Care Home: Ridgewood

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What the care home does well Ridgewood provides comfortable and homely accommodation for up to twelve service users (11 at the time of the inspection) with sufficient staff to meet their needs and respond to individual preferences. Westbourne provides comfortable and homely accommodation for up to five service users (one resident at the time of the inspection) with sufficient staff to meet their needs and respond to individual preferences. Prospective residents and their representatives receive well-presented informative material to support them in making a choice about the home. The registered provider has developed user-friendly material with pictures and simple language, though more could be done to expand on this and ensure the information is current. The provider obtains copies of needs assessments from the commissioning agencies involved with prospective residents. Staff from the home visit prospective residents and carry out their own assessment to ensure that the home can meet their needs. Care planning and risk assessment are generally good. The staffing group are stable providing a continuity of care. The registered providers, registered manager, and staff have an in-depth knowledge and understanding of the residents`needs and capabilities. The home`s staff respect the individuals` right to privacy and dignity, and work hard to promote independence. Outcomes for the people that live there are good. Staff interact with residents in an appropriate positive and adult manner. Residents have their own rooms, which reflect their individual preferences and interests, spacious shared areas and a secluded and secure garden. The home is clean, hygienic and well maintained. Staff receive all required training and are encouraged to pursue their own personal development. The staff have a high level of NVQ qualification. The manager is qualified, maintains and updates her skills and knowledge, and the staff have confidence in her. What has improved since the last inspection? The provider has improved the management structure of the homes. Alison Brown is the responsible individual, and Karen Potts has become the registered manager of Ridgewood. The registered manager position at Westbourne has not been filled at the moment. Karen Potts runs Ridgewood on a day-to-day basis. Westbourne has one person living there, though the registered provider assured the inspector that a registered manager would be appointed. The registered provider has continued to decorate and refurbish the homes (Westbourne being added since the last inspection). What the care home could do better: More can be done to ensure that the Statement of Purpose and Service User Guides are current and accurate, providing all the information specified in Schedule 1. The registered manager should ensure that care plans are reviewed to ensure they provide the information needed in order to direct care provision.More can be done to ensure that people are offered and enabled to make a choice of meal. The registered manager should confirm that the current induction programme meets the requirements of the Sector Skills Council specification. The findings from quality assurance surveys, including any action taken as a result, should be summarised and published. Key inspection report Care homes for adults (18-65 years) Name: Address: Ridgewood 51 & 54 Mount Pleasant Road Camborne Cornwall TR14 7RJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Alan Pitts     Date: 0 6 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Ridgewood 51 & 54 Mount Pleasant Road Camborne Cornwall TR14 7RJ 01209710799 01209714624 relubbushouse@gmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Matley-Jones Brown Ltd Name of registered manager (if applicable) Mrs Karen Potts Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 17 The registered person may provide the following category of care only: Care Home only (Code PC), to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning Disability (Code LD) - maximum of 17 places, Mental Disorder (Code MD) - maximum of 5 places, to be accommodated at 51 Mount Pleasant Road only. Date of last inspection Brief description of the care home Ridgewood is a detached house situated in a residential area of Camborne. The Registered Provider is Matley-Jones Brown Ltd. Mrs A Brown is the Responsible Individual. Mrs Karen Potts is the registered manager of Ridgewood, a registered manager is yet to be appointed for the sister-home Westbourne. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 0 17 5 Brief description of the care home Ridgewood is registered to provide accommodation and care for up to twelve adults with a learning disability. The statement of purpose states that the intended age group is between 30 and 65 on admission, though some people have now lived at Ridgewood some considerable time. All the bedrooms are single, and are situated on both the ground and first floor. The accommodation is served by a 6-person passenger lift. All bedrooms have their own toilet and hand basin, and some have their own bath. One entrance provides access to wheelchair users. The ground floor is on one level. The communal rooms are on the ground floor. There is a spacious and secluded garden. The home is within walking distance of the town centre and local facilities. Cornwall Adult Social Care Department commissions day activities for some service users, and the registered provider arranges day activities for other service users