Inspection on 14/11/05 for Rydal Mount

This inspection was carried out on 14th November 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rydal Mount 12/01/09

Rydal Mount 30/01/07

Rydal Mount 16/02/06

Rydal Mount 03/03/05

Rydal Mount 20/12/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Rydal Mount Station Hill Wigton Cumbria CA7 9BJ Lead Inspector Gordon Chivers Unannounced 14 November 2005 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. Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Rydal Mount Address Station Hill Wigton Cumbria CA7 9BJ 016973 49266 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) Community Integrated Care Janice Coates Care Home 4 Category(ies) of LD - Learning Disability registration, with number of places Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 03 March 2005 Brief Description of the Service: Rydal Mount is a care home for four people with a learning disability operated by Community Integrated Care. It is a detached bungalow at the bottom of Station Hill on the outskirts of Wigton, Cumbria, within a short distance of the amenities of the town. The home is in its own grounds and is approached by a steep driveway, through an attractive well-kept garden. The gradient of the driveway necessitates the use of the vehicle when residents want to leave the grounds. There is a large fully accessible patio area with seating, to the rear. This leads onto a large slopping lawn.Inside the building comprises a large lounge/dining room and a smaller lounge, both of which are furnished and decorated to a good standard. There is a good size kitchen and utility room. There are four single occupancy private bedrooms within easy reach of fully accessible, specially adapted bathing and toilet facilities. Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, commencing at 09.30 and lasting six hours. The inspection took place in the presence of Susan Muir a support worker. The inspection included: • A tour of the premises, • Reference to a range of documents including a sample of service users’ case files, • Interviews with members of staff, and • Observation of and brief conversations with three of the service users. The inspection focused upon recommendations made, and those standards, which were not assessed, by the last inspection. The inspector would like to thank the service users and staff of Rydal Mount for their welcome and cooperation during this inspection. What the service does well: What has improved since the last inspection? What they could do better: Reviews should focus on whether the care plan is appropriate and whether it has been carried out as it should have been. Introduce a system to identify and meet the service users’ needs which takes all of their personal characteristics into account. The manager should ask service users and their families what would improve the service and use that and other information as the basis of an annual Development Plan for the home. Arrange for more staff to train to NVQ level 2; and that all staff have training on the prevention of abuse and neglect of vulnerable people. Ensure that all staff are supervised at least six times a year. Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 Page 6 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. Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 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 Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 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) 5 The rights of the service users are respected by a contract which states the terms and conditions of their residency and support they receive. EVIDENCE: Each service user has an up to date contract with CIC which has been signed on their behalf by a relative. Some of the contracts do not have the required information about the service user’s representative. Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 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 standard(s) 6,7,8 Each service user’s needs are constantly reassessed and there are plans in place to meet those needs. The formal reviews of the care plans should focus on the plan and how it is implemented rather than just on the needs. The home is making good progress in developing person centred plans for each service user. The service users are helped to make decisions about their lifestyles and are consulted on a range of domestic issues. EVIDENCE: A personal risk assessment has been completed for each service user and is kept in their file. These risk assessments are reviewed every six months. Management guidelines are in place so that staff understand how to support service users if their behaviour is antisocial or otherwise unacceptable. There are also comprehensive care plans for each service user, although the CIC format for recording these plans is very cramped with insufficient space to present all the necessary information fully and clearly. These are reviewed monthly, and then every four months on a more formal basis. These reviews tend to focus on the service user’s needs rather than whether the care plan is appropriate and whether the work undertaken to meet the care plan has been effective. The service users and their families have a ‘standing’ invitation to Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 Page 10 these ‘key-worker’ reviews. The service users sometimes attend but the families rarely attend, nor do the home send them a copy of the review. CIC and the home would have made a start in introducing person-centred planning, but the PCP facilitator has been off sick for three months and has only returned to work quite recently. There is plenty of evidence in the case files and on the notice boards in the office about how service users are supported in making decisions for themselves on a range of everyday life things such as bedtimes, clothes to wear, past-times and leisure activities. Service users are consulted, individually and collectively, on domestic issues such as the décor and furnishings of their bedrooms and group activities such as barbeques and similar social events. Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 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 standard(s) 11,12,14,15,16,17 The care plans are about service users’ personal development. The service users undertake a wide range of activities and have varying contact with their families. Staff respect the service users’ rights and help them to understand social responsibilities. They are offered a varied and balanced diet. EVIDENCE: The care plans and the records of everyday events and issues in the service users’ lives show how the staff look for ways and means for them to retain existing skills and have new experiences. Two of the service users elect to go to Chrysalis day services, (one on a part time basis). Some of them attend a local evening club for people with learning disabilities once a week. All of them are supported in deciding upon and undertaking a range of activities from shopping to concerts to holidays. The keyworkers take responsibility to look out for leisure and recreational opportunities for the service users. The staff have supported the service users to indicate the things they like to do in their leisure time, both inside and outside of the home. They all engage in crafts or puzzles and games when and for as long as they chose. Some of the Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 Page 12 staff wished they had more time to work with the services users who are not all that well motivated or who have short spans of attention. All the service users are able to choose whether they have contact with their families. Most of them do have contact to varying degrees. Friendships are drawn from the people they have contacted with at the day services or evening club. The staff support the service users to understand their social responsibilities in respect of acceptable conduct and self control. Staff are also given guidance to respect the expressed wishes of the service users (‘no means no’) and not to try to push them into doing things. Weekly menus are prepared in advance and these take service users’ needs and preferences into account. The diet of one of the service users has been based upon advice from a NHS dietician. The menu is varied and balanced with fruit and plenty of vegetables. Some of the service users were observed having their lunch, and all said they were enjoying it. There is a choice in some, but not all, of the main daily meals. In view of the sedentary lifestyles of some of the service users, the home might find NHS guidance on calorie levels and nutrition useful. Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 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) 20 Staff manage and administer service users’ medication according to the procedures. EVIDENCE: None of the service users manage and administer their own medication. The home has a copy of the CIC administration of medication in place. Medication is stored in a locked metal cabinet fixed to a wall in the office. There is a small lockable box inside the cabinet for controlled drugs. The administration of medication to the service users is correctly recorded on the MAR sheets. All staff have been trained in the safe handling of medication. Medication which is disposed of or returned to the pharmacist is recorded on the MAR sheets. Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 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) 23 Policies and procedures for the prevention of abuse or neglect of service users are in place, but refresher training has not yet taken place. EVIDENCE: The home has procedures to deal with abuse and neglect, or suspected abuse and neglect. These are supplemented by guidelines on the use of physical restraint, dealing with aggression and violence, and challenging behaviour. The CRB and POVA checks have been undertaken in respect of the staff. The procedure regarding service users’ finances has been reviewed as recommended by the last inspection and a supplementary procedure is now in place. All the service users’ financial transactions are now recorded separately and double checked against records kept in respect of each individual service user. The planned refresher training on the protection of service users from abuse and neglect has not taken place, partly because of the amount of sickness levels amongst staff since the last inspection. Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 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) 27 There are two bathrooms, each with a toilet, and both equipped with excellent bathing and showering facilities selected to meet the needs of the service users. EVIDENCE: With the addition of the new bathroom, the home has excellent facilities that meet the varied needs of the current group of service users. Assessments have taken place and appropriate aids and adaptations are in place. This includes high/low baths, grab rails, lifting and handling hoist, walk-in shower, bath chair and commode. Both bathrooms are spacious and well decorated. These facilities maximise independence and help to maintain dignity. Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 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) 33,35,36 The staff team is effective in supporting the service users’ needs. However, the staff are not qualified overall to the standard required. The records of training undertaken and plans training for the next year assist the home in improving the quality of service it provides. The manager has not supplied the information about formal staff supervision requested. EVIDENCE: The 382.5 staff hours per week in the home are adequate to meet the needs of service users. The additional hours in place at the time of the last inspection were temporary and supernumerary. The home currently deploys a member of staff from the ‘bank’ whom it is hoped will become permanent in the home. Some staff questioned whether the rotas could be changed so they had more free weekends en-bloc. Of the ten members of staff, only one will have completed NVQ level 2 in care by the end of 2005. One member of staff is due to complete NVQ level 3 and three should complete level 2 during 2006. The manager maintains a record of the training which staff have received over the last year, and a training plan for the forthcoming year. The training covers a wide range of care and support issues, some of which is undertaken ‘in-house’, and some provided by outside training agencies. Due to staff sickness and cancellation of some courses, some staff missed some of the training courses they were due to attend. The Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 Page 17 manager will re-refer staff to the next scheduled training course, but training availability is limited by CIC. The manager, Susan Coates, was contacted by phone after the inspection and asked to send the dates when staff had been formally supervised over the last twelve months. The Commission has not received this information. CIC is due to implement a system of Annual Appraisal of staff during 2006. Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 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 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) 37,39 The home is well managed, but the views of service users and/or their families are not sought or used to improve and develop the service. EVIDENCE: The manager has been in post for nine years. She has a nursing qualification and has completed the Registered Managers Award. The staff considered that she ‘knew the job’ and that she and the senior support worker worked well together. Morale within the staff team is said to be good. The home does not formally survey the service users and/or their families for feedback on the service it provides. The home does not produce an annual Development Plan based, in part, on feedback from service users and/or their families. Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 Page 19 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 3 Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x 4 x x x Standard No 11 12 13 14 15 16 17 3 3 x 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 x 2 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Rydal Mount Score x x 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 1 x x x x F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 Page 20 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 6 Regulation 15 Requirement The home must review the appropriateness of service users care plans and the effectiveness of the action to meet the goals of each care plan. The registered person must arrange for all staff in the home to have refresher training on the prevention of abuse and neglect of service users. The registered person must ensure that more than half of the staffing complement have either completed or have been registered to undertale NVQ level 2 during 2006. The home must seek the views of the service users and/or their families about the type and quality of service it provides. The registered manager must provide information about the dates when staff have been formally supervised over the last twelve months. Timescale for action Immediate. 2. 23 13 28/2/06 3. 35 18 30/6/2006. 4. 39 24 28/2/06 5. 36 18 Immediate Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 Page 21 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. 3. Refer to Standard 36 39 Good Practice Recommendations The registered person should ensure that an Annual Appraisal system is implemented during 2006. An Annual Development Plan should be produced based in part upon the views of the service users and/or their families. Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Rydal Mount F58 F10 s22577 rydal mount v247800 141105 ui stage 4.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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