Inspection on 11/07/06 for Ryder House

This inspection was carried out on 11th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ryder House 08/06/07

Ryder House 29/01/07

Ryder House 13/12/05

Ryder House 05/05/05

Ryder House 14/02/05

Ryder House 27/09/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Ryder House 115/116 London Road Dover Kent CT17 0TQ Lead Inspector Kim Rogers Unannounced Inspection 11 /12th July 2006 09:35 th Ryder House DS0000023532.V294535.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 Ryder House DS0000023532.V294535.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. Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ryder House Address 115/116 London Road Dover Kent CT17 0TQ 01304 214832 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) The Robinia Care Group Ltd Care Home 14 Category(ies) of Learning disability (12), Physical disability (4) registration, with number of places Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residential Care for older people with a learning disability is restricted to 3 persons whose d.o.b is 18/05/1936 and 16/10/1936 and 13/10/1939. 13th December 2005 Date of last inspection Brief Description of the Service: Ryder House is part of the larger Company of Robinia Care, who specialise in care of people with Learning Disability. The home is a large detached property with accommodation for service users on three floors. There are nine single rooms and two shared rooms. The home is located in Dover with easy access to local amenities, and public transport. There is a large well-maintained garden to the rear of the property. The fee range for Ryder House is £45,000 to £55,000 per year. For information about fees and services please contact the Provider. Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and was carried out over two days, a total of about 11 hours. A variety of methods was used to assess the home including talking to service users and staff, talking to the acting manager and area manager and talking to care managers. The inspector carried out observations on both days, looked at records and had a look around the home. The manager provided the Commission with a pre inspection questionnaire. The manager resigned before this inspection so the acting manager and area manager assisted the inspector. There are currently 12 service users living at Ryder House. The inspector found evidence of a range of institutional abuse and poor practice. Staff were observed supporting service users in a disrespectful manner with little or no regard for service users dignity, rights or privacy. The inspector found that one service user was in her bedroom and the bedroom door was locked. The inspector reported this to the acting manager, area manager and adult protection coordinator at social services. Poor practice and concerns have also been reported to the previous manager, area manager and regional manager over the past few months by staff. No action has been taken to address these concerns so the poor practice has continued. Staff at this home do not have the skill and competency needed to meet service users needs. Several requirements made at the last inspection have not been met. Extended timescales were not issued as the Commission is considering enforcement action. The home has been through lots of change with 3 managers on the past year and frequent staff changes. This has impacted on service users because of a lack of continuity of care and support. The area manager said that the organisation is committed to improving the service. However, staff have pointed out their concerns about poor practice over the past few months but no action has been taken. Major shortfalls were found to meeting most of the National Minimum Standards. Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There are major and minor shortfalls towards meeting most of the National Minimum Standards. Although the area manager said that a decline in the service has been recognised by senior managers at the organisation who were said to be ‘appalled’ no action has been taken to address the serious concerns. Shortfalls include, Assessments of service users Service user plans Risk assessments Behaviour management guidelines Inconsistent support Lack of participation Low engagement levels Lack of choice for service users Staff unable to communicate with service users Service users rights, privacy and dignity not respected or supported Lack of control for service users Lack of inclusion including community facilities and activities Lack of promoting independence Poor medication practices Health and personal care needs not supported Service uses views about the service not sought Staff unaware of abuse No challenging of poor practice Lack of audit and monitoring Lack of staff support and supervision Lack of induction and training Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 7 Lack of staff skill and competency. Recruitment checks Environment including service users rooms Fire safety Poor management Staff retention, sickness and numbers Lack of reporting incidents and accidents. Poor recording of incidents Please read the main body of the report for more detail about these shortfalls. 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. Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 8 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 Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 9 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): 1,2,5 Service uses do not have the information they need to make a decision about moving into this home and service users are not aware of the conditions of their stay. Service users cannot be sure their needs and aspirations will be assessed and supported. Quality in this outcome area for service users is poor. