Care Home: Ridgeway Court

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What the care home does well The registered manager and staff had continued to provide high standards of care and support for people with diverse needs. All previous requirements and good practice recommendations had been put in place. There were comprehensive assessments of each person`s needs prior to admission. Information was used to develop person centred care plans, which provided staff with guidance to meet each person`s needs. Relatives told us that they were always made welcome and were given information in a timely way. People living at the home told us food was excellent and staff were caring and friendly. The organisation`s policies demonstrated a positive attitude to complaints and the protection of vulnerable people. The home was clean, free from any offensive odour, appropriately decorated and well maintained with good quality furnishings and furniture. There was an appropriate skill mix of staff and an excellent Registered Manager. There was a strong commitment to staff training and development, which benefits people using the service. Recruitment and selection procedures are robust and safeguard the people living at the home. Health and safety was proactively managed, with records of fire drills and an accident analysis and evaluation to minimise risks. What the care home could do better: The storage of medication must be improved so that it is stored in accordance with manufacturers` instructions to be effective to maintain people`s health. Bedrails must be used in accordance with the Health and Safety guidance to safeguard people from risks of harm. Safe and clean floor covering must be provided for the ground floor corridor so that people are protected from potential hazards. A small number of good practice recommendations were suggested to be implemented to further improve the very good standards of care provided, such as closer weight monitoring when people can no longer be weighed and monitoring to make sure pressure reliving mattress are at the correct setting for each person`s weight and comfort. Random inspection report Care homes for older people Name: Address: Ridgeway Court 2 Dudley Road Sedgley Dudley West Midlands DY3 1SX two star good service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jean Edwards Date: 2 8 0 4 2 0 1 0 Information about the care home Name of care home: Address: Ridgeway Court 2 Dudley Road Sedgley Dudley West Midlands DY3 1SX 01902883130 01902665680 home@hbhchwm.eclipse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Iris Worrell Type of registration: Number of places registered: Conditions of registration: Category(ies) : Midland Property Investment Fund Ltd care home 39 Number of places (if applicable): Under 65 Over 65 39 old age, not falling within any other category Conditions of registration: 0 Voluntary removal of cateogories of PD(E) and DE for a period of time to be agreed with CSCI. Date of last inspection Brief description of the care home Ridgeway (formerly known as The Hollies & Bloomfield) is a Care Home in two adapted properties, which have been linked via a connecting extension. A passenger lift provides access to the first floor. The home is situated on a busy road close to local amenities and Sedgley town. It is on a main bus route and there is ample of off-road parking at the rear of the building. The home provides 24-hour personal care for up to Care Homes for Older People Page 2 of 11 Brief description of the care home 39 older people, with general frailty (over the age of 65 years not falling into any other category). Thirty-six of the beds are provided within the two main buildings with a further three beds located in a flat accessed through a separate ramped entrance at the rear of the building. The flat is a semi-independent unit, with any residents accommodated accessing the home in the daytime and having access to staff at night via a call system. The homes Statement of Purpose includes details of the registered provider, registered manager and staff team. The fee for this service is not included. People are advised details to contact the home for up to date information about current fee levels. Care Homes for Older People Page 3 of 11 What we found: We, the Care quality Commission (CQC) undertook this random inspection visit to monitor standards of care at the home, which had been rated as good at the last key inspection on 12 September 2007. This random inspection was unannounced, which meant the home was not given notice of our visit. We spent part of a day at the home and looked at the medication systems and health care records and how peoples healthcare needs were being managed. We also looked at how people were supported and given assistance to promote their health and well being. We briefly looked around the premises, including communal areas and a sample of bedrooms. We spoke to people who were able, and to staff and visitors. We observed interactions with people without verbal communication. We looked at a sample of the medication held at the home. We noted that staff had received medication training and were knowledgeable. There were areas of good practice with medication well organised and we saw that medicines were administered to people in a timely manner, with appropriate records. There were photographs with the MAR charts, which reduced the risk of medication being given to the wrong person. We noted that