Care Home: Rydan Lodge

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What the care home does well This was a positive inspection. The Provider and manager were both keen to respond to our findings and were already acting on some issues at the time of inspection. We were told that Rydan Lodge is the `best of the best` and provides people with the `highest level of care`. We were told that people could not praise the staff or service highly enough. The admission procedure is good and shows that staff make sure they can meet the person`s needs before they are admitted. Relatives tell us that the admission process is made easier by the staff at the home. People receive a good standard of personal care, and communication with healthcare professionals in the community is very good. The care people receive is provided in a safe way. Staff at the home ensure people see healthcare professionals when they need to. Care of the dying is also performed very well with relatives telling us `The personal care and attention we as a family received was fantastic. This could have been the worst three years my mother could have had but instead the staff made it one of the best three years of her life`. `The staff are all very professional, caring and go that extra mile to make us feel better`. People have access to activities and are able to maintain contact with their family. People are supported to maintain their spiritual beliefs and where available people enjoy the activities provided by the home particularly the opportunities for quizzes, music and exercise. People particularly like the 1:1 time with staff. People tell us that the food is good at the home. Any issues regarding dietary requirements, preferences or weight issues are sensitively managed. The kitchen is well maintained and the menu is varied and full of home cooking. People who use the service and their relatives can be confident that if they complain. Their concerns will be listened to and acted on. Complaints are kept to a minimum because of the daily presence of the manager and provider. Relatives said they had never needed to complain. Recruitment, induction and training is good at the home and means that vulnerable adults are cared for by a stable group of staff who have had the necessary pre employment checks, risk assessments and training in order to provide care in a safe and effective way. The staff group are popular with people who live in the home who describe the staff as `marvellous`. Interactions are appropriately affectionate, sensitive and appropriate for each person. Rydan Lodge is a safe and clean place to live and work. Maintenance systems are very well managed and a satisfactory level of decor and furnishings is provided at the home. The Provider, manager and staff group have suitable qualifications and experience to care for people who require personal care. The home is well-managed. What has improved since the last inspection? Care plans have improved since the last inspection. They are clear to read and identify what needs each person has. Relatives have been consulted where people are not able to have an input themselves. A new medication cupboard has been purchased which improves the storage facilities to medicines in the home. The ongoing redecoration programme continues at the home. The carpet in the lounge, Hall and dining room has been replaced and many bedrooms had been been painted. What the care home could do better: Safeguarding people must be a priority of staff at the home. People can be protected by ensuring robust systems are in place to ensure the balance of money held for people in the home is always correct, and systems are in place to show that the process is transparent protecting both people and staff at the home. Transparency should also be a focus for the providers at the home. The statement of purpose and service user guide must clearly show people that they will be charged for additional items such as entertainment and toiletries, with information regarding what this process is. This will enable people to decide before they move into the home whether they are happy with this facility. People who are cared for in bed with use of bed rails must also be protected to show that the decision to use bed rails is in the best interests of the person. Staff must demonstrate why and how the decision has been made and who has been involved in this process. If the decision is that bed rails are appropriate, risk assessments must be in place to ensure the equipment is suitable and does not cause additional risk to the person. The management of medication must also be improved to ensure any risks to people are kept to a minimum. Creams prescribed for one person should only be used for that person and should not be located in other people`s bedrooms. Staff should obtain a controlled drug register to record what a person has been given a controlled drug and record the balance of medication kept in the home. The controlled drug box should be securely attached to the metal medication trolleys, and a separate container should be kept for medications that require refrigeration. It is also suggested that when staff copy a prescription onto the medication administration sheet, two staff sign to check the prescription has been copied correctly. This will reduce any risk of errors occurring. Other records in the home should also be improved. The statement of purpose and service user guide should be updated as planned. The needs assessment used for assessment of people before they move into the home should also be improved to ensure staff have all the information they need to decide whether they