Care Home: Ranworth House

Similar services:

• Thorndene
• Insight - Eastchurch
• Southfields
• Magenta
• Seabourne House
• 33 St John`s Church Road
• Dovedale Court
• Lyncol House

What the care home does well What has improved since the last inspection? The home has taken action and tried to arrange a more appropriate appointee for one person living at Ranworth House. Unfortunately this has not been successful. What the care home could do better: Each existing and prospective service user should receive a copy of the service user guide so they have available information regarding the home. The homemust agree a contract of terms and conditions with each person living at Ranworth House. Care plans should be further developed to contain information on all aspects of peoples care needs, their aspirations and goals. Any limitations of choice in place taken for safety reasons should be included in the care plan and evidenced as agreed with people. Ensure all risks associated with people living at Ranworth House are assessed and recorded. Minor improvements are needed to medication records to fully protect people. The home should develop formal quality assurance systems to gain feedback from all stakeholders CARE HOME ADULTS 18-65 Ranworth House 1 Prideaux Road Eastbourne East Sussex BN21 2NW Lead Inspector Sally Gill Key Unannounced Inspection 20th November 2007 09:40 Ranworth House DS0000067623.V352741.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 Ranworth House DS0000067623.V352741.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. Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ranworth House Address 1 Prideaux Road Eastbourne East Sussex BN21 2NW 01323 644860 01323 644859 ranworth@broadhamcare.co.uk 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) Broadham Care Ltd Jennifer Carey Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is nine (9). Service users must be aged between eighteen (18) and sixty-five (65) years on admission. Service users with a learning disability only to be accommodated. Date of last inspection 13th February 2007 Brief Description of the Service: Ranworth House was registered in 2006 to accommodate a maximum of nine adults who have a learning disability and admits people with low to medium dependencies. Broadham Care Ltd owns the business and the Registered Manager, Jennifer Carey has day-to-day control. Ranworth House was totally refurbished prior to opening. Accommodation is over three floors. There are nine bedrooms all with ensuite shower/bath, toilet and wash hand basin, which are situated on the first and second floors. On the ground floor there is a larger lounge with doors to the side garden, a smaller quite lounge, a small sensory room, laundry, kitchen, dining room, staff office, shower room and separate toilet. People with live at Ranworth House have access to a good-sized garden which is fenced for safety. The home is situated on a busy road but access for people who live there is off a quite road at the side of the house. There is a small parking bay and parking is available on roads nearby. The house is situated a 15 minute walk from the centre of Eastbourne with all local amenities and a train station. The home has two vehicles available to transport people who live at the home and a bus stop is nearby. The staff compliment consists of a registered manager, deputy, senior support workers and support workers. Support workers work a rota that includes a minimum of four staff on duty in the morning and five in the afternoon. At night two members of staff are on wake duty. Addition support is in place as needed. Currently charges range from £1350.00 to £2000.00 per week. Previous inspection reports are available from the provider or can be viewed and downloaded from www.csci.org.uk. Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was carried out over a period of time and concluded with an unannounced visit to the home between 9.40am and 4.45pm. The registered manager assisted throughout. We spoke to two people that live there and staff during the visit. Interactions were observed. Nine people were living at the home on the day of the visit with no vacancies. Surveys were sent to the home to distribute to people that live there, relatives and health and social care professionals. Feedback was received from people that live there and relatives. People completing the surveys had taken considerable time to give very detailed feedback about the home. Feedback was on the whole was very positive and people were happy with the overall care. Some comments related to what people felt would make life better. The care of two people that live at Ranworth House was tracked to gain evidence to help come to judgments regarding their outcomes. Various records were viewed during the inspection and most parts of the home viewed with the exception of some bedrooms. The manager completed the Annual Quality Assurance Assessment (AQAA), which was returned within the timescale asked. Information was clear and comprehensive. It identifies areas that have improved in the last year and areas where further development is planned. The manager advised that people who live at Ranworth House do not really like the term resident or service users so in this report they will be addressed as people who live at Ranworth House. What the service does well: People that live at Ranworth House feel they were asked whether they want to move there. Positive comments included ‘I like going shopping at the weekends’, ‘I go to St Johns in Brighton full time and really enjoy it’; ‘mainly Jennifer, X, X, X and X are very good at this’ - listening and acting on what you say, ‘a lot on at weekends’, ‘staff are nice’ and ‘I like living here’. Relatives comments were very positive including ‘they are very good at keeping me informed’, ‘excellent support’, ‘the care is good staff don’t panic over my X illness. They don’t call me every few days with queries on what to do next. I find this of good comfort to me and I don’t worry as much’, ‘our X needs seem to be well catered for and X is being very well looked after’, ‘our X is a very fussy eater and the care service has been very good in encouraging them to try different foods’, ‘Ranworth House have tried a number of different strategies to help our X settle and adapt to their new home, seem to us to Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 6 have done a good job so far’, ‘they have developed a good daily programme of activities for our X’, ‘the home is clean and of a very high standard of