Care Home: Ranmore House

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What the care home does well The home provides a safe and comfortable environment for residents to live. The standard of cleanliness is excellent, and the home has a spacious and airy atmosphere. Good care plans that are person centred, outline the support required and reflect changing needs and goals. These are updated daily and reviewed frequently. The medication policy in place is safe and ensures that residents receive their medication as prescribed. The residents benefit from excellent leisure activity arrangements. Individual activities reflect choice, hobbies, and interests. Residents were keen to share photographs of various events and activities with the inspector. Staff support residents to follow a healthy eating routine and help them to plan menus, and meals out. The staff team have the skills and qualifications necessary to meet the needs of the residents. The staff recruitment procedure in place protect the residents living in Ranmore House. The home is well managed in the best interest of the residents. The health, safety and welfare of the staff and residents are promoted and protected. What has improved since the last inspection? The requirements and recommendations made at the last inspection have been met. All staff have undertaken training in safeguarding adult procedures. Mandatory training is ongoing with health and safety training planned fot the week following the inspection. Systems are in place for the monitoring of quality assurance, including resident and relative surveys. A risk assesmnet has been put in place for two uncovered rediators identified at the last visit. Pre admission assessment forms have been implimented as an assessmnet tool. The financial support required by residnets has now been included in care plans that are also signed. What the care home could do better: The home has identified specific areas of the premises that require redecorating or repair. The manager stated that this has been scheduled to take place when the residents go on holiday later in the year. There are no requiremnets as an outcome of this inspection. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ranmore House 12 Fir Tree Road Banstead Surrey SM7 1NG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mary Williamson     Date: 0 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Ranmore House 12 Fir Tree Road Banstead Surrey SM7 1NG 01737379481 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): ranmorehouse@tiscali.co.uk Mr Maithri Krishantha Jayawardana,Mr Ranjith Hikkaduwa Liyanage care home 5 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 5 The maximum number of service users to be accommodated is 5. The registered person may provide the following categories of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD) Physical Disabilities (PD) Date of last inspection Brief description of the care home Ranmore House is a five bedded detached property situated in Banstead, Surrey. The service is registered to provide 24-hour residential care for five adults with learning disabilities. The accommodation is provided on two floors with five single bedrooms, one of which has en-suite facilities. The living area consists of two lounge/dining areas, which provide quiet areas for service users to spend time in if they wish. The service has a well-maintained and secure garden to the rear. There is ample car parking to the front of the premises. Care Homes for Adults (18-65 years) Page 4 of 28 Brief description of the care home The weekly fees range from £743 to £1298. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The star rating for this service is a TWO star rating. This means that people who use the serviceexperienxe GOOD quality outcomes. This was the first site visit of a key inspection and was unannounced. Mary Williamson Regulation Inspector carried out the inspection over a period of four and a half hours. Mr Liyanage one of the providers was present for the duration of the inspection and Mr Jayawardana was present for the feedback. The people who live in Ranmore House prefer to be called residents, which is the term used throughout this report. Care Homes for Adults (18-65 years) Page 6 of 28 A tour of the premises was undertaken and records relating to the care of the residents and the management of the home were examined. These included care plans, risk assessments, medication records, menus, staff employment files, training profiles, and health and safety procedures. It was possible to meet all the residents and talk with some in more detail than others. It was also possible to have discussions with the staff on duty and gain some feedback on their experiences about working in the home. An Annual Quality Assurance Assessmnet (AQAA) was completed by the service and submitted to The CQC prior to the inspection. This provided us with detailed information regarding the home and some numerical information we also require. The CQC would like to thank the residents, and staff team for their assistance and hospitality during this inspection. What the care home does well: What has improved since the last inspection? What they could do better: The home has identified specific areas of the premises that require redecorating or repair. The manager stated that this has been scheduled to take place when the residents go on holiday later in the year. There are no requiremnets as an outcome of this inspection. Care Homes for Adults (18-65 years) Page 8 of 28 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have the information they need to help them make a decision about where they live. All residents have a needs assessment undertaken prior to admission to establish if the home is suitable to meet their individual needs. Contracts of occupancy are in place for all residents living in the home. Evidence: All residents have access to a statement of purpose and service user guide prior to admission. This provides them with appropriate information to help them make a choice about living in the home. This is also available in picture format. Relatives and advocates also have access to this information. Full