Care Home: Rivendell

Similar services:

• Polesworth Group Friary Road
• Polesworth Group Pooley Heights
• Polesworth Group 32 Station Road
• Polesworth Group 70 Long Street
• Breme
• Polesworth Group 64 Long Street
• Polesworth Group 68 Long Street
• 10 Whitfield Avenue

What the care home does well Information is collected about people who may be coming into this home. People are visited at their home and other places where they spend their time to build up a picture of how to care for them. Staff interact with people well; for example people who were being assisted to eat had the benefit of staff who talked to them throughout and maintained eye contact. People were also enabled to make choices despite having limited communication. People had regular access to health professionals having clinic appointments every 3-6 months. Where people`s health changed the home also arranged for health appointments. People have access to a range activities and the home has access to appropriate transport for visits and appointments. We received a comment saying ` (The home) Provides transport and outdoor activities. They take service users out of the home and access community activities.`RivendellDS0000073225.V377314.R01.S.docVersion 5.2Staff spoken to were knowledgeable about the people they cared for and were interested to improve their skills. People had their personal hygiene needs met and were dressed in a way that reflected their age and interests. People have their medication administered well and this helps to ensure that people remain well. The home has policies and procedures in place to respond to people`s concerns and to safeguard people. Staff are recruited well with all the checks being made. Staff receive good training and this helps to safeguard people in the home. The home is light and airy. The two bungalows have a small garden each and a good amount of space inside. People have single bedrooms with en suites that contain showers. There is enough equipment to meet people`s needs and there are sufficient communal areas. The staff have started to make them more homely but this will improve once further decoration begins. All health and safety checks have been completed on the building and equipment. The manager of the home has had the appropriate training and is experienced in caring for people with learning disabilities. Staff feel supported by the management group. What has improved since the last inspection? This is a new service. What the care home could do better: Although the home collects good information before people are admitted this is not put into the organisations forms in a timely way. This means that information can get mislaid, or not be quickly retrievable. Care plans and risk assessments for new people are not written in a timely way and this means that people may not have a consistent way of for example being moved from place to place nor have risks to them minimised. This can mean that people could be at risk of harm. The medication rooms were too hot at this inspection and this means that medication may be spoilt by the heat. Some monitoring records needed to be in place for people whose behaviour may leave marks on their body. Key inspection report CARE HOME ADULTS 18-65 Rivendell 57 - 59 Marsh Lane Erdington Birmingham West Midlands B23 6AX Lead Inspector Jill Brown Key Unannounced Inspection 24th August 2009 08:55 Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 2 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 Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rivendell Address 57 - 59 Marsh Lane Erdington Birmingham West Midlands B23 6AX 01217485955 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) Jaffray Care Society Tayla Allen Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 10 The maximum number of service users to be accommodated is 10. 2. Date of last inspection New service Brief Description of the Service: Rivendell is a purpose home with 2 units- Rivendell and Lorien. Each unit provides residential care for up to 5 persons who have a learning disability as their primary need. Each unit is a bungalow set in its own grounds and there is a secure and safe garden at the rear of each unit. There is some parking available for people visiting the site. Inside the bungalows there is a large shared lounge-dining area, an assisted bathing facility, a toilet facility, a kitchen and laundry as well as offices. Bedroom accommodation is all single and each bedroom has an en suite which includes a shower as well as a toilet. There is one larger bedroom in each of the bungalows to accommodate people who are wheelchair users. The home has enough specialist equipment and hoists to assist with the care of people. The fees for the home vary according to the needs of the person an currently this ranges from £1465.64 to £2048 per week . There are additional charges for toiletries, some activities and chiropody. Rivendell DS0000073225.V377314.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 1 star. This means the people who use this service experience adequate quality outcomes. We visited the home without notice on a day in August 2009 and spent about 9 hours in the home. During the inspection three peoples care was case tracked. This case tracking involved looking at all the records and information about them, looking at their medication and their rooms and observing their care. This assists us to make a judgement about the care given. We received four comment cards, three from staff telling us about the service. We also took account of information we had received from all sources about the home since the last key inspection. Services are required to complete an Annual Quality Assurance Assessment (AQAA) on a yearly basis. This shows how the quality of the service given is checked by the service and how they intend to improve the service. During the inspection we spoke with one person and observed interactions between staff and five people living in the home. We spoke to the deputy manager and 3 staff. What the service does well: Information is collected about people who may be coming into this home. People are visited at their home and other places where they spend their time to build up a picture of how to care for them. Staff interact with people well; for example people who were being assisted to eat had the benefit of staff who talked to them throughout and maintained eye contact. People were also enabled to make choices despite having limited communication. People had regular access to health professionals having clinic appointments every 3-6 months. Where peoples health changed the home also arranged for health appointments. People have access to a range activities and the home has access to appropriate transport for visits and appointments. We received a comment saying (The home) Provides transport and outdoor activities. They take service users out of the home and access community activities. Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 6 Staff spoken to were knowledgeable about the people they cared for and were interested to improve their skills. People had their personal hygiene needs met and were dressed in a way that reflected their age and interests. People have their medication administered well and this helps to ensure that people remain well. The home has policies and procedures in place to respond to peoples concerns and to safeguard people. Staff are recruited well with all the checks being made. Staff receive good training and this helps to safeguard people in the home. The home is light and airy. The two bungalows have a small garden each and a good amount of space inside. People have single bedrooms with en suites that contain showers. There is enough equipment to meet peoples needs and there are sufficient communal areas. The staff have started to make them more homely but this will improve once further decoration begins. All health and safety checks have been completed on the building and equipment. The manager of the home has had the appropriate training and is experienced in caring for people with learning disabilities. Staff feel supported by the management group. 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 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. Rivendell DS0000073225.V377314.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 Rivendell DS0000073225.V377314.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 4 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available for people that are considering this home and the home is continuing to look at ways of making information relevant to people that live there. Information collected about peoples abilities and difficulties were not always available and this could lead to peoples needs not being met. EVIDENCE: Rivendell is a newly built home that was registered with us in February 2009. It has two units Rivendell unit and Lorien unit. People living in Rivendell unit were transferred with staff from a smaller home also called Rivendell, owned by the same organisation (Jaffray Care Society). The small home has since closed. Lorien unit has no people transferred and is open to admitting new people. The statement of purpose and the service user guide were provided to us before the home was open. These provide the required information and assist peoples representatives to decide whether the home will suit the person. Most Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 9 of the people cared for have difficulty in understanding written information and some people would not recognise picture representations. We were told that some people living in the home are learning widget (picture form) communication and if successful they will look at how important bits of information in statement of purpose and service user guide can be put into this format. The homes Annual Quality Assurance Assessment stated that a brochure is available and a website. We looked at the information provided on the website following the inspection and found that the philosophy and aims for Jaffray Care Society and contact details for the home were available. However elsewhere on the organisations website a picture of the closed small home was in the information and this could be misleading. We understand the organisation has retained the home and will be developing it for supported living and that the website will change. We looked at the process of two people being admitted into the home. We found that there was information available about the people but this varied in the amount and how it was presented. One person had information gathered from a previous placement, school and by visits to the home but this had not resulted in a formal assessment about whether the home could meet the persons needs. Some information was available to staff but not in the usual format. The other had a more formal assessment which included a pen picture of the abilities and difficulties of the person however we could not find when this was completed so we do not know if this information was available to staff at the point of the person being admitted. Not all risk assessments were undertaken. (please Standard 9) People have an opportunity to visit the home, and be visited in their own homes, schools, centres and so on. This means that the person has a chance to meet with staff that will be assisting them and staff have an opportunity to see how the persons care is managed currently. Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessments were not always written in a timely way and this can mean that people do not care in a safe and consistent way. Staff in the home are committed to communicating with people to ensure that that they have choices were ever possible and this enhances peoples lives. EVIDENCE: The homes Annual Quality Assurance Assessment stated that all people have individualised care plans that include interventions, therapeutic programmes, communication passports, adaptations, equipment and staffing report requirements. This was not the case for one person whose care records were looked at, where no care plan had been written. Both other people whose care was looked at had care plans in place. Information collected about the person was available to staff but did not cover all the areas it needed to. Another Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 11 person had been in the home some weeks before a full care plan had been developed. We could not find that the home had a record instructing staff how to deliver the care in all important areas in the interim. Where plans are in place these are detailed and include plans for the safe way to assist the individual with, personal care including bathing and showering, eating and drinking, their health care needs, triggers for challenging behaviour and what the person likes and dislikes. Consideration is given to the gender of the care giver and whether this is appropriate to the person. Care plans also indicate what tasks a person can do for themselves with guidance and support. On arriving at the home we observed one person being assisted to choose the clothes that they wanted to wear that day. Records did not show that people that people had timely