Inspection on 12/06/06 for Welcome House - Ruby Lodge

This inspection was carried out on 12th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Welcome House - Ruby Lodge 27/02/06

Welcome House - Ruby Lodge 23/11/04

Welcome House - Ruby Lodge 08/06/04

Welcome House - Ruby Lodge 09/03/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

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

CARE HOME ADULTS 18-65 Welcome House - Ruby Lodge Ruby Lodge 58 Pelham Road Gravesend Kent DA11 0HZ Lead Inspector Sarah Montgomery Unannounced Inspection 12th June 2006 04:00 Welcome House - Ruby Lodge DS0000023771.V300298.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 Welcome House - Ruby Lodge DS0000023771.V300298.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. Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Welcome House - Ruby Lodge Address Ruby Lodge 58 Pelham Road Gravesend Kent DA11 0HZ 01474 355594 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) whrubylodge@aol.com Dr Toqeer Aslam Ms Teresa Moss Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th February 2006 Brief Description of the Service: Ruby Lodge is a large detached property situated on the outskirts of Gravesend. The home is owned by Welcome House whose offices are situated in Lords Wood near Chatham. The home is registered to provide personal care and support for up to 17 people with a mental disorder. There are currently 15 service users living at the home. The service user guide, statement of purpose, and reports from the Commission for Social Care inspection are available to service users and are kept in the office. Weekly fees are £545. Purchasers of the service will be given a full breakdown of the fees charged. The home is staffed 24 hours. There is a registered manager and a team of support staff. Accommodation is set over three floors. Eleven rooms are for single occupancy, and there are three shared rooms. There is a large lounge, smoking room, and separate dining room on the ground floor. Service users have access to a large garden at the rear of the property. The office is at the end of the garden in a purpose built structure. There is limited parking at the front of the house. Ruby Lodge is close to several local amenities and a bus route. Service users are able to access local community resources as they wish. Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Sarah Montgomery conducted this unannounced inspection on Monday 12th June between 4pm and 9pm. Evidence was gathered from reading documents, talking to staff and management, and speaking with service users. Sixteen standards were inspected. 9 standards were assessed as being met, with the remaining 7 standards assessed as being almost met. The home has made significant improvements following the inspection in February 2006, and has clearly demonstrated a commitment to compliance in meeting national minimum standards. What the service does well: What has improved since the last inspection? The home has improved it’s approach to pre-assessment, care planning and risk assessment. This has meant a marked improvement in service delivery and has provided learning opportunities for the manager and staff team. Welcome House has also developed a more robust Regulation 26 format. These visits are carried out monthly, and serve as a working tool for ongoing review of the homes practice and policies. Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 Page 6 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. Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 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 the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users can be confident that their individual aspirations and needs will be assessed. EVIDENCE: No new service users have been admitted to the home since the previous inspection. The previous inspection report identified shortfalls in the preassessment process. In order to rectify this, the home has undertaken to reassess all service users currently living in the home, and assured the inspector that all prospective service users will undergo a thorough assessment in order for the home and service user to make an informed choice about the suitability of the placement. The home manager has completed two re assessments. Both were inspected. Service users had been assessed in two key areas; mental health and independent living skills. The mental health assessment covers the historical aspect of the service user’s mental health, and also gives an up-to-date assessment of the service user’s current mental health status and support needs. Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 Page 9 The independent living skills assessment looks at what the service user has been (previously) known to be competent in, and assesses the current situation with more focus given to motivation and re-learning a skill. All assessment information is very detailed, and gives the service user and the support staff a up-to-date baseline of assessed support needs. The home manager informed the inspector that all service users living at the home will undergo reassessment by the end of July 2006. Welcome House - Ruby Lodge DS0000023771.V300298.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can be confident their assessed and changing needs and personal goals are reflected in their individual plan, but would benefit if more information regarding how the service user is to be supported was added. EVIDENCE: As previously stated, the home manager has begun the process of re-assessing all service users living at the home. Two assessments have been completed. These assessments are used as the baseline for creating individual care plans and risk assessment tools. Two care plans were inspected. It was evident through reading these care plans, and by talking to the manager and a service user, that service users are involved in formulating their care plans, and in making decisions about their lives. Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 Page 11 Care plans are goal orientated, and are split into two main sections; one section which addresses the service user’s assessed needs, and another section which concentrates on any aspirations the service user may have. Care plans inspected have identified both needs and aspirations with the individual service user. Individual service users and staff would benefit if the care plans were more descriptive, and if areas of identified support contained a breakdown support needs. Care plans are reviewed frequently (at least every 3 months). This process is enhanced by monthly 1-1 keywork sessions in which service users are given the opportunity to comment on their care plan, and give suggestions or raise a complaint or grievance. New style risk assessments give historical and up-to-date information regarding the service user’s mental health. Risk assessments provide clear information about levels of risk, and give guidance to staff around appropriate responses to situations. One service user with significant physical health needs and who cannot tell the difference between hot and cold water, did not have a risk assessment regarding this. The manager assured the inspector that this would be put into place. Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 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 the following standard(s): 12 and 13. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from taking part in appropriate activities. Service users are supported to be part of their local community. EVIDENCE: The inspector read a sample of daily care notes and care plans. The daily care notes evidenced that service users are offered opportunities to partake in activities. Many service users access the community without staff support. Many activities are community based. These include visiting cafes, using local shops, accessing further education courses, and using local leisure and healthcare facilities. Service users are actively encouraged to partake in household chores as part of moving towards independent living. Service users are supported to keep their own rooms clean and tidy, and to take part in cleaning communal areas Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 Page 13 of the home. Ruby Lodge is working towards service users taking a more active role in meal preparation. Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 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 the following standard(s): 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be confident that their physical and emotional needs are met. Service users are protected by the homes policies and procedures for dealing with medicines. EVIDENCE: The home’s reassessment of all service users includes ensuring that all healthcare needs are assessed and recorded. All service users have care plans regarding their healthcare needs; this includes their physical and emotional health. Many service users have contact with health care professionals outside the home, particularly psychology and psychiatry. The home ensures that all appointments are recorded, and service users are offered support to attend appointments if required. The home supports service users with medication. All staff receive regular medication training. The medication file contains details on all prescribed medication, including any possible side effects. Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 Page 15 Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 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 the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be confident their views are listened to and acted upon. Service users can be confident that they are protected from harm. EVIDENCE: Conversation with a service user evidenced adequate knowledge of the homes complaints procedure. He demonstrated an awareness of roles within the home and within the organisation, and gave examples of whom he would talk to should he have a complaint. Service users are encouraged to give feedback on the service they receive. All service users have monthly 1-1 keywork meetings in which they are asked if they have any concerns. The manager operates an ‘open door policy’. It was observed during the inspection that service users feel able to talk with the manager about issues concerning them and others at the home. Staff spoken with displayed adequate awareness of adult protection issues. All staff receive training on adult protection. Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 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 the following standard(s): 24 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a homely and comfortable environment, but would benefit from some parts of the home being redecorated. Service users benefit from living in a clean and hygienic environment. EVIDENCE: The inspector spoke to service users about the environment they live in. All service users expressed satisfaction with the home, and told the inspector that they enjoyed living at Ruby Lodge and that it felt ‘like home’. Ruby Lodge is homely, comfortable and clean. Service users were observed to be relaxed and comfortable in the home, and comments from service users clearly indicated that they felt happy. A tour of the communal areas evidenced some shortfalls. The walls of the smoking room were stained and could do with redecoration. The kitchen floor is uneven and as such is considered a hazard. The flooring in the kitchen is stained. Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 Page 18 A cupboard door in the kitchen is not secure. Wallpaper in some areas of the lounge is discoloured and is peeling from the wall. The downstairs shower room has mouldy sealant around the base of the shower and in the tile spaces. An upstairs bathroom has a broken chest of drawers in it. The bathroom also has wallpaper peeling off the walls and stained flooring. An upstairs toilet has lino tiles, some of which are coming off the floor. The toilet seat was dirty. The registered provider and the registered manager are aware of the above shortfalls and have a maintenance programme in place. The inspector was informed that all maintenance issues should be addressed by November 2006. Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 34. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are supported by competent staff. Service users are supported and protected by the home’s recruitment policies and practice. EVIDENCE: Staff spoken with during the inspection displayed adequate knowledge of their roles within the team, and their responsibilities with regard to supporting service users. The new care planning and risk assessment tools have provided clarity for staff, and serve as a working tool enabling staff to support service users. Staffing hours have been increased. There was evidence to demonstrate that service users are being actively encouraged and supported to learn or regain skills in independent living. Staff demonstrated knowledge of individuals mental health needs. They displayed a sensitive and individual approach to service users, particularly service users experiencing a relapse in their mental health. Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 Page 20 The inspector was unable to fully judge whether staffing levels are adequate to meet the needs of the service users. Once all service users needs have been reassessed, and their care plans and risk assessments are updated, a true picture of ratios of staff to service users will emerge. This will be fully inspected at the next visit. Samples of staff files were inspected. All files complied with Schedule 2, and the home could demonstrate that their recruitment practice was robust and protected service users. Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 39. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a well run home. Service users can be confident that their views underpin all self-monitoring, review and development by the home. EVIDENCE: Welcome House have worked hard to developed and improve the way in which service users are supported to lead valued and fulfilling lives. Most notably, improved documentation and information in the way of pre-assessment, assessment, care planning, risk assessment, and quality audit documentation have been successfully implemented and demonstrate Welcome House’s commitment to providing a service which meets the needs of the service users. The manager was knowledgeable and enthusiastic about the new systems in place. She was confident that this approach to care planning and risk assessment would enhance the lives of service users. Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 Page 22 The Regulation 26 monitoring form (‘internal home audit form’) gathers information on working practice within the home, and policy and procedures. Information read in the May 2006 internal home audit form evidenced a comprehensive system of ensuring standards are met, while at the same time including views and opinions of service users. The audit form would benefit from including an ‘action by’ column, and for completion of the action to be dated and followed up at the next month’s audit. Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 X 3 X 3 X X X X Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 Page 24 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. Standard Regulation 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 3 4 Refer to Standard YA2 YA6 YA9 YA24 Good Practice Recommendations Ruby Lodge completes its re-assessment of service users by July 31st 2006. Ruby Lodge completes care planning for all service users by 30th September 2006. Ruby Lodge completes all risk assessments for service users by 30th September 2006. Ruby Lodge supplies the Commission with a programme of maintenance. Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Welcome House - Ruby Lodge DS0000023771.V300298.R01.S.doc Version 5.2 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. 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. 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