Inspection on 18/02/08 for The Ranch

This inspection was carried out on 18th February 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Ranch 23/02/07

The Ranch 24/01/06

The Ranch 14/12/05

The Ranch 28/02/05

The Ranch 06/01/05

Similar services:

Southfields

Thorndene

Insight - Eastchurch

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

1 Marten Road

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

CARE HOME ADULTS 18-65 The Ranch Well Path, Well Lane Horsell Woking Surrey GU21 4PJ Lead Inspector Ms Suzanne Magnier Unannounced Inspection 18th February 2008 08:15 The Ranch DS0000059190.V357864.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 The Ranch DS0000059190.V357864.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. The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Ranch Address Well Path, Well Lane Horsell Woking Surrey GU21 4PJ 01424 438813 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) isaactagoe.questhaven@gmail.com Quest Haven Ltd Mr Isaac Tagoe Care Home 3 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (3) of places The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd February 2007 Brief Description of the Service: The Ranch is a detached bungalow situated within a quiet residential area of Woking. The home provides 3 single bedrooms two of which have en-suite facilities, a communal bathroom, lounge, and conservatory, dining area, kitchen, office, utility room and a small rear garden. There is ample parking space to the front and side of the property. Local transport links provide access to Woking and surrounding areas. The current rate of fees are £1,300.00-£1,612.87 per week. The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the care home was an unannounced ‘Key Inspection’. Some additional standards were assessed and have been included within the report. Ms S Magnier Regulation Inspector carried out the inspection and the registered manager and a senior staff member represented the service. For the purpose of the report the individuals using the service prefer to be addressed as clients or individuals. The inspector arrived at the service at 08.15 and was in the home for five hours. It was a thorough look at how well the home is doing. It took into account detailed information provided by the home and any information that CSCI has received about the service since the last inspection. The Commission sent questionaires to people associated with the service the responses of which have been included within the report all of which are favourable. The use of an ‘expert by experience’ (who is a person who visits the service with the inspector to help the get a picture of what it is like in or use the service) was not used as part of this inspection. An ‘easy read’ inspection report summary using pictures, plain english and large print has been made in order that the clients have information in a way that they can understand what we (the commission) are saying about their home. The home had supplied the commission with a documented Annual Quality Assurance Assessemnt (AQAA) some detail of which has been included within the report. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes statement of purpose and service user guide, clients care plans, daily records and risk assessments, medication procedures, staff files, a variety of training records, health and safety records, and several of the homes policies and procedures. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of clients who have diverse religious, racial or cultural needs. The Ranch DS0000059190.V357864.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: It is recommended that the protocols and risk assessment records be further developed to include evidence that the information about the client’s daily lives and known hazards are more frequently reviewed. It is recommended the home of develop the use of clearer goals and outcomes for clients so that clients can be more involved in maintaining and developing new and existing skills. The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 7 Medication procedures need to be further strengthened to ensure that medication is administered to all clients in a safe and appropriate way. The homes ‘managing abuse policy’ must be amended to adhere to the local authorities safeguarding protocols in order to safeguard clients being harmed or suffering abuse or being placed at risk of harm or abuse. Maintenance of client’s private facilities and infection control procedures need to be improved. Client’s wellbeing and safety needs must be improved due to the health and safety shortfalls for example ill fitting fire doors and unsafe water temperatures in the bathroom. 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. The Ranch DS0000059190.V357864.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 The Ranch DS0000059190.V357864.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): 1, 2. People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. There is up to date information about the home so that individuals can make an informed choice if they want to live at the home. The homes admission and assessment procedures ensure that individual’s needs are appropriately identified and met. EVIDENCE: The home’s Statement of Purpose and Service User Guide have been updated following the previous inspection. Both documents are well written in plain English and include pictures to assist clients in making a choice if they wish to live at the home. The home has an admission and assessment procedure, which ensures that all prospective clients have a care needs assessment prior to admission to the home to ensure that the home could be able to meet the individual’s needs. The home currently has one vacancy and the manager confirmed that he would undertake any assessments prior to individuals moving to the home. The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 10 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, 10. People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The support, risk assessments and