needs assessments are undertaken on all prospective residents to establish if the home and the resources available can meet their individual needs. This assessment is undertaken by the manager and discussed with the staff team prior to a decision being made. The current group of residents have been living in the home for several years Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: and there have been no new admissions since the last inspection. The manager demonstrated a new admission format he developed as a recommendation from the last inspection. This is detailed and includes all the required information necessary to make a professional decision. Individual contracts of occupancy are in place. These outline the accommodation offered, the care provided, the fees payable and the method of paymnet. Care Homes for Adults (18-65 years) Page 12 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Well maintained care plans that are person centred, and reflect residents needs and personal goals. Residents are supported to make choice regarding all aspects of their daily lives. Good risk assessments promote independence both within the home environment and community based avtivity. Evidence: Residents are encouraged to make decisions regarding their daily lives. On arrival in the home the inspector observed staff supporting residents planning their day, which included a wide range of activity. A resident stated that he chooses to go to bed fairly early when he attends the activity centre and can stay up late when he has days off. He said he plans the television programmes he watches, and what he wears. All residnets have a choice of menu, what activities they undertake, and can decide when they get up and go to bed. They are also supported to manage their own financial affairs when appropriate. Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: Risk assessmnets are in place for all identified risks and form part of the care plan. These include activities in the home and community participation. Risk assessmnets in place do not restrict residents and are designed to promote independence. Care Homes for Adults (18-65 years) Page 14 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to take part in appropriate activities that meet their assessed needs. Family and community links are maintained, and diverse needs of residents are supported. The dietary needs of residents are met, and they are offered a menu that is nutritious and flexible to meet their individual lifestyles. Evidence: Individual activity programmes are in place and forms part of the care plan. Some residnets attend structured activities during the week at local day centres or college. Two residents and two staff were planning a boat trip that day on the River Thames to include Hampton Court. They were looking forward to the trip. One residnet was able to show the inspector photographs of his recent birthday party which we had enjoyed. Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: More residnets were planning a trip to the local shop to buy the radio times, and one was planning to post letters. An example of activities include, aromatherapy, trampoline, hand massage, foot massage, visits to the cinema, watching television and videos, music therapy, and gardening. Residents told the inspector that they were planning a holiday later in the year to Centre Parks. Relatives and visitors are welcome in the home at any reasonable time. Relatives participate reviews of care and attend home functions and parties. Relative meetings take place and the manager stated that he is in regular conract with relatives by email or telephone and that they are consulted in home decisions. Diverse needs of residents are addressed and spiritual needs supported. One resident stated that he attends Mass every Sunday and that staff help him to do this. Menus are planned by residents and staff taking into account individual likes, dislikes, and dietary needs. A sample of these menus were seen and the food offered is wholesome, nutritious and varied. Meal times are flexible to accommodate residnets lifestyles. A residnet was having a late breakfast following a lie in. The main meal is usually served in the evening although a residnet stated that they all enjoy a Sunday lunch. Some residents are encouraged to help in the kitchen. All staff working in the home have a current food hygiene certificate. There is also access to a dietician, and special diets including cultural needs can be catered for if required. Care Homes for Adults (18-65 years) Page 16 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive personal support in a way they prefer and require. Appropriate arrangements are in place to meet the health care needs of the residents. The medication policy in place protects the residents living in the home. Evidence: Staff provide flexible personal support for residents as agreed and outlined in individual care plans. Privacy and dignity is observed and a resident stated that he did not mind if a carer was male or female. All the residents were very well groomed and well cared for. All residents are registered with a local GP and can arrange appointments when necessary. All care needs are identified and outlined in health action plans. The manager also stated that they can access chiropody treatment, dental care, psychology support and the support of the district nurses when required. Specific behaviour therapy progremmes are overseen by the psychologist regularly. The home has a medication policy in place and all staff that administer medication are Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: familar with this policy. All staff undertake medication safety awareness training prior to undertaking this procedure. Lloyds pharmacy in Epsom provide the medication for the home. They also undertake regular audits of medication. The medication recording charts were seen and are well maintained. Medication is stored safely. Currently there are no residents in the home that self medicate. Care Homes for Adults (18-65 years) Page 18 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure and the safeguarding vulnerable adult procedures in place protect the residents