CARE HOMES FOR OLDER PEOPLE
Rydan Lodge 3 Nelson Road Brixham Devon TQ5 8BH Lead Inspector
Susan Samways Unannounced 10th May 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 Older People. 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. Rydan Lodge D54-D07 S18422 Rydan Lodge V215816 100505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Rydan Lodge Address Rydan Lodge, 3 Nelson Road, Brixham, Devon, TQ5 8BH 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) 01803 858590 Mrs Lily McCarthy Mr Malcolm Edward McCarthy Vacancy Care Home 12 Category(ies) of Dementia (12), Old age, not falling within any registration, with number other category (12) of places Rydan Lodge D54-D07 S18422 Rydan Lodge V215816 100505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One Service User, named elsewhere, who is out of age range, may reside at the home Date of last inspection 17/12/04 Brief Description of the Service: Rydan Lodge is a detatched property situated in a residential area overlooking Furzeham Green and near to local facilities and amenities. The home is registered to provide care for up to 12 service users within the categories of old age or dementia. Accommodation is arranged over two floors with a stairlift providing access to the first floor. There are ten bedrooms, four of which are on the ground floor. Some rooms are en-suite, all others are close to bathroom and toilet facilities. The gardens are very pleasant with the one to the rear of the property being secure and particularly suited to service users needs. Rydan Lodge D54-D07 S18422 Rydan Lodge V215816 100505 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place as a follow-up to an additional visit made in response to a complaint. The complaint was not upheld but some issues regarding staff recruitment had been identified. The inspection took 3.5 hours. What the service does well: What has improved since the last inspection? 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.
Rydan Lodge D54-D07 S18422 Rydan Lodge V215816 100505 Stage 4.doc Version 1.20 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Rydan Lodge D54-D07 S18422 Rydan Lodge V215816 100505 Stage 4.doc Version 1.20 Page 7 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Detailed assessments enable all concerned to decide whether Rydan Lodge is an appropriate home for a prospective resident. EVIDENCE: The files for three residents were examined. As much information as possible had been obtained from care management assessments but the content of these varied both in quantity and quality. Therefore detailed assessments covering all aspects of care and daily living had been completed by the registered provider who stated that wherever possible residents are visited prior to their admission to the home. Assessments also included likes and dislikes, key points about their past history and family relationships. Rydan Lodge D54-D07 S18422 Rydan Lodge V215816 100505 Stage 4.doc Version 1.20 Page 8 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 Care plans and daily records provide sufficient information to enable staff to meet residents’ needs. EVIDENCE: Three care plans were examined. All aspects of the residents’ care were detailed and included contributions from residents’ relatives. Daily records had been completed appropriately. Visits by health care professionals such as G.P. or district nurse were highlighted in the daily records thus ensuring that all staff were made aware of any changes in the care or treatment required for a resident. The registered provider stated that the local mental health team provide the home with good support. Medication records seen had been completed correctly. Medication is stored securely. No residents manage their own medication at present. Residents were seen to be clean and nicely dressed. Staff were observed to approach them in an appropriate manner, respecting their privacy and dignity. The records of a recently deceased resident showed that the wishes of the resident and their relatives regarding their care, including spiritual needs, when they were dying and following their death had been recorded and carried out.