can meet a persons needs. The contract should also be updated to include information on what the fee does and does not cover. Key inspection report Care homes for older people Name: Address: Rydan Lodge Rydan Lodge 3 Nelson Road Brixham Devon TQ5 8BH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Clare Medlock     Date: 0 1 0 7 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 33 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 33 Information about the care home Name of care home: Address: Rydan Lodge Rydan Lodge 3 Nelson Road Brixham Devon TQ5 8BH 01803858590 01803882246 rydan.care@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Malcolm Edward McCarthy,Mrs Lily McCarthy care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: One Service User, named elsewhere, who is out of age range, may reside at the home Date of last inspection Brief description of the care home Rydan Lodge is a detached property situated in a residential area overlooking Furzeham Green and near to local facilities and amenities. The home is registered to provide care for up to 12 people within the categories of old age or dementia. Accommodation is arranged over two floors with a stairlift providing access to the first floor. There are ten bedrooms, four of which are on the ground floor. Some rooms are en-suite, all others are close to bathroom and toilet facilities. The gardens are very pleasant with the one to the rear of the property being secure and particularly suited to peoples needs. Fees charged range from three hundred and sixty five pounds and four hundred and Care Homes for Older People Page 4 of 33 12 0 Over 65 0 12 Brief description of the care home twenty five pounds depending on the assessed needs of each person. Additional charges are made for personal requirements such as hairdressing, chiropody, entertainment and toiletries. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home 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 2 star. This means the people who use this service experience good quality outcomes. Prior to this inspection we sent surveys to people who use the service and to staff. The findings of these surveys are incorporated into the report. This key inspection included a visit to the home on Wednesday 1st July 2009. During this time we spoke to the registered manager/provider, who will be referred to as the Provider and the deputy manager who is also in day to day control of the home. In this report the deputy manager will be referred to as the manager. We also spoke to the other Provider. We did not speak in depth to people in the home because of their ability to understand Care Homes for Older People Page 6 of 33 the question or respond. Conversations were very short and often used closed questions. However, we spoke at length with two visitors, and to two members of staff. We case tracked two people who use the service. This means we looked in detail at the care these people receive. We spoke to staff about their care, we looked records that related to them, and made observations if they were unable to speak to us or provide feedback. We looked at care plans, maintenance records, four staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the recruitment and safeguarding systems work and what this means the people who use the service. During inspection we also watched interactions between staff and people living at the home. At the inspection the Provider also presented us with a well completed annual quality assurance assessment for inspection (within timescales). The AQAA is a selfassessment record that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at Rydan Lodge. Care Homes for Older People Page 7 of 33 What the care home does well: This was a positive inspection. The Provider and manager were both keen to respond to our findings and were already acting on some issues at the time of inspection. We were told that Rydan Lodge is the best of the best and provides people with the highest level of care. We were told that people could not praise the staff or service highly enough. The admission procedure is good and shows that staff make sure they can meet the persons needs before they are admitted. Relatives tell us that the admission process is made easier by the staff at the home. People receive a good standard of personal care, and communication with healthcare professionals in the community is very good. The care people receive is provided in a safe way. Staff at the home ensure people see healthcare professionals when they need to. Care of the dying is also performed very well with relatives telling us The personal care and attention we as a family received was fantastic. This could have been the worst three years my mother could have had but instead the staff made it one of the best three years of her life. The staff are all very professional, caring and go that extra mile to make us feel better. People have access to activities and are able to maintain contact with their family. People are supported to maintain their spiritual beliefs and where available people enjoy the activities provided by the home particularly the opportunities for quizzes, music and exercise. People particularly like the 1:1 time with staff. People tell us that the food is good at the home. Any issues regarding dietary requirements, preferences or weight issues are sensitively managed. The kitchen is well maintained and the menu is varied and full of home cooking. People who use the service and their relatives can be confident that if they complain. Their concerns will be listened to and acted on. Complaints are kept to a minimum because of the daily presence