Inspection on 29/01/07 for Ryder House

This inspection was carried out on 29th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 7 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 11/07/06

Ryder House 13/12/05

Ryder House 05/05/05

Ryder House 14/02/05

Ryder House 27/09/04

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Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

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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 Key Unannounced Inspection 29th January 2007 08:45 Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 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.V320852.R01.S.doc Version 5.2 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.V320852.R01.S.doc Version 5.2 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.V320852.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th August 2006 Brief Description of the Service: Ryder House is part of the company Robinia Care, who provide residential care and support services for people with a learning disability. Ryder House provides personal care and support to up to 14 people with a learning disability. Some may also have a physical 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 garden to the rear of the property and parking to the front. The fee range for Ryder House is £45,000 to £55,000 per year. For information about fees and services please contact the Provider. Pervious inspection reports are available from the Provider or can be viewed and downloaded from www.csci.org.uk Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced. The site visit to the home took about 5.5 hours. During the site visit the inspector spoke to service users, the acting manager and staff, made observations and checked records. Work was carried out before the inspection including surveying service users and talking to care managers and other professionals. The acting manager provided a pre inspection questionnaire. Three inspections of this service have been carried out within the past inspection year and poor and abusive practice was found. Social services following this carried out an adult protection investigation. This investigation is now closed and concluded that service users suffered institutional abuse and the management was to blame. Care managers, health professionals and social services have been conducting monitoring visits. Some service users have moved out since the last inspection. There are currently 8 service users living at the home. Immediate requirements and other requirements were issued to address the shortfalls to the National Minimum Standards. Statutory enforcement notices were issued when a lack of improvement was evident. The organisation provided the commission with an action plan detailing its intentions to improve the service. Improvements were evidenced at this inspection. Most of the requirements have been met but three requirements remain unmet. Comment cards received showed that most service users said they do not go food shopping, they do not look after their own money and they do not always choose what to eat. Some said they do not feel well cared for and do not have enough to do. Most said that they feel safe at Ryder House and that they have a care plan. One service user comment card said that not being able to have a bath was something not good about the home. Staff said ‘It is better here since we had all the training’ ‘Service users do more now’ ‘The training has helped the whole staff team’ Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Managers must ensure that staff concerns and views are listened to and acted on. A full time permanent manager must be recruited. The home should ensure that people can have a bath or shower when and if they want to. Personal goals and aspirations should be identified and supported. Communication should be better supported to ensure service users can make choices and decisions about their lives and give their views about the home. Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 7 The quality assurance system should be based on all service users views and opinions. Risk assessments should be carried out for staff who have declared health issues. Service user privacy must be respected by means of suitable door locks and lockable storage for valuables. Staff should not enter the home without knocking. Service users enjoy a balanced diet but should be involved in preparing meals, drinks and snacks. Suitable contracts should be developed so people are aware of the conditions of their stay. Service users should be better supported to make new friends. 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. The summary of this inspection report can be made available in other formats on request. Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 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.V320852.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2,5 Service users cannot be sure their aspirations and personal goals will be assessed and supported and are unaware of the conditions of their stay. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. EVIDENCE: No service user has been admitted since the last inspection by agreement between the Commission and the Provider. Therefore there were no pre admission assessments to view. The inspector sampled service user plans. Detail of recording and review frequency of plans has improved, however there was no mention of service users personal goals and aspirations. The acting manager showed the inspector a new assessment the company plan to introduce. This had no mention of aspirations included. The inspector heard about a service users goal but this was not recorded or planned for. Service users have had assessments relating to moving and handling as previously required. Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 10 Contracts of terms and conditions of residency were found at the last inspection to contain omissions and were out of date. The acting manager said she believes this has not changed and therefore remains a recommendation. Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 There is more detail relating to service users needs and risks but personal goals and aspirations are not supported. There should be more emphasis on promoting independence and quality of life issues. More frequent review means changing needs are identified sooner. Service users need better support to make choices and decisions. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each service user has a service user plan. Some plans were sampled. These are needs lead plans with a focus on deficiencies e.g. ‘area of difficulty ‘ For example one plan read ‘He cannot…He is unable …He is not…..’ rather than focus on what the person can do and be supported to do. Aspirations and goals are not recorded nor the persons background and history. After reading you do not get a feel for who the person is, where they are from and any significant life events. Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 12 Some clinical language is included for example analgesia and athetoid. When asked, support workers were unaware of what these words meant. The detail of recording of service users needs has improved but should be recorded in a way support workers can understand. An advocacy agency has worked with individual service users to start a person centred planning process. This is an improvement and should now be taken forward, implemented and generalised to all service users so this good start is not lost. Staff need support and training if they are to do this. Risk assessments have been updated to include more detail but should have more emphasis on enabling rather than restricting. It was evident that plans and risk assessments are being reviewed more frequently than before. This means that changing needs should be recognised more quickly. There are some cases where review needs to be more frequent in relation to specific risk areas and this was discussed with the clinical services manager. Two service users with no verbal communication were case tracked. There was limited detail about their communication needs and no communication assessment or interventions in place. Some contradictions were noted in service user plans. For example one said ‘does not use Makaton’ while an assessment by a professional said ‘use Makaton’ Another said ‘seems to have good comprehension’ and ‘it’s difficult to assess level of comprehension’ One plan said ‘observe the non verbal communication ‘ and ‘understands simple words’ but there was no mention of what these were. Daily reports by staff showed a lack of awareness of communication needs. The present environment does not support communication. There is a picture board showing the meals for the day, which is an improvement, but otherwise the day/week is not predictable. Some service users like to know who is on duty and sleeping in that day and at present have to ask staff. A day activities assessment said ‘use objects of reference’ but these communication systems are not used. During breakfast one service user appeared distressed. Staff were trying to find out what the problem was by asking the person and this proved ineffective. Communication aids may have helped this person to communicate their needs and give service users with more profound disabilities a voice to increase their choices and decision-making ability. Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Not all service users are full members of the community. The range of activities should be increased to ensure that service users enjoy meaningful, appropriate activities. Current relationships are supported but some service users need more support to make new friends. Service users rights and responsibilities should be better respected and supported. Service users enjoy a healthy diet but are not all supported to take part in preparing meals with access to drinks and snacks limited. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection service users have been consulted about their preferences in activities. There is a record of this in service user plans. Service users now have key workers. Staff said they think service users ‘do more now’ Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 14 Each service user now has an individual planner covering morning and afternoons Monday to Friday. Some ‘clip art’ pictures have been included. This is an improvement however could be more meaningful to some service users. One activity plan indicated lots of 1-1 or ‘relaxation’ sessions in the persons bedroom. One afternoon was given to attending a service user meeting but the person had only attended one out of the last ten meetings. This suggested the person spends most of their time on their bed in their room. One outing into the community was included, a walk on a Monday morning. Daily records showed the person does not go out at weekends often although the more able service users attend church. From comment cards most service users said they did not have enough to do. The inspector observed low levels of engagement and participation for example no one was seen being supported to carry out any cooking or cleaning. Most service users were sitting in the lounge with the radio on. Three service users were in the dining room with staff doing tabletop activities. Although levels of engagement and participation are low they appear to be better for some than at the previous inspection. The inspector discussed the need to ensure service users take part in a range of meaningful, appropriate, preferred activities at home and in the community. The acting manager said she has had discussions with staff about this and has some plans. Details of service users family and friends are recorded in service user plans. Service users talked about seeing their family and keeping in touch with old friends. On comment cards some service users said they have no friends and family visiting. The clinical services manager explained this was because some service users have no family and have not made any friends. Although there are opportunities to attend Monday club and Gateway club not all service users have this opportunity. Staff suggested that more staff on duty on these two nights would enable more service users to attend but this has not happened. More could be done to support service users to make new friends and develop relationships. The clinical services manager agreed and suggested ways this might be improved. There was little evidence that the daily routines promote independence. The home has a cook and a cleaner but no service user was involved in any cooking or cleaning. From comment cards all but one service user said they do not go food shopping. The cook said that most service users couldn’t access the kitchen due to the risk of the cooker and knives. She said some service users take part in making cakes etc and use the dining room but this is not the case for all service users. There is evidence that service users have a balanced diet but are not involved in the preparation of meals. Access to drinks and snacks depends on the ability of staff to communicate with service users, as Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 15 free access is very limited. The requirement made at the last inspection regarding the need to provide adequate