Care Home: Ridgmont

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What the care home does well All the residents appeared well cared for. They have access to a range of social and leisure activities that meets their needs. The residents have learning difficulties and the staff are trained to assist and support them to lead a reasonably independent lifestyle. The members of staff present during the visit interacted well with the residents in their care and were readily available to assist them. In a recent questionnaire survey by us, those residents who were able to respond gave positive feedback about the care and service provided. Comments include "I am very happy living here." "Involved in planning." "Staying with (family)." What has improved since the last inspection? Since the last inspection a number of staff have left the service, including the deputy manager. However, the service has appointed a part-time deputy manager and has recruited a number of support workers. Agency workers are deployed to make up the numbers. Since the last inspection, the provider, Adepta and Stoneham Housing have agreed to carry out repairs and redecoration work over the next few months to bring the environment up to an acceptable standard. . Therefore extensive renovation and refurbishment work is currently in progress for the benefit of the people who live there. To ensure people are kept safe all doors have now been installed with automatic hold-open door devices. What the care home could do better: The home manager has ensured residents` safety and ensures that their daily routine is not unduly disrupted while building work is being carried out. The building work will continue throughout the summer months. However, some building work may not be carried out until planning permission has been granted by St Albans Council (and their Conservation Team) as Ridgmont House is a listed building. CARE HOME ADULTS 18-65 Ridgmont 8 Ridgmont Road St Albans Hertfordshire AL1 3AF Lead Inspector Yoke-Lan Jackson Unannounced Inspection 9th June 2008 15:30 Ridgmont DS0000019510.V366106.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 Ridgmont DS0000019510.V366106.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. Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ridgmont Address 8 Ridgmont Road St Albans Hertfordshire AL1 3AF 01727 811159 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) ihead@adepta.org.uk www.pentahact.org.uk PentaHact Limited trading as Adepta Ian Frederick Head Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th June 2007 Brief Description of the Service: Ridgmont is a care home providing personal care and accommodation for six younger adults with learning disabilities. It provides a specialist environment for people with autistic spectrum disorder (ASD) and associated challenging behaviour. The home was opened in 1991. The provider of the service is Adepta (formerly known as PentaHact), a charitable organisation. The semi-detached, three storey Victorian building is owned and managed by Stoneham Housing Association. It is located in a residential area south of St Albans city centre. All the community services are within easy reach. There are good transport links nearby for the city centre, other Hertfordshire towns and London. The home has its own minibus service. All the bedrooms are for single occupancy. The bathroom and toilet facilities are nearby. The home does not have a lift and would not be suitable for service users with restricted mobility. There are one bedroom on the ground floor and four bedrooms on the first floor. The administrative office and the sixth bedroom are on the second floor. The laundry is in the basement. The home has an enclosed garden with a patio, garden furniture and a summerhouse. The fees range from £1490 - £2962 per week. Information about the home and the service it offers is contained in the Statement of Purpose and the Service Users Guide. A copy of these and the most recent CSCI inspection report are available in the home. Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use the service experience good quality outcomes. The unannounced inspection was carried out on 09/06/08. The registered manager was present. The home has 6 people in residence. The inspection included a tour of the premises. Time was spent observing how the staff interacted with the residents. Staff and residents were spoken with and key documents were examined. There were no relatives present during this site visit. Information received by us (The Commission for Social Care Inspection) since the last inspection was reviewed. This included the written survey questionnaires and the Annual Quality and Assurance Assessment (AQAA) which providers of registered services are required to complete. The AQAA focuses on how the outcomes are being met for people using the service. What the service does well: What has improved since the last inspection? Since the last inspection a number of staff have left the service, including the deputy manager. However, the service has appointed a part-time deputy manager and has recruited a number of support workers. Agency workers are deployed to make up the numbers. Since the last inspection, the provider, Adepta and Stoneham Housing have agreed to carry out repairs and redecoration work over the next few months to bring the environment up to an acceptable standard. . Therefore extensive Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 6 renovation and refurbishment work is currently in progress for the benefit of the people who live there. To ensure people are kept safe all doors have now been installed with automatic hold-open door devices. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 7 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 Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 8 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): Standard 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective clients can be assured that a pre-admission assessment will be completed before they are admitted to ensure that the home can meet all their care needs. EVIDENCE: The home has not had an admission since the last inspection but the home manager said that the management team would carry out a thorough assessment of care needs before a client is admitted. The pre-admission documents of existing clients were seen in the care plan folder. Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 9 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): Standards 6, 7 and 9. 