of the manager and provider. Relatives said they had never needed to complain. Recruitment, induction and training is good at the home and means that vulnerable adults are cared for by a stable group of staff who have had the necessary pre employment checks, risk assessments and training in order to provide care in a safe and effective way. The staff group are popular with people who live in the home who describe the staff as marvellous. Interactions are appropriately affectionate, sensitive and appropriate for each person. Rydan Lodge is a safe and clean place to live and work. Maintenance systems are very well managed and a satisfactory level of decor and furnishings is provided at the home. The Provider, manager and staff group have suitable qualifications and experience to care for people who require personal care. The home is well-managed. Care Homes for Older People Page 8 of 33 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. Care Homes for Older People Page 9 of 33 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 10 of 33 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 11 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The out of date information provided does not contain enough detail for people to have the information they need to decide whether Rydan Lodge is the care home for them. The admission procedure is good and means that staff have the information to decide whether they are able to meet the needs of the person. Evidence: Relatives told us that the home had been recommended to them by health care professionals. One relative said moving into Rydan Lodge could have been the worst three years of mums life but it turned out to be three of the best years of her life. The manager told us the statement of purpose and service user guide were in the process of being updated. Copies seen were indeed out of date. Care Homes for Older People Page 12 of 33 Evidence: Although the statement of purpose contains details of the fee structure and they did not include specific details of what the fee included and did not include, or details of the charges made for entertainment and toiletry provision. An example of the contract was also found in the statement of purpose. Discussion was held about the importance of including what extras are charged on top of the basic fee. The manager explained that at present most admissions are being received from a domiciliary care service which operates from the building behind the care home. We were told that domiciliary care staff prepared the home where persons condition deteriorated. Once a decision had been reached about a care home being the best option Rydan Lodge was suggested along with other care homes. The manager explained in this situation the pre-assessment of the person was streamlined and continuous with the admission process. We were told that staff in the domiciliary care service came into the care home is a familiar face of the person and this seemed to work well. A thank you letter seen in the home read sadly things deteriorated at home, and I must say thank you once again, feel health in suggesting dad that he had a rest in Rydan Lodge. We were told for people being admitted they were not part of the domiciliary care service, a pre-screening check was performed over the telephone before the provider or manager going out to see the person to perform an assessment. Pre-admission assessment documents were seen. These were in formal notes suitable for each person and did not contain prompts for a full needs assessment. Each person is provided with a contract from the home in addition to contract from social services if relevant. These contracts contain the room to be occupied fees charged and other responsibilities of both the home and person. Care Homes for Older People Page 13 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal care people receive is of a good standard and provided in a respectful way. The care planning systems are good but improvements would mean that short-term needs are recorded in a clear and consistent way. The management of medications is generally good. However, improvements would minimise risks. Evidence: People living at Rydan Lodge have an access to a range of health care services both at the home and in the community. People have access to the local NHS services including screening programmes. Each person is designated a general practitioner who attends when staff request. Visits from other healthcare professionals are also available via the GP. During inspection people looked very well cared for with the finer details such as eye Care Homes for Older People Page 14 of 33 Evidence: care, nail care and appropriate foot wear present. Relatives said people always looked well cared for whenever they visited the home. One relative told us that she attended the home at various times during the day, always unannounced, and found people in the home to be very well cared for always looking clean and well presented. The AQAA stated the evidence to show that the home provide health and personal care to a good standard is families and even district nurses comment on how happy and clean our clients and the home is. Surveys from people who live in the home told us they always receive the care and support they needed. Relatives told us the care provided was always a very highquality. We were told that staff go that extra mile with staff even sending photographs of the persons relative looking very comfortable when the relative was anxious about the person not settling at night. One relative said she had received feedback from healthcare professional who said the staff at Rydan