décor’, X has said many times that they are very happy at Ranworth House’, ‘X has been offered great alternatives to TV and the internet for their free time choices. Not an easy thing to get X to make good choices’, ‘I believe the senior management and house manager to be excellent’, ‘Ranworth provides a warm caring family feel’ and ‘Ranworth is working hard with my X to give them chances they need to make choices in life. X has a lot of potential but little confidence so they are being supported to try lots of new and exciting things. Life looks good for X at Ranworth’. People have the opportunity to test drive the home and are made to feel very welcome. The transition to Ranworth House is well planned and individual to each person. People have good access to the local community. People are involved with planning their own social activities. They have a wide range of opportunities for leisure and educational activities. The possibility of work placements is being explored. People have a choice of meals and both meat and vegetables are shopped for locally with a preference for organic produce. People’s health needs are monitored closely and referrals are made where there are concerns. The home works closely with health professionals and act on advice and guidance. People that live at Ranworth House benefit from a home which has recently been completed refurbished to a high standard, it is spacious, comfortable and really homely. Robust recruitment practices are in place to protect people living at Ranworth House. Time is taken to recruit the right calibre of staff. Staff are committed, and enthusiastic. They feel part of a team and well supported by the manager. They enjoy coming to work, which can only benefit people living at Ranworth House. What has improved since the last inspection? What they could do better: Each existing and prospective service user should receive a copy of the service user guide so they have available information regarding the home. The home Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 7 must agree a contract of terms and conditions with each person living at Ranworth House. Care plans should be further developed to contain information on all aspects of peoples care needs, their aspirations and goals. Any limitations of choice in place taken for safety reasons should be included in the care plan and evidenced as agreed with people. Ensure all risks associated with people living at Ranworth House are assessed and recorded. Minor improvements are needed to medication records to fully protect people. The home should develop formal quality assurance systems to gain feedback from all stakeholders 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. Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available and people have the opportunity to test drive the home in order to make a choice as to whether this home is right for them and can meet their needs. People’s needs are assessed. But they are not protected by a written contract with the home. EVIDENCE: The statement of purpose and service user guide is available in the hall in a folder named visitors information together with the latest inspection report. The service user guide is in pictorial format. The manager was unsure whether the people that live at the home have received a copy of the service user guide. Generally relatives felt that they get sufficient information in order to make decisions. However one person said they felt they did not receive sufficient information prior to moving in about the home but were asked if they wanted to move in. It is recommended as good practice that each person should be given a copy of the service user guide. There have been nine admissions to the home since the last inspection. Two were short-term care, which moved onto the sister home in Dover. The age range of people is 19 – 52 years old with most in the younger group and two in the older range. The home completes their own assessment, which are used Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 10 to develop care plans. In addition copies of the local authority assessments and other professionals involved in the peoples care are obtained. Copies of all assessments are held on files. People felt that the home meets the needs of their relative and the different needs of others. Surveys confirmed that there were opportunities to visit the home prior to admission. One relative said ‘Ranworth House staff were very hospitable when our X did an overnight stay. They provided us with lunch on arrival and a barbeque later in the day. They made us feel very welcome’. The manager advised that the transition to Ranworth House is well planned and individual to each person. In one case it was assessed as appropriate that there was no pre-admission visit and in another case there were several visits, which built up over an eight-week period. A photograph board was used to help people familiarise themselves when they first moved into the home. There is an issue in the home at present where the behaviours of one person do impact on others living there. This was raised in surveys and discussions and discussed at length with the manager. The home is taking action to resolve this situation, as they understand that everyone living there has to remain reasonably compatible. Currently there are no contracts/agreements in place between the home and the people that live there. It is a requirement that written contracts are developed and agreed with those that live at Ranworth House. Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care needs are met. Care planning and recording the involvement of individuals in decisions about their lives and planning their care and support they receive could be developed further. EVIDENCE: The care of two people was case tracked to gain information. A care plan is in place for each person. The manager is currently introducing a new improved format for the care plan folders with some already in place. The care plans were reviewed as up to date and are particularly informative to staff in relation to personal hygiene and any behaviour management, which have been developed in conjunction with professionals. Care plans should be reviewed to ensure they cover all areas including communication and sexuality. In discussion with the manager it is evident that that the ethos of the home is to recognise the rights of people who live there and for them to take control of their lives but this could be better recorded in care plans. There are some examples of good person centred