facilities for all service users to prepare their own food and drink and ensure that such facilities are safe for use by service users by 12/9/06 is unmet. The inspector observed breakfast time at Ryder House. This was more relaxed and improved since the last inspection. Service users were given a choice of cereals and offered hot or cold drinks. Service users were encouraged to help themselves to more and supported discreetly and appropriately. Assessments have been carried out about ability to have a bedroom door key since the last inspection. Most service users do not have the ability to have an everyday door key so locks have been removed from bedroom doors. Most service users rooms have no lockable storage for valuables. Techniques should be in place such as doorbells, flashing lights and suitable locking devices to ensure privacy for all service users. No service user has a front door key. Staff were observed letting themselves into the home without knocking so service users do not know who is entering their own home. This practice should be reviewed. Interactions between staff and service users have increased since the last inspection. Effective shift planning could increase this further. One service user was observed smoking in the dining room. The home should ensure that a plan is in place to meet forthcoming legislation regarding smoking in the workplace. Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Service users cannot be sure they will be supported with their personal care in the way they prefer. Service users have support to access health care advice and support. Medication practice has improved. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal care needs are recorded in service user plans. Some need more detail to ensure service users are supported in the way they prefer. For example one plan said ‘full bed bath in morning’ and ‘needs teeth cleaned’ There should be more emphasis on maintaining and maximising independence. One plan said ‘the bathroom is too small so he cannot have a bath’ ‘he cannot sit on the shower chair so cannot have a shower’. This person said what was not so good about Ryder House was that they could not have a bath. This home is registered to provide personal care support to Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 17 up to four service users who have physical disabilities so should be able to support the personal care needs of everyone. Service users are supported to access a range of health professionals. One service user was supported to attend a doctor’s appointment during the visit. Service user plans contain a record of health appointments. There are neither health assessments nor health action plans in service user plans. Some important health information was missing from one plan. The inspector was shown a new health assessment booklet, which key workers plan to complete with service users. A start has been made on these. Although not complete and not fully implemented, this is an improvement since the last inspection. A pharmacy inspector carried out an inspection of medication practices on 25/07/06 and made some requirements and recommendations. The inspector observed medication administration. Staff checked records and administered medication individually and appropriately. The site of the storage of medication has improved so transportation is no longer an issue. There is now a list of sample signatures and records of administration were in order. The temperature of the drug fridge is now monitored. Competency assessments have been introduced that test staff regularly to ensure continued competency. Guidelines are in place for ‘when needed’ medication however, these should detail how a person lets you know that they need the medication. This is especially important for service users who do not communicate verbally. An attempt has been made to deal with issues of consent. Unfortunately this has not taken new legislation (from April 2007) into account. For example one service user plan stated ‘not able to consent due to learning disability’ although no capacity assessment has been conducted and there was no evidence of the decision being presented in a way the person could understand. Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Without the communication support they need service users cannot make complaints and disclosures. Issues and concerns raised by staff must be acted on. Staff are more aware of what abuse is. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. EVIDENCE: The adult protection investigation initiated following the last inspection is now closed. The investigation found that service users suffered institutional abuse and the management was to blame. No referrals have been made to the Protection of Vulnerable Adults list. Since the last inspection staff have attended training in safeguarding vulnerable adults. Staff were observed interacting with service users in a respectful manner. From records of one to one meetings and during a visit by the responsible individual staff raised concerns and made suggestions. There was no evidence that these concerns have been acted on. For example during a visit to the home by the area manager on 30/10/06 staff suggested that more service users could go to Monday and Wednesday club if staffing was increased on these two evenings. This was not included on the action plan from this visit. Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 19 The lack of communication support means that service users do not have the help they need to make disclosures and complaints. The complaints procedure is not accessible to service users. The Commission received two reports about incidents of challenging behaviour. It was evident if the first incident had been dealt with more effectively the second incident could have been prevented. Some guidelines were seen about self-injurious behaviour. There was no functional assessment and lack of strategies for staff to follow to prevent incidents. Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 The home is generally safe, clean and well maintained. More could be done to ensure service users privacy. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector had a look around the home, which was generally clean and well maintained. The home has some shared rooms and some single rooms. There are no en suite rooms. No room has a suitable lock fitted, some have no lock at all and one bedroom door was propped open. Although assessments have been carried out to establish if service users can use a conventional key or not, no alternative has been provided. The acting manager said that there is no lockable storage provided for valuables. Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 21 In one bedroom toiletries were padlocked in a box on top of a wardrobe. The acting manager was unaware of the reason of this restriction. A staff office has been created on the first floor in addition to the basement office. Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Staff supervision and training has increased. Recruitment checks are carried out but potential risks to staff must be assessed and managed. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. EVIDENCE: Shortfalls in staff training were found at the last inspection. Since then staff have attended various training sessions including basic values and competency assessments relating to medication practice have been introduced. Staff now complete an appropriate induction. Staff will need training and support to develop individual person centred plans with service users. One staff said ‘ it is better since we had all the training’ Staff have been trained as key workers and now work in teams. There is no shift plan in place so management of the shift is paramount. Some service users have 1-1 shown on activity planners although no staff is allocated to this 1-1. Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 23 Staff have suggested that more staff on duty at certain times will increase community presence although no action has been taken. Staff deployment should be reviewed to ensure effectiveness. Staff files were sampled. Recruitment is dealt with by head office so service users are not full involved in recruiting new staff. Recruitment checks are carried out before a person starts work at the home. The last inspection found that some staff have declared health issues that need assessing. There was no evidence in files that these assessments have been carried out. The acting manager confirmed this. Regular staff meetings are now held and recorded. The frequency of staff supervision has increased. Some records showed that staff have repeatedly raised concerns and issues at supervision sessions. No action was evident even though concerns related to service users. Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 There continues to be no full time manager in post. Not all service users are supported to give their views about the service. Health and safety of service users is better protected. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the area manager has left the organisation. There continues to be no full time manager in post. An acting manager who manages two other homes nearby and another manager are on call to support staff. The recruitment of a new manager has been on hold due to the uncertainty about the future of the home following the adult protection investigation. A full time manager must now be recruited to maintain and continue the work done to improve the home. Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 25 An important shortfall found during the adult protection investigation was the lack of effective audit and monitoring of practice. The acting manager said the responsible individual carries out regular visits although the last report was dated 30/10/06. Staff had made a suggestion during this visit but no action was recorded. The acting manager said that audits of training, finances and human resources have been carried. There continues to be little evidence that service users and stakeholders (including staff) views underpin the review and development of the service. Weekly service user meetings are held but not all service users attend. Questionnaires are given to service users but are not appropriate to all service users needs. Lack of communication support means that service users do not have the support they need to air their views. All staff have now attended safe moving and handling training. Assessments of service users relating to safe moving and handling have been carried out. Staff have attended fire awareness training and a fire drill was held on 3/10/06.Not all staff attended this drill or the previous drill of 21/7/06. Staff must take part in drills at regular intervals to ensure competency. Reporting of incidents has improved. Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 26 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 2 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 1 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 1 X 2 X X 2 X Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 27 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 YA17 Regulation 16 Requirement The registered person must provide adequate facilities for all service users to prepare their own food and drink and ensure that such facilities are safe for use by service users by 12/09/06 NOT MET, REVISED to 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 by 12/10/06 NOT MET, REVISED to The registered provider must establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided home. Improvement and review should be based on service users, relatives and staff views by 12/09/06 NOT MET, REVISED to (Standards 7,22,23) the registered person must ensure that service users have the communication support they need to make choices and decisions about their lives and enable them to air their views. DS0000023532.V320852.R01.S.doc Timescale for action 31/03/07 2. YA37 8,9 31/03/07 3. YA39 24 31/03/07 4. YA7 12, Sch.3 30/04/07 Ryder House Version 5.2 Page 28 5. YA18 23 6. YA2 14 7. YA16 12 Individual communication guidelines should be developed. The registered person must ensure there are suitable facilities such as bathrooms and showers to meet service users personal care needs and preferences. Service users aspirations and personal goals must be assessed, recorded and supported in a person centred way. The home must be run in a way that respects service users privacy and dignity. Staff should knock before entering not just let themselves in. Suitable locking devices should be provided for bedroom doors and lockable storage should be provided for service users valuables. 31/07/07 30/04/07 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA5 YA20 YA15 YA34 Good Practice Recommendations Individual terms and conditions of residency should be developed with each individual in line with the standard. Service users consent to medication and other treatment should be obtained and recorded. Service users should be supported to make new friends Service users should be involved in recruitment of staff Ryder House DS0000023532.V320852.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V320852.R01.S.doc Version 5.2 Page 30 - 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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