Lodge were always good at following instructions and seeking advice where they needed. Thank you letters seen at the home read I have always been more than pleased with the loving care and attention that none receives, and I appreciate being kept informed mums condition a regular basis. another thank you letter read on visits to my mother the staff regained are always welcoming, to my mother and other residents. They appeared to be well looked after by courteous and compassionate carers. Another letter read the standard of care, attentiveness of all the staff, surroundings etc cannot be faulted, a real home from home experience. Care needs for people are communicated both verbally between staff and within care plans. Staff told us that there are handovers where relevant information is passed between staff. Care is also recorded in well written care plans. The manager explained that care plans have been updated since the last inspection. each person has a plan, which sets out his or her long-term specific needs. Each plan contains assessments relevant for that person and include issues such as falls, nutrition, and more general risks. We were told that any short-term problems are highlighted in the daily record using a highlighter pen. Discussion was held over the importance of writing a short term care plan so staff are aware of what the problem is and what action needs to be taken. People who were being cared for in bed looked comfortable, clean and pain free. Some Care Homes for Older People Page 15 of 33 Evidence: people were being cared for in beds that were fitted with bed rails. The reason for bed rail use was not recorded within the care plan and a risk assessment had not been performed. Discussion regarding the importance of this process took place with information on good practice being given. The manager gave reassurances that this would be performed as a matter of importance. Specialist health care professionals are sought for advice and guidance. Examples of healthcare professionals included chiropodist, GP, palliative care nurse, continence care nurse and district nurses. The management of medications is performed by staff who have had training in medication and is overseen by the manager of the home. Since the last inspection staff have been provided with a metal medication cupboard which can be wheeled around the home. Medication is are supplied within blister packs from a local independent pharmacist. Some medications have to be written on the medicine administration record. Discussion was held regarding the added safety of obtaining two signatures to ensure the prescription had been copied to correctly. The medication trolleys were clean, tidy and in the process of being fitted with a lock to secure it to a wall. Medications needing to be stored in a fridge are stored in a domestic kitchen fridge but were not stored in a separate container. The home have recently been provided with controlled drugs for one person. There was no clear record of the numbers of these medications received all returns to the pharmacist. Discussion was held regarding the need for recording these medications within a controlled drugs register. The manager had devised a separate administration record for this controlled drug. A tour of the home revealed creams that had been prescribed for one person being located in the bathroom for another person. These creams were removed by the provider and this issue was reported to the manager. People are able to stay at Rydan Lodge in the end days of their life. One relative told us that the service her mother received was faultless. The relative explained that staff bent over backwards to make sure the person received the best care. We were told that staff liaise with the local hospice nurses to make sure that the person was painfree at all times. We were also told that staff enabled to the relative to stay with the person as much as they wanted, even offering a bed to sleep in overnight so that they were able to stay close. The relative explained that many staff attended the funeral and seemed genuinely upset to have lost her mother. We were told staff sent cards, and text messages of sympathy which were greatly appreciated. This relative said the three years spent at Rydan Lodge could have been the worst three years of her life, but it was the staff that made them three of the best years. Care Homes for Older People Page 16 of 33 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. The routines of daily life are performed in accordance with the wishes and feelings of people in the home. The satisfactory activities programme means that people have access to meaningful stimulation at the home. Evidence: Surveys received informed us that the home does a range activities people can take part in. One comment read but I do not always do them. discussion with the provider informed us that to external activity organisations are invited into the home. One person attends the home to perform chair exercises with people. We were told this is popular and that all people attend these activities although some do not stay for the entire session. The provider told us the charge for this activity is divided equally amongst all people living in the home. This information is not recorded in the statement of purpose or contract and this shortfall has been reported earlier in this report. Relatives told us that staff are all so organised their own activities which are just as popular with people in the home. We were told the quizzes were very popular and Care Homes for Older People Page 17 of 33 Evidence: seemed to trigger the interest of people. The AQAA stated