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home has a Statement of Purpose and Service users guide. These should give prospective and current service users information about the service to be provided so individuals can make an informed choice about the home. The inspector noted the information was out of date and had not been reviewed. A previous manager is named as the manager of the home. The organisation NCSC is referred to but no longer exists. The area manager said that the organisation has recognised the need to review this information. The pre inspection questionnaire provided by the manager stated incorrect fee information. When asked the acting manager and area manager were not aware of the current fee. This information was found at the home but was out of date. Some contracts were seen between the home and service users detailing what is to be provided. However this information was out of date and omissions were noted against the minimum standard. Service users therefore were not aware of the fee and what it includes and other terms and conditions of their stay. Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 10 The inspector asked to view assessments of service users carried out by the home. The acting manager and area manager said that there are no assessments at the home. They said a senior manager carries out assessments, which are kept at head office. The acting manager produced a few hand written notes in respect of one service user about their daily routine. The inspector was informed by a care manager of significant life events in a service users’ life which impact of their current needs. The inspector asked some staff about this service user’s past and significant life events. Staff nor the acting manager were aware of this service users or other service users past. The inspector was informed that a service user had moved in recently. Staff and the acting manager said that this person has now moved out because the home recognised it could not meet the persons needs. Staff said they were not involved in this person’s assessment. The standards recognise the assessment of service users needs and aspirations as crucial as this assessment forms the basis of the service user plan. Staff must be have knowledge of and access to such assessments if they are to provide the right consistent support. A requirement as made to address this. Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 11 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): 6,7,9 Staff support is inconsistent placing service users at risk. Service users cannot be sure their needs, changing needs and goals will be supported. Service users have little control over their lives as their communication needs are not supported. Without regular evaluation and review risk assessments are ineffective and do not protect service users or promote independence. Quality in this outcome area for service users is poor. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Each service user has a service user plan. The inspector sampled service user plans. None evidenced regular review. The acting manager said that there should be a front review sheet but there were none. Without evaluation and monitoring by way of regular review service users cannot be sure that their current and changing needs will be recognised and supported. Aspirations and goals are not recorded or supported. Service user plans focus on basic care needs. Staff were not aware when asked of service users aspirations in fact, staff showed low expectations of service users by making Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 12 excuses why individuals could not do things rather than creatively thinking how to support people to achieve. The inspector asked several staff how they support individual needs. All talked about different ways of supporting service users that contradicted each other. Staff were also observed supporting users in inconsistent ways. This inconsistent support means that service users needs especially relating to challenging behaviours are not met. This inconsistent support has lead to increased behaviours putting service users at risk of harm from themselves and others. One service user has detailed behaviour management guidelines developed with staff by health professionals. These guidelines were not in the service user plan but in a filing cabinet in the basement office. Staff and health professionals said that the service user’s challenging behaviours reduce if the guidelines are followed. Staff were observed using punishers for some behaviours telling service users they would have to go to their rooms and would not go out if behaviours continued. It was evident after talking to staff and making observations that behaviours are not managed consistently or positively. Guidelines are not implemented or followed by staff placing service users at risk of harm. There are restrictions in place including a lock on the front door and kitchen and some wardrobes in service users bedrooms are locked. One service user has had their personal possession removed from their room. There were no assessments showing that these restrictions are made in service uses best interests and are the least restrictive alternative. On the contrary restrictions have become institutionally accepted and are not reviewed. Staff cannot communicate with service users effectively so decision-making is not supported and service users are unable to make choices about their lives. Some service users use alternative forms of communication. The acting manager and staff told the inspector about communication needs and said that these needs need supporting. However, there were no individual communication guidelines in any service user plan sampled. Staff told the inspector ‘I can’t understand him, I haven’t done the course’ When the inspector spoke to service users staff said ‘He can’t talk’ ‘He cannot communicate’ There was no evidence of any pictures or symbols to aid communication. There is a picture board in the reception area but staff and the acting manager said it was not used and the information on it does not relate to what actually happens and is out of date. The board with staff photos on did not relate to who was actually on duty that day. Service users were observed being frustrated because staff could not communicate with them. The acting manager said she plans to train staff on how to be a key worker. Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 13 There was no evidence that service users or their representatives have been involved in developing individual plans. Care managers said that service users do not attend review meetings, as they should. One staff was heard to use a derogatory name for a service user. The acting manager confirmed that this was not the service users preferred form of address. Risk assessments showed no sign of regular review and monitoring. One service users plan had risk assessments dated 1998 and 1999 with no review evident. Another has assessments dated 2003 with the last review 8/3/05. Some strategies used are restricting rather than enabling independence. Risks are not supported and managed to enable service users to live independent lives. No assessments were seen to indicate the reasons why some restrictions have been made that impact on service users rights. A requirement was made at the last inspection for service user plans and risk assessments to be updated and reviewed by 31/1/06. This requirement has not been met. The inspector noted that some information about service users is not held securely. One service user plan was on a trolley in the dining room for much of the first day along with a medication administration record belonging to a service user. The lock on the cupboard containing sensitive information about service users is not secure. Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 14 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): 12,13,15,16,17 Service users are segregated and isolated with most not accessing any community facilities. Service users do not take part in planning or preparing meals and have no access to drinks and snacks. Service users rights are not recognised or respected. Service users are not part of their local community. Quality in this outcome area for service users is poor. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The acting manager said that no service user accesses community activities of facilities. Activities happen in the home on an ad hoc basis as nothing is planned. This leaves service users isolated and segregated and not playing any role in their local community or in the home. One service user goes out with her family regularly and one stays with her family at weekends. Another attends a nearby Robinia home for some activities. There were no individual activity planners in service users plans Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 15 sampled. The activity planner on the wall in the reception did not reflect what actually happens and is out of date. On the first day of the visit most service users were sitting in the lounge. The television was on but had a poor picture and was very loud. No service user had the controls to the television and no one seemed to be watching. Low levels of engagement were observed. On the second day most service users were in the lounge. During the morning staff put on a party tunes CD and gave service users a percussion instrument each. Some service users were making a noise with their instrument but there was no support by staff to structure this activity and support service users. Care managers confirmed that they are concerned about the lack of activities. Service users were observed to be self-stimulating by rocking, pacing, playing with a net curtain. Very little interaction with staff was observed. Staff were talking exclusively to each other rather than talking to service users. Some staff moved in to the dining room to talk as they said service users were making too much noise in the lounge. No service user was supported to participate in any daily household tasks. The acting manager and staff said that service users are not allowed in the kitchen due to health and safety risks. Staff and the acting manager made excuses why people can’t do things rather than creatively thinking about how they can support people to achieve. Staff were observed entering service users rooms without knocking first. The pre inspection questionnaire stated that service users do not have a choice of menu and that service users do not have access to drinks and snacks. The acting manager confirmed this and staff who said the cook plans and prepares the meals which are served and cleared by staff. The kitchen is kept locked. The area manager also noted on a report of 11/05 that service users should be involved in planning and preparing meals although no action has been taken to promote this. The inspector observed lunchtime at Ryder House. Staff prompted service users to sit up and placed tabard type aprons on all service users. A support worker brought in meals to the dining room on a trolley as the cook had the day off. All service users had the same meal although some staff had an alternative of sandwiches. Some type of meat burger (turkey drummer) was served with baked beans. Staff were observed placing meals in front of service users and not saying much or interacting. Jugs of cold drink were placed on tables. One service user was incontinent during the meal and was assisted by staff to change in her room. Fifteen minutes later when the service user returned for her meal it was still where she left it on the table and was not reheated by staff. Some service users require assistance to eat. Staff although sitting at the same level as service users were not