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 can be assured that they will have written care plans so that staff are able to identify their goals and care needs appropriately. This gives the people an opportunity to make everyday choices with staff respecting their preferences and requests, enabling them to achieve independent lifestyles. EVIDENCE: Each resident has a written care plan. Work is in progress to improve the written care plans to include person-centred planning. The home manager said that key workers have been assigned to complete the task hopefully within the next three months. Three completed care plans were examined and they were found to be comprehensive and person-centred. Risk assessments and changing needs were reflected in the care plans examined. Each written care plan includes an individual learning plan, which is an accreditation requirement of the National Autistic Society (NAS). The home has a yearly accreditation assessment by NAS. Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 10 Residents’ care needs are reviewed monthly and there is an annual review of care needs that involve the resident, their relatives, the social worker and other healthcare professionals. The written care plans are updated accordingly to ensure staff are aware of peoples latest care needs and objectives. All the residents have learning difficulties and they are supported to make decisions about their lives with assistance when needed. The home has a keyworking system to ensure that each resident is consulted on all aspects of life in the home and that they are supported in the choices made. Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 11 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): Standards 12, 13, 15, 16 and 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 can expect that their rights will be respected and that they will be encouraged to lead an independent lifestyle and engage in communal activities and maintain contact with their friends and family. A healthy diet is promoted which meets peoples needs and expectations. EVIDENCE: The daily routine promotes independence and individual choice. The activity programme is planned to suit individual needs and interests and the residents are encouraged to participate in valued and fulfilling activities and are encouraged to make use of local leisure facilities. Members of staff assist each day with the transportation, which is provided by the home. The home adopts the guidelines from the National Autistic Society (NAS) and is accredited each year by the NAS. Each resident has an activity and learning Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 12 plan and their participation in therapeutic and recreation activities is monitored and recorded on a monitoring form. Equality and diversity are promoted. Residents are supported in their religious practice and celebrations. On the day of the site visit, members of staff were observed to interact well with the residents who seemed happy and content. Some residents had gone to the day centre and they all had returned after 4pm. Shortly afterwards, staff accompanied them to the local shops. One of the residents attends a Weight Watchers’ club regularly. There were no visitors present during the site visit. The manager said that relatives are in constant contact and some residents return to their own home regularly. He said that the relatives seemed pleased with the service provided as reflected in the surveys conducted. Some relatives have been involved in choosing the décor for the residents’ bedrooms. The home offers residents a nutritious and balanced diet. Residents have a menu to choose from and the menu is in picture format. Each member of staff takes turns to cook the meals. Sometimes residents prefer take-away food and they are supported to do so. Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 13 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): Standards 18, 19 and 20. 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 treated with dignity and receive individual care and support in the way they prefer and require, including a full range of healthcare facilities. They can be assured that their medicines will be administered safely since they are not able to administer the medicines themselves. EVIDENCE: Staff have a good working knowledge of the residents’ conditions, and their likes and dislikes, and deliver care and support in the way residents prefer and require. Most of the residents are not able to communicate verbally but staff understand their gestures and assist them accordingly. During the site visit we saw that residents were treated with respect. A trained member of staff administers the medication in accordance with the home’s medication policy and procedures for the receiving, recording, storage, handling and administration of medicines. Since the last inspection there have been no medication errors. The manager said that the deputy manager will continue to audit medication and the Medication Administration Record charts Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 14 regularly to ensure that the standards of administration and the recording is well maintained. Medicines are stored in a drug trolley that is attached to the wall in the dining room. There are no controlled drugs in use at the present time. The manager said that the service has an agreement with the local pharmacist, who will supply a Controlled Drug Cupboard if needed. The home has the support of health care professionals such as the General Practitioner and the Community Learning Disability Team. Behavioural concerns are referred to them for immediate assessment. The provider, Adepta, has a Behaviour Support Team who give assistance when required. The support plans regarding each resident’s physical and emotional healthcare are assessed regularly. One of the residents has had their referrals to a specialist brought forward with the help of the local Healthcare Facilitator. Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 15 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): Standards 22 and 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 can be assured that they will be listened to and that they will be protected from self-harm and abuse. EVIDENCE: The manager said that all members of staff have had training on issues regarding abuse and safeguarding adults (the protection of vulnerable adults) as well as the Whistle-blowing policy. Arrangements are being made for new members of staff to attend training as soon as possible. The manager ensures that all staff are aware of the joint agency Safeguarding Adults (Adult Protection) procedures of Hertfordshire County Council Adult Care Services. Since the last inspection, the home has not received any complaints and there were no safeguarding incidents reported. Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 16 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): Standards 24 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that the provider is working towards making the environment more homely, safe and comfortable to live in. EVIDENCE: The premises have not been kept in a good state of repair externally and internally for some time. At the last inspection (dated 07/06/2008), the provider, Adepta, and Stoneham Housing (who own the building), have been working together to arrange funding, repair and redecoration work. As a result, extensive building work and redecoration are being carried out this year (2008). Risk assessments are in place to ensure residents’ safety. The manager said that the building work is being carried out during the daytime when the residents are at the day centre so that their daily routine is not disrupted. On the day of the site visit, the workmen were on site and they left shortly before the residents returned from the day centre at around 4.15 pm. Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 17 Since the building is listed, not all the building repair can be done until planning permission is approved by St Albans City Council. This includes the windows. However, the manager has ensured that any work that can be done is being done. Automatic hold open door devices have been installed to those doors that need to be kept open instead of wedges being used to ensure people are kept safe. The entrance hall, dining room and some of the bedrooms have new laminated flooring. Some bedrooms and communal rooms have been redecorated. The manager said that repair and redecoration will continue throughout the summer months. Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 18 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): Standards 32, 33, 34, 35 and 36. 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 can be assured that the home has an effective staff team who will support them and can be confident that they are safeguarded by the home’s robust recruitment policy and procedures. EVIDENCE: Since the last inspection there has been a high staff turnover. However, the staffing level has been maintained using regular agency care workers. On the day of the site visit, the skill mix and the staffing level were well maintained. A number of new staff have been recruited and a part-time deputy manager has been appointed. The home’s recruitment policy and procedures have been followed and the new workers only commenced work after the Criminal Bureau Record (CRB) checks and the Protection of Vulnerable Adult (POVA) Register checks had been cleared. The staff files examined included training certificates, supervision notes and a cover note with the reference number of the CRB certificate. All recruitment records are kept at the head office. Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 19 New staff have a period of induction including mandatory training that includes Moving and Handling, Fire Safety, First Aid and Food and Hygiene. Each member of staff has an annual appraisal and a monthly supervision. There is a rolling training programme, including refresher courses on medication, learning disability, safeguarding and equality and diversity. Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 20 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): Standards 37, 38, 39 and 42. 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 can be assured that the care and service provided will continue to improve. They can be assured that their health and safety are promoted and protected. EVIDENCE: The standards of management and administration of the service have improved. Any shortfalls in the service have been addressed since the last inspection. The registered manager has completed and attained the NVQ4 Registered Management Award in Care and Management. The provider carries out an annual quality assurance and monitoring survey. This includes written questionnaire feedback from residents, relatives and Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 21 others. The audit documents were readily available for inspection. There is a monthly proprietor’s report in compliance with regulations. The organisation has introduced a diversity workshop available to managers and the information has been cascaded down to the care workers. The organisation works in partnership with the Stonewall organisation which champions the cause of equality and diversity within the work place. The home is not involved in the residents’ finances but the home manager oversees the personal allowance for each resident and has signing authority to access the resident’s own account. Accounting records are kept. The area manager carries out regular accounting audits. All records for the protection of the residents are kept secure and handled in accordance with the Data Protection Act 1998. The servicing records have been well maintained. The Annual Quality Assurance Assessment (AQAA) forms issued by the Commission were received after the due date. The information provided was detailed and has been included in this report. Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X 2 3 3 X 4 X 5 X 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 2 25 X 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 3 X Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? yes 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 YA24 Regulation 23 (2)(b) & (d) Requirement The premises must be of sound construction and kept in a good state of repair externally and internally. All parts of the care home must be kept clean and reasonably decorated. All repair and redecoration work must be carried out as soon as possible and be completed within a reasonable period. This was a requirement at the previous inspection. As building work has been started the compliance date has been extended. Failure to meet this extended deadline could lead to the issuing of a statutory requirement notice. Timescale for action 30/10/08 Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA24 YA42 Good Practice Recommendations To ensure that people needs are person centred it is recommended that all written care plans are revised and completed without undue delay. It is recommended that management continue to minimise the disruption to the daily routine and ensures the continued safety for the people living in the home while building work is in progress. Ridgmont DS0000019510.V366106.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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