Care Home: Lower Ridge HFE

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What the care home does well There was useful written information about the residents and the care they needed, how this care should be provided, and also about the preferred daily routine. This was detailed and provided staff with the right information that they needed to help them make a decision about whether or not Lower Ridge was the right place for them to live. The written information about the care needs of the residents and how staff should look after people was detailed and covered all the relevant matters. This provided staff with useful information to help them look after people. Residents were well cared for, and had all the health care they needed. Residents spoke positively about the care in the home. People said, "we`re very well looked after" and "the staff are kind and patient". All the residents who completed the questionnaires said that they always had medical attention when needed. Catering arrangements were good with choices and alternatives offered at every meal. Residents spoken with thought the meals were `very good`.People were satisfied with the leisure activities available in the home, and those who completed questionnaires said there were always suitable leisure activities. Concerns were taken seriously and people knew what to do if they were not happy with any aspect of the service. The staff training and the home`s policies and procedures helped protect residents from abuse. The home was decorated, furnished and maintained to a satisfactory standard. There were a number of different lounges, including a smoking lounge, and a conservatory, so residents had a good choice of where to sit. There was a pleasant enclosed garden area at the back of the home where residents could enjoy sitting in warm weather. The standard of training, and commitment of the home to training, was good. A very high proportion of staff consistently have the right qualifications for looking after older people. There was a member of the management team on duty at all times, and staff also benefited having an area manager who visited the home every month to check how the home was running. Residents had good opportunities to give their views about the home and influence the service provided. There were regular residents meetings and residents had the opportunity of completing questionnaires every 6 months. All residents spoken with and those who completed questionnaires felt that staff listened to them and acted on what they said. The residents` "spending money" kept in the home was managed safely, and good records were kept of money given to residents and spent on their behalf. Health and safety policies and practices made sure that the home was a safe place for the residents and staff. What has improved since the last inspection? The way that residents were admitted to the home had improved so that the manager made sure people`s needs were assessed before being admitted and that staff had a better understanding of what they had to do to look after people. The written information about the care people needed and how they preferred their care to be given had improved (see above). There was a lot more useful information about people`s preferences, interests and spiritual needs. All relevant sections were completed. Some aspects of the way residents` medication was managed and administered had improved and made the procedures safer so that residents were more likely to receive the correct medication at the right time. The heating and the hot water supply in one bedroom had improved and was now more comfortable in this respect for the resident concerned. Also table lamps had been provided to residents who said they wanted one. What the care home could do better: Some aspects of medication management could be further improved to ensure safer administration of medicines to residents. For example the recording of the administration of controlled drugs should be accurate to help ensure that residents are given this medication correctly. Also residents must be given their medication at the correct time in relation to food as not doing this can affect the way the medicines work. Some relatives felt that communication between the home and them-selves could be better. One person felt that they were not informed of falls and accidents and one felt there could be better communication about relative`s needs prior to visiting. Some parts of the environment could also be further improved. There was some unsightly damage to the doors caused by wheelchairs and the odour in some bedrooms was unpleasant and this must be eliminated. This was a problem at the last inspection and should be urgently addressed. A relative also felt that the home needed new furniture and carpets in some areas. Lancashire Count Care Services should make sure there are always enough staff on duty to meet the assessed needs of the residents. The way staff were recruited to work in the home could be improved to help ensure that residents are protected from unsuitable staff. References must always be sought from employers and people who are not friends, so that a truer picture can be formed about whether or not people are suitable for working in the care home. The Commission should be notified of all incidents and accidents affecting the well being of the residents so that these can be monitored. CARE HOMES FOR OLDER PEOPLE Lower Ridge HFE Belverdere Road Burnley Lancashire BB10 4BQ Lead Inspector Mrs Pat White Key Unannounced Inspection 09:30 31st October 2007 X10015.doc Version 1.40 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 Lower Ridge HFE DS0000035131.V346731.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 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. Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lower Ridge HFE Address Belverdere Road Burnley Lancashire BB10 4BQ 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) 01282 429020 01282 457245 Lancashire County Care Services Miss Eunice France Care Home 35 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (5), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (1), Old age, not falling within any other category (35) Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the overall total of 35 the service is registered to accommodate: up to 35 service users over the age of 65 years (OP); up to 5 service users in the dementia (DE) category; 1 named service user in the category Mental Disorder over the age of 65 years (MD(E)) 25th October 2006 Date of last inspection Brief Description of the Service: Lower Ridge is registered with the Commission for Social Care Inspection to provide personal care and accommodation for thirty- five older people. The home is owned by Lancashire County Council and managed by Lancashire County Care Services. The property is a three storey building set back off a main road and on a bus route to Burnley. There are gardens to the side and rear. The garden at the rear has decking and raised flowerbeds for the residents to enjoy. Accommodation is offered in single bedrooms and there are a number of lounges. There is a conservatory, a visitor’s room and a treatment room. A passenger lift links the 3 floors. There were sufficient bathrooms and toilets, and various equipment was provided throughout the home to assist residents to be independent. The home had a Statement of Purpose and a Service User Guide providing information about the care provided, the qualifications and experience of the owner and staff and the services residents can expect if they choose to live at the home. The fees charged are £320 - £360 per week for care and accommodation, with extra charges for hairdressing, chiropody, toiletries and papers and magazines. Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection site visit was carried out on the 31st October 2007. The site visit was part of an inspection from which an overall assessment on the quality of the services provided by the home was determined. This included checking important areas of life in the home that should be checked against the National Minimum Standards for Older People, and checking the progress made on the matters that needed improving from the previous key inspection. The inspection included: talking to residents, touring the premises, observation of life in the home, looking at residents’ care records and other documents and discussion with the registered manager. Six residents spoken with gave their views on the home. In addition survey questionnaires from the Commission were sent to residents, relatives, staff and health professionals asking them for their opinion of the home. Seven residents, four relatives and three members of staff returned these questionnaires. Some of the views of these people are included in the report. In addition the home provided the Commission with written information about the residents, staff and services provided, and some of this is also included in the report. What the service does well: There was useful written information about the residents and the care they needed, how this care should be provided, and also about the preferred daily routine. This was detailed and provided staff with the right information that they needed to help them make a decision about whether or not Lower Ridge was the right place for them to live. The written information about the care needs of the residents and how staff should look after people was detailed and covered all the relevant matters. This provided staff with useful information to help them look after people. Residents were well cared for, and had all the health care they needed. Residents spoke positively about the care in the home. People said, “we’re very well looked after” and “the staff are kind and patient”. All the residents who completed the questionnaires said that they always had medical attention when needed. Catering arrangements were good with choices and alternatives offered at every meal. Residents spoken with thought the meals were ‘very good’. Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 6 People were satisfied with the leisure activities available in the home, and those who completed questionnaires said there were always suitable leisure activities. Concerns were taken seriously and people knew what to do if they were not happy with any aspect of the service. The staff training and the home’s policies and procedures helped protect residents from abuse. The home was decorated, furnished and maintained to a satisfactory standard. There were a number of different lounges, including a smoking lounge, and a conservatory, so residents had a good choice of where to sit. There was a pleasant enclosed garden area at the back of the home where residents could enjoy sitting in warm weather. The standard of training, and commitment of the home to training, was good. A very high proportion of staff consistently have the right qualifications for looking after older people. There was a member of the management team on duty at all times, and staff also benefited having an area manager who visited the home every month to check how the home was running. Residents had good opportunities to give their views about the home and influence the service provided. There were regular residents meetings and residents had the opportunity of completing questionnaires every 6 months. All residents spoken with and those who completed questionnaires felt that staff listened to them and acted on what they said. The residents’ “spending money” kept in the home was managed safely, and good records were kept of money given to residents and spent on their behalf. Health and safety policies and practices made sure that the home was a safe place for the residents and staff. What has improved since the last inspection? The way that residents were admitted to the home had improved so that the manager made sure people’s needs were assessed before being admitted and that staff had a better understanding of what they had to do to look after people. The written information about the care people needed and how they preferred their care to be given had improved (see above). There was a lot more useful information about people’s preferences, interests and spiritual needs. All relevant sections were completed. Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 7 Some aspects of the way residents’ medication was managed and administered had improved and made the procedures safer so that residents were more likely to receive the correct medication at the right time. The heating and the hot water supply in one bedroom had improved and was now more comfortable in this respect for the resident concerned. Also table lamps had been provided to residents who said they wanted one. 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 summary of this inspection report can be made available in other formats on request. Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 & 5. Standard 6 is not applicable Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s admission procedures, including a comprehensive pre admission assessment of prospective residents’ needs for care and support, helped to ensure that the home could meet people’s needs. EVIDENCE: The home had a Statement of Purpose and Service User Guide to inform people about the home, and this was found to contain all the information needed and recommended by the guidelines. In the questionnaire surveys residents said they had received a contract with information about the terms and conditions and had enough information about the home. Relatives in general also felt they had enough information about the home to help them make decisions. Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 10 The records of two recently admitted residents, and discussion with the manager, confirmed that these people’s needs had been assessed prior to admission and that copies of a detailed comprehensive social work assessment had also been obtained before or soon after admission. The manager visited people if possible to carry out the pre admission assessments and relatives and prospective residents could visit the home. These procedures helped to make sure that people’s needs could be met within the home. However some of the falls risk assessments seen did not included strategies for eliminating or minimising the risks. Residents spoken with said there needs were met and that they were well looked after. Staff also had the necessary qualifications to assist them to look after older people and also had the opportunity to undertake training in dementia awareness in order to help them to understand the specific needs of those residents with dementia. In the questionnaire surveys all the residents said that they always received the care and support they needed and one relative said that Lower Ridge always met the needs of their relative and the different needs of individuals. However relatives said their relative’s needs were only “usually” met and one said the home “never” met the needs of the resident concerned. Relatives felt that the home “usually” met the individual diverse needs of the residents. The three staff who completed questionnaires said they “usually” had the right support and experience to meet the diverse needs of individual residents. Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of the residents were met, and in general the medication procedures and practices ensured the safe adminsitration of medication. The residents’ rights to privacy and dignity were upheld. EVIDENCE: All residents had care plans, and these had considerably improved since the previous inspection. They now contained detailed useful information about all relevant matters to assist staff understand the care and support required and how people preferred to be looked after. There was a useful section called daily living plan which gave information about residents preferred routines and likes and dislikes. The care plans had useful information about moving and handling requirements and appropriate risk assessments for nutrition and pressure areas. However not all the risk assessments for falls viewed included strategies to manage and minimise this risk. There was evidence that the care plans had been reviewed and updated appropriately. The use and need for bedrails were also assessed and reviewed by the District Nurses. Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 12 Records viewed, discussion with the manager and the questionnaire surveys showed that residents received the health care they needed, including mental health support, and support from the District Nurses for the care of pressure areas. In the questionnaire survey all seven residents stated that they always received the care and support they needed and that staff were either always or usually available when needed. All the residents said that medical support was “always” available when needed. Two relatives said that the home usually gives the care and support that they expected and agreed. Residents’ medication in general was managed and administered safely, and a number of legal requirements from the previous inspection had been met. The home had comprehensive policies and procedures that covered all the necessary parts of medication management, and a number of good practices were followed: Accurate records of medication entering and leaving the home were kept, staff verified the medication with the GP when people were admitted and prescriptions were checked at the home prior to dispensing. The area manager carried out unannounced audits on the medication management of the home. These were recorded and showed that they