interacting or at times even looking at the service user as they supported them to eat. One service user was sat by staff with his back to other service users and was fed from the side as staff ate their own meal. A deputy manager from another home was in the dining room Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 16 throughout eating her lunch. None of this poor practice was recognised or challenged. The records of meals in service user plans were incomplete. From the menus supplied by the home and from the visit made it is evident that service users do not have a well balanced diet. No attempt has been made to support service users to gain independent life skills. Staff were unaware of active support and teaching skills techniques. On the contrary the culture is to ‘baby-sit’ service uses rather than enable them to lead more independent lives. One staff commented that staff are task orientated and spend their time cleaning rather than working with service users. Some staff said they would like to support service uses to access the community but they are often short staffed due to sickness. The acting manager confirmed that any one to one time with service users is lead by staff numbers. There is no one to one time recorded on the rota. Staff showed low expectations of service users. Achievement goes unrecognised and uncelebrated. Care managers reported that some service users have lost their skills since moving to Ryder House. As mentioned there are several restrictions in place, which have become institutionally accepted. These restrictions are not always made in service users best interest and are not always the least restrictive alternative. These restrictions must be reviewed. Some service users moved to this home together from a long stay institution. Although care managers told the inspector about some significant events in a persons life staff and the acting manager were unaware of this and it was not recorded in the individual plan. There is little opportunity for service users to make new friends, as community access is limited. This is especially concerning as some service users do not have any family. There was no mention of any friends in one service user plan sampled but then no intervention to support the person to make friends. The inspector observed the daily routine for 3 hours on the first day of the visit and for some time on the second day. The daily routines do not promote independence, individual choice and freedom of movement. Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 17 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): 18,19,20 Medication practices place service users at risk and must be reviewed and improved. Health needs are not fully assessed, reviewed or fully supported consistently. Service users personal care needs are not met. Quality in this outcome area for service users is poor. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Service user plans sampled had some information about service users personal care needs. Because of the lack of review it was unclear if service users continue to be supported in the way they prefer. The inspector noted that 2 hours after lunch 4 service users had dried baked beans around their mouths. Staff had not supported service users with this. A staff member was heard to say ‘X your feet stink’ but made no attempt to address this. One care manager reported that service users personal care needs has increased due to lack of consistent care and support. Due to the lack of communication intervention there was no evidence to show that service users choose their clothes, hairstyle and make up or choose which staff supports them with their personal care. Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 18 One staff told a service user ‘your hair looks funny like that’ and pulled the service users hair band out. Later another staff member put the hair band back in. Each service user is registered with a GP. The acting manager said that an optician and chiropodist visit the home. There was no reason for this, it has become institutionally accepted. Service users should be supported to access local community facilities for health professionals if they prefer. Some health professionals reported that there is a lack of communication and monitoring of health needs by staff. This was evident in service user plans sampled. Care managers reported that individual health needs have not been met and have deteriorated. One care manager reported that due to inconsistent support a service users health needs have increased. No health assessments or health action plans were seen. The area manager showed the inspector some form of health spreadsheet on his laptop although this is not implemented and therefore is of no benefit to service users. Records of monitoring health needs are haphazard and inconsistent and do not correspond to other records. This lack of effective monitoring of health needs places service users at risk. The inspector observed medication being administered by a team leader. Staff checked the medication administration record (MAR) before dispensing the tablet to a pot then transported it to the service user. This is not a safe system for transporting medication and a requirement was made at the last inspection of 15/12/05 to address this by 30/1/06. There were some gaps on the MAR so it was not clear if service users had their medication or not. Staff could not explain the gaps on the record. There seemed to be no audit or monitoring to pick up theses mistakes even though the acting manager said these records are checked by the team leader, manager and area manager. Highlighter pen is used on the MAR. Staff and the acting manager said this is used as a reminder to staff however, if staff need remanding there is a training need. Highlighter pen should not be used on MAR. Some medication is being given not as it is prescribed. When staff were asked why this was they said ‘not sure’ Medication prescribed as ‘as needed’ is being given all the time. When asked about this staff said ‘because the GP prescribes it we just give it’ this means that service users are taking medication that may not be necessary. There are no guidelines for these ‘when needed’ medicines. Staff shrugged and said ‘don’t know’ when asked how they would know a service user was in pain. Staff lacked awareness about medication in the home, what medication is for and side effects. Consent by service users to medication is not recorded. Allergies are not recorded. Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 19 Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 20 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): 22,23 Service users cannot be sure their views will be listened to and acted on. Service users are suffering harm and abuse and are at risk of further harm and abuse. Quality in this outcome area for service users is poor. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Service users communication needs are not supported therefore they have litttle or no opportunity to make their views or complaints heard. There is no independent advocacy services available to service users. The inspector sent some comment cards to service uses to gain their views. None were returned to the Commission. The acting manager gave the comment cards to the inspector. None were completed; the acting manager said that no service user was able to complete the comment card. No thought had been given to supporting service users to answer the questions on the cards. There was a notebook with a record of complaints. The book recorded 2 complaints since the last inspection. The acting manger could not find the details of these complaints or the action taken to address the issues. Later the inspector found details of one complaint by a member of staff in a staff file. The complaint was about staff concerns about poor practice and lack of support. The manager at the time (1/3/06) interviewed a second member of staff following this complaint. There was a record of this. There was no record of any action taken to address the issues of concern raised. Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 21 The inspector observed and was told about poor practice including neglect, verbal and physiological abuse and the inappropriate use of restraint. Incidents of self-harm and service users harming each other continue and some have increased. These incidents have not been reported to care managers, adult protection or to the CSCI. There have been adult protection alerts raised since the last inspection and a current adult protection investigation is underway. Aggression and other behaviours are not understood or supported consistently by staff. Some staff make these behaviours worse with their approaches. The practice of locking service users in their rooms has become institutionally accepted. One service user who took her top off in front of other service users was not supported appropriately by staff so her dignity was not respected. The acting manager said that the previous manager reported in January 2006 that ‘staff do not now what abuse is’ Staff have reported concerns about abusive practice to the manager, area manager and senior manager. No action has been taken to address this so abusive practices continue and go unchallenged. Following this inspection the findings were reported to the adult protection coordinator for investigation. An immediate requirement was made to stop these abusive practices and to safeguard service users from any risk of further harm or abuse. Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 22 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): 24,26,30 Bedrooms do not promote independence. Service users lives would be enhanced with improvements to the décor and furnishings of the home. Service users do not have support to do their own laundry. The home is generally clean but not always secure. Quality in this outcome area for service users is poor. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The inspector toured the home with staff and the acting manager. Some areas of the home and some furniture and fittings are in need of replacement and repair. Some areas are stark. Because of this the home does not have a homelike feel. The acting manager said she has noted this and has organised an audit of rooms. The inspector looked at bedrooms. Some did not have a mirror. Some wardrobes were locked with no assessment in place detailing the reason for this. Some cupboards in service users rooms are storing equipment and belongings that do not belong to that person. This includes art materials and bathing equipment. This means staff enter service users rooms to access this equipment which is not acceptable. In one room the windows cannot be reached because of items placed in front of them .One service users personal Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 23 possessions have been removed from her room making it very bare. The acting manager said this was due to the person’s increased behaviours. However, there was no plan in place to replace items gradually to see if items could be tolerated again. This meant the service user was taking other peoples possessions and being punished for this. This bedroom had 2 dressing gowns o the back of the door. One was stained and torn in places. The other was heavily stained. The inspector asked the acting manager why staff had not addressed this. The acting manager said she did not know. The inspector noted that some rooms have commodes even though service users are mobile and have WC’s close by. One commode seat was broken and taped together the other smelled unpleasant. The acting manager could not give a reason why service users