Inspection on 20/10/08 for Ryde House

This inspection was carried out on 20th October 2008.

CSCI found this care home to be providing an Good service.

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

Ryde House 13/11/07

Ryde House 17/10/06

Ryde House 29/11/05

Ryde House 16/06/05

Ryde House 08/12/04

Ryde House 08/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ryde House Binstead Road Ryde Isle Of Wight PO33 3NF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Nick Morrison     Date: 2 0 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Ryde House Binstead Road Ryde Isle Of Wight PO33 3NF 01983564004 01983564008 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr John Raymond Clewley,Mrs Miranda Cruz Clewley Name of registered manager (if applicable) Mrs Miranda Cruz Clewley Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 64. The registered person may provide the following category of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD). Date of last inspection Brief description of the care home Ryde House is a residential care home providing care and accommodation for up to twenty-four people with learning disabilities. The home is a Grade 2 listed building that is approached via an extended private drive, and has extensive grounds leading through gardens and woods to a private beach. There is a golf course adjacent to the drive and a garden centre in the grounds. Ryde House is owned by Mr and Mrs Clewley and managed by Mrs Miranda Clewley. Weekly Fees at the home range from #390 #1,727 per week, this is dependant on need and residents are responsible for paying for their own toiletries, hairdressing and items of a personal nature. Care Homes for Adults (18-65 years) Page 4 of 25 care home 64 Over 65 0 64 Care Homes for Adults (18-65 years) Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 20th October 2008 and lasted five hours. During this time we toured the main building and the four new buildings, looked at the files of four service users, met two of them and observed the support they were receiving. We also met the Manager and two members of staff and observed interaction between staff and service users. All records and relevant documentation referred to in the report was seen on the day of the inspection visit. We also referred to services own self-assessment of the home. Care Homes for Adults (18-65 years) Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from having their needs and aspirations assessed prior to moving into the home. Evidence: The home requires a full care management assessment for each person before they move into the home. In addition to this, the home does its own comprehensive skills assessment and identifies peoples support needs. Records showed that all assessments were in place prior to the person moving in and that service users and their families had been involved in the assessment process. Care Homes for Adults (18-65 years) Page 9 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from having clear care plans and risk assessments in place and from being supported to make their own decisions. Evidence: There had been a requirement from the previous inspection that the home must ensure that service users plans provide clear information as to how service users needs in respect of their health and welfare are to be met. This will enable staff to have the information they need to offer the correct level of support. We looked at the care plans of four people and these had all been updated since the previous inspection. The information contained in them was clear and gave details about what support was required and how it was to be provided. Staff spoken with were aware of care plans and said they followed them in providing support. Where possible, service users had been involved in devising their own care plans. The service is now moving towards a more person centered approach to care planning which aims to involve service users more fully and to base plans on the needs and aspirations of service users. Care Homes for Adults (18-65 years) Page 10 of 25 Evidence: There had been a requirement from the previous inspection that service users plans of care must be regularly reviewed and recording should provide written information to evidence that care has been delivered effectively. The care plans we looked at had been reviewed on a monthly basis and altered as necessary. All care plans seen were up to date. Care plans appeared to reflect the current needs of service users and also reflected their assessed needs. Care plans also contained risk assessments that were also kept up-to-date and reflected the current needs of service users. The care plans also emphasised the need for service users to make their own decisions and observation of staff interactions with service users throughout the day demonstrated that staff understood this and were able to support people to make their own decisions rather than making decisions for them. Care Homes for Adults (18-65 years) Page 11 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from having their rights respected and from balanced and nutritious meals. They also benefit from having the opportunity to engage in a wide range of activities both inside and outside of the home. Evidence: Records of activities and discussion with staff showed that service users were supported to make use of a wide variety of local facilities and to be involved in the activities they had chosen. The service has its own resource centre on site from which daytime activities are planned. Individual preferences about activities were recorded in peoples care plans and it was clear that the activities arranged for each person reflected their interests. Records of activities demonstrated that activities were individual and that sufficient staff support was allocated. Service users were involved in a wide range of activities such as eating out, shopping, using the local pub, hiking, Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: art, games and bowling. People living in the home were supported to maintain contact with their friends and families. Records were kept of visits from families and of people going to stay with families. People were also supported to maintain contact with their families over the telephone and staff assisted them to make telephone calls if necessary. The home had done some very positive in ensuring that people retained good contact with family members and were working with one person to try to help her rebuild relationships with members of her family. Menus showed that food in the home reflected the identified preferences of each person living there. People had individual meals according to their preferences and were able to make choices on the day about what they wanted if they did not want what had been identified on the menu. Staff ensured that mealtimes were a relaxed, enjoyable and social occasion for people and provided the support each person needed. Care Homes for Adults (18-65 years) Page 13 of 25 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from having their healthcare needs met and are protected by the homes medication policies and practices. Evidence: Care plans contained information on how people preferred to be supported with their personal care. The files of people living in the home demonstrated that healthcare needs were monitored and that people were supported to use healthcare services as necessary. There were comprehensive records relating to each persons health. Each persons healthcare needs were monitored and recorded on a regular basis. Where people had used healthcare services there were records detailing the time and date, the reason why they attended and any outcomes as a result of the consultation. Staff in the home liaised closely with healthcare professionals in the interests of people living in the home. There had been a requirement from the previous inspection that the home must ensure that staff have a clear protocol with regard to administering when required (PRN) medication and this protocol should give guidance on how and when medication used to control behaviour is administered and recorded. Care Homes for Adults (18-65 years) Page 14 of 25 Evidence: Examination of records during this inspection showed that PRN guidelines were now in place and that other forms of intervention were preferred prior to resorting to medication. The home had liaised with the GP in writing the PRN guidelines. The system for administering medication in the home was clear and was stated in the