planning in the form of a picture board and a Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 12 morning routine. Behavioural guidelines would benefit from being dated. In one care plan two monitoring documents were not fully up to date, the GP and family contact sheet although the manager was able to give a full verbal account. Further work also needs to be achieved to ensure goals are in place and are aspirations and developmental which at present they are not necessarily. Most people have had a review since moving into the home and the manager advised those that had not were planned. A key worker system is currently being developed with people in the process of deciding whom they wish to be their key worker. People are clearly able to make some decisions about their lives and it is evident that they do in areas such as daytime social activities and not wanting to take responsibility for some household tasks. Some appropriate limitations of choice are in place for safety reasons, which is not recorded in the care plan, and therefore no evidence was seen that they are agreed with the people that live there or others such as families/professionals representing them. Where others have made decisions this should be recorded in the care plan such as access to areas of the home and the use of listening monitors. Risk assessments are in place and describe the steps to be taken to minimise the risk. However in one case the manager advised not all not all risks have been recorded as assessed and should be. Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to make choices about their life style. The home is working to supported people to develop some of their life skills. People have a good range of social, educational and recreational activities opportunities. EVIDENCE: A staff member said that development has been made with people since they have moved in. One example was in the confidence of one person within the home demonstrated by a happier person with decreased mood swings. People have a wide range of opportunities to participate in leisure and educational activities. Five people attend a college in Brighton five days per week, which specialises in autism. One said how much this was enjoyed. Others attend college for courses such as photography, cookery, gardening, sensory music, sensory relaxation and computers. Discussions highlighted that Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 14 the manager is also looking into the possibility of a work placement. People have access to the local community. The manager advised that recent trips out have included a show in Eastbourne (Elvis impersonator), day trip to France and Brighton Sea Life centre. Discussion and records confirmed social activities include shopping in town, swimming, painting, writing, church, tai chi, aromatherapy, boot sales and the pub. People are encouraged to try new activities. A staff member gave an example where working with relatives a new activity was tried and although at first it appeared that it was not going to be successful with time the person now really enjoys this. Some lovely Christmas cards were seen which the people living at the home had made. People felt the home support people to live the life they choose. Two surveys indicated that there is plenty to do at weekends and time is occupied in the day but felt there was not enough to do in the evenings and not being able to do what people want in the evenings. One example was discussed with the manager. The manager felt that people have to get up early on weekday mornings and everyone’s preferences do have to be taken into account. In discussions people said they went home to stay with families. One person talked happily about their home visits, friends and their boyfriend. Home visits happen regularly from every weekend to one in four. Relatives felt communication with the home was good and the home supports their relative to keep in touch with them. Surveys also included comments such as a relative would like a communication book to aid the communication between them and the home, one would like a weekly telephone call from the home or their relative, one felt they were not offered a tea/coffee when visiting and felt it would be nice at times be invited to stay for a meal as this is what happens in family life. All these were discussed with the manager who said she was surprised that relatives were not always offered drinks and was happy to introduce all the suggestions. The home has purchased a laptop, which will have Internet access and a web cam so people can email/communicate with their families. This will be great for those that do not communicate verbally. People are involved in household chores and meals. One person said they did clean their room and another said they would like to be involved in cooking. Developing this participation was discussed with the manager. Goal planning could also aid this development. Five people have a key to their room. Breakfast is toast and cereals and people are assisted as necessary. Lunch is sandwiches or a light meal. Sunday is a cooked breakfast at brunch as people have chosen to have a lay in. The main meal is in the evening. Menus are currently planned according to known like and dislikes on a four weekly basis. There are usually two choices unless it is a dish that staff knows everyone will like. Staff said that pictures are used to aid choice and people are being encouraged to offer different suggestions, which are then incorporated into the menu. Although one comment disagreed and felt staff set the menus. The Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 15 menu showed a good variety of dishes. An alternative way to create menus and encourage/involve people in the cooking was discussed with staff. The manager advised that meat and vegetables are purchased regularly from a local butcher and green grocer with a preference for organic produce. Other shopping is bought at a supermarket. A bowl of fresh fruit was available in the home. One person attends weight watchers, which has helped to encourage a healthier diet, and staff help with points counting and another diet is catered for. Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 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 that people receive is based on their individual needs. Minor improvements are needed to medication systems to fully protect people. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Care plans evidenced where and what assistance in personal hygiene is required. Staff have worked with one person to build a picture board of their morning routine. One survey said that the home is ‘very good with personal care, as our x needs a lot of help with this’. People confirmed that getting up and going to bed times are flexible. People confirmed that they had been asked whom they would like as their key worker and they had chosen. People were dressed appropriately and individually. They talked about their having their haircut and shopping for clothes. The manager advised that people have access to doctors and a chiropodist. A chiropodist visits every six weeks. The manager said that referrals had been made to a dentist specialising in learning disability. It is evident that the Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 17 health of people is monitored closely and appropriate referrals made. Where professionals have had input and offered advice and guidance this has been incorporated into care plans. Currently the home is monitoring one person closely whose behaviour has deteriorated with the help of professionals and a referral via the GP has now been made. The medication system was examined. Medication is stored appropriately. Staff that administer medication have received training. Some staff have also received training in specific medication administration. The medication administration record (MAR) charts showed appropriate use of signatures and codes. Although it is recommended that handwritten entries should be signed, witnessed and dated. The manager advised a signature sheet is in place. The administration of medication was observed which in line with the homes policy two staff undertakes. Currently no one is self-administering medication although the manager feels this will be developed. Additional written protocols for PRN medications are recommended which should include trigger to flag/report i.e. maximum dose and authorisation needed. The manager advised that medication returned to the chemist and taken out/return from home visits is all recorded. Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 &23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service feel able to express their concerns and have systems to protect them from abuse. EVIDENCE: A robust complaints procedure is in place. The complaints procedure is contained within the visitor’s information folder next to the visitors book in the hall. One complaint has been received from a relative since the last inspection. Records showed this was investigated and the complainant informed of the action taken and outcome. The complaint was unsubstantiated. It is suggested the home keeps a complaints log for ease of monitoring complaints. People living at the home said they feel comfortable in raising any concerns with staff although one said they had not been shown how to make an actual complaint. Most relatives said they know to make a complaint. Although one said they did not know how to complain not that they had any complaints. This was discussed with the manager, as was one comment that a concern was not dealt with sensitively. Most relatives commented that any concerns raised had been addressed appropriately or they felt sure that any concerns would be acted upon. Nearly all staff have received training in protection of vulnerable adults (POVA). Staff spoken to was clear how to report any suspected abuse within the organisation. However one was unclear of whom to report to outside of the home, which needs to be clear. Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 19 The manager advised it is not the homes intention to take people who have challenging behaviour. The behaviour of one person at present in the home has deteriorated which other people living at the home can find frightening. Any incidents of aggression are recorded. Seven staff is trained in conflict management and others will be booked onto this training. In addition some staff have attended behaviour management and de-escalating technique training. Staff were observed to care for the person when showing signs of aggression with patience and calm. Relative comments included ‘staff are usually supportive of my x and are good at seeing when their extremely high anxiety levels can lead to inappropriate behaviour on their part. They are good at putting strategies in place to ease future situations’. To address a previous recommendation the manager advised that where the director is an appointee the local authority had been contacted, as had a family member to take over appointee ship but both had refused. Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables people that live there to live in a safe, well maintained, and very homely environment, which meets their needs. EVIDENCE: A tour of most of the home was undertaken with the manager. The home was fully refurbished throughout prior to opening in 2006. This has resulted in a very high standard of décor, which provides people with a comfortable, spacious and really homely environment. Survey comments included ‘the atmosphere of the home is very welcoming and decorated in calming colours’ and ‘the home is clean and of a very high standard of decoration’. People living at the home all have a single bedroom with ensuite facilities, which include toilet, wash hand basin and bath or shower. Bedrooms are spacious, light and individual and reflect personal interests and hobbies. Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 21 There is a larger lounge with television and doors leading to the garden, a smaller quiet lounge also used at times for activities, a small well equipped sensory room, dining room with hatch way to the kitchen, kitchen, laundry downstairs shower room (shower, toilet and wash hand basin) and also a separate toilet. The side and rear garden is enclosed, well-maintained being mainly laid to lawn with a patio area, seating and a barbeque. Security locks are in place on the stairs and front door for safety some people living at the home have swipes. A shaft lift is in place, which everyone can access and it accesses all floors. Although the kitchen is locked three people living at the home have a key others would be assisted by staff in the kitchen. The laundry and sensory room is locked when not in use to ensure safety. The front door is locked and accessed by swipes. All radiators were guarded. One survey commented that their bedroom is not warm enough. The home was clean, tidy and hygienic throughout. Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Ranworth House benefit from sufficient numbers of staff that are experienced, trained and skilled. EVIDENCE: There is a team of 18 staff both male and female. Five have completed an NVQ level 2 or above and another five are undertaking the qualification. This will give fifty percent. There is usually four staff on duty in the morning and five in the afternoons. There is two wake night staff. The manager advised at the weekends there can be up to six staff on duty, which is planned depending on what’s happening that weekend. There have been some leavers since the last inspection for a variety of reasons. The home still has two vacancies. The emphasis is on recruiting the right calibre of staff. The manager advised this has been difficult and has resulted in the use of agency at present. Surveys indicated that people felt that staff have the right skills and experience to look after their relative. One Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 23 comment said ‘the staff are all trained to understand the needs of autistic people, the staff are always very pleasant’. The manager advised there have also been problems with POVA checks taking a long time to come through. The manager said that although there have been difficulties she feels they have a very good staff team at present. The staff spoken to and met on the visit appeared committed, enthusiastic, very caring and open to suggestions for development. Two people living at the home said the staff are very nice. A negative opinion received about individual staff was discussed with the manager. Two staff files were examined these showed that a robust recruitment process is followed and that all checks are in place. Where staff are working on a POVA 1st the manager demonstrated she has the right levels of supervision in place. Staff advised that manager is responsible for staff’s induction. Staff undertake shadowing of experienced staff usually for three to five days. Staff confirmed that the shadowing continues until the new member of staff is confident. They read the policies and procedures of the home and this is evidence by signatures against each item. They also undertake mandatory training. The induction does not clearly evidence that it is to Skill for Care specification. It is suggested the home review the content of induction to ensure it meets the specification. Training has also been undertaken in epilepsy awareness and rectal diazepam, epilepsy and epilepsy treatments and medications, autism and aspergers and risk assessment. Staff confirmed that they ‘definitely’ felt well supported and received regular supervision. One staff member said it is the first place they have worked where they enjoy coming to work, there is a lot of support, staff are nice and work as a team. Team meetings are held as well as annual appraisals. Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect. More formal quality assurance systems need to be developed to ensure all stakeholders’ views will inform the development of the home. The health, safety and welfare of all is promoted and protected. EVIDENCE: The manager is qualified. She has obtained her Registered Managers Award at NVQ level 4 in care. She has been the manager at the home since opening, which is just over a year although she has worked previously as a registered manager. Jennifer has over five years experience within learning disability services as a manager and previously has delivered training to staff and has undertaken trouble shooting in under performing services. In recent months the manager has undertaken training in epilepsy, autism, medication, health Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 25 and safety, POVA, risk assessment and statutory training. Staff said the manager is fair, easy to talk to, approachable and a good all round manager. One person living at Ranworth House said ‘Jennifer is very good at’ listening and acting on what you say. It was apparent that the manager has an open door policy and works as one of the team when needed. The manager advised that the director undertakes regulation 26 visits monthly and the home receives a copy of the report. Formal quality assurance is an area where further development is recommended. There are as yet no meetings for the people that live a Ranworth House to voice their views something asked for in surveys. A formal system to invite feedback from service users, relatives or professionals involved in the home should be developed. An annual questionnaire was discussed. Implementing staff competency checks and one to one talk time was also discussed. People that live at Ranworth House incidents and accidents are reported under regulation 37. A valid insurance certificate was displayed, as was the registration certificate. The manager advised that health and safety checks such as water, fridge and food temperatures are carried out regularly with records maintained. Fire safety equipment is tested regularly. Staff have either undertaken or are booked onto statutory training including manual handling fire, first aid, infection control and food hygiene. Some staff has completed H&S training. Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 26 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 3 2 3 3 X 4 3 5 1 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 4 25 4 26 3 27 4 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA5 Regulation 5 (1) b, c Requirement The home shall develop individual written contracts of terms and conditions, which shall be agreed with each person living in the home. Timescale for action 20/01/08 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 5 Refer to Standard YA1 YA6 YA7 YA9 YA20 Good Practice Recommendations Each existing and prospective service user should receive a copy of the service user guide Care plans should contain information regarding all care needs (including communication & sexuality), aspirations and goals Ensure all limitations of choice in place are recorded in the care plan and evidenced as agreed with the person living at the home. Ensure all risks to service users are assessed and recorded. Handwritten entries on the MAR charts should be signed, witnessed and dated. Written protocols for medications prescribed as required should be in place. DS0000067623.V352741.R01.S.doc Version 5.2 Page 28 Ranworth House 6 YA39 The home should develop formal quality assurance systems to allow feedback from all stakeholders. Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Ranworth House DS0000067623.V352741.R01.S.doc Version 5.2 Page 30 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!