personal care that clients receive is based on their individual needs set out in their protocols. The documents need to be further developed and reviewed more frequently. Client’s dignity and respect is promoted. EVIDENCE: Both individuals living at the home has a care plan, which the home refers to as protocols. Whilst looking at the protocols it was noted that both client’s records were stored in one file, which did not offer either of the client’s the right to have their records stored privately. This was talked about with the manager and the staff member who promptly placed one clients records in a separate file. One protocol was looked at by the inspector and was clearly written to describe the clients individualised personal care needs and how care and support were The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 11 provided taking into account the persons choices and preferences on how they liked to receive care and support for example times of getting up and going to bed, their likes and dislikes for example having a cigarette, listenning to music, and having a shower. The other protocol looked at by the inspector had some information about the client yet there was a lack of all the protocols in the file. This was talked about with the manager who told the inspector that the records were on the computer. The records were printed and put into the clients individual file. The protocols were clearly written and described the specfic support the individual needed in their daily life and those avialable had been signed by staff to confirm they had read them. The protocols detailed the individuals religion, next of kin or significant people in their life, and the individual’s current medication. Daily records written by staff were looked at and included reporting on the individual’s daily activities, their interactions, achievements and general demeanour throughout a 24- hour period. Staff had signed the daily records and it was noticed that both clients had their own individual diary in order to promote their rights to individuality, privacy and confidentiality. The home has person centred plans and it was noticed that these were only partly completed by the client and the staff. The senior staff member and manager told the inspector that they have to wait until the client wants to be involved in the development of their person centred plan yet the plan was not accessible to in the daily ‘working’ file used by the staff. During the inspection the manager put the person centred plan in the daily ‘working’ file in order that it was accessible to the client and staff in order that it could be more fully completed. There was evidence in the client’s files to indicate that formal and informal reviews of the care provided to the clients had been held in order to make sure that the home continues to meet their needs since they came to live at the home. It is acknowledged that the clients may not wish to sign their protocols and this detail should be recorded on the protocols on behalf of the individual. The inspector watched the staff member speak and listen to the client at home in a calm, reassuring and confident way. By the clients choice they were addressed by staff and people they knew by their nickname, which supported the professional trusting relationship. Whilst looking at the protocols the inspector saw that the home had completed some risk assessments, which documented potential hazards in the client’s daily lives for example having a cigarette, using the kitchen and road safety. The protocols and the associated risk assessments were talked about with the manager and senior staff member. A large number of the records were dated The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 12 March 2007 and there was no evidence written on the protocols or risk assessments to show that they had been reviewed even if there had been no change. The manager explained that changes are written in the clients individual daily record book yet agreed with the recommendation that the protocols and risk assessment records could be further developed to include evidence that the information about the clients daily lives and the known hazards are more frequently reviewed. The Ranch DS0000059190.V357864.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): 11, 12, 13, 15, 16, 17. People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. Individuals are able to exercise choice in their daily lives, maintain bonds with family and friends, and take part in social, cultural, religious and recreational activities. The home provides a healthy and balanced diet. EVIDENCE: When the inspector arrived two staff were in the house one of which was the night care worker who was leaving to go off duty. One client had left the home to go to out for the day. The protocols looked at during the inspection evidenced that both the clients are involved in daily living skills which include house work for example wiping up the dishes, keeping their bedrooms tidy, using the vacuum cleaner, cooking meals with help, doing their laundry and shopping for household groceries. The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 14 During the inspection the client at home was distressed and told the staff member that they didn’t want to go out to the local day centre and the staff member acknowledged their choice not to attend and was flexible in supporting the client later in the morning when they had changed their mind and wanted to go. The client at home told the inspector that they liked the home and that they thought they had settled down well in the year they had been there. They confirmed that they are able to keep in touch with people who they want to and that the staff and the manager are nice and they feel well looked after. The inspector saw some records from family and looked in the visitor’s book and the daily diaries which showed that clients are encouraged and supported to keep in contact with people close to them and can also use the homes telephone if they choose. The home has a system of recording client’s