reviews. On one occasion a persons behaviour had changed and this did not prompt a review. We received a comment They needed to keep us (agencies) better informed of issues /problems (and) changes in circumstances. We spoke to staff about the way they communicate with people that use the service and how they enhance decision making. The home has weekly meetings with and about people. Where possible people are enabled to make decisions about how they would like the service to run. This includes decisions about food and activities. Staff spoken to were able to express how they communicate with individual people whose communication was limited. One person thought that training in this area needed to be improved and be given in a more timely way. One person was found to have menu for themselves clearly showing their decision on what they would like to eat. Throughout the inspection we observed staff communicating well with people. Risk assessments were not always in place especially for people that had not been in the home long. There were no risk assessments in place for bed rails or bed restraints for 2 people and no clear moving and handling risk assessment for moving and handling for one person. This had put a person at risk of injury. We found that people that had been at the home longer had risk management plans in place for issues such as behaviour that challenges. Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 12 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): This is what people staying in this care home experience: 12,13,15 16 & 17 People using the 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 living in this home have the benefit of activities that are meaningful to them. They are encouraged to maintain contacts with family and the community and this improves their quality of life. People are given good food and where necessary assisted to eat well and this helps to maintain their health. EVIDENCE: People have access to a range of activities. The homes AQAA stated that this was an area the home kept under review so that can be sure that activities are meaningful for people. Some people attend college others do not. We looked at three peoples activities record for August and we found the following range of activities: - playing with balls, shopping, walking, aromatherapy, being in the garden, listening to music, watching the TV, looking at projected images, playing with a puppet, holiday to Butlins, Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 13 Drayton Manor park visit, domestic tasks, going out to the Sea life centre, for a pub meal, the cinema and to the Peak district for a picnic. It was clear that the type of activity chosen matched the persons abilities. The home has access to tail lift transport and this means they can be flexible about the timing of activities, people, who are able, are also encouraged to use Ring and Ride services or public transport. We received a comment saying (The home) Provides transport and outdoor activities. They take service users out of the home and access community activities. People are encouraged to maintain their relationships with people that are important to them including family. One person is assisted to text a relative when they sign the person. Visitors are welcomed to the home and people spend time with their relatives. People living in the home have a range of abilities, this means that some people cannot use door locks and need assistance for all tasks. Some people where able to assist with cleaning, shopping, setting tables and so on. People have freedom of movement within the units however because of the risks to some people there are locks on the doors to the outside and the garden. People are assisted to go out if they wish at all reasonable times. We looked at the menus for both units and found that each unit had details of the food to be provided for four weeks. Each unit had different menus because where possible the menus were either chosen by people in the weekly meeting or, staff put on the menu what people seem to enjoy if they could not say. One person had a separate menu and another person had special food arrangements. People had a good range of food available to them and had at least one hot meal daily. Menus included snacks where this was appropriate. We observed two people being assisted to eat and this was done well. We found that staff encouraged people to eat and maintained eye contact. Where concerns were raised about peoples eating they were appropriately referred to appropriate services such as speech and language therapists, psychiatrists and so on. People that have difficulties with eating have care plans to say how this should be managed. Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 &20 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to health services when their health changes and routinely. Medication is administered appropriately. This helps to keep people well. A lack in routine planning can mean that people do not receive a consistent service. EVIDENCE: Peoples care plans were mostly detailed enough to show how Healthcare should be given. For example care plans include information about communication, and how staff can determine whether the person needs to be encouraged to go to bed, or what to if a person has some challenging behaviour. People have designated key workers and that helps the home determine that the areas that may affect a person are considered. Records show us that people have access to health professionals including GPs, community nurses, speech and language therapists, psychologists and psychiatrists as needed. On the day of the inspection one person was being assisted to see the GP. The homes annual quality assurance assessment said Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 15 that people had their annual health check and 3 to 6 monthly clinic appointments. We looked at the information that the home gave to staff about people specific health needs. This included information about epilepsy, weight management, challenging behaviour management and special dietary arrangements. We found that background information was provided to staff about epilepsy, people had care plans about pre-seizure signs so staff were aware what to look for, there were instructions for what staff were to do and staff received training in epilepsy. For one person on two days a review of the plan had not been recorded when the plan looked like it had not been followed. Staff spoken to were knowledgeable about and interested in the people that they care for and this helps to ensure that people