Care Home: Ridgway House

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What the care home does well Various information such as the service user guide, menus and the complaints procedure have been made available to people in a range of different formats such as large print, pictorial and audio tape to make them easier for people to understand. Care plans contain good information about people`s needs and preferences to make sure that staff have all of the information that they need to care for and support people as individuals. People told us that they were happy with the care and support that they receive. One person told us "we are well looked after and cared for - cannot fault the care. " another said that she was "happy with everything." Another person told us that she was happy that staff "let me be independent." The home has good links with the local community. People spoke highly of the staff. One person told us that the "staff are helpful - they come quickly if I ring the bell. " Communal areas had been decorated and furnished in a way to make them feel homely. Pictures of the staff who work in the home are on display in the home`s foyer. This helps the people who live in the home and visitors to know the names of the staff and what their job is within the home. The results of a recent satisfaction survey were generally very positive with people saying that they liked the home, felt well cared for and were treated in dignified manner. What has improved since the last inspection? People with dementia have detailed dementia care plans which give staff good information about how to support people in the right way. In the Annual Quality Assurance Assessment (AQAA) the manager gives a lot of detail about how the home has developed over the previous twelve months including introducing a falls prevention checklist, introducing a post admission satisfaction survey, various staff training and improvements to the environment. What the care home could do better: The care plan for someone nearing the end of life did not fully detail how they wished to be cared for in their last days. There was however evidence that this person was receiving sensitive and appropriate care. Bathing facilities should be reviewed to ensure that people can easily access an appropriate bathroom close to where their bedroom is situated. Key inspection report Care homes for older people Name: Address: Ridgway House 1 Swinneyford Road Towcester Northants NN12 6HD     The quality rating for this care home is:   three star excellent 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: Catherine Perrins     Date: 2 4 0 9 2 0 0 9 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 Older People Page 2 of 27 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 Older People 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) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Ridgway House 1 Swinneyford Road Towcester Northants NN12 6HD 01327350700 01327352369 sholland@northamptonshire.gov.uk www.northamptonshire.gov.uk Northamptonshire County Council care home 35 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: No person falling within the DE(E) category can be admitted where there are 14 people of DE(E) category already in the Home. No person falling within the OP category can be admitted where there are 32 people of OP category already in the Home. No person falling within the PD(E) category can be admitted where there are 3 people of PD(E) category already in the Home. The Home may continue to provide care for 1 existing, named resident with Sensory Impairment. Total number of service users in the Home must not exceed 35. Date of last inspection 0 0 0 Over 65 14 35 3 Care Homes for Older People Page 4 of 27 Brief description of the care home Ridgeway House is a residential care home owned by Northamptonshire County Council. It provides personal care for up to 35 older people, some of who have physical disabilities and some have dementia. The home is situated close to the town centre of Towcester and its local amenities and facilities and can be accessed by public transport. The premises are set back from the road and consist of two-storey building with a lift provided. Fees are 499 pounds per week. Extra charges, not covered by the fees, include services such as Chiropody and Hairdressing. People are also responsible for charges for newspapers, toiletries and transporting costs for example Taxis. Care Homes for Older People Page 5 of 27 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three stars. This means the people who use this service experience excellent quality outcomes. This was an unannounced key inspection which means that we focused on the key national standards. The key standards are those considered by the Commission to have the most impact on outcomes for residents. As part of the preparation for this inspection a period of four hours was spent reviewing the information that CQC has about this service. We looked at all the information that we have received, or asked for, since the last key inspection. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. Care Homes for Older People Page 6 of 27 The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Surveys returned to us by people using the service and from other people with an interest in the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. Relevant information from other organisations. The inspection visit lasted six hours during the morning and afternoon of a weekday. During the inspection four people were case tracked. This involves looking in detail at all aspects of their care and experiences at Ridgway House, including looking at their individual plans of care and other records, talking to them and talking to their care staff. Because people with dementia are not always able to tell us about their experiences we also used observations of peoples state of well being and how they interacted with staff members and others. A sample of staff files were also viewed as part of the inspection. The Registered Manager was present for the inspection. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 27 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 Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given good information in a range of formats and their needs assessed to ensure that the home is right for them. Evidence: The home has a statement of purpose which gives people good information about the home and the services it offers. There is also a service user guide which is available in large print and in a pictorial format to make the information accessible to older people who may have difficulty reading ordinary print and to people with dementia. Copies of the statement of purpose and service user guide are on display in the central area of the home and so can be accessed by people living at the home and visitors. The service user guide is available on an audio cassette and a tape player is also kept in the foyer for people to use should they wish to access the information that way. Records show that people are thoroughly assessed before they move in to the home to ensure that the home can meet their needs. The manager explained that if their is any Care Homes for Older People Page 11 of 27 Evidence: uncertainty about whether the home could meet a persons needs further assessments would be carried out to ensure that the Ridgway House was the right place for them. One person told us that she wanted to move to Ridgway House because she has always lived locally. Another person told us We visited another home and did not like it - we came here and knew it was right for us. The