Inspection on 05/05/05 for Ryder House

This inspection was carried out on 5th May 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ryder House 08/06/07

Ryder House 29/01/07

Ryder House 11/07/06

Ryder House 13/12/05

Ryder House 14/02/05

Ryder House 27/09/04

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Thorndene

Insight - Eastchurch

Southfields

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Dovedale Court

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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 Penny McMullan Unannounced 5 and 9 May 2005 9:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Ryder House Address 115/116 London Road, Dover Kent CT17 0TQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01304 214832 Robinia Care South East Ltd CRH 14 Category(ies) of LD/PD 14 registration, with number of places Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Residential Care for older people with a learning disability is restricted to 2 persons whose d.o.b is 18/5/36 and 16/10/36 Date of last inspection 14/2/05 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. There is a high commitment from the Company to provide quality care and support to the service users. 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. Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Ryder House is part of the group of homes owned by Robinia Care South East Limited. This was a joint visit with the Adult Protection Co-ordinator to investigate an anonymous complaint made with regard to the health and welfare of the service users. After discussion with the Manager and reviewing documentation it was decided that an Adult Protection Alert would not be raised. Requirements and recommendations are referred to in the summary in the body of the report e.g. evidence. The Adult Protection Co-Ordinator left the home at 1pm the Inspector continued to carry out an unannounced inspection. The Certificate of Registration requires to be amended as another service user is now over 65 years old and the home is in the process of applying to the Commission for a variation to their current registration to continue to accommodate this service user. Mr Roy Smith, is the Acting Manager who has been in post since November 2004 was in attendance and during the inspection all service users were in the home. The current service users have limited communication skills, therefore there is only minimal feedback with regard to the services being provided. There were no relatives or professionals visiting the home at the time of the inspection. An announced inspection will be held during the year to ensure that all people involved in the provisions of care at Ryder House are consulted as to the homes ability to meet the needs of the service users. What the service does well: There is good interaction between staff and service users. Staff demonstrated their knowledge of meeting the service users needs and strive to promote communication and understanding. At the time of the inspection the staff was observed working well as team and promoting service user independence. Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The home has robust policies and procedures for prospective service users admission to the home. EVIDENCE: This standard can not be fully assessed as there have been no admissions to Ryder House during the last two years. Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,9 The care planning/medical system of recording is not consistent to adequately provide staff with the information they need to meet service users needs. The home has risk assessments in place however the lack of recording changes in mobility will leave service users at risk of harm and their rights to be safe are not protected. EVIDENCE: The service user plans were detailed and cover all aspects of health and social care and include risk assessments and daily record sheets. However, daily record sheets in the service user plans do not reflect the monitoring of the health and welfare of the service users. Clear, concise information must be recorded to ensure that service user needs are being met. Information recorded in the medical book was not included in the service user plan and information in the service user plan re medical needs was not recorded in the medical book. Body maps were completed but not all dated and signed. Accidents/incident forms were completed but were not always monitored in the service user plan daily records. Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 10 The Service User Plans contain risk assessments, but these were not consistently updated. A risk assessment for an outing was requested and found to be missing at the time of the inspection. It is recommended that some service user plans may require to be reviewed more frequently due to the ageing service user group. Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15,16 The lack of transport and shortage of staff to cover the home due to sickness, maternity leave and annual leave is restricting service users activities. Service users are supported to ensure contact with relatives is ongoing and a record of visits, telephone calls and correspondence is recorded in service users plans. EVIDENCE: The homes own transport is currently off the road and having repairs. This has not been available for use since February. The lack of this facility is currently preventing one service user travelling to day care. The Acting Manager said that the garage is still waiting for a part for the vehicle and this has been reported to head office that are in the process of reviewing the transport facility. Service users all go to the local shops and out for walks. At the time of the inspection one service user went to the town for shopping. In house activities are being restricted as the Day Care Co-ordinator is covering for carers on Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 12 annual leave or sick. Service users are able to go to church if they wish and no service users participated in the general election. One service user is able to attend college for drama once a week and eight service users attend day care services two mornings per week. One service user attends trampoline sessions at the sports centre in Folkestone. On occasions there is aromatherapy, yoga and the Acting Manager is in the process of arranging music therapy sessions. The home also has music entertainment every three to four weeks. All family contact and visits are recorded in the service user plan. The Home has no quiet room as such, but there is a separate dining room and service users usually see their relative or friend in their own bedroom. All locks on service users rooms have been risked assessed; some are not locked due to the presenting needs of the service users. This information is clearly detailed in the service user plan. Staff was interacting with service users in a respectful caring manner and service users were observed accessing all areas of the home. The Acting Manager said that he assists service users to open their mail and the preferred name is recorded in the service user plan. Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 The system for medication administration is not satisfactory and places service users health care at risk. EVIDENCE: The home has robust policies and procedures in place for the administration of medication. There was an incident where cream prescribed for one service user was used on another service user. This information was recorded in the daily record sheets. The home must ensure that only prescribed medication is used for the individual service user. It is the current practice in the home to leave creams in service users rooms, this cream was not stored safely and there are no risk assessments in place. The home must therefore review the storage of creams in line with the Royal Pharmaceutical of Great Britain Guidelines. At the time of the inspection there was a discrepancy in the number of tablets prescribed to one service user. One tablet had been dispensed into a pill pot with a sticky label over the top. This is classed as secondary dispensing and this practice is not acceptable. There were four tablets unaccounted for, these could not be traced. This medication was prescribed on an as required basis and some entries on the mar sheet had been completed. The transporting of medication requires to be reviewed, as there is no locked facility to ensure the Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 14 security of the drugs. The Manager has been requested to carry out an investigation and inform the Commission of the outcome by Wednesday 11 May 2005. On a further visit to complete the inspection on 10 May the inspector was verbally informed that the draft report from the investigation had traced the missing tablet. The tablets had been administered to the service user and records showed that this information had been recorded in the medical notes but not on the MAR sheets. The returns book was not available, as this had been retained by the Pharmacy when drugs had been returned for disposal. The home must ensure that there is a record of returned medication. Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 The home has a satisfactory complaints system in place and demonstrated that any issues of complaint are investigated and actioned appropriately. There are robust policies and procedures in place for the protection of vulnerable adults. EVIDENCE: The home has received one anonymous complaint, which was made direct to the Commission. This resulted in a joint visit by the Adult Protection Coordinator and Inspector to investigate the issues raised over the welfare of service users. The outcome of the investigation proved there were no adult protection issues. The Acting Manager had already addressed some areas of concern outlined in the complaint and further action identified from the investigation is included in the requirements and recommendations of this report. There is a complaints log in the home and there have been no other complaints since the last inspection. The home has a policy on abuse, which is called Guidelines for Raising Concerns at Work. All staff attends de-escalation skills training and how to deal with aggressive behaviour and 5 staff have attended adult protection training and 6 staff are booked to go on the course. The Acting Manager said that all staff would be attending this training. Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29, 30 The Acting Manager is in the process of accessing equipment to maximise service users independence. Service users are at risk of infection due to the lack of hand washing facilities. EVIDENCE: The Acting Manager is currently receiving quotes to purchase a mobile hoist for service users who are at risk of falling due to the ageing service users group. The home does not have a shaft lift and is looking at the possibility of installing a stair lift. One service user has a dedicated hoist. The Acting Manager said that the thermostats to ensure radiators are individually controlled in service users rooms should be fitted this week. The home has been given a timescale of 31st May, as this had been an outstanding requirement from the last two inspections. Bedrooms viewed were well furnished and were decorated to service users choice and contained personalised items. Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 17 There home has a policy on infection control however the toilet opposite the lounge does not have a hand washbasin. The home has installed a dispenser for cleaning hands with an anti bacterial hand wash. At the time of the inspection on 5 May 2005 the dispenser was empty, on checking the dispenser on the 9th May it was still empty. The service users who use this facility may require assistance to use the dispenser and in some cases are not able to rinse their hands; they are therefore at risk of infection. The home needs to ensure that the dispenser is regularly monitored to ensure the dispenser has anti bacterial gel at all times or provide hand washing facilities. The home must also review the toilet facilities used by staff. Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34,35,36 The retention of staff at Ryder House is good however the lack of staff cover restricts service users in house activities and therefore their social needs are not being fully met. Recruitment policies have not been consistently followed resulting in Service users receiving care from staff that has not been appropriately vetted. The staff are well qualified offering consistency of care in the home, however the lack of updates or other mandatory training puts service users and staff at risk. The home has a supervision programme in place. EVIDENCE: The home needs to ensure that staff is covered for sickness, maternity and annual leave to ensure the Day Care Co-ordinator is available to provide in house activities. There is currently no planned programme of activities. The home also manages with three care staff for part of the afternoon although four staff is on the rota to work. The Acting Manager and Deputy Manager assist when required. Whilst it is acknowledges that all personal care and support is given the lack of staff restricts service user choice, outings and activities. This situation was highlighted at the previous inspection on 14 February 2005. Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 19 The home is fully staffed but is experiencing difficulty in covering shifts due to sickness, maternity and annual leave. The Acting Manager is aware of this problem and has produced a rota for next month, which indicates that in house activities will take place on a regular basis. CRB and POVA checks are in place however one staff file only contained one written reference. Staff confirmed that the Company is proactive in providing training to meet the needs of the service user. The home has a training matrix and ongoing training has been booked for First Aid, Food and Hygiene, De-escalation, Break away, adult protection, epilepsy, infection control and report writing. Staff confirmed that supervision is taking place and supervision notes were on file. Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,41,42 The Acting Manager has a good understanding of what needs to be improved in the home. Requests have been made to head office to facilitate the purchasing of aids and adaptations and equipment for the home. Overall the management of the home is satisfactory however the lack of accurate up to date recording potentially puts service users at risk. The system for service user consultation was not evidence at the time of the inspection and there is no evidence that relative and stakeholders views are sought. The health, safety and welfare of service users is at risk due to the lack of mandatory training EVIDENCE: The Acting Manager was aware of some of the issues raised in this report and has already addressed some of the issues. He demonstrated his knowledge of Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 21 the service user group and staff said that he has improved service user choice, since his appointment in November 2004. They said that he is approachable and supportive to the management team and staff. There is a quality assurance system in place and the Acting Manager said that the service users had completed a questionnaire in January and the results were forwarded direct to head office. There was no evidence of this survey at the time of the inspection. Some of the records, service user plans, medical records, and daily record sheets did not reflect the correct information to meet service user needs. Some risk assessments were not up to date and body maps not signed and dated. Induction records were also not signed and dated. All records are secure and stored appropriately. Some members of staff require updates or mandatory training. Due to the ageing service user group all support workers are required to complete or update moving and handling skills. Records viewed confirmed that all appliances have been checked this year and environmental risk assessments are in place. Accidents were recorded but some were not included in the daily records of the service user plan. The home received a visit from the Environmental Health Office on 5 October 2004 who has recommended that the kitchen be replaced within a year. 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 22 “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x 2 x x 3 2 Standard No 11 12 13 14 15 16 17 x 3 3 x x 3 x Standard No 31 32 33 34 35 36 Score x x 2 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 x 1 x Standard No 37 38 39 40 41 42 43 Score 2 3 2 x 2 2 x Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 23 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 6,18 Regulation 14,15 Requirement To ensure all documentation is signed and dated. To ensure accidents/incidents are recorded and monitored in the service user plan. To ensure risk assessments are reviewed and updated To ensure that only prescribed medication is administered to named service users. To implement risk assessments and provide secure storage of prescribed creams left in service users room. To ensure that medication is only dispensed at the time of administration. To ensure MAR sheets are signed on administration of medication. To review the transport of medication. To ensure the home has a record of medication retrned to the Pharmacy for disposal To provide individually controlled heating in service user rooms. This was an outstanding requirement form the last two inspections, timescales and 30/11/04 and 31/3/05 To review handwashing facilities in the toilet opposite the lounge Timescale for action 30/6/05 2. 3. 6,9 20 13,15 13 30/6/05 30/6/05 4. 26 13 Revised timescale 30/5/05 5. 27,30 13 30/6/05 Page 24 Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 to prevent the spead of infection 6. 33 18 To ensure adequate staff are on duty to ensure there is no restriction on service user choice and activities, This was a requirment from the last inspection , timescale 31/3/05 To ensure that two written referneces are obtained prior to employment To implement a quality assurance system including relative and stakeholders To ensure that all records are accurate, clear and up to date To provide all staff with mandatory training Revised timescale 30/6/05 7. 8. 9. 10. 34 39 41 35,42 19 12 17 13 30/6/05 30/6/05 30/6/05 30/6/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Ryder House H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 25 Commission for Social Care Inspection 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 H56 H05 S23532 Ryder House V223642 050505 Stage 4.doc Version 1.20 Page 26 - 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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