have commodes. This does not promote and maintain service users independence. One service user has been moved to a small room upstairs as a new service user is planning to move in and needed a ground floor larger room. Although the acting manager said that the care manger was aware and agreed to this the care manager said she was not aware and had not been consulted. There has been 1 break in at the home recently and 1 attempted break in. Despite this the communication noted that staff are failing to check ground floor windows and that some have been left open at night. The home has a separate laundry room. Staff use red alginate bags to deal with soiled laundry. Staff said that service users do not access the laundry saying that only one service users brings his laundry down as he is the only one who understands. The pre inspection questionnaire stated that there was no procedure for dealing with clinical waste and no policy for the control of infection. The acting manager said that this was not the case. There is no domestic staff at present. The inspector understands that a person has been recruited to this post. Service users do not take part in any household tasks as the standards expect. Staff carry out the cleaning. One staff said staff are very task orientated. The home was generally clean on the day of the inspection. Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 24 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): 32,34,35,36 Staff are not competent in supporting service users needs. Staff are not adequately trained or supervised. This places service users at risk Recruitment procedures are not robust placing service users at risk. Quality in this outcome area for service users is poor. This judgement has been made using available evidence including a visit to the service. EVIDENCE: During this 2 day inspection staff were observed disregarding basic values including dignity, respect, independence, privacy, choice and control. This appears to have been recognised by the area manager and senior manager but ignored. The area manager and new acting manager said they have never observed practice and work from the office in the cellar. Poor practice goes on unchallenged and has become institutionally accepted as the norm because practice is never monitored. When the inspector noticed that a service user was locked in her room and pointed this out to staff they seemed unaware that this was wrong and not acceptable and is abusive practice. Some staff on duty said they have never had an induction. This was a concern as some staff are new to working with people with a learning disability. The inspector sampled staff files of the new staff on duty. No induction was present Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 25 just blank sheets. The team leaders file had an induction booklet dated 31/8/04 although there were just ticks with no record of how this person was assessed as competent. Training is limited. One staff in post for 2 months who had no induction had one certificate on the file date 7/6/06 for conflict management. There was no evidence of specialist training to meet individual needs like Diabetes. There was no observation or assessment and this staff was observed by the inspector managing behaviours in an inappropriate way and not respecting service users dignity and privacy. No training needs analysis was seen for individual staff and no training plan was seen. The acting manager said that a deputy manager from another Robinia home was there to audit staff files. Again no action had been taken to address identified shortfalls. Some staff said they could not communicate with service users, as they have ‘not done the course’ Service users were observed becoming frustrated because staff could not communicate with them. The pre inspection questionnaire stated that 4 out of 28 staff have an NVQ qualification. Health professionals report a lack of communication and awareness of service users needs by staff. It was evident that staff do not have the skills needed to support service users needs as required by the minimum standard. The inspector sampled staff files looking at recruitment practices. All 3 sampled declared significant health needs of staff on the health declaration. From the interview records it was evident that none had been questioned further about this. There were no risk assessments in place or extra support for staff. There are high levels of sickness by staff. Staff said they would like to do more with service users but staff sickness at short notice often leaves them short staffed. One application form was not completed however the staff member has been recruited. The inspector looked for evidence as to why this candidate had been short listed. There was no short-listing form ‘proforma 1’ as the recruitment and selection policy stated. The acting manager said the deputy would bring the short listing form from head office. The inspector left before the deputy arrived back. The Commission at the time of writing this report has received no copy of this form. 2 out of 3 files had no proof of identity for staff. All 3 had satisfactory Criminal Records Bureau checks. One reference seen was unsatisfactory and had not been checked further or another referee requested. 2 out of 3 had blank supervision documents. One had an appraisal dated 4/06/03. On one supervision record dated 7/4/06 staff comment that ‘staff need to watch the language they use between themselves and in front of service users’ and that ‘staff need to be more aware of service users needs, for example wiping service users mouths’ No action had been taken to address these concerns. Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 26 One staff meeting has been held this year by the previous manager on 20/1/06. The minutes detail concerns about health and safety, infection control, fire drills, laundry, storage and labelling of food and recording of food served and also include actions from the previous inspection. There was no evidence that any action has been taken to address these issues. Team meeting minutes of 2005 namely, 27/10/05, 23/6/05 and 23/2/05 highlight concerns by staff about care practices, mixed service user group, lack of opportunities for outings, concerns about the environment, that neglect of care leads to abuse, lack of staff knowledge to meet service users needs. Again there was no action taken to address the concerns of staff about poor practice. The pre inspection questionnaire stated that the home has no code of conduct for staff. The acting manager said this is not the case and that staff are issued with the code of conduct for care staff issued by the General Social Care Council. This was seen in one staff file however the staff member should have this readily available to them. Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 27 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): 37,39,42,43 This home is not well run. There is no effective monitoring and audit of the service. Service users views do not underpin the review and development of the home. The health and safety of staff and service users is not protected. Quality in this outcome area for service users is poor. This judgement has been made using available evidence including a visit to the service. EVIDENCE: There have been 3 managers at the home in the past year. The previous manager resigned during a recent and ongoing adult protection investigation. There is currently an acting manager from a nearby Robinia home overseeing the day to day management. Although the area manager has been consistent there is no registered manager at this home. The acting manager said that there is no quality assurance system in place. The area manager confirmed this. This means that service users views are not sought about the service they receive and that these views do not underpin the review and development of the service. This is the required outcome of the Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 28 minimum standard. The last service user minutes were dated 31/8/05 and 9/8/04. Some unsafe systems for moving and handling people were observed and reported to the inspector. There is no induction covering health and safety for new staff. Staff have raised concerns about health and safety including food storage and labelling although there was no evidence that action has been taken to address this. The inspector looked at the fire log book. Although there is a fire risk assessment it is not implemented. Staff do not have the training they need and new staff have had no fire training and have not taken part in a fire drill. There was one drill recorded for this year and one drill recorded for last year although the fire risk assessment states that drills must be held quarterly. Competency relating to fire awareness and practice has not been assessed. Some faults in fire equipment have been recorded in the fire logbook for 2 consecutive months and not remedied. With this and a service users found locked in their bedroom the inspector was very concerned and issued an immediate requirement to address this. The accident book was inspected. Incidents of aggression between service users were recorded as accidents inappropriately. Some accidents were recorded as non-violent incidents. Staff are not clear about how to record accidents and incidents. There was no action recorded to prevent further occurrence. The acting manager said that the manager should complete a quarterly return and keep a track of accidents and incidents. She said that the area manager checks these reports also on a monthly basis. This system has failed with incidents and accidents going unnoticed by the manager and area manager. The inspector was further concerned to find that none of the recorded incidents or accidents have been reported to the Commission as required or to care managers. The area manager seemed unclear of the requirements of Regulation 37 in this regard. The previous manager was also unclear about this regulation. The Commission has received no regular audit reports as required by Regulation 26 for the year 2006. The acting manger said that there were no reports for this year at the home, the last one in the file dated 11/05. When asked about this the area manager who conducts these visits said the reports for 2006 were on his laptop. The acting manager said that a more senior manager completed the last Regulation 26 inspection. There was no report for this. The Commission is very concerned about the lack of effective audit and monitoring by the organisation. It was apparent that several staff have raised concerns on numerous occasions to the manager, area manager and senior manager. These concerns have not been addressed so the poor abusive practices have continued. Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 29 Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 30 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 1 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 1 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 x 32 1 33 X 34 1 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 2 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 X 15 2 16 1 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 X 1 X 1 X X 1 1 Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 31 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 YA19 Regulation 14,15, Timescale for action To ensure that the personal care 12/08/06 and health care needs of service users are assessed, recorded and monitored. To review the plans on a regular basis and update with any changes. To update key worker information. Revised timescale 31/1/06 NOT MET The Registered Person must 12/08/06 ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. Risk assessments should be developed and regularly reviewed to ensure effectiveness. Revised timescale 31/1/06 NOT MET The Registered Person must 12/08/06 ensure that service users are consulted about their social interests and make arrangements to enable them to engage in local, social and community activities. Revised timescale 31/1/06 NOT MET The Registered Person shall 12/08/06 make arrangements for the DS0000023532.V294535.R01.S.doc Version 5.1 Page 32 Requirement 2. YA9 13 3. YA13 16 4. YA20 13(2) Ryder House 5. YA41 17 6. YA32 18(1)a 7. YA35 18(1)c i 8. YA36 18(2) 8. YA42 37 9. YA43 26 recording, handling, safekeeping, safe administration and disposal of medicines received into the home. Revised timescale 31/1/06 NOT MET The Registered Person must maintain in respect of each service user records as required by Schedule 3 and Schedule 4. This was a requirement from the last inspection, timescale 30/6/05. Revised timescale 31/1/06 NOT MET Standards 32 & 35 The Registered Person must ensure that at all times suitably qualified, competent and experienced persons are working at the home in such numbers as are appropriate for the health and welfare of service users. Revised timescale 31/1/06 NOT MET The Registered Person must ensure that staff receive training appropriate to the work they are to perform. Revised timescale 31/1/06 NOT MET The Registered person must ensure that persons working at the home are suitably supervised. The Registered Person shall give notice to the Commission without delay of any accident or incident in the home and other events required by this Regulation. Accidents and incidents must be recorded appropriately The Registered Person shall ensure an unannounced visit is made to the home at least once a month when service users and staff are interviewed, an inspection of the premises carried out, record of events and record of complaints is DS0000023532.V294535.R01.S.doc 12/08/06 12/08/06 12/08/06 12/09/06 12/08/06 12/08/06 Ryder House Version 5.1 Page 33 inspected. A written report must be prepared on the conduct of the home and a copy supplied to the Commission and the manager of the home. 10. YA23 13(6)(7) The Registered Person must make arrangements, by training staff or by other measures to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. IMMEDIATE The Registered Person must make adequate arrangements for; The evacuation in the event of fire of all persons in the home, The maintenance of all fire equipment Make arrangements for staff to receive suitable training in fire prevention Ensure by means of fire drills and practices that staff are aware of the procedures to follow in case of fire including the procedure for saving life. IMMEDIATE The Registered Person must make suitable arrangements to ensure that the home is conducted in a manner, which respects the privacy, rights and dignity of service users. IMMEDIATE The Registered person shall not provide accommodation to a service user unless the needs of the service user have been assessed and a copy of the assessment is kept at the home. The Registered person shall enable service users to make decisions with respect to the care they receive and their health and welfare. Guidelines must be developed DS0000023532.V294535.R01.S.doc 12/07/06 11. YA42 23(4)c (d)(e) 12/07/06 12. YA16 12(4)a 12/07/06 13. YA2 14 Sched.3 12/08/06 14. YA7 12(2) Sched.3 12/09/06 Ryder House Version 5.1 Page 34 to detail specialist communication needs of service users and their methods of communication. 15. YA17 16(2) (h) The Registered person must provide adequate facilities for service users to prepare their own food and ensure that such facilities are safe for use by service users. 12/09/06 16. YA22 22 (2)(3)(6) 17. YA34 18. YA24 The Registered person must 12/08/06 ensure that any complaint made is fully investigated and that the complaints procedure is appropriate to the needs of service users. 19 Sched. The Registered person shall not 12/08/06 2 employ a person unless a. the person is fit to work at the home b. (i) he has obtained in respect of that person documents specified in Schedule 2. 23(2)(b)(d) The Registered person shall 12/11/06 ensure that the premises are of sound construction and kept in a good state of repair externally and internally. All parts of the home must be kept clean and reasonably decorated. 8,9(2)b i The Registered Provider must appoint an individual to manage the home. The person must have the qualifications, skills and experience necessary for managing the home. The Registered Provider must establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided home. 24A Improvement plan 12/10/06 19. YA37 20. YA39 24 12/09/06 Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 35 (1) If requested to do so by the Commission, the registered person shall produce a plan (the improvement plan) setting out the methods by which, and the timetable to which, the registered person intends to improve the services provided in the care home. (2) The registered person shall provide a written copy of the improvement plan to the Commission within one month of receipt of the request referred to in paragraph (1). (3) A copy of the plan shall be made available to— (a) service users and their representatives 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 Refer to Standard YA5 YA1 Good Practice Recommendations Individual terms and conditions of residency should be developed with each individual in line with the standard. The Statement of Purpose and Service User Guide should be reviewed and updated. Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 36 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 Ryder House DS0000023532.V294535.R01.S.doc Version 5.1 Page 37 - 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. 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