Rydan Lodge D54-D07 S18422 Rydan Lodge V215816 100505 Stage 4.doc Version 1.20 Page 9 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: None of these standards were examined during this inspection. Rydan Lodge D54-D07 S18422 Rydan Lodge V215816 100505 Stage 4.doc Version 1.20 Page 10 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18 Residents are protected by complaints being acted upon and by staff having an understanding of the protection of vulnerable adults. EVIDENCE: The home has a clear complaints procedure and any complaints received are recorded. The home also has on record letters and cards of thanks that they have received. A recent complaint regarding Rydan Lodge received by the Commission for Social Care Inspection was not upheld. However, during the investigation some other issues came to light and these have been acted upon by the registered provider. All residents are registered to vote and are enabled to do so if they wish. The home has a policy regarding the protection of vulnerable adults and there is a copy of the Alerters’ Guide available in the staff area. Training records showed that the majority of the staff had received basic training in recognising the different forms of abuse, which includes watching and discussing the ‘No Secrets’ video. Rydan Lodge D54-D07 S18422 Rydan Lodge V215816 100505 Stage 4.doc Version 1.20 Page 11 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,26 Rydan Lodge provides residents with a safe, well-maintained and homely environment in which to live. EVIDENCE: Rydan Lodge provides the residents with a homely environment. The lounge and dining room have large windows which allow a lot of natural daylight into the rooms. They overlook Furzeham Green which is a pleasant outlook. The home is well maintained and provides a safe environment. Since the last inspection all radiators have been covered. Sensors covering the bottom of the stairs and the upstairs bedrooms, used to alert staff of residents’ movements which could result in a fall, have recently been installed. The home was found to be clean hygienic and free from offensive odours. The kitchen was clean and well organised as was the laundry area. The home has an infection control policy and records showed that most of the staff have received training in infection control. Rydan Lodge D54-D07 S18422 Rydan Lodge V215816 100505 Stage 4.doc Version 1.20 Page 12 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 Improvements to the staff recruitment and training practices have increased the security and safety of residents. EVIDENCE: This inspection was unannounced. On arrival at the home the deputy manager was in charge and sufficient staff were found to be on duty to meet the residents’ needs. When the registered provider/manager arrived the files of the two most recently appointed staff were examined. Both contained completed application forms, which had signed criminal record declarations, two references and proof of identity. The application form, however, should be re-designed to allow more space for applicants to record their previous work history. This will ensure that previous experience and any gaps in employment can be explored. The dates of the CRB disclosure applications showed that they had been completed at the time of interview or a couple of days later. The registered provider stated that the POVA checks were slow in coming back, which was delaying new staff from taking on their full responsibilities. However, the good will of other staff have meant that the home had remained well staffed while new staff worked under close supervision until CRB clearance had been obtained. The deputy manager stated how much the support of the staff team was appreciated. Since the last inspection the deputy manager has compiled two induction checklists to be completed with new staff. One covers the running of the home and the other all aspects of the care of the residents. These had been used with the new staff. Training records showed that staff have had training in
Rydan Lodge D54-D07 S18422 Rydan Lodge V215816 100505 Stage 4.doc Version 1.20 Page 13 topics such as manual handling, infection control, health and safety and fire safety. However, staff training plans are not in place nor are schedules for refresher training. Training in managing challenging behaviour has yet to be provided. These now need to be addressed urgently. Rydan Lodge D54-D07 S18422 Rydan Lodge V215816 100505 Stage 4.doc Version 1.20 Page 14 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 Staff support has improved by the re-instatement of one-to-one staff supervision and monthly staff meetings. EVIDENCE: Since the last inspection staff supervision has been re-instated with all day staff having had at least one session but night staff yet to be started. Staff meetings have also restarted and are taking place at least once a month. A copy of the General Social Care Council’s Code of Practice was seen in the staff area so is now available to all staff. Rydan Lodge D54-D07 S18422 Rydan Lodge V215816 100505 Stage 4.doc Version 1.20 Page 15 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x x x x x 2 x x Rydan Lodge D54-D07 S18422 Rydan Lodge V215816 100505 Stage 4.doc Version 1.20 Page 16 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 30 Regulation 18 Requirement The registered provider must ensure that each member of staff has a training and development plan which includes a schedule for refresher training. The registered provider must ensure that staff receive training in managing challenging behavior (previous timescale of 01/04/05 not met). The registered provider must ensure that all staff receive regular supervision, at least six times a year (previous timescale of 01/04/05 not met). Timescale for action 30/09/05 2. 30 18 30/09/05 3. 36 18 30/09/05 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. Refer to Standard 29 Good Practice Recommendations The registered provider should re-design the job application form to allow sufficient space for past work history to be detailed. Rydan Lodge D54-D07 S18422 Rydan Lodge V215816 100505 Stage 4.doc Version 1.20 Page 17 Commission for Social Care Inspection 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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