living in the home. Evidence: The home has a complaints procedure in place. This forms part of the service users guide available to all residents and their relatives on admission to the home. This is also available in picture format. There have been no complaints received since the last inspection undertaken in April 2007. The home has a safeguarding vulnerable adults procedure in place. Since the last inspection all staff have undertaken training in this procedure and certificates are in place on staff training files to support this. During discussion with staff it was evident that they were aware of this procedure and would not hesitate to implimet these procedures if an allegation of abuse had taken place. The home also has a copy of Surreys Multi Agencies Policies and Procedures on Safeguarding Vulnerable Adults in place and the manager has attended training in these procedures. There are currently no referrals in place using these procedures. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is suitable for its stated purpose. Residents live in a safe and comfortable environment. Communal facilities are excellent, providing residents with ample space to meet their assessed needs. Bedrooms suit individual lifestyles. The standard of cleanliness and hygiene is good. Evidence: A tour of the premises was undertaken and residents invited the inspector to viwe their bedrooms. The home is spacious, well presented, comfortable and homely. There is ample communal space provided including a large lounge, large dining room and leisure room all well equipped and furnished to a good standard. Residents bedrooms are comfortable and there is an ongoing maintenance programme in place to address repairs and wear and tear issues associated with individual behaviour patterns. The manager stated that plans are in place for the refurbishment of bedrooms and bathrooms in October when the residents are on holiday. There is a well maintained secure garden located to the rear of the home with a garden house, trampoline, swing chair,and garden furniture for residnets recreation. The home also has its own transport for residents use and parking facilities at the front Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: of the home for this. The home is clean and odour free and residnets are encouraged to help maintain their own bedrooms whenever possible. The laundry is well equipped and there is also an infection control policy in place. Two residents stated that they are satisfied with the facilities available in the home, and that they liked their bedrooms. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by a competent and skilled staff team in sufficient numbers to meet their assessed needs. The staff recruitment procedure protects the residents living in the home. Evidence: Staff are employed in sufficient numbers with the skill necessary to meet the current residents assessed needs. There are a minimum of two staff on duty throughout the day with additional staff allocated for specific activities, appointments and outings. Staff training is ongoing. All staff undertake induction training and this is recorded on staff pesonal development files. Mandatory training is monitored and updated when required. Currently 70 of the staff are studying for or have achieved NVQ Level 3. Staff confirmed the training they had undertaken during individual discussion. They also demonstrated a sound knowledge of residents needs, and the communication skills and observation skills used to interact effectively. Staff have formal supervision every eight weeks. Records are retained on file for information. The home has a staff recruitment procedure in place. All staff complete an application Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: form, and attend an interview. Two written references, an employment history, and a Criminal Records Bureau (CRB) disclosure are in place prior to commencement of employment. The staff employment files seen are well maintained and included all the required documentation. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well managed home. Appropriate quality assurance systems are in place to monitor outcomes for residents. Policies in place promote the health, safety, and welfare of the residents, and staff. Evidence: The home is one of two services owned by Mr. Jayawardana, and Mr Liyanage. They are both qualified learning disability nurses, with considerable experience between them. Mr Jayawardana is the registered manager, and plans are in place for Mr Liyanage to become registered so they each manage a service. The home is well managed and there are good lines of communication and and management support in place including sound arrangements to cover days off and holidays. The home operates an open and inclusive atmosphere with residents and relatives involved in decisions regarding the home and outcomes for residents. Quality assurance is monitored and quistionnaires are distributed to residents and relatives for comments. Feedback is acted upon and changes made when necessary. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: Outcomes are retained on file for information. Residents meetings, relative meetings and general audits of care, medication, health and safety,catering, and housekeeping are undertaken as part of the quality assurance process. The home has a policy in place that promotes the health, safety, and welfare of the residents and staff. All staff undertake mandatory training in health and safety policies and procedures. The manager stated that a health and safety training course had been arranged for the 16/04/2009 following this inspection. Fire safety is observed and all staff are instructed in fire safety awareness. There is a contract in place for the maintenance of fire fighting equipment and emergency lighting. COSHH procedures are followed. Risk assessmnets are in place for all identified risks and safe working practice. The AQAA outlines the safety certificates and checks in place and the freequency of renewal. Accidents and incidents are recorded and acted upon. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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