as part of their packages of care. Westbourne is registered similarly for up to 5 adults and is located on the opposite side of the road to Ridgewood. There are 5 bedrooms, two on the ground floor and three on the first floor. Two bedrooms are en-suite, though the remainder have an allocated bathroom each. There is a lounge/dining room on the ground floor and a quiet lounge on the first floor. Stairs access between floors. There is a spacious garden to the rear. The fees generally range between GBP741.35 to GBP1350 weekly. Fees are based on an assessment of the prospective residents needs. Care Homes for Adults (18-65 years) Page 5 of 29 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: This was a planned unannounced inspection to inspect against the key national minimum standards. The inspection took place on the 6th April 2010 and included inspecting records and documents, touring the premises and having discussions with the registered manager, staff, and some of the people that live there. The commission also sent surveys to residents and to their relatives and representatives. Ridgewood provides an established staff team and homely environment for people, many of whom have lived there for a considerable number of years. Westbourne promises the same, but this is a new service yet to establish itself. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: More can be done to ensure that the Statement of Purpose and Service User Guides are current and accurate, providing all the information specified in Schedule 1. The registered manager should ensure that care plans are reviewed to ensure they provide the information needed in order to direct care provision. Care Homes for Adults (18-65 years) Page 7 of 29 More can be done to ensure that people are offered and enabled to make a choice of meal. The registered manager should confirm that the current induction programme meets the requirements of the Sector Skills Council specification. The findings from quality assurance surveys, including any action taken as a result, should be summarised and published. 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 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 8 of 29 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 9 of 29 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. Information for residents is available and efforts have been made to provide this in alternative formats. The registered providers endeavour to ensure that prospective residents will fit in with the existing residents, and obtain pre-admission assessment information to aid this. Evidence: The registered provider produces a Statement of Purpose and service User Guide for each home. These documents are provided to prospective residents and/or their representatives, and are available in simple language with photographs. We discussed the options available to ensure that the information was accessible to all prospective residents, including the possibility of an audio/video version of the documents. The homes Statement of Purpose (SoP) and Service User Guide (SUG) have been reviewed (2008), but care should be taken to ensure they are current and accurate, reflecting the level of service offered (e.g. staffing levels available, transport charges). Detailed assessment and care planning information is obtained from the commissioning authority. A member of the homes staff also completes a written needs assessment for prospective residents. Trial visits to Ridgewood and Westbourne Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: are arranged in order to meet the staff and residents, and see the home. We were advised that staff will discuss the service users guide and complaints procedure with each resident. Placements are initially agreed on a first month trial basis, and the home maintains good contact with referring agencies, family and representatives. The registered manager is aware of the importance of a successful placement for the existing residents as well as the new person coming to the home. Care Homes for Adults (18-65 years) Page 11 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each resident has a plan of care. The care documentation shows the involvement of other health care professionals. The registered providers described practices that do enable some residents to take responsible risks. Evidence: Care plans are in place for each resident. We case tracked three residents records. Care plans are not always signed and dated, demonstrating regular review. Each person has a clear, well written care plan based on a strengths and needs assessment. Care should be taken to ensure care plans provide accurate up-to-date information, sufficient to direct care provision. There is a, not uncommon, tendency to assume knowledge as many of the residents and staff are long established, and consequently the care plans do not always reflect changes in care needs. Plans include supplementary information particular to each individual and specific records suited to the care needs of each individual. Individuals needs and preferences, and capabilities are evident in the plan of care (e.g. going to bed/getting up, bathing), but money management and capabilities were not evident. We were advised that the care plans Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: are discussed with the individual resident, but the records seen did not demonstrate this. There was good evidence of multi-agency involvement in reviews. There were detailed risk assessments, which document, where appropriate, agreed