handwritten entries on MAR (Medication Administration Records) charts had been signed and witnessed by two trained staff, which demonstrated good practice and reduced the risk of errors. There were also photographs with the MAR charts, which reduced the risk of medication being given to the wrong person. There were comprehensive care plans and protocols for the administration of as and when needed (PRN) medicines. This meant people received their medication appropriately to promote their health and well being. We looked at the storage and administration of controlled drugs, which was satisfactory, with all records and balances of medication accurate. This meant that people requiring these powerful medicines were receiving them as prescribed by their doctor. Overall the systems in place for administering medication were very well managed. There was one area, which needed improvement. The temperature records for the room where medication was stored showed that the air temperature was frequently above 25 degrees C, despite efforts to keep the room cool. This meant that medication was not consistently stored according to manufacturers guidelines, which could result in medication not being efficacious to maintain peoples health. An effective air cooling or air conditioning system must be installed. We also noted that the signage for the storage of oxygen needed to be updated to comply with current legislation for storage of flammable gas. We looked at a sample of care records for people living at the home. The care plans were very well organised and reflected the assessed needs. They were up to date and provided essential information to ensure each persons needs where understood and met. Care plans had monthly evaluations and daily records were maintained by each shift. We saw that people had good access to health care professionals such as GPs, dentist, ophthalmic and chiropody services. We noted that the home provided appropriate care for Care Homes for Older People Page 4 of 11 people vulnerable to pressure ulcers and diabetes. We noted that people with diabetes or fluctuating weight advice was sought from the doctor and community dietician. The registered manager told us the staff had not received specialist diabetic training and acknowledged that additional training would be beneficial to enhance skills and knowledge, improving the care for people with diabetes. We saw that appropriate care was being provided for someone who had a pressure ulcer. Equipment, such as adjustable nursing profile beds and pressure reliving mattresses were provided as needed. Where pressure relieving mattresses were not automatically adjustable to each persons body weight, we recommended that the pressure setting for the mattresses should be recorded and monitored to be comfortable and effective for each persons needs. We noted that when people could no longer be weighed there was no alternative method used to monitor their weight. We recommended that an alternative method of weight monitoring should be used, such as the Malnutrition Universal Screening Tool (MUST) and the Mid Upper Arm Circumference (MUAC) should be measured when people are unable to be weighed. We saw that people looked well presented and were dressed appropriately according to their preference. There was very good interaction between staff and the people living at the home, with conversation at a level and pace appropriate for each person. We spoke with relatives who told us they felt the home was very well managed and provided excellent care. Comments included, the care is very good, doctors are called very quickly and we are kept informed; staff have a good rapport with residents, X has a beautiful bedroom, always clean; and I would have no qualms if I had to live at this home. People living at the home were complimentary saying, the food is excellent, always a good choice, often three choices to choose from, there are lots of activities and parties for birthdays, with everyone involved, all staff are helpful. We looked at the homes systems to deal with complaints. We saw that there was a complaints procedure displayed in the home and included in the Service User Guide. The registered manager told us that there had been seven complaints in the last 12 months, generally minor issues such as missing laundry. All concerns and complaints had been appropriately investigated and resolved to the complainants satisfaction. This demonstrated a proactive approach to improve the service, where the management encouraged people to raise any issues of concern. The registered manager told us there had been one safeguarding referrals in the past 12 months, which had been satisfactorily resolved. The home had policies and procedures to inform staff about abuse and responsibilities for reporting suspicions or incidents. All staff were receiving robust training, mainly from the Local Authority training provider, so that they understood the lead agencys procedure Safeguard and Protect to protect vulnerable adults. We spoke to relatives, who told us they had no complaints but could tell the staff or manager if they wanted to complain. We looked briefly around the premises and noted maintenance was generally being carried out to acceptable standards. There were improvements such as ongoing redecoration and provision of new furniture, as it became necessary. We noted that the carpet in the main ground floor corridor was shabby and stained despite repeated