that the home had highlighted a need to find activities for people who do not like to get involved or for those people with dementia. The AQAA also stated in the last 12 months staff take clients that are able to go out in the car for a ride. The AQAA also stated the new music Lady was very good with the clients. Staff told us that they often bought their pets into the home which proved very popular with the residents. Music was being played in the lounge area. People were seen tapping their feet in time to the music, with one lady occasionally joining in with the more popular songs. Interactions between staff and people in the home were very positive. The use of appropriate affection, sensitive approach and light banter was noted to be particularly popular with people. The staff we spoke with were very knowledgeable about both physical and social needs of the person and were keen to improve the activities and opportunities for people in the home. Staff surveys told us that staff were pleased with the general care provided at the home, but thought more activities could improve things for people. One comment read we could get to go on trips if possible, but we would need to look at clients mobility, whilst another survey read it would be nice to have more time for activities. Staff informed us that a monthly religious Minister attends the home, and this is on a rolling programme with churches of different faiths. The manager informed us that at present all people in the home were Christian that no one had a specific spiritual needs, but this could easily be facilitated if needed. People told us the food tasted lovely and was super. The meal of the day was roast turkey, roast potatoes, broccoli, cauliflower, stuffing and gravy. A sample of the pureed meal was taken. This was full of flavour colour and texture. The chef told us that although there was a regular menu, this could be adapted according to the needs and preferences of people in the home. The chef gave as an example where on the day of inspection rhubarb crumble was swapped with fruit salad because of the hot weather. Staff reported food wastage to the chef, who then reported this to the manager. Nutritional risk assessments were located in care plans to monitor weight loss or gain. Care Homes for Older People Page 18 of 33 Evidence: The kitchen was clean, well managed, with cleaning schedules and food maintenance programmes well conducted. Care Homes for Older People Page 19 of 33 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 can be confident that complaints will be well managed at the home. The training and staff knowledge helps to protect people from abuse. Evidence: The care quality commission has received no formal complaints regarding Rydan Lodge since the last inspection. The provider also confirmed that the home have not received any complaints either. The complaints procedure is located within the entrance hall and communal areas of the home. Contact details for the care quality commission were contained on this document. There is also a complaints and suggestions book located by the visitors book in the entrance hall. Relatives we spoke to said that they had never needed to make a complaint and that had been always happy with the standard of care provided at Rydan Lodge. This relative said that they knew how to make a complaint that communication had been good to prevent this occurring. Staff recruitment process helps to protect people by ensuring that criminal records bureau checks (police checks) and protection of vulnerable adults checks are performed on all staff. Where staff declared they have had a criminal record, this is Care Homes for Older People Page 20 of 33 Evidence: discussed at interview and a risk assessment performed to see whether the person should be employed. Where staff are employed before the CRB has been returned staff work in pairs. Staff are provided with in-house training on the protection of vulnerable adults, and senior staff had attended a deprivation of liberties and mental capacity act training. All staff spoken to were aware of the correct reporting procedures is allegations of abuse are made or witnessed. This included how to report the provider and manager externally. During the inspection we saw no examples people being restrained. Some people were being cared for in bed using bed rails. The shortfall is regarding risk assessment in care planning were reported in an earlier section of this report. Relatives told us that staff do not manage their financial affairs. the provider informed us that small number of people have their finances managed by the local trust or solicitors, and in these situations a small amount of cash was held for the person. This is reported upon in a later section of the report. Care Homes for Older People Page 21 of 33 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. Rydan Lodge is a pleasant, clean, and safe place to live and work. Evidence: A tour of the home showed that the environment was a safe and well maintained place to live and work. A programme of routine maintenance and renewal of the decoration of the home had continued since the last inspection. New carpets had been provided within the hall, lounge and dining areas. Bedrooms had also been repainted when a person leaves the room. The AQAA stated that the home now have a maintenance man, who is cleaning carpets etc. The provider informed us that care staff clean the sink in each persons bedroom on a regular basis, and that additional domestic staff attended the home to perform more in-depth cleaning schedules. All areas of the home were clean, tidy and free from the