restrictions on choices and freedom. Each resident has an identified key worker. Staff complete daily records of activities and events which are signed and dated. The care plans set out the residents lifestyle preferences. There is good evidence of the people that live there being able to make meaningful choices about their lives, including participation in activities, and selection of colours and fabrics for their rooms. Staff demonstrated warm, skilled, and effective communication with residents during the inspection. All of the people living at Ridgewood and westbourne have a family member or someone to act in their interests. The responsible individual is appointee for benefits for one resident, where there appears to be no other appropriate person to take on this role. The registered manager and staff were knowledgeable of individuals capabilities, and liaise effectively with the local community and other health professionals. The home maintains good links with the external facilities used by the people that live there. Risks are assessed before admission as part of the assessment and admission process for each resident. The residents records case tracked contained detailed risk assessments for activities and other areas of risk. The assessments directed staff in specific interventions to control the identified risks. The registered manager discussed a number of examples where residents were supported to take responsible risks. There is a missing person procedure. Confidentiality is included in staff induction training, and records are stored securely. Comments from people that live at the homes were, without exception, positive, including I like living at Ridgewood, yes I do Care Homes for Adults (18-65 years) Page 13 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are encouraged to have social relationships with family and friends, and lead active lives outside of the home. Risk-assessments help to identify where residents rights and responsibilities need to be respected. The meals provided in the home are satisfactory with residents commenting that they enjoy the food. Evidence: Residents may make use of external facilities, such as day centres, clubs, and work experience. All have a family member available, though contact varies. Residents attend a range of weekday activities as part of their individual care packages commissioned by Cornwall Adult Social Care and the registered provider. These activities include Camborne College, the Murdoch and Trevithick Centre at Redruth, the John Daniel Centre at Penzance, Drym Valley Centre, Choice Centre, Boscawen Farm, and other placements. Ridgewood and Westbourne are in a residential street within walking distance of the town centre. Residents use local shops and cafes in Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: Camborne, and visit other towns. The homes have a vehicle for transporting residents, for which there is a charge of 44 pence per mile according to the homes Statement of Purpose. A resident was planning to go out in Camborne on the day of the inspection. The home provides television, DVD, video and music equipment. Residents have their own televisions and music centres in their rooms. Games and jigsaws are available. Residents have their own varied individual leisure interests and preferences. Residents are free to decide if they want to be sociable or if they would prefer to spend time alone in their room. One resident enjoys reading, and has a good selection of books and is supported to use the local library. One residents room is set up and decorated as a sensory room. Another resident is interested in horses and dogs, and their room and leisure activities reflect this. There is an open door for visiting, although visitors are asked as far as possible to integrate with residents lifestyles, preferences and planned outings. Daily records evidence when people have had visitors. Residents can see their visitors privately in their own rooms or in shared areas such as the conservatory and the garden. A number of residents have regular arrangements for spending time with their families away from the home, and one person was away on holiday at the time of the inspection. Residents have general freedom of movement around the home and grounds. The garden is secluded and secure. When staff are not in the kitchen with residents, it is locked to protect their safety. Residents can lock their room doors from the inside; staff can override this if necessary. Residents can also lock their rooms, if they wish to, when they go out. Residents choices about joining in activities are respected. The residents participation in housekeeping and personal tasks is set out in their care plan and related to their abilities, preferences and personal action plan. There is a smoking area on the patio outside the back door. The homes meet a range of needs in relation to food and diet. Breakfast is generally cereal, toast, juices and drinks. The midday meal on weekdays for residents not out of the home attending activities is a sandwich, soup or a savoury snack, and the menu and record of food provided demonstrates a choice is available. Tea is the main meal of the day on weekdays. The menu for the midday meal and tea are swapped at weekends. Comments received from the people that live there confirmed that the food is of a good standard and enjoyed. Staff know the residents likes and dislikes. Where appropriate, staff complete nutritional assessments, and allergies and specific dietary needs are clearly recorded. The