activities using a tick box form called ‘opportunistic plans’. Staff members complete the form by using a tick if the client takes part in any activities, which would include daily living skills and social activities. The manager and the senior support worker discussed with the inspector the recommendation of developing the use of clearer goals and outcomes for clients so they could be more involved in maintaining and developing new and existing skills. For example the Annual Quality Assurance Assessemnt (AQAA) received by the commission identifies that clients do not have a key to their bedrooms, as they (the clients) do not know how to use a key. The home have identified that this an area of development to support and encourage clients to learn how to use the keys for their bedroom doors. The home has written menus to offer what was considered a well-balanced meal with healthy living options. All meals are home cooked with an alternative option available for each mealtime. Mealtimes can be varied and the home has made arrangements that client’s can have their meals in the dining area or on their own if they prefer. The dining area is located in the conservatory of the home, which was observed as spacious, bright and well decorated. No formal meals were observed during the inspection. The homes fridges and pantry were well stocked with fresh vegetables and fruit. Special diets can be are provided and drinks and snacks were seen to be available at all times. The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 15 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. People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The client’s physical, emotional and health care needs are monitored and met. Individual’s choice and dignity is promoted. Medication procedures need to be further strengthened to ensure that medication is administered to all clients in a safe and appropriate way. EVIDENCE: The protocols had been developed from the available pre assessment records and included the client’s care and support needs. The protocols were well written to allow the reader to gain a good overview of the individuals medical, social and personal care needs including complexities in their mental and physical wellbeing. Due to some client’s complex needs the staff told the inspector that the protocols had been developed with the client’s families and other health care professionals involvement where possible. One client’s protocols indicated a specfic medical condition which had been effectivley managed by the home and by the use of prescribed medication. The protocols gave no recent The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 16 indication that the clients condition had improved and it is recommended that these details are included within the protocols in order that the records reflect the current needs of the client as previously documented. The protocols detailed individual choices of how the client likes to be supported by staff and how much support the client would like. Some choices included having a healthy eating plan and being weighed monthly, making sure that the client had physical activity and worked towards a reduction in cigarette smoking. The staff told the inspector that both clients did not need assistance with personal care. The homes diary and opportunistic plans evidenced that regular and appropriate health care appointments are attended including visits to the individuals General Practitioner (GP) when necessary. Through looking at records it was evident that the home has maintained good working partnerships with health care professionals which included opticians, dentists, chiropodists, and ongoing psychiatric/psychological support when required to ensure that the clients health care needs continue to be met. Two healthcare professionals completed comment cards, which were received by the commission. The comments included ‘ good joint working with the community nurse’ ‘ there is a stable staff team in place and the feedback from other professionals and family indicates the clients privacy and dignity is positively promoted.’ ‘ The home provides a stable environment and responds to the needs and anxieties of clients appropriately’.’ The community nurse and family are pleased with how the client is doing and the service provided’. ‘I have been impressed by the manager and staffs willingness to seek support and advise when the clients needs change and then make an improvement’. The home has a monitored dosage system in place and all administration cards were fully documented. The two care staff members showed the inspector that the home has good, clear procedures in place for the monitoring and recording of all medicines administered and those entering and leaving the home. Staff training in medication has been conducted and all staff except one who administers medicines had been certificated as safe to do so. Following the previous inspection it was required that the home record clear written procedures with regard to the administration of ‘as required’ medication in order to safeguard the clients and staff. The home had developed guidelines for one client and not the other and a requirement has been made that all clients must have clear guidelines in place regarding the administration of ‘as required’ medication. The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 17 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. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The clients are protected by the homes complaints procedures. The homes safeguarding procedures need to be reviewed to fully safeguard clients from harm and abuse. EVIDENCE: The home has an established complaints procedure. The manager told the inspector that any complaints received by the home would be fully investigated using the homes complaints procedure. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. One comment card received by the commission included ‘On occasions when the need to raise concerns about the care provided at the home the manager and staff have been swift to respond to these concerns’. The Annual Quality Assurance Assessemnt (AQAA) received by the commission details that following the homes quality assurance monitoring the feedback indicated that people associated to the home for example client’s next-of-kin, commissioners and health professionals were not fully aware of the homes complaints procedures. The home has since sent out the complaints procedures in order to ensure that people feel they are listenned to and any concerns they have will be acted upon. The two staff files seen by the inspector indicated that staff had attended safeguarding vulnerable adults training. Following the previous inspection The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 18 records seen by the inspector evidenced that the home have made sure that all the eight staff employed at the home have a Criminal Record Bureaux check (CRB) and a Protection of Vulnerable Adult (POVA) first check to make sure that clients are safe. The home has a copy of the Surrey County Council Multi-agency Procedures for the Safeguarding Vulnerable Adults. The homes ‘managing abuse policy’ states that staff would hold a multi disciplinary meeting following any allegation of abuse at the home. This was discussed with the manager who recognised that this was not in keeping with the Surrey County Council Multiagency Procedures for the Safeguarding Vulnerable Adults protocols. A requirement has been made that the homes ‘managing abuse policy’ must be amended to adhere to the local authorities safeguarding protocols in order to safeguard clients being harmed or suffering abuse or being placed at risk of harm or abuse. The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 19 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, 25, 27, 30. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides accommodation for clients that is personalised, homely, and odour free. Maintenance of client’s private facilities and infection control procedures need to be improved. EVIDENCE: The home provides a homely environment for clients. The premises were viewed as well decorated, comfortable, bright, airy, clean and free from offensive odours. Security lighting is installed to the outside of the building to help the clients feel safe. The inspector looked at the two client’s bedrooms and noticed that they were well decorated and contained a variety of personal items, and were appropriately furnished. In one bedroom it was observed that the client’s toilet seat was broken and there was no hot water available at the sink tap outlet. The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 20 The manager and staff member confirmed on separate occasions that the faults had been reported yet had not been rectified. It was also observed that the client had used adhesive tape on the bedroom wall to secure the radio aerial. When these shortfalls were brought to the senior staff member’s attention she agreed that it was not acceptable for the clients private accommodation to be in a state of disrepair. It has been required that the shortfalls are rectified in order to ensure that the clients bedrooms and amenities are comfortable and suit their needs and lifestyle. The home has a weekly cleaning schedule, which takes into account the guidelines for infection control however it was observed that there were no paper hand towels throughout the property for people to use. It has been recommended that these be provided by the home in order to ensure satisfactory standards of infection control are maintained. The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 21 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. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The staffing levels of the home were considered adequate to meet the current needs of the clients. Clients are protected by the homes recruitment policies and procedures. Staff are trained and competent to do their jobs. EVIDENCE: The home employs seven care staff some of whom work full or part time. Two healthcare professionals completed comment cards, which were received by the commission. The comments included ‘I have been impressed with the staff retention of this unit. There has been no staff change in the past year and minimal use of agency staff. Staff have acquired skills and I provide additional mental health training relating to the specific needs of the client’. ‘ Staff team willingness to learn and improve and there is good communication’. ‘ the staff team are excellent’. Three staff comments cards were received and the comments included ‘ most of the training courses booked keep getting cancelled or bookings are full’. ‘we could improve by having more outside activities to promote more The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 22 independence to each individual’. ‘ more organised training programmes (are needed)’. The home had a relaxed atmosphere and the senior staff member was observed to undertake her tasks in an orderly manner. The staffing levels of the home were evidenced and considered adequate to meet the current needs of the clients. Two staff recruitment files were viewed. It was evidenced that one file contained all items required under the Care Homes Regulations 2001. The other file did not contain two written references, evidence of mandatory training and or a full induction to the home. The manager explained that the staff member had been employed for a month and was working alone on night duty and it was confirmed by telephone to the inspector that a written reference was being held at the homes head Office and would be faxed to the home. The senior staff member told the inspector that she had given the staff member an induction to the home although this had not yet been fully completed and had also supported the staff member through a night duty and was on call for the home in the event of an emergency. The manager told the inspector that the staff member had been booked to do the remainder of her mandatory training and induction over the next two months. The home were reminded of their responsibilities with regard to the welfare and well being of clients with regard to staff recruitment and training. The Annual Quality Assurance Assessemnt (AQAA) received by the commission details that 100 of the care staff were working towards achieving or had achieved their National Vocational Qualification (NVQ) level 2 or 3 in care. The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 23 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, 40, 42. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management arrangements of the home are robust. Clients are consulted regarding the running of the home and their financial interests are safeguarded. Client’s wellbeing and safety must be improved due to the health and safety shortfalls. EVIDENCE: There were clear lines of accountability during the day of the inspection and staff demonstrated an understanding of their roles and responsibilities in order for the home to continue to run smoothly. The registered manager is a trained learning disability nurse (RNMH) and keeps his UKCC registration up to date, along with continuing his professional The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 24 development. He has also recently completed the NVQ Registered Manager Award (RMA) at Guildford College. It was observed that the client and staff member responded favaourably to the manager of the home and professional relationships were maintained. It was noted that staff had a good rapport and knowledge of the clients and were seen to listen to their views and opinions. There was evidence seen to support that regular scheduled client meetings were held and a suggestion box for clients and any visitors to the home was used to encourage feedback about the home to make sure that the home continues to improve. The Annual Quality Assurance Assessemnt (AQAA) received by the commission details that the home are encouraging clients to have independent advocates who can help them to make decisions and have received results of the satisfaction surveys completed by next-of-kin and healthcare professionals/commissioners who are satisfied that the clients have settled well and are being well supported. The senior staff member explained that the home takes responsibility for peoples finances and records looked at evidenced appropriate safekeeping with receipts detailing purchases and a regular audit of the accounts. Records indicated that some health and safety checks are maintained however concern was raised that six fire doors for example all the bedroom doors, kitchen, bathroom and lounge doors were wedged open and were not closing properly and could be potentially hazardous in the event of fire. It has been required that the home must consult with local fire department to seek advice regarding the use door closing mechanisms and ensure that the repair and maintenance of the fire doors is undertaken to promote the safety and well being of all people in the home in the event of a fire. During the tour of the premises it was observed that the laundry area was clean and tidy. The communal bathroom bath temperatures were tested and it was found that the water temperature exceeded 50 degree Celsius. The manager explained that no client uses the bath and a mixer tap was used to mix the temperature of the water however a requirement has been made that the temperature of the water is reduced to safe limits in order that the hazard of clients suffering harm from the extreme water temperature if they choose to use the bath are reduced. The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 2 26 X 27 3 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 3 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 3 3 X 2 X The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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 YA20 Regulation 13. (2) Timescale for action Clear written procedures must be 18/04/08 developed with regard to the administration of ‘as required’ medication in order to safeguard all the clients and staff. 18/04/08 Requirement 2. YA23 13. (6) 3 YA27 The homes ‘managing abuse policy’ must be amended to adhere to the local authorities safeguarding protocols in order to safeguard clients being harmed or suffering abuse or being placed at risk of harm or abuse. 23. (2) (c) The following shortfalls in a (j) client’s en suite bathroom facility must be rectified in order to ensure that the amenities are comfortable and suit the client’s needs and lifestyle. 1. That the client has hot running water from the en suite sink tap outlet. 2. The client toilet seat is repaired to ensure their comfort, safety and dignity. The home must consult with DS0000059190.V357864.R01.S.doc 18/04/08 4 YA42 23. (4) (c) 18/03/08 Page 27 The Ranch Version 5.2 (i) 24. c (iv) local fire department to: 1. Seek advice regarding the use door closing mechanisms. 2. Ensure that the repair and maintenance of the fire doors is undertaken to promote the safety and well being of all people in the home in the event of a fire. 18/03/08 The bath water temperature is reduced to safe limits in order that the hazard of clients suffering harm from the extreme water temperature if they choose to use the bath is reduced. 5 YA42 13. (4) (a)(b)(c) 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 YA6 YA9 YA19 2 YA11 It is recommended the home of develop the use of clearer goals and outcomes for clients so that clients can be more involved in maintaining and developing new and existing skills. It has been recommended that paper hand towels be provided throughout the property for people to use in order to ensure satisfactory standards of infection control are maintained. Good Practice Recommendations It is recommended that the protocols and risk assessment records be further developed to include evidence that the information about the client’s daily lives and known hazards are more frequently reviewed. 3 YA30 The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection 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 The Ranch DS0000059190.V357864.R01.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!