CARE HOME ADULTS 18-65
TIKVAH TOVAH Ravenswood Village Nine Mile Ride Crowthorne Berkshire RG45 6BQ Lead Inspector
Katy Brown Unannoucned 1 June 2005 @ 12:25 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. TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Tikvah Tovah Address Ravenswood Village Nine Mile Ride Crowthorne Berkshire RG45 6BQ 01344 755529 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) Norwood Ravenswood Care Home 5 Category(ies) of Learning Disability (LD) registration, with number of places TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 13/12/04 Brief Description of the Service: Tikvah Tovah cares for five adults with learning disabilities. It is set in Ravenswood Village, which is a Jewish community. Tikvah Tovahs underpinning ethos is derived from the Jewish faith and the beliefs practices and values of Judaism underpin all aspects of residents lives. The home is a bungalow and each resident has their own bedroom, none of them have en-suite facilities. There is a spacious lounge area and a separate diningroom. The home has its’ own vehicle and service users are able to access public transport, as appropriate. TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over four hours. There have been no additional visits made since the last announced inspection. A tour of the premises took place and staff records, residents’ care records and some of the homes’ records were inspected. Five of the staff on duty and three of the five residents were spoken to. What the service does well:
The home has a group of staff that work well together and have a good understanding of the residents needs. The staff receive lots of training and new staff are not left alone with the residents until they understand their needs. Staff also keep accurate records of events that occur in the resident’s lives and make sure that appointments with doctors and dentists are kept. The staff talk to the residents and listen to what they are saying and support them to make choices and decisions that affect their lives. Residents are comfortable with staff and receive care when they need it and if they ask for it. Residents that were spoken to say that staff treat them very well and that they are happy living at the home. They enjoy going to the pub, bowling, swimming, horse riding and trips to the cinema; residents also said that they are supported to take part in hobbies of their own choice. The residents said that they had not made any complaints, but felt happy that staff and the manager would take their concerns seriously and do what they could to resolve any issues. TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
When the food safety officer visited the home in August 2004, they said that staff should have more training in food handling. They also said that fly screens should be fitted to the kitchen windows to prevent food from becoming infected and that the food safety policy should explain that staff that prepare food should not return to work for at least two days if they have been unwell. None of these things have been done. Two residents’ need their food cut up into small pieces to help them when they are eating, however, this information is only recorded in one residents’ plan of care. The district nurse used to visit the home every week, to give a resident an injection. However, she has now trained a member of staff to do this for her and this change in care has not been recorded in the residents’ file. Staff use a listening device in a residents bedroom to enable them to hear when the resident is having an attack of epilepsy. As the monitor is kept in the office, staff rarely hear if an attack is taking place and during the nighttime, staff make regular checks on the resident. As this monitor does not allow the resident any privacy, staff must check that it does reduce the risk of harm to the resident and also check that the resident is happy for it to still be used. These are things that are required by the Care Homes Regulations 2001. TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 7 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. TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 5 The staff employed at the home and the services and facilities that are available to residents are able to meet their assessed needs and each resident has been provided with terms and conditions that outline the service provided. EVIDENCE: The home keeps individual records for each resident and an inspection of the records for three residents’ that live there, confirmed that their identified needs were being met and that specialist support had been implemented when required. The residents’ each have their own service users guide, which informed them of the services provided and information about the terms and conditions of the home. The guide is in a language that is accessible to the residents. TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 Residents are involved in their care planning process and are provided with a good standard of care that is consistent with their identified need and risk management plans. However, the use of monitoring devices that restrict privacy must be reviewed regularly and only used if identified as a need and resident’s special dietary requirements must be included within the plans of care, as this lack of information to staff could place residents’ at risk. EVIDENCE: Individual plans of care are available for all residents and they contain information about their personal care and social care needs. However, one resident that requires his food to be cut up prior to him eating his meal did not have this recorded within his plan of care, although this need had been identified to prevent him from choking. Staff that were spoken to, are aware of this risk but share the information verbally. A resident that suffers from seizures has a listening device in her bedroom, although staff are rarely within hearing distance of the monitor as it is permanently placed in the office. Although staff make hourly checks on the resident during the night and records indicate that the residents nocturnal
TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 11 seizures are rare, this device continues to be used and the risk assessment does not give an accurate reflection of the reasons why. There is no record that the resident has agreed to the use of this device. Residents confirmed that they are supported to take sensible risks and an inspection of records and discussion with the residents’ and staff, indicated that the residents’ needs are being met and that plans of care and risk management strategies are reviewed. Residents that were spoken to say that they attend weekly meetings at the home and that they are involved in decisions that are made about the way the home is run and also about their care. Advocates and befrienders visit the home and one resident has meetings with a volunteer on a weekly basis. Information about advocates is available to everybody and residents are provided with advocacy support when required. TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 12 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, 15 and 17 The residents do take part in a variety of activities that includes attendance at college and also supported to maintain good relationships with families and friends. Meals provided at the home are varied and well balanced and meet the needs of the residents. EVIDENCE: All residents have individual activities programmes, which enable them to be aware of what things they will be doing each day. A programme of activities is kept in individual bedrooms and also on the wall of the office to assist the residents. Some of the activities that are currently provided include, horse riding, swimming, visits to the cinema and regular trips to the local pub for meals. All the residents are provided with opportunities to attend day services within Ravenswood Village, which provide support with daily living skills and one resident attends a college in Bracknell to learn needlecraft skills. Staff have recently arranged for an external agency to visit a resident and encourage him take part in activities, as he is reluctant to leave the home.
TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 13 A resident said that he enjoyed is activities and was never bored. Staff support residents’ to write letters and send gifts to friends and family and many of the residents visit their families in their homes and spend weekends or holidays with them. Residents confirmed that they could use the telephone when they wished. Visits by friends and relatives are encouraged and staff that were spoken to, say that they have a good relationship with relatives and people involved in the residents’ lives. A record is kept of the residents’ dietary requirements and staff are aware of identified needs. Residents’ are given pictures of a variety of meals during their weekly meetings to assist then with their selection of meals; their likes and dislikes are then incorporated in the menu planning process. The residents’ that were spoken to said that they enjoyed the food that was provided and that there was always enough to eat. TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 14 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) 18, 19 and 20 The residents’ are provided with a good standard of care that reflects their wishes. The residents that take medication are protected by the homes policies and procedures and care practices. However, a record must be kept within the residents’ files, when nurses have delegated their medical responsibilities to named staff. This will ensure that a clear audit trail is in place. EVIDENCE: Staff that were spoken to were very clear about individual residents’ likes and dislikes and were seen treating them with respect and dignity and in a way that made them happy. Residents said that they do visit the doctor and dentist and that staff take them to appointments. Individual records are kept for residents medication needs and health related visits and correspondence from health professionals requesting that residents attend appointments are adhered to. The district nurse has delegated a medical task involving muscular injections for a resident, to a named member of staff although; there is no record of this delegation within the residents file. Staff have satisfactory guidance in place
TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 15 to support the residents with their medication and only staff that have received appropriate training are permitted to administer medication. TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 16 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 and 23 The residents are protected from abuse and harm and their views are listened to and acted on. Residents’ are confident that their complaints will be taken seriously and investigated properly. EVIDENCE: Residents said that they had not yet had cause to complain; however, they would be comfortable making a complaint, as they believed that their complaint would be taken seriously. All residents have a copy of the complaints procedure that is in a language that they can access. The manager and staff keep a record of complaints that are made and manager them well. There have been no complaints received at the home since the last inspection. The CSCI has not received any complaints in respect of this service. The home has satisfactory policies and procedures in place for the protection of vulnerable adults and Ravenswood Village has a named Vulnerable Adults Co-ordinator in place, to provide support and guidance to both staff and residents. All staff receive training in the Abuse of Vulnerable Adults and Whistle blowing as part of their induction. Staff confirmed that since the previous inspection, they have received refresher training in challenging behaviour and de-escalation techniques. TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 17 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) 30 The home is clean and hygienic and free from infection. EVIDENCE: There are policies and procedures available for the control of infection that support staff in their day-to-day practice and staff confirmed that they do attend training in infection control and hygiene. A tour of the premises identified that the home is clean and hygienic. The residents’ take responsibility for cleaning their own bedrooms, although staff do provide support with domestic tasks when required. The laundry facilities are situated in a separate part of the home and the laundry is washed and dried by staff within the premises. Residents confirmed that they are encouraged to attend to their own laundry. TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 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) 34 and 35 The procedures for the recruitment of staff are robust and provide safeguards for the residents. Staff receive an induction to the home and are provided with a variety of training that enables them to provide a good service to the residents that live there. EVIDENCE: The home has a satisfactory policy for the recruitment of staff. A member of staff that has recently been employed at the home confirmed that all the necessary recruitment checks had been completed prior to her commencement of work at the home. Staff that were spoken to, confirmed that they receive training that helps them meet the needs of residents and said that they have recently completed a number of refresher courses. Inspection of records identified that new staff receive an induction when starting work at the home and that training is provided on a regular basis. TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 19 TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 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) 39 and 42 The manager and staff at the home do seek the residents views and opinions and ensure that they are reflected in the way that the home is run. The safety and welfare of residents’ is met through the health and safety policies and care practices at the home. However, recommendations made by other regulatory agencies must be adhered to, to reduce the risk of harm to residents. EVIDENCE: There is no formally accredited quality assurance system in place in Ravenswood Village; however, there is a system of lay visitors with a quality assurance remit on behalf of the organisation. Lay visits are made to the home quarterly and a report is provided to the manager and to senior management about their findings. The most recent visit took place in November 2004 did not raise any concerns. TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 21 Relatives are able to voice their views and opinions at regular meetings held at Norwood Ravenswood (The provider organisation), which is based in London and residents’ attend weekly meetings at the home. A resident said that the manager and staff do listen to them and that they are involved in making decisions at the home. The home has satisfactory health and safety policies and procedures in place and an inspection of records identified that regular maintenance checks are completed for equipment used at the home. The fire officer visited the home in May 2005 and all the requirements that were made have now been met. Regular fire checks and drills are carried out at the home. A visit by the environmental health officer in August 2004, recommended that staff should receive refresher training in food and hygiene, a fly screen should be fitted to the kitchen window and that a statement that food handlers should not return back to work until they have been fee of symptoms for 48 hours is included in the company food and safety policy. This has not yet been done. TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x 3 x 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score x x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 x x 3 x 3 Standard No 31 32 33 34 35 36 Score x x x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
TIKVAH TOVAH Score 3 2 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 2 x H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 23 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 6 Regulation 15 Requirement That the specialist dietary requirements for residents are recorded within their plans of care. That the use of a listening device for residents is identified as a care need and that consent is sought from the resident to enable staff to use a the device when she is alone in her bedroom. That the delegation of the administration of the steroid Beta Interfeeral injection, to a named member of staff, is recorded within the residents plan of care. That the recommendations made by the environmental health officer are complied with. Timescale for action 15th June 2005 15th June 2005 2. 7 17 Schedule 3 3. 19 13 (2) 15th June 2005. 4. 42 12 (1) (a) 1st September 2005. 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.
TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 24 Refer to Standard Good Practice Recommendations TIKVAH TOVAH H52-H01 11371 Tikvah Tovah V227915 010605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection 2nd Floor 1015 Arlington Business Park Theale Reading RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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