CARE HOMES FOR OLDER PEOPLE
The Ridings Calder Close Daventry Road Banbury OX16 3WR Lead Inspector
Carole Moore Unannounced 18 May 2005 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 Older People. 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 Ridings H57-H08 S13127 The Ridings V222241 180505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Ridings Address Calder Close, Daventry Road, Banbury, OX16 3WR 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) 01295 276767 01295 277107 Anchor Trust Mr Richard Martin Armstrong Care Home 40 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (21) The Ridings H57-H08 S13127 The Ridings V222241 180505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 11 Oct 2004 Brief Description of the Service: The Ridings opened in 1996 and was purpose built to provide accommodation in flats or bed sitting rooms. It is situated on the outskirts of Banbury. The home offers thirty-nine permanent places and one respite place in a designated room. Among the facilities at the home are a large lounge and dining room with a bar, shop, activity room, library and small sitting room on the ground floor. There are two laundry rooms and a telephone kiosk for residents’ use. On the first floor there is another lounge, small sitting room and a hairdressing room. There are two lifts that are fully wheelchair accessible and equipped with a seat. The grounds and the gardens at the rear of the home are very attractive with a gazebo and garden ornaments and a large patio area for service users to enjoy. There is an adjoining day centre, which is staffed and managed separately from The Ridings. The Ridings H57-H08 S13127 The Ridings V222241 180505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Since the last announced inspection the home had received a complaint following a resident’s fall. The complaint had been investigated by Health and Social Care earlier this year and the manager had produced an action plan of improvements he intended to make by 14 May 2005. This included improvements to recording methods of accidents, professional visits, communication between the staff and to introduce prevention of falls training by 14 May 2005 Two inspectors made an unannounced inspection of the home lasting for 3.5 hours on 18 May 2005. During this time a tour of the building was undertaken. Four care staff, a cook and a cleaner were spoken to, plus the manager and deputy manager. Five residents and a visiting district nurse were also spoken to. Four records of care were looked at in detail to see if the record keeping had improved. Records of accidents, risk assessment and nutritional risk assessment were also seen to assess whether other aspects of the action plan had been implemented. What the service does well:
The home encourages resident participation in the running of the home. The manager said “we empower our residents to have their say by having resident meetings once a month and by encouraging residents to join in with discussions on all aspects of the Home”. The meetings are well attended and he feels this works well. Minutes of resident meetings were seen, plus a notice on the board telling residents of the next meeting. The home has a well organised plan of activities that is related to the wishes and the abilities of the residents. Staff spoke about the activities co-ordinator and how she identifies hobbies and interests from the Independent Living Agreement. A bingo session was just finishing and residents spoke about the activities that were available to them and how they enjoyed them. Residents are encouraged to maintain their independence. The amount of help they need for personal care and for cleaning their flat is identified from their Independent Living Agreements. Examples of this were seen in the records examined. Some residents walk to the nearby shops to do their own shopping.
The Ridings H57-H08 S13127 The Ridings V222241 180505 Stage 4.doc Version 1.30 Page 6 Two residents had just returned from the shops. They explained how they walked to the shops every day. They said it helped them keep fit and to keep their minds active. One lady said “we walk every day to keep fit and to keep in touch with life outside”. On the day of inspection the home was clean and bright and both the home and garden appeared well maintained. A resident confirmed that the home was always very clean and the garden well tended. She said she always had help to clean her flat. 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
The Ridings H57-H08 S13127 The Ridings V222241 180505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Ridings H57-H08 S13127 The Ridings V222241 180505 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and4 Residents are assessed prior to admission to ensure that the Home can meet all their needs. EVIDENCE: Evidence of assessment was found in four records of care. A member of staff interviewed also confirmed that two members of staff went out to assess each potential new resident when there was a vacancy. The manager explained that if there was no bed vacancy a brief assessment would be done after a referral from social services or a relative. A problems/needs assessment would be completed, and an independent living agreement written by the prospective resident. A life history of the person would be taken to enable the staff to have a deeper understanding of them. Key staff would then discuss whether the home could meet this person’s needs including their cultural, spiritual and social needs. They also consider how the person will fit in within in the home. The Ridings H57-H08 S13127 The Ridings V222241 180505 Stage 4.doc Version 1.30 Page 9 An introductory visit is always given after the initial assessment. Staff have specialist training, such as dementia training, to meet the individual needs of each new resident. The manager has developed a comprehensive assessment form for the initial assessment. However, if Social Services has already assessed the person they do not always use their own form. The Ridings H57-H08 S13127 The Ridings V222241 180505 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8 