were useful in ensuring the systems remained safe. At the time of the inspection staff responsible for administering medication had undertaken suitable training. However a few improvements could be made. In the Controlled Drugs register the administration of a tablet the previous evening had not been recorded though it had been recorded on the MAR sheet. Some entries on another page in the Controlled Drugs register had not been completed accurately which made it difficult to follow and check. Also for one resident whose medication was checked there was evidence that two medicines were not always being given at the right time in relation to food intake and this could reduce the effectiveness of the medicines and put residents at risk. Also at the time of the site visit two people were administering medication, one was taking the medication from the containers and signing the MARs and another was taking the medicines to the residents. This potentially could lead to mistakes being made, such as medication being given to the wrong person. Residents spoken with said that staff treated them appropriately and respected their right to privacy, such as being able to stay in their bedrooms if they wished, including having their meals there. Residents said that staff carried out personal care in a way that respected their dignity. Staff were observed treating residents respectfully and kindly. However one relative who completed the questionnaire felt that the resident concerned was not always treated with respect and that care staff could be abrupt. Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were varied leisure activities which appeared to suit the needs and preferences of the majority of residents. Residents had sufficient choices in their everyday lives and were enabled to maintain contact with their relatives and the community. The food served was wholesome and varied and met the needs and the preferences of the residents. EVIDENCE: Some routines were flexible to suit individual preferences. Residents confirmed that they could go to bed and get up when they wanted and sit wherever they wanted, including the designated smoking lounge. Useful information about preferred routines and spiritual needs were recorded on the care plan. Activities listed on the notice board, and the information supplied by the home, included music sessions, bingo, entertainers, dominoes, quizzes and gardening in the home’s sensory garden. Some residents spoken with said they enjoyed the activities. Two residents said they enjoyed a summer outing and were looking forward to a trip to Blackpool Illuminations. In the questionnaire survey all residents who completed a questionnaire said that there were suitable activities. Church Ministers visited the home and there was evidence that residents were supported to continue practicing their faith. Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 14 Visitors were welcome in the home at any reasonable time but of the three relatives who completed questionnaires two said that they felt that communication about important matters between the home and them-selves could be improved. Residents had some choices (see above), and which included choices of meals. Residents could also smoke in the smoking lounge. Most residents had brought small items of furniture from home to personalise their rooms. Residents could bring their own bed from home. Some residents managed their own finances and were assisted by staff to do this. Discussions with residents, and the menus viewed, showed that the food served was wholesome, varied and nutritious. All residents spoken with praised the food. Comments were made, such as the food was good, and I enjoy the food. In the survey questionnaires most residents said they usually enjoyed the food and two said they “always” did. However in conversation some residents said they were not hungry at lunch – time and this could be as a result of meals being served too close together (see below). A cooked breakfast was served every day and a snack meal was served at lunchtime when there was a choice of hot and cold snack dishes, such as soup and sandwiches, and a choice of desserts. The main meal was served in the evening and there was a choice of two cooked dishes. The cook knew people’s likes and dislikes and changed the menus every few weeks according to residents’ preferences. However at the time of the site visit it was observed that breakfast was served relatively late in the morning and lunch and tea served relatively early, so that the 3 meals were served in a short time span. It was also observed that the evening meal was served about an hour earlier than the time stated in the Statement of Purpose. Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The local authority complaints procedure was available to residents and visitors, and residents stated that they knew who to speak to if they had any concerns. There were satisfactory policies and procedures to protect the residents from abuse. EVIDENCE: The home had a Local Authority complaints procedure which was in the Service User Guide and accessible to residents and relatives. On the survey questionnaires residents said that they knew how to make a complaint and who to speak to if they were not happy. Of the relatives who completed a questionnaire three stated that they knew how to make a complaint and one said they were not. There were no recorded complaints since the previous inspection and none had been made to the Commission about the home. Residents spoken with at the time of the inspection stated they had no complaints and knew who to speak to if they were not happy with any aspect of their care. There were appropriate policies and procedures and staff training to help protect residents from abuse. There had been no recent allegations or suspicions of abuse. Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was satisfactorily maintained and furnished and provided pleasant, comfortable, accommodation. The residents’ rooms were comfortable and personalised and suited their needs. However there was an ongoing problem with unpleasant odours in some bedrooms. EVIDENCE: Lower Ridge is a purpose built residential home near to Burnley town centre. The property is a three storey building set back off a main road and on a bus route to the town centre. There was a passenger lift linking the 3 floors. There were gardens to the side and rear in which residents could walk. There was an enclosed garden at the back of the home with scented plants, decking and raised flowerbeds. It was safe for all residents, including those with dementia, to walk out freely and enjoy this area without staff having to escort them. There was a choice of communal areas, including six lounges, one of which was a smoking lounge, and a conservatory. There was also a large separate dining area. Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 17 General maintenance was carried out by Lancashire County Care Services, and this ensured that jobs were carried out as prioritised. A fire sprinkler system had been installed and a previous requirement to improve the heating and hot water system in on of the bedrooms had been met. The home was furnished to a satisfactory standard, though a number of the doors and doorways throughout the home had noticeable damage from wheelchairs and at least one relative felt that some carpets and furnishings in the communal areas needed replacing. Most of the bedroom furniture was modern, tasteful and in good condition and since the last inspection, bed - side lights had been made available for those who wanted them. The bedrooms were all tastefully decorated and some carpets had been replaced with easy to clean but fashionable wooden floors, to minimise odours. However a number of bedrooms still had unpleasant odours. Residents said they liked their bedrooms. They could lock their door safely, and those who could manage a key were provided with one. All rooms were fitted with a call bell to summon staff help, but extension leads were missing from the call bells in some bedrooms so the residents may not be able to call for help whilst in bed. Bathing facilities were satisfactory, and hot water taps had safety valves fitted to prevent residents being accidentally scalded. Hot water temperatures were tested at random outlets and found to be within an acceptable range. All radiators throughout the home were covered with protective guards. Laundry facilities and procedures were good, and the laundry was equipped with washing machines designed for heavy soiling and infection control. Two laundry assistants were employed and ensured the laundering was of a good standard. In general the home looked clean throughout at the time of the site visit, but as stated above several bedrooms had unpleasant odours. Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 18 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff had the necessary qualifications, skills and training to assist them look after the residents, but were not always in sufficient numbers. Staff recruitment and selection procedures help to ensure that suitable people worked in the home, but did not fully comply with the Care Homes Regulations. EVIDENCE: At the time of the site visit there was evidence from the rotas and talking to staff that there had been some difficulties in maintaining the assessed staffing levels needed. Some domestic staff had been on long term sickness absence and there was a problem with short notice absences of care staff, particularly in the evening, and when shifts were not always filled. This was the case on the day of the site visit. Whilst there was no evidence that the needs of the residents were not being met, there was evidence from conversations with staff and from the staff questionnaires that staff felt sometimes there were not enough staff on duty, and felt under pressure to work extra hours to fill shifts. This matter was also raised at the previous inspection. All those residents spoken with stated that they felt well looked after, but one resident who completed a questionnaire said that staff were only sometimes available when needed. Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 19 At the time of the site visit all the care staff at Lower Ridge had relevent National Vocational Qualifications for working with older people. Staff training records were kept according to requirements. These records, the staff questionnaires and discussion with staff, showed that staff had completed other training in accordance with Government guidelines and that staff felt sufficiently trained for their work. This training included dementia awareness, infection control, and medication. There was a rolling programme of training in moving and handling, food hygiene and fire safety. Staff records showed that staff recruitment procedures should help protect residents from unsuitable staff and that staff were not commencing work in the care home until all the police checks had been undertaken. However these procedures and record keeping for this process could be further improved. One reference for one recently appointed member of staff was from a friend and not a previous employer, even though a full employment history had been given. Another member of staff whose records were viewed had transferred from another post within Lancashire County Council Care Services but the records kept at Lower Ridge were incomplete. There was no evidence of the police checks that had been undertaken and no training records. Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 20 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was managed by an experienced and qualified manager who was well supported by an area manager. Quality assurance policies and procedures were implemented which took into account the views of residents and relatives. Residents money was managed safely and efficiently and the health and safety of both residents and staff were promoted. EVIDENCE: The registered manager was experienced and had completed the Registered Managers Award. She had worked as the manager at Lower ridge for about 5 years and had many years employment with Lancashire County Care Services. She had also completed a professional trainers qualification. An area manager undertook monthly unannounced monitoring visits as required under Regulation 26 of the Care Homes Regulations. Staff spoken with and those who completed the staff questionnaires felt adequately supported in their Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 21 work. Senior staff were available on a day to day basis for supervision and support of care staff, and met with them in one to one structured sessions to assist people to improve and develop. The home carried out the Local Authority’s quality monitoring policy. Residents and relatives’ questionnaire surveys were undertaken every 6 months to ensure the views of the residents were used to develop the service. The results of these surveys were analysed at head office and an action plan devised. On the information supplied to the Commission there was a high level of satisfaction with all aspects of the service. In addition residents meetings were held about every 6 weeks, and these were now based around themes. One had recently been held about how dignity is promoted within the home. In the questionnaires residents said that they felt staff listened to them and acted on what they said. Residents’ money was managed safely. Those residents who were able managed their own spending money. The spending money of some residents was managed by staff, and stored securely and separately in the home’s safe. Appropriate records of receipt of money, that given to residents, spending/withdrawals on residents’ behalf and the balance remaining were kept . A spot check showed that the amount of the money in the safe balanced with the amount on the records. Recipts of items purchased were kept. The home provided a safe environment for residents and staff. The information supplied to the Commission prior to the site visit and records kept in the home showed that all appliances, installations and equipment had been serviced and maintained appropriately. There had been a recent fire safety inspection and some recommendations were made. These will be addressed by the departments Health and Safety section. The maintenance and testing of the fire equipment was satisfactory and appropriate fire records were kept. Hot water was tested at random and found to be at a safe temperature and radiators and pipes were covered. Staff undertook appropriate training in health and safety, including training in infection control, first aid, food hygiene and moving and handling. Accidents, including falls, were recorded and monitored appropriately by head office. However the Commission was not notified of all deaths and other “notifiable incidents” under the Care Home Regulations, for example admission to Accident and Emergency. Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 22 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X 2 3 3 2 STAFFING Standard No Score 27 2 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 X X X X 3 Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 23 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 1. OP8 13(4)(b) When risk assessments are 07/12/07 (c) undertaken re the risk of falling, appropriate management strategies must be identified for the reduction or elimination of the risk. 2. OP9 13 (2) Medication must always be given 30/11/07 at the correct time in relation to food intake to ensure the medication is as effective as possible. 3. OP23 23 (2)(n) All residents must have access to 07/12/07 a call bell whilst in bed so that they can summon staff if need be. 4. OP26 16(2)(k) All areas of the home must be 07/12/07 kept free from offensive odours. (Previous timescale of 30/11/06 not met) 5. OP27 18 (1)(a) There must be sufficient staff on 21/12/07 duty at all times in accordance with the assessed needs of the residents. 6. OP29 19 (1) With respect to staff recruitment 07/12/07 Schedule procedures, references must be 2 sought from previous employers if at all possible, not friends, and all records (including the CRB check and proof of qualifications/training) according to schedule 2, or details of these records, must kept in the care home. Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 24 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 OP9 OP9 Good Practice Recommendations Both the Controlled Drugs register and the Medication Administration Record sheet should be signed when the controlled drug is administered. The practice of different members of staff giving out medication and signing the Medication Administration Record sheets should cease to prevent mistakes from occurring. Communication between the home and some relatives should be improved so that relatives are kept informed of important matters regarding the residents concerned. The timing of the meals served should be reviewed with residents to see if the meals need to be spaced out more so that residents are more ready for lunch and tea. All parts of the home should be in a satisfactory state of maintenance and repair including the doors and the doorframes. The registered person should ensure that the Commission is notified of all “Notifiable Incidents” according to the Care Homes Regulations so that these can be monitored. 3. 4. 5. 6. OP13 OP15 OP19 OP38 Lower Ridge HFE DS0000035131.V346731.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Lower Ridge HFE DS0000035131.V346731.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. 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