last food hygiene inspection by the environmental health officer was May 2009. The home uses the Safer Food, Better Business Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: guidelines provided by the local authority. All the care staff and the cook have had training in handling food safely. Although the menu shows that a choice is available at the main meal of the day, the record of food provided tends to show that everyone had the same option. Options for ensuring people can choose were discussed with the registered manager, including the use of picture cards portraying the meals available for that day. Care Homes for Adults (18-65 years) Page 16 of 29 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. The home provides sensitive and flexible personal support. Residents receive access to all the healthcare facilities available. Residents are protected by the homes medicine practices. Evidence: The support for residents with their personal care and healthcare follows a person centred approach. The registered manager and staff said they ensure that appropriate personal support, care and encouragement are provided in such a way as to respect residents privacy and dignity. The care records, observation, and discussion with the registered manager and staff show that the residents waking day is flexible. Residents are encouraged to direct their own lifestyle, including clothing, appearance, activities, and relationships. Discrete guidance and support regarding personal hygiene is provided. The residents care plans set out the assistance they need with their personal care, their areas of independence and how staff can support them in their independence. The plans include the individuals preferences and choices in relation to personal care. Residents have designated key workers. The staff are suitably trained and competent to deliver this care. The registered manager and staff obtain advice and guidance from the appropriate clinical specialists and community nurses. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: Care is conducted in privacy. Residents choose their own clothes with some guidance as to weather conditions and proposed activities. Staff support residents to shop for their own clothes. Residents were wearing modern clothes appropriate for their age. Residents use a local hairdresser and barbers in Camborne. Comments received from the people that live there confirmed that they are very satisfied with the standard of care provided. The records provided evidence that the registered person ensures that the residents healthcare needs are assessed, recognised and addressed. All residents are registered with a GP. Staff record detailed contact records for all appointments and treatment with GPs, community nurses, clinical specialists, consultant psychiatrists, chiropodists, dentists, opticians and other healthcare services. Care plans generally give directions for staff regarding the residents healthcare needs. The residents are receiving access to the health care facilities they are entitled to (e.g. dental checks, eye tests). There is a policy and procedure on the handling of medicines and the registered person has a copy of the Royal Pharmaceutical Society guidance. Medicines are stored in a locked metal medicine trolley in the dining room/sitting room. Residents sign a written consent to the administration of medicine. The homes use the Boots monitored dosage system. The administration records document the checking of medicines on receipt, the administration of medicines and their disposal. The medication administration records folder contains photographs of residents. Patient information leaflets are retained in individual files, with supplementary information about the medicines prescribed. The medication administration records were well maintained, showing no missed signatures in the sample examined. Changes to the prescription for individual residents are dated and referenced. Where residents are taking medicines prescribed as when required there was very clear written guidance for staff on the circumstances in which medicines were to be administered. The supplying pharmacist had visited the home the week before this inspection. Staff who administer medicines have completed a course in the safe handling of medicines. Care Homes for Adults (18-65 years) Page 18 of 29 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. Residents were seen to interact with staff in a relaxed manner. The staff have a clear understanding of Adult Protection issues and procedures that will protect service users from abuse. Evidence: The people that live at Ridgewood and Westbourne are enabled to maintain contact with relatives and friends, and external agencies through visits and telephone calls. The registered provider has a written complaints procedure which complies with the standard and the regulation. Residents receive a pictorial and simple language version. People are asked if they have any complaints or concerns at the regular residents meetings. Feedback from the people that live there indicated that they knew how to make a complaint. Residents comments confirmed that the registered manager and staff were kind and approachable, and they had confidence in them. There have been no formal complaints since the last inspection. The registered provider has a written policy and procedure on adult protection and has issued easy to understand guidance for staff. The registered provider has a copy of the revised multi-disciplinary vulnerable adult protection