homes policies. Staff spoken with who were involved in administering medication said they had received good training and demonstrated that they had a good understanding of medication issues. Medication records were clear and up-to-date and all medication was stored appropriately and safely. There was a comprehensive system in place for monitoring medication with regular checks and crosschecking to minimise the possibility of any errors occurring. Care Homes for Adults (18-65 years) Page 15 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from having their views listened to and are protected by the homes policies and practices Evidence: There had been a requirement from the previous inspection that the home must ensure that there is a procedure in place for considering complaints and ensure that all complaints both written and verbal are recorded and investigated. Records examined during the inspection showed that the home now has met this requirement. There had been a requirement from the previous inspection that residents must be safeguarded by suitably trained staff, including staff that has training to enable them to care for those residents with challenging behaviour. Examination of training records and discussion with staff showed that this requirement has now been met. There had been a requirement from the previous inspection that any person living at the home subject to restrain must only have this carried out as agreed by a multi disciplinary team and by staff trained in its correct application and this must be documented as part of care planning as well as after each event Training records, care plans and discussion with staff demonstrated that this requirement has now been met. Care plans had been rewritten and contained clear information about how to support individuals with their behaviour. Observation on the day of the inspection showed that staff understood the care plans and supported people accordingly. Care Homes for Adults (18-65 years) Page 16 of 25 Evidence: There has been a history of mild but continuous incidents involving one particular service user showing aggression to other people living in the home. These incidents were well documented and the home has ensured that relevant people were informed about each incident. The new Manager has ensured that care plans detail exactly how this person should be supported on these occasions and has liaised with the Community Learning Disability Team in devising the plans. These support plans, along with the fact that there is now a more defined and regular staff team in the home, have resulted in the number of these incidents decreasing significantly over the past few months. Staff spoken with confirmed this and said they were able to deal with incidents in a more positive way now. Observation on the day of the inspection visit showed that staff were aware of the plans to support this person and that they implemented them. This resulted in potential incidents being dealt with before they escalated. Part of the way staff dealt with these incidents occasionally necessitated mild physical intervention where staff needed to physically redirect the person. Not all staff had received training in physical interventions at the time of the inspection visit, but the Manager assured us that training was planned for those people who had not already received it The home has a complaints policy in place, but no complaints had been received. The home has good policies and procedures in place for dealing with allegations or suspicions of abuse. Staff had received relevant training and had read the homes policies. Care Homes for Adults (18-65 years) Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from living in a clean, comfortable and safe environment. Evidence: The house is very homely and comfortable. There are pictures of service users in the lounge area and the kitchen/dining room acts as a focal point for activity in the house. Service users are able to move freely around the home and appeared to feel comfortable. Service users bedrooms are well equipped and they have been able to bring their own possessions with them to the home. The home was clean throughout, while remaining comfortable and homely. There were cleaning rotas in place for each day of the week to ensure that cleanliness was maintained and clear records were kept of what cleaning had been done. Service users were supported to be involved in the cleaning of the house if they had identified this as something they had wanted to do. Care Homes for Adults (18-65 years) Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from being supported by adequate numbers of well-trained staff and are protected by the homes recruitment policies and practices. Evidence: There had been a requirement from the previous inspection that the registered person must ensure that all persons employed to work at the home receive training appropriate to the work that they are asked to perform. This will help to ensure that residents are at all times supported by suitably trained staff. Training records and discussion with the Manager and staff demonstrated that this requirement has been met. Staffing levels had been increased since the previous inspection. On the day of the inspection there were initially two members of staff on duty and a third member of staff later. The Manager was also present. This appeared to be sufficient for the needs of the people living in the home. This related to the people in the old house and not the new buildings. The increase in staffing had contributed to the decrease in problems in the home. The home had previously been managed in conjunction with another home and staff had worked across both of them. The new Manager and the Provider had altered this so that the home is now managed independently and staff only work Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: in the one home. This has produced positive effects for the home and for people living there. Recruitment records in the home demonstrated that all staff were employed within the homes recruitment policy and that all necessary pre-employment checks had been undertaken prior to them beginning work in the home. Staff spoken with confirmed they had been required to provide all relevant information prior to beginning work in the home. Staff training was well managed and good records were kept of the training that each member of staff had received, what training they still needed to do and when updates were required. Staff spoken with said the training was useful and relevant to their role and that access to training was good. Discussion with the member of staff on the day of the inspection visit, as well as reference to staff files, demonstrated that all staff received regular support and supervision sessions with the Manager and that records were kept of these sessions. We were also told that the Manager was always available for advice and support and that staff found her to be very supportive throughout their work. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from living in a well managed home that is safe and responsive to their needs. Evidence: The Registered Manager has responsibility for all the buidlings on the site and there is an additional manager in each building. Staff spoken with on the day of the inspection visit said that the Management Team were available and supportive, ensuring that staffing numbers were sufficient and ensuring that care plans were in place and followed consistently. The quality assurance process in the home is being developed and is focused on the people living in the home and will use their feedback as the basis for improvements to the service. The Manager has a good understanding of quality assurance processes and plans to develop the system further and fully implement it. Examination of the fire logbook demonstrated that it was kept up-to-date. There were Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: effective systems in place for monitoring and managing health and safety issues in the home. Good records were kept of all health and safety issues including fire, appliance servicing, substances hazardous to health, accidents and electrical testing. All staff received initial training in health and safety as part of their induction as well as regular updates. Regular checks and records were kept relating to health and safety aspects of the home. Care Homes for Adults (18-65 years) Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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