people who we case tracked had signed contracts on their files which detailed the terms and conditions of their stay at the home. The home conducts a post admission questionnaire to determine whether people were happy with the admissions process, results seen were generally very positive. Care Homes for Older People Page 12 of 27 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their health and personal care needs will be met and their preferences will be respected. Evidence: Each person who lives at the home has an individual plan of care. This contains their care plans and other information that staff need to care for people in the right way. Care plans seen covered areas such as personal care, mobility, communication, hearing, sight, orientation, memory, emotional needs, hobbies and interests, religious and cultural needs and night time support. Details of peoples individual preferences were included throughout their care plans, for example one person likes a cup of tea in the morning, another person likes to have a drink available in the night. Records show that care plans are updated as peoples needs change to ensure that staff have accurate information about peoples current needs and how to support and care for them. There was evidence of people being encouraged to make choices and remain as Care Homes for Older People Page 13 of 27 Evidence: independent as possible for example choosing what time they wish to go to bed and how often they are checked at night. One of the lounge areas in the home is predominantly used by a group of men. The manager explained that they will set their own dining table ready for meals and clear and wash the pots afterwards. Where people had needs with regard to dementia care, records show that they have a specific care plan which details how staff should support and care for them. For example the dementia care plan for one person detailed how staff should offer reassurance if the person became anxious. Records show that people had been assessed to find out if they are at risk of developing pressure sores. Where it was identified that there was a risk measures were put in place to reduce the risk such as provision of specialist equipment and helping people to change position regularly. Records show that the provision of specialist equipment and care for one of the people we case tracked had ensured that his pressure sore had healed and he no longer required any specific equipment in relation to pressure areas. Recognised assessments and screening tools are used to assess people for the risk of falls, moving and handling and nutrition and where risks are identified records detail strategies to monitor and reduce those risks. For example a falls prevention checklist is used for people who have been assessed as being at greater risk of falling. Records show that people have access to a range of health care professionals such as general practitioners, specialist nurses, dentist, opticians and chiropodists to make sure that their full range of health needs are addressed. Various information about a range of health related topics is available for people to look at in the homes foyer. People told us that they were happy with the care and support that they received. One person told us we are well looked after and cared for - cannot fault the care. another said that she was happy with everything. Another person told us that she was happy that staff let me be independent. One of the people that we case tracked was nearing the end stage of life. Their care plan did have a section on end of life care which gave some detail of their care needs and preferences but it did not fully detail how they wished to be cared for in their last days of life. The manager explained that arrangements had been made to ensure that a staff member was with the person at all times to make sure that they received the Care Homes for Older People Page 14 of 27 Evidence: care and support that they required. The administration of medication is generally well managed. The manager explained that she conducts an audit of the medication on a monthly basis and at the last audit no errors were identified. A spot check of the medication administration record showed that one staff member had not signed to say that medication had been administered on one occasion. Care Homes for Older People Page 15 of 27 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. People are able to choose how they spend their time and are able to participate in various activities and entertainment. Evidence: Lunch was observed during the inspection. Prior to lunch being served staff were seen putting fresh table cloths and napkins out on the dining tables. Staff were seen assisting people in sensitive manner, talking to them and explaining what the food was. People told us that the food was good. Menus were on display in the lounge areas for people to look at. Catering staff showed us a pictorial menu that they were in the process of putting together. This contained photographs of the various meals on the menu to help people choose what they would like to eat. Two choices of main meal are available each day, staff explained that if someone does not like either of the choices then something else would be prepared for them. Catering staff told us that a record is kept of which foods people have enjoyed and that this is used to plan the menus. Menus seen appeared varied and nutritious. During the day of the inspection people were observed listening to music, reading newspapers and books, writing letters, watching the television and chatting to each other. There were a number of magazines available if people wished to read them as Care Homes for Older People Page 16 of 27 Evidence: well as large print word search books. Peoples individual plans of care contained details of their life histories. These gave staff an insight into peoples past lifestyles, hobbies and interests and provide opportunities for discussions and reminiscence. People told us that someone comes into the home to do exercises and that they also have various entertainers such as singers on a regular basis. There is an activities board in the foyer which details the activities planned for each day. On the day of inspection the manicures and bowling that had been planned did not happen. The manager explained that because one member of staff was not in work due to ill health and another staff member was involved in providing additional support to someone who needed it there was not enough staff to provide the planned activities. The manager explained that various groups from the community come into the home such as local school children, a group who help with the garden and take a shop trolley around and a the local church who provide a monthly service. The home produces a newsletter which gives people details about forthcoming activities and events. This was available in the foyer so it can be accessed by visitors as well as people who live at the home. Care Homes for Older People Page 17 of 27 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. People are protected by the homes policies, procedures and practices. Evidence: The home has a complaints procedure which outlines what people should do if they wish to raise a concern about the home and the response that they can expect. The complaints procedure is displayed in the foyer along with information about local advocacy schemes, the contact info for the Care Quality Commission and the local Citizens Advice Bureux and information about the Mental Capacity Act 2005. Records show that the home has received one complaint since the last inspection. One referral has been made by the home to the safeguarding adults team under the locally agreed safeguarding adults procedure. The manager explained that this is still being investigated. Staff spoken to were aware of how to raise any concerns that they may have and were aware of their responsibilities to ensure people are safe from harm. Care Homes for Older People Page 18 of 27 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, 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. 