procedures. There is a useful flowchart posted on the Ridgewood office notice board, which summarises the procedure. Safeguarding is included in the homes induction training for new staff. The majority of staff have completed the multi-agency alerters or foundation training. The provider cooperated fully with one referral made under the safeguarding procedures Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: and appropriate actions were taken. The responsible individual is appointee for benefits for one resident. There is a written record detailing the payments of the homes fees, signed by two staff. The remaining residents can manage their own finances, or have a representative do so for them. The home holds personal allowance money for residents if requested. The staff maintain weekly records of money received and spent, with receipts. The cash is kept securely as individual balances. A sample was checked against the records and receipts and found to be accurate. Care Homes for Adults (18-65 years) Page 20 of 29 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. Residents live in a comfortable, homely environment, which is clean and hygienic. Evidence: The homes are situated in a residential area of Camborne, within walking distance of the towns facilities and shops. Westbourne is registered similarly for up to 5 adults and is located on the opposite side of the road to Ridgewood. There are 5 bedrooms, two on the ground floor and three on the first floor. Two bedrooms are en-suite, though the remainder have an allocated bathroom each. There is a lounge/dining room on the ground floor and a quiet lounge on the first floor. Stairs access between floors. There is a spacious garden to the rear. The domestic laundry is housed at the rear of the property. Bedrooms and communal areas are comfortable and appropriately furnished. Westbourne is intended for more able clients. The main entrance of Ridgewood is on the side of the premises. This entrance has a step. Wheelchair users can access the building from the car park through another entrance on the front of the building. The ground floor is on one level. There is a flight of stairs to the first floor, but access is also aided by a 6-person passenger lift (regularly maintained). Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: The office is on the first floor. The quiet lounge/activity room is on the ground floor. The shared spaces now comprise the large sitting room/dining area and conservatory with its dining area and activity area. There is a patio area outside the back door and a secluded and secure garden. The premises are well maintained and in good decorative order. The homes were comfortable, bright and cheerful with no untoward odours. Residents, and staff all commented that the home was kept clean and fresh at all times, though both also made comment about Ridgewood perhaps being warmer at times. Furniture is of good quality and domestic in style. There is a maintenance programme with records. Every effort is made to involve clients in deciding their own decorating colour schemes and in choosing furnishings. The furniture and fittings reflect the needs and preferences of each resident. Residents expressed satisfaction with the accommodation and facilities. All bedrooms have their own individual identified toilet and hand basin in a separate room. Some rooms on the first floor also have their own bath. There is a level entry shower on the ground floor, and a bathroom on the ground floor with a powered assistance seat. All the bathrooms, toilets and basins inspected were clean and hygienic. The laundry is a separate room with a ceramic tiled floor accessed from the ground floor hallway. There are two domestic washing machines and two tumbler dryers. The staff manage some fouled clothes and linen. There is a policy and procedure for infection control and written guidance. There are hand-washing facilities for staff with liquid hand wash and paper towels in the kitchen, and at other points. Gloves and aprons were available around the home. Regular maintenance and testing of both premises is undertaken, to include; for example, gas safety and appliance testing. The registered manager said that it would be confirmed when the electrical system was last tested, and a copy of the most recent hard wiring test would be copied to the Commission. Care Homes for Adults (18-65 years) Page 22 of 29 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. The home is providing sufficient, competent support staff to provide for the welfare of the people that live at Ridgewood and Westbourne. The homes consistently adhere to a robust employment procedure. Evidence: The staff roster for both homes details all staff on duty, including the registered manager and ancillary staff. This information is displayed for residents daily on a pictorial board in the ground floor hallway of both homes. There is usually four staff on duty at Ridgewood during the daytime, with two waking staff at night. Staffing at Westbourne is currently under review, with 1:1 provision likely. Levels of staffing allow reasonable flexibility in supporting residents in their preferred activities and outings. There are currently no trainee staff under 18. We discussed the process of recruitment and selection of staff. Applicants are invited to the homes for an interview, a look around and to meet residents. Staff support the residents to meet the applicants and ask questions, so that their views can be obtained. The records of recent staff recruitment contained structured application forms and interview records with standard questions. The files showed two references, Criminal Records Bureau disclosures, identity information, and copies of qualification certificates. There were photographs for all staff. The registered provider issues statements of terms and conditions, and job descriptions to staff. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: The registered manager maintains a summary training record for all staff detailing the training completed and the training planned. Each staff member has an individual training record. The induction training appears to be based on the common induction standards set out by Skills for Care, but as discussed this should be confirmed with the training provider. Staff completing this induction currently do not receive a certificate. Staff also undertake an in-house induction to the homes, and a completed sample was seen. Care should be taken to ensure that the record demonstrates that the training took place over a period of time, rather than as the sample showed signed off on one date. There is a rolling programme of training in moving and handling, intervention techniques, health and safety, first aid, food hygiene, adult protection, and fire safety. 16 out of the current 22 care staff employed at both homes have NVQ at level 2 or above (not including the Ridgewood registered manager). This is close to a 75 rate of qualification. Staff comments received confirmed that without exception, all enjoyed working at Ridgewood and Westbourne, and they felt effectively supervised and supported to do their jobs well. One comment from a staff member was I feel Ridgewood supports our clients to live in their home, enabling them to have as normal a life as possible. I believe clients have a safe, warm, friendly, and happy home, which we are allowed to share with them. Care Homes for Adults (18-65 years) Page 24 of 29 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. The home is led by a manager who is able to demonstrate, through her qualifications, experience, and ability, that she is competent in all areas of her job and provides strong leadership of staff and provides high quality services. People are confident their views underpin all self-monitoring, review and development by the home. The health safety and welfare of the people that live at Ridgewood is protected and promoted. The registered manager position at Westbourne is currently vacant, its operation overseen by the Ridgewood registered manager. Westbournes operation is currently overseen by the Ridgewood registered manager. Evidence: Alison Brown is the responsible individual. There are clear lines of accountability. The registered managers post has a job description which details the managers responsibilities. The registered manager at Ridgewood has completed the registered managers award, and has also achieved NVQ Levels 2 and 4. The homes records are maintained to a good standard. Staff comments confirmed that the management team are very approachable and supportive. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: There is a quality management policy and procedure. A quality survey has been carried out in 2010 through questionnaires to relatives and representatives. The responses indicate a high level of satisfaction with the services and facilities. We discussed the options for summarising and publishing the findings from the surveys (e.g. including the findings in the Service User Guide). Staff have regular 1:1 meetings with each resident, which are recorded. The registered provider has produced Health and Safety policies and procedures, which detail organisational and individual responsibilities for health and safety. The manager has developed a system whereby all staff are given appropriate policies and procedures relating to the job they are doing at the time and are encouraged to familiarise themselves. Staff sign to indicate they have read policies and procedures. Records detail regular required checks on fire systems and staff training. The registered provider maintains current invoices and records to show ongoing maintenance and safety checks. The insurance cover in place ensures that the home is well able to fully meet any loss or legal liabilities. The homes use an external company to develop their fire safety risk assessments. The fire records detailed the required regular checks on the alarm system, emergency lighting, and extinguishers. Staff receive regular training in fire safety. The fire procedures are posted at strategic points around the homes. All records inspected were up to date and in sufficient detail. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 1 1 The registered manager should ensure that the Statement of Purpose and Service User Guides are current and accurate, providing all the information specified in Schedule 1. The registered manager should ensure that care plans are reviewed to ensure they provide the information needed in order to direct care provision. The registered manager should ensure that people are offered and enabled to make a choice of meal, and that this is recorded. The registered manager should confirm that the current induction programme meets the requirements of the Sector Skills Council specification. The registered manager should summarise and publish the findings from quality assurance surveys, including any action taken as a result. 2 6 3 17 4 35 5 39 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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