risks. Furnishings throughout the home were of a good standard and domestic in style. Bedrooms were clean, tidy and contained varying amounts of personal memorabilia and furniture. People who are more mobile are able to wander around the home freely. There are Care Homes for Older People Page 22 of 33 Evidence: walking aids, and stair lifts available for those with mobility problems. The home is fitted with alarms and sensors which are triggered when people access the stairs or leave their bedrooms at night. This enables people to freely wander, whilst protecting them by allowing staff to be aware that they are walking around the home unattended. Maintenance records showing the home has routine and ad hoc checks are well maintained. The provider has asked relatives whether they consider having locks on bedrooms doors appropriate for the person. So far, no one has requested a door lock. The majority of people spend their time in the communal lounge and dining areas. Three of the bedrooms are en suite, but accessible toilet facilities are located on each floor. The home has a bath, but staff informed us that the shower was more popular. Laundry facilities were well organised and contained equipment suitable for washing items of foul laundry. Sheets, towels and flannels are also washed at the home. Staff informed us that those with incontinence issues are well-managed with the use of pads, but any soiled items are either placed directly into the washing machine using the dissolvable bags. Where items need to be sluiced this is done within the adjoining sink. Personal protective clothes were available with the exception of eye goggles. We were told that not all staff had received training in infection control. This was supported by training records. This shortfall is reported upon in a later section of this report. Care Homes for Older People Page 23 of 33 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. The recruitment, induction and training programmes mean that people are cared for by staff who are suitable to work with vulnerable adults. Evidence: The interactions between staff and people in the home was very positive throughout the inspection. Relatives explained that when they had visited the home they have witnessed peoples faces lighting up when they hear or see a member of staff. Relatives were also very positive about the staff at the home. Comments such as they go above and beyond to make sure people are cared for. All staff surveys commented that they thought they cared for the welfare of residents very well, and provide a friendly atmosphere for the clients and always try to treat them as if they were a family member and provide a homely atmosphere. Another comment read we try to give the clients as much support as possible to live a comfy and normal life, as is possible for clients diagnosed with dementia. Surveys also commented that the home was a good place to work. All staff surveys informed us that the induction provided either mostly or very well covered everything they needed to know about the job. All surveys also informed as that the employer carried out checks such as CRB and references before staff started work. Care Homes for Older People Page 24 of 33 Evidence: Staff files were well completed and contained information such as application form, two written references, forms of identification, health assessment, interview record and in all but one case and completed criminal records bureau check and POVA check. The one example is which did not contain CRB check contain additional information and criminal declaration which resulted in the staff member only being able to work in a supervised capacity. All staff surveys said they felt they had enough support, experience and knowledge to meet the different needs of people who live at the home. Examples of the induction record used were seen and showed that staff have been provided with information regarding emergency procedures and also the routines of the home. Staff told us they are able to access NVQ (National vocation qualification) training and are supported in this by the provider and manager. The chef informed us that she was doing her NVQ two at present. Staff surveys informed us that staff felt there were usually enough staff on duty to meet the needs of people at the home. We were told that the agency staff were not used, but that staff covered for any holidays or sickness. Extra staff are employed at peak times of the day. The manager explained that a member of staff comes in to the home at teatime, to help prepare clothes for the next day and served and clear up the evening meal. Care Homes for Older People Page 25 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provider, manager and supporting team have the skills to run the home in an efficient way. Improvements are needed to show that the management of personal money is robust and protects both the person and the staff in the home. Evidence: The provider, Mrs McCarthy, is the registered manager of the home. She has NVQ two and three and also has the registered managers award at NVQ level 4. Mrs McCarthy is supported on a day-to-day basis by the deputy manager who also has her registered managers award. Both the provider and manager attend the mandatory training provided for staff. All staff surveys said that the manager regularly gives enough support and meet with them to discuss how they are working. We were told there was a very low turnover of staff at the home and that morale amongst staff ws good. We were informed staff meetings are held on a regular basis Care Homes for Older People Page 26 of 33 Evidence: where new information is