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. People benefit from having a comfortable, clean and homely place to live. Evidence: Ridgway house is a purpose built property situated in a residential area of Towcester close to amenities and opposite the local health centre. Communal areas within the home consist of five lounge / dining rooms each of which has a small kitchen area. Communal areas had been decorated and furnished in a way to make them feel homely this being further enhanced by plants, flowers, pictures and ornaments. There is a further small library area and a seating area in the foyer. The manager explained that the home has a smoking room but that this is currently not in use as none of the people who live in the home smoke. The home has a separate wing which caters for people with dementia. This is accessed by a link corridor from the main home and has its own lounge and small enclosed garden area. One of the lounges in the main part of the home is also predominantly used by people with dementia. There are a number of bath and shower rooms throughout the home. The bathroom in the dementia area was not in use as it is awaiting refurbishment and the fitting of a ceiling hoist to assist people with mobility problems. This means that people have to Care Homes for Older People Page 19 of 27 Evidence: access bathing facilities elsewhere in the home. The manager explained that work to this bathroom has been scheduled and is due to happen before April 2010. Bedrooms seen had been made personal with people being able to bring in their own pictures, ornaments and effects. Each of the bedrooms in the home has a wash basin. The manager told us that she has requested that the surrounds to the wash basin units be replaced as the current ones have a potentially sharp corner which people could be at risk of bumping into. There is a courtyard garden area that people are able to sit in if they wish to when the weather is warm. The manager explained that the home has been given some funding from the local community to assist with improvements to the environment this included purchasing some garden benches for the outside area. The home was clean and hygienic throughout. Care Homes for Older People Page 20 of 27 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. People are cared for by a competent staff team who have a good knowledge of their needs and preferences. Evidence: Pictures of the staff who work in the home are on display in the homes foyer. This helps the people who live in the home and visitors to know the names of the staff and what their job is within the home. The recruitment of staff is well managed with all of the necessary pre recruitment checks being carried out to ensure that staff are suitable to work with older people. Staff told us that they had an induction when they first started working at the home which included working alongside an experienced colleague to make sure that they had all of the information that they need to do their job in the right way. Staff explained that they attend training courses such as food hygiene, safeguarding of adults, dementia care, infection control, fire safety and moving and handling. People spoke highly of the staff. One person told us that the staff are helpful - they come quickly if I ring the bell. Care Homes for Older People Page 21 of 27 Evidence: Staff were observed caring for and supporting people in a kind and sensitive manner. Interactions showed that they had a good understanding of peoples needs and preferences. Staff spoken to told us that the standard of care that people who live in the home receive is very good, however, at times they feel that there is not enough time to sit with people and spend time talking to them or doing activities. On the day of inspection some of the planned activities did not take place. The manager explained that one member of staff was not in work due to ill health and another staff member was involved in providing additional support to someone who needed it and that this had meant that the activities could not happen as planned. Care Homes for Older People Page 22 of 27 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed in the the best interests of the people who live there. Evidence: Observation showed that the registered manager has a good relationship with the people who live in the home and a good understanding of their needs. People spoke highly of her saying that she ran the home well. The registered manager informed us that she was going to be moving to manage another home owned by Northampton County Council and that another manager, who currently manages another County Council home, will be moving to Ridgway House. People told us that they were sad that she was going. Discussions with the registered manager demonstrated a commitment to the people who live at Ridgway House and a desire to deliver a high quality service to them. For example the manager explained how she strives to ensure that any staff employed by the home have a high level of competency to care for and meet the needs of the people living at the home. Care Homes for Older People Page 23 of 27 Evidence: In the Annual Quality Assurance Assessment, a self-assessment of the service that the manager undertakes and submits to the Care Quality Commission, the manager clearly states how the home has developed in the previous twelve months and comprehensive plans for the development priorities for the forthcoming year. This demonstrates a good knowledge of the key issues within the home and a clear focus on continually improving the service offered to the people who live at Ridgway House. Records show that the necessary safety checks such as fire checks, checks on the water system and portable appliance testing have all been carried out recently. Hoists and lifting equipment has been serviced as per manufacturers recommendations. The manager told us that the home carries out a satisfaction survey twice a year. The results were viewed and were generally very positive with people saying that they liked the home, felt well cared for and were treated in dignified manner. Results of the satisfactions surveys were available for people to view in the homes foyer. The registered manager explained that she carries out audits of the administration of medication on a monthly basis and an audit of peoples care plans two or three times a year. Care Homes for Older People Page 24 of 27 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 Older People Page 25 of 27 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 11 Care plans detailed people end of life care should be further developed to ensure that staff have all of the information that they need to support and care for people in their last stage of life in a way that respects their preferences and ensures that their spiritual needs, rites and functions are observed. Bathing facilities should be reviewed to ensure that people can easily access an appropriate bathroom close to where their bedroom is situated. 2 21 Care Homes for Older People Page 26 of 27 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). 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