.V267669.R01.S.doc Version 5.1 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, 14 and 17. There is an emphasis on creating as normal a lifestyle as possible for the residents, including opportunities for education and work, and they enjoy a wide variety of leisure activities. The catering arrangements are satisfactory. EVIDENCE: The Rivendell daily programme (work sheet) was examined, listing many of the activities which residents were engaged in for that day. About twenty of them have work placements and several of these are on a paid basis. Some are employed part-time at a local restaurant, one works in a care home kitchen, one at a local playgroup, one for a building company, one doing forestry work etc. The resident working for a local building company had been to work on the morning of the inspection, and said how much he enjoyed it. Educational opportunities are also available at the local adult education centre and local community colleges. The home has five vehicles for transporting residents, and in addition some staff also use their own cars. Numerous leisure activities take place in the local community, for example swimming, bowls at the indoor bowling arena, horse riding, walking, pubs etc. The service manager said that all residents have the opportunity of at least one week’s annual holiday away from Rivendell, and one resident described his holiday in Turkey and showed photographs of it.
Rivendell DS0000003790.V267669.R01.S.doc Version 5.1 Page 11 The residents spoken to said they were happy with the meals provided, and the lunch served on the day of the inspection was appetising and plentiful. Three choices of main course were available. Rivendell DS0000003790.V267669.R01.S.doc Version 5.1 Page 12 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): 20 and 21. There is a satisfactory system for handling residents’ medication, and clear evidence that ageing and illness are handled sensitively and respectfully. EVIDENCE: The home has a written medication policy and procedures. At present it is judged inappropriate for any of the current residents to self-medicate. The medication is kept securely double–locked in each of the houses and is administered to them by the staff. The medication cupboard and a sample of the medication administration recording sheets were inspected in one of the houses and found to be satisfactory. The residents’ personal files contain a health recording sheet, and their health needs are always addressed in their care reviews. The input from health professionals in respect of one resident with advancing dementia has been increased, and this resident was seen. She is clearly very well cared for, and special equipment has been obtained for her including a special bed and mattress to prevent pressure sores. Daily exercises for her recommended by a physiotherapist are carried out, fluids taken are recorded and personal care given is recorded (these records were seen). Rivendell DS0000003790.V267669.R01.S.doc Version 5.1 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): 22. Residents seemed confident that they are listened to and their views are taken seriously EVIDENCE: Residents spoken with were sure that staff would try to help them if they were worried or unhappy about something. The home’s complaint procedure is included in the Residents’ Charter. They are consistently encouraged by staff to express their views, which was apparent during the activities taking place in the afternoon (for example the Lions Club meeting). The weekly meeting with staff is in fact chaired by residents who volunteer for this. Two residents attended a Service Users’ Regional Forum meeting in Exeter on the morning of this inspection. A monthly meeting on self-advocacy is being run in the home by a local advocacy charity. No complaint has been made to the Commission for Social Care Inspection since the last inspection. Rivendell DS0000003790.V267669.R01.S.doc Version 5.1 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): 26 and 30. The home is well located and provides homely, comfortable accommodation and was clean. EVIDENCE: All of the bedrooms seen were comfortable, well furnished and have been personalised to the particular resident’s taste. Bedroom doors are lockable, although some residents are not interested in using this facility. All of the rooms seen, including communal rooms, were reasonably clean and there was no odour. Each of the houses is equipped with a domestic washing machine and dryer. There is also a central laundry room containing commercial equipment which is used for heavily soiled clothing. It was noted that some minor repairs were needed in one of the houses visited. Rivendell DS0000003790.V267669.R01.S.doc Version 5.1 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): The staffing arrangements are satisfactory. Staff are committed to the welfare of the residents and well motivated, and morale is high. EVIDENCE: This was an unannounced inspection and there was a good number of staff on duty during the day, and staff consulted felt that staffing levels are always at least adequate. Many of them have worked at Rivendell for a substantial time and there has been little staff turnover in recent years. The staff on duty treated residents with respect and encouraged them to speak for themselves. The organisation has the Investor in People award. Just about half of the staff have achieved NVQ level 2 or above, and the service manager said that currently twelve of the staff are working towards level 2 or 3. (Indeed during the day of the inspection an NVQ assessor saw some staff at the home). Rivendell DS0000003790.V267669.R01.S.doc Version 5.1 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. The home is managed in a professional way and there are satisfactory quality monitoring systems in place. EVIDENCE: The registered manager is very experienced in working with this client group, and is supervised by the overall service manager who is based at the home (and who set up the service over twenty years ago). The registered manager has almost completed the registered managers award, and when that happens this Standard will be fully met. The HFT assistant director makes regular quality assurance visits to the home and the HFT regional health and safety officer carries out an extensive annual health and safety audit. However the Commission for Social Care Inspection has not received reports on the conduct of the home in recent months as required by Regulation 26. These must recommence, and the home should be visited by an employee of the organisation who is not directly concerned with the conduct of the home. Rivendell DS0000003790.V267669.R01.S.doc Version 5.1 Page 17 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 4 23 x ENVIRONMENT Standard No Score 24 x 25 x 26 3 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 x 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 x x 3 x LIFESTYLES Standard No Score 11 x 12 4 13 x 14 3 15 x 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 3 3 2 x x x x x x Rivendell DS0000003790.V267669.R01.S.doc Version 5.1 Page 18 No. 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 YA24 Regulation 23 Requirement The broken tiles behind the cooker in house 3 must be replaced, and the front door handle (also house 3) must be repaired. The home must be visited at least monthly by an employee of HFT who is not directly concerned with the conduct of the home, and a report on the conduct of the home must be sent to the Commission for Social Care Inspection. Timescale for action 28/02/06 2. YA39 26 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rivendell DS0000003790.V267669.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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