communicated. Also a communication book is used where staff are asked to sign when they have read new notices or policies. The AQAA stated that policies have been updated this year. Health and safety is taken seriously by the manager. Falls are of particular interest to the manager with in depth reports on the place and time of falls being carried out and reported to the CQC to monitor trends. Accidents are recorded well with any incidents being reviewed by the manager before filing in the persons notes. The AQAA stated that equipment in the home is serviced or tested ona regular basis. Dates for electrical equipment, stair lifts, hoists, fire equipment, emergency lighting, gas and waste were recorded. Staff informed us that they had attended mandatory training or were booked on upcoming sessions. The three staff files selected showed that staff had received training in moving and handling, fire safety, and the protection of vulnerable adults. One member of staff who had only been working at the home for a number of weeks was awaiting to attend food hygiene training. Systems were in place to renew mandatory training with the exception of infection control. All three staff files showed that staff were out of date for infection control training. Relatives told us they were able to maintain the controller finances for people in the home. Where this is not possible the manager explained either solicitors or the local trust act as appointee. Inspection of the personal monies revealed that the system was not as robust as it could be. Discrepancies in two of the balances were noted (both in favour of the person). A letter from the local trust highlighted a discrepancy and the thank you letters even at the home also highlighted a discrepancy. Although receipts for hairdressing and chiropody and other items are maintained, receipts for toiletries are not provided. The provider informed us that hairdressing, chiropody, toiletries and entertainment is paid for by the home. The relatives or person responsible for managing the finances of the person is then invoiced for the amount accrued. The provider explained to a set amount each month is charged for toiletries regardless of how many items are used, and the entertainment is divided between all residents regardless of whether they attend or not. The statement of purpose does not stay to this occurs, nor does the contract. This shortfall is reported upon in an earlier section of the report. Quality assurance surveys have been performed since the last inspection. The manager told us the response had been fair and she was looking for ways to improve Care Homes for Older People Page 27 of 33 Evidence: this system next time. The manager also explained that because her and the Providers were around on a daily basis many issues are raised informally which changes the service continually. Care Homes for Older People Page 28 of 33 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 29 of 33 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 1 1 13 Systems should be in place 08/10/2009 to inform people and their relatives, before they are admitted to the home, about extra charges including entertainment and toiletries. This will protect people from financial abuse, and show that the system used is transparent which will also protect staff at the home. 2 8 13 Systems and records must be in place to show why a person needs bed rails to keep them safe and must include a risk assessment regarding equipment used. This will show that the decision to use bed rails is in the best interest of the person and will also protect people from risk. 08/10/2009 3 9 13 Creams that are prescribed for a person must only be used for that person. 08/10/2009 Care Homes for Older People Page 30 of 33 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 This will mean that any product prescribed for one person is only used for a person that is being prescribed for. 4 35 13 The provider must ensure 08/10/2009 robust systems are in place which show that money held on behalf of the person is safely managed, with a clear audit trail of receipts showing what money has been spent on. This will show systems are in place which protect people from financial abuse. It will also show the process is transparent which protects staff. 5 38 13 The manager must ensure staff are up to date with mandatory training. This must include infection control. This will show that staff have all the skills and knowledge required to care for people in a safe way. 08/10/2009 Care Homes for Older People Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The statement of purpose, service user guide, and contract should include clear details of what the fee does and does not include The provider should continue with the updates to the statement of purpose and service user guide The needs assessment documents should be improved to include all the information listed in standard three Care plans should include short term problems so that staff are aware of what the problems are and how they can be actioned. The records used for bed rails should include who has been involved in this decision making process. A controlled drugs register should be obtained to record the balance of controlled medications in the home The controlled drugs box should be secured within the metal medicine cabinet. The manager should continue to seek ways of improving the activities programme for people with dementia. Eye goggles should be available for staff use when sluicing soiled laundry 2 3 4 1 3 7 5 6 7 8 9 8 9 9 12 26 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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