Care Homes for Older People Page 5 of 11 attention. The floor was also uneven in places and posed a potential tripping hazard. The flooring in the ground floor corridor must be made safe and an appropriate floor covering must be provided. This is to provide a safe environment for people at the home. We noted that the height of some bedrails used in conjunction with pressure relieving mattresses were less that the Health and Safety Executive (HSE) permitted 220 mm uncompressed height from mattress dimension. The registered manager told us that she felt she had been misinformed by an advisory agency, with advice that there were no stipulated height dimensions for bedrails. She raised this issue with them during the inspection visit. We gave the contact details of the HSE website for information and training available. Bedrails risk assessments must be reviewed and the height of bedrails must comply with the HSE dimensions so that people are safeguarded from risks of harm. We saw that there were 35 people accommodated at the home, on two units, with a range of diverse needs. We looked at copies of staff rotas and discussed the staffing levels with the registered manager in relation to occupancy and dependency levels. She was able to give us detailed information about the people accommodated, to identify what were their diagnosed conditions were and confirm the numbers of care staff to meet their needs. We looked at a sample of two personnel files of staff recently employed. The files were well organised with a recruitment checklist. The recruitment process was robust and provided safeguards for people living at the home. The Registered Manager, Iris Worrall, a well qualified and experienced registered nurse and manager, had worked at the home since January 2007. She holds the Registered Managers Award, Level 4 National Vocational Qualification in Care and other related qualifications. Since taking up her post the manager has made progress in improving the physical environment and developing practice. We received very positive comments about the management, including, they are very fortunate to have Iris as manager. There were quality assurance checks and rigorous audits, with remedial actions for improvements. Examples were the management and administration of medication, the standards of the premises and the rigorous recruitment to safeguard people at the home. There were Regulation 26 visits and reports from a representative for the company and we were told she frequently visited the home and regular formal supervision as support for Registered Manager and advice when needed. We were told the Responsible Individual for the home had changed approximately three months ago and the registered manager had very limited contact with this person but was able to access whatever was required for the home through the company accountant. There was delegated supervision system and the registered manager has devised a calendar system to ensure that each person was six supervisions each year. The fire safety records appeared satisfactory and we noted that there were regular fire drills. There were incidents and accident records with accident analysis and evaluation, which was good practice to identify trends and identify risks, which nurses used to revise and update individual risk assessments to control or minimise hazards. Care Homes for Older People Page 6 of 11 What the care home does well: What they could do better: 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 2. Care Homes for Older People Page 7 of 11 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 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, 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 1 9 13 An effective air cooling or air 30/06/2010 conditioning system must be installed in the room where medication is stored. This is to ensure that medication is consistently stored according to manufacturers guidelines, so that medication will be efficacious to maintain peoples health and well being. 2 38 13 Risk assessments for bed 30/06/2010 rails must be expanded to incorporate all areas of risk to the person, including risks of entrapment and incompatibility with the bed and / or mattress; and staff must be provided with training, so that a competent person undertakes visual checks of bedrails in the home on a regular basis to ensure that they are safe. This is to ensure people living at the home are safeguarded at all times. Care Homes for Older People Page 9 of 11 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 3 38 13 The flooring in the ground 30/06/2010 floor corridor must be made safe and an appropriate floor covering must be provided. This is to provide a safe environment for people at the home. 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 1 8 An alternative method of weight monitoring should be used, such as the Malnutrition Universal Screening Tool (MUST), with the Mid Upper Arm Circumference (MUAC) measured when people are unable to be weighed. The pressure setting for the mattresses should be recorded and monitored to be comfortable and effective for each persons needs, where pressure relieving mattresses are not automatically adjustable to each persons body weight. The signage for the storage of oxygen should be updated to comply with current legislation for storage of flammable gas. 2 8 3 9 Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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