The Home meets the health, personal and social care of the residents. EVIDENCE: Records examined contained evidence of professional visits by the GP, district nurse and optician. The manager confirmed that the community psychiatric nurse visited and that people with hearing problems were referred to the hearing clinic by the GP. Residents are being taken to the dentist as there was not one available to visit at present Records contained evidence of the care being given. Care staff confirmed that they now have dedicated time to write in these records twice per day. A visiting district nurse confirmed that she or a colleague visit twice a day to give insulin to a resident. She said the staff were very approachable and very caring. She said that the staff had asked her for more information regarding diabetes so they could give the best care possible to the resident. The Ridings H57-H08 S13127 The Ridings V222241 180505 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 14 Residents were happy with the home and felt all their needs were being met. They are involved in decisions and are given choice and control. EVIDENCE: During the inspection some residents were just finishing a bingo session and others had chosen not to join in. Two residents said they had decided to walk to the shops, which they chose to do every day if possible. Hobbies and interests are well listed in the records. The residents are encouraged to maintain their previous interests and also to learn new hobbies. Care staff said that the activities co-ordinator also talks to the residents on an individual basis to find out what activities they wish to participate in. On this day the activities co-ordinator was on a course for exercises for the older person and another member of staff was involved in the activities of the day. Two residents confirmed that they had a choice at mealtimes. A menu was seen showing this. They also stated how happy they were with their home and care. The manager said that a resident had been taken to Birmingham to a temple as his chosen place of worship. Cultural, social and spiritual needs of the residents are well documented.
The Ridings H57-H08 S13127 The Ridings V222241 180505 Stage 4.doc Version 1.30 Page 12 Records of residents’ meetings were seen giving evidence of the residents involvement in decision making. The Ridings H57-H08 S13127 The Ridings V222241 180505 Stage 4.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Staff are protected from abuse but some of the recording needs to be improved. EVIDENCE: All staff have recently received abuse training. This was confirmed by staff interviewed. Improvements have been made in recording accidents and incidents. Evidence of this was seen in the records. However, in the notes of a recent admission a recording of bruising was made but the result of any investigation was not recorded. Staff confirmed that this bruising was from a hip replacement operation prior to her admission to the Home. Staff need to be more careful to fully record any observation of bruising and the subsequent investigation. The bruising of this resident should have been recorded on admission. The Ridings H57-H08 S13127 The Ridings V222241 180505 Stage 4.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The residents live in a clean and well-maintained environment. EVIDENCE: The tour of the building showed that the home was clean and well maintained. It is bright and pleasant. A cleaner was working around the home during the time of inspection. One small area on a bathroom floor appeared discoloured, possibly due to wear, and needs to be monitored. One lady said she could smoke in her room or outside but not in the communal rooms. She confirmed she was allowed her own possessions in her room and that staff helped her to clean it. She also praised staff for keeping the flat and the home clean and tidy. The Ridings H57-H08 S13127 The Ridings V222241 180505 Stage 4.doc Version 1.30 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 Residents are cared for by adequate, well trained and competent staff. EVIDENCE: At the time of inspection there were three carers, one senior, a deputy manager and the manager on duty. Also on duty was a cook and a cleaner. The care staff confirmed that they had received training in prevention of falls, dementia and diabetes. The staff also confirmed that any training they needed was provided. The Ridings H57-H08 S13127 The Ridings V222241 180505 Stage 4.doc Version 1.30 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38 The home is run in the best interests of the residents and the health, safety and welfare of residents and staff are promoted. EVIDENCE: Risk assessments for the residents were seen in their records. Training on protection of falls, and prevention of abuse, has been given to all staff. This was confirmed by the staff present. The district nurse confirmed that staff had requested more information on diabetes in relation to a resident. Minutes of residents’ meeting, empowering them to take an active part in the running of the home were seen.
The Ridings H57-H08 S13127 The Ridings V222241 180505 Stage 4.doc Version 1.30 Page 17 Independent living agreements show evidence that the care planned is in the best interests of each individual resident. The Ridings H57-H08 S13127 The Ridings V222241 180505 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x 3 x x x x 3 The Ridings H57-H08 S13127 The Ridings V222241 180505 Stage 4.doc Version 1.30 Page 19 no 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 Regulation None Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 19.2 18.3 Good Practice Recommendations Bathroom floors need to be monitored for wear to prevent a potential accident. All observations of injury, including those on admission, should clearly be recorded with the results of any subsequent investigation. The Ridings H57-H08 S13127 The Ridings V222241 180505 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Burgner House, Cascade Way Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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