get a good service. People have their weight recorded on admission to the home but there is no indicator whether this is within healthy limits. Not all people who have special nutritional needs are weighed routinely. Plans were in place showing how people could be assisted to eat are maintained a healthy diet. Staff had specific training to meet the needs of one person, information was available about how to do this, but no care plan has yet been written. We looked at three peoples plans for the managing of their behaviour that may put the person or other people at risk. We found where necessary the person was referred for specialist help where the persons behaviour may put another person living in the home at risk. However for one person within the home there was not enough review of the risk assessment on behaviour to ensure that the measures in place were sufficient. Another person needed more records about how their behaviour may mark their body to ensure that the home could respond to this behaviour if it increased. People we observed during the inspection looked well and seemed to have their personal hygiene needs met. People were dressed in a way that was appropriate for their age and activity. People appeared to be happy, one person spoken to said its ok. We looked at the administration of medication and found that this was generally administered well. There were no errors found. The home has good process for checking the medication that comes in is what the doctor prescribed. If more medication than needed is brought into the home it is returned. The amount of medication found in stock match the record in all but one case. We found in both units, according to both of the homes thermometers, that the medication rooms were too hot to comply with how the medicine should be stored. There is a system of checking the medication weekly in each unit and this is audited again monthly. People administering medication had medication training and the person assisting those on the day of the inspection was knowledgeable about what medications were for. Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 &23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place for people to be assisted in raising concerns. Staff are recruited well and are aware of the process they are to undertake if they have concerns about the service and this helps to protect people. EVIDENCE: The homes Annual Quality Assurance Assessment told us that they had no complaints and since they had opened. This was confirmed on inspection. We have received no complaints about the service. The home has the complaints policy which they submitted to us at the point of the home being registered and this states any complaint will have a response within 10 days. Where necessary the home stated they would look for an advocate for the person when a complaint was made. The people living in the home have a simple makaton (picture) version of the complaints procedure directing them to the manager of the home if they are unhappy. We saw compliments about one of the units one said thanks again the further ongoing support to (a person living in the home, one of the management team) is doing a wonderful job with the great team of support workers. Safeguarding issues were raised about the challenging behaviour of one person living in the home over a couple of days following us receiving a notification from the home. The home had plans in place to try and minimise Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 17 the recurrence of this behaviour to safeguard of the people living in the home. This had not been referred as safeguarding to Social Services. We have not been informed of any other incidences within the home. The home has policies and procedures in place and staff interviewed knew what the process was. Staff are recruited appropriately in this helps to protect people. Staff are given information about 10 client rights that the organisation have identified which the staff are to uphold. These include not to be subjected to degrading or intimidating behaviour and not to be discriminated against these expectations help to keep people safe. We looked at the records of 2 residents money that was held by the home. The home does not hold large amounts of money. Money is kept in a bank account administered by the Finance manager. The home asks for money as and when it is needed for people that they are assisting. No records were held at the home for the money held in the bank account so a full check of this could not be undertaken. The money in the record matched the money held within the home. Receipts were seen for the money spent. People spend money for leisure activities, aromatherapy and toiletries. Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,29 &30 People using the 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 people living in this home have the benefit of a light, bright, fresh, safe and comfortable place to live with equipment and facilities to meet their needs. EVIDENCE: This is a new home that meets the standards required for new buildings including wheelchair access. People in the home have access to a spacious building with good facilities. Each person has an en suite in the bedroom which includes shower facilities, a toilet and wash hand basin. One bedroom in each unit is larger with a larger en suite to be more appropriate for people with multiple needs. The buildings need to be decorated in a more personalised style however they are waiting until all the minor issues with new buildings are finished before decoration is started. Currently there are pictures on the walls, nice Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 19 comfortable furnishings in the communal areas and peoples bedrooms had some items that reflected their lifestyle. People had equipment and furniture to meet their needs and preferences. In one bedroom looked at for example the person had a queen size bed, another had the projector in place and some luminescent stars on the ceiling, one bedroom did not have a lot of furnishings because the person couldnt tolerate this. There is a garden attached to each of the units it is the intention that one garden to be a sensory garden and the other to have a vegetable plot. People are able to use the gardens now. There was a good level of equipment to assist those people who needed help getting from place to place. There was an assisted bathing facility available on each unit which had a ceiling hoist available. There was laundry and kitchen on each unit and these were secured so they did not pose a risk to any person living in the home. The home was clean and fresh on both units at the time of inspection. Staff spoken to understood the need of good infection control practices. We noted that toilet roll holders were not yet in place and this made it difficult for one person in the home to maintain good hygiene practices. Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 &35 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff to provide the care that people need. Staff are recruited appropriately and receive good training and this protects the people living in the home. EVIDENCE: We were supplied with staffing rotas for both units for a period of eight weeks covering July and August 2009. The manager of Rivendell tends to work Monday to Friday 9 to 5 however was due to go on holiday with a number of people from the home. Each unit has its own staffing complement. Loriens daily rota showed that at a minimum there were two care staff on duty and more recently that had moved to 3 care staff excluding the manager whose office is sited in that unit. Rivendell unit which is fully occupied has had between three or four care staff available excluding the manager on a daily basis. At night there is a member staff on each of the units and an additional member of night staff who works between the units. Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 21 The Homes Annual Quality Assurance Assessment (AQAA) states that 90 of the care staff has achieved a National vocational qualification level II in care or above. This means staff have received the training required to assist them in caring for people. We looked at the recruitment records of two members of staff. Staff were only recruited following appropriate checks including Criminal Records Bureau and Protection of Vulnerable Adults lists and references secured. Staff work as an extra member of staff of the first week of their employment, are on trial period for a month and then undertake a probationary period of six months. This gives the organisation time to determine whether the staff member is suitable to undertake this work. During the initial month staff have weekly supervision and this helps the management determine the staff members strengths and weaknesses. The homes induction programme includes induction to work, behaviour expected and how to work with particular people living in the home. New staff are getting training within reasonable timescales for issues such as epilepsy, protection of vulnerable adults, first aid and fire training. One comment card told us excellent staff training. Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall people benefit from a well run home. People in this home have staff and management that are interested in communicating with them about the service they receive. Some areas of quality assurance need to be improved to ensure that records are consistently good throughout the home. EVIDENCE: The manager was registered with us at the previous home and was successfully registered for this home. She has the relevant Registered Managers Award which is the recognised qualification for management of a care home. She has a background in working with people with learning disability and has a qualification in nursing in this area. She was able to demonstrate that she has kept her knowledge current attending relevant Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 23 courses. She has over 20 years experience working with people with learning disabilities. The manager was not present at the time of the inspection. Staff interviewed were happy with the management of the home and the service they provide. We are aware that the home has a quality assurance system and that audits are undertaken in such areas as medication administration. The homes Annual Quality Assurance Assessment told us that the Quality Assurance system is in place that is discussed at all levels of the organisation but access this information was restricted as the manager was not on duty. There needs to be some improvement to make peoples care plans and records become a working tool for staff and management to ensure a consistent service people. At the point of opening the home had to present to us certificates to confirm the Fire, electrical and gas safety of the building and these remained current and therefore were not checked at this inspection. Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 X 4 3 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 3 25 3 26 X 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 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 2 3 X 3 X 2 X X 3 X Version 5.2 Page 25 Rivendell DS0000073225.V377314.R01.S.doc No Are there any outstanding requirements from the last inspection? 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 YA6 Regulation 15(1) Requirement Care plans must be in place within 72 hours of people coming into the home. Timescale for action 09/10/09 2 YA9 This is to ensure that staff have enough direction to give care in the way agreed. 13(4)(a)(c) Risk assessments must be carried out before people are admitted for risks that are identified in the assessment such as moving and handling. This is to ensure that the risks to people are minimised Where bed rails or bed restraints are to be used a risk assessment must be undertaken and plans made to maintain and monitor their continued safety. Records must be kept of this. This is to ensure that people are not put at extra by the use of bed rails or restraints. The home must ensure that medication is stored at a temperature with its product licence. 09/10/09 3 YA9 13(4)(c) 09/10/09 4 YA20 13(2) 12(1)(a) 09/10/09 Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA2 YA6 YA19 Good Practice Recommendations Information collected should be on a standard organisation format so that staff can retrieve the information quickly if needed. Care plans and risk management plans should be reviewed if incidents occur to ensure that enough is in place to provide care and minimise risk. People on admission should have determination about whether they are nutritionally at risk. Plans should be in place for those people who under or over weight including routine weight records and at what point specialist help is to be called upon. Where people have self injurious behaviour a standard record for injuries should be maintained. 4 YA19 Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 27 Care Quality Commission Care Quality Commission West midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. Rivendell DS0000073225.V377314.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!