Care Home: Ryder House

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What the care home does well The manager and staff worked together to support a person calmly and sympathetically during an emergency situation. Service users enjoy fresh local food prepared by the cook. Service users can also make their own drinks and snacks in the kitchenette. People`s health needs are documented and well supported so people can stay healthy. Most of the staff team are longstanding so they know service users well. Induction for new staff and training for staff is comprehensive equipping staff with underpinning knowledge and skills. This means that staff attend training facilitated by internal and external providers covering a wide range of subjects related to service users specific needs. There are sound systems in place to safeguard people`s money held by the home. What has improved since the last inspection? After a period of instability, with different managers at the home, it is now stable with the current Registered Manager being on post for over a year. This means that service users know the manager is fit to run the home and gives service users and staff consistency. People have more control over their medication as medication is now kept in individual bedrooms. This means that administering medication to people is now more private and dignified. A service user said he prefers having his medication in his room. The company have made a decision that bedrooms will no longer be shared. This means that service users will all have a single bedroom therefore, more privacy. Communication is better supported with the introduction of a communication board in the dining room. This shows colour photographs of activity choices and the menu for the day. Referrals have been made for extra help with communication. Person centred planning has been introduced after some staff training. Everyone has worked with their key worker to identify and record personal goals for the future. Some people need more robust action plans to support these goals or they may not be achieved. As a result of person centred planning people are going out more and enjoying more activities. Risk taking is supported so people are enabled and not restricted. Work has started to convert a bathroom to a walk in shower room. This means that everyone will have the opportunity to have a shower rather than just a bed bath. The manager said that deliveries of bread and milk have been stopped so that service users can go out daily with staff to buy these items. This means that people get out more.The manager has made referrals for extra support. This had lead to advice about more suitable shower facilities for people and the provision of a walking aid and an adapted armchair to give a person more independence. What the care home could do better: Person centred planning should continue to be implemented to increase opportunities for people. All goals should have an action plan to make sure that staff know what to do to help people achieve their goals. Holding PCP meetings, getting everyone important to the person involved will a broader perspective and more support. Four staff said it would be good to have vehicle that accommodates a wheelchair so that wheelchair users have more opportunities. Privacy could be better supported. The manager should consolidate her knowledge and experience with the completion of the required qualification of an NVQ 4 in management and care. Service users would benefit if the manager completed a qualification relating to service users specific needs. Make sure service users have a choice of hot meal at lunchtime. Add weekend and evening activities to individual activity plans so people know what the options are during evenings and weekends and activities at these times are planned rather than ad hoc. CARE HOME ADULTS 18-65 Ryder House 115/116 London Road Dover Kent CT17 0TQ Lead Inspector Kim Rogers Unannounced Inspection 12th June 2008 09:30 Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ryder House Address 115/116 London Road Dover Kent CT17 0TQ 01304 214832 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) ryder.house@robinia.co.uk The Robinia Care Group Ltd Mrs Denise Maria Moon Care Home 14 Category(ies) of Learning disability (0) registration, with number of places Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 14. Date of last inspection 8th June 2007 Brief Description of the Service: Ryder House is part of the company Robinia Support Solutions, who provide residential care and support services for people with a learning disability. Ryder House provides personal care and support to up to 14 people with a learning disability. Some may also have a physical disability. The home is a large detached property with accommodation for service users on three floors. There is a mixture of single and shared rooms. The home is located in Dover with easy access to local amenities, and public transport. There is a garden to the rear of the property and parking to the front. The fee range for Ryder House is about £45,000 to £55,000 per year. For information about fees and services please contact the Provider. Pervious inspection reports are available from the Provider or can be viewed and downloaded from www.csci.org.uk Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key site visit took place on 12 June 2008 between 09.30am and 3.30pm and is part of the key inspection. The Registered Manager, Denise Moon, service users and staff assisted with the process. The inspection process consisted of information collected before and during the visit to the home. Comment cards/ surveys were received from 6 service users and 7 staff members. Records were sampled including support plans, staff records, and medication and activity records. Some service users gave face-to-face feedback. A service user showed the inspector their room and other parts of the home. Organised and spontaneous activities were taking place throughout the visit, and observations formed part of the evidence collected. The manager completed the AQAA (Annual Quality Assurance Assessment). This gives information about how the home has improved and how the home intends to improve. The AQAA gives good evidence of what they do well, what could be improved and how they intend to improve. Staff said ‘My induction was very good’ ‘The training is very good’ ‘We should buy a mini bus to increase social independence’ ‘The manager is approachable’ ‘We have a good team that work together well’ From comment cards received service users said that they feel safe and have the support they need. One person said that they would like to go out more. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. What the service does well: The manager and staff worked together to support a person calmly and sympathetically during an emergency situation. Service users enjoy fresh local food prepared by the cook. Service users can also make their own drinks and snacks in the kitchenette. People’s health needs are documented and well supported so people can stay healthy. Most of the staff team are longstanding so they know service users well. Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 6 Induction for new staff and training for staff is comprehensive equipping staff with underpinning knowledge and skills. This means that staff attend training facilitated by internal and external providers covering a wide range of subjects related to service users specific needs. There are sound systems in place to safeguard people’s money held by the home. What has improved since the last inspection? After a period of instability, with different managers at the home, it is now stable with the current Registered Manager being on post for over a year. This means that service users know the manager is fit to run the home and gives service users and staff consistency. People have more control over their medication as medication is now kept in individual bedrooms. This means that administering medication to people is now more private and dignified. A service user said he prefers having his medication in his room. The company have made a decision that bedrooms will no longer be shared. This means that service users will all have a single bedroom therefore, more privacy. Communication is better supported with the introduction of a communication board in the dining room. This shows colour photographs of activity choices and the menu for the day. Referrals have been made for extra help with communication. Person centred planning has been introduced after some staff training. Everyone has worked with their key worker to identify and record personal goals for the future. Some people need more robust action plans to support these goals or they may not be achieved. As a result of person centred planning people are going out more and enjoying more activities. Risk taking is supported so people are enabled and not restricted. Work has started to convert a bathroom to a walk in shower room. This means that everyone will have the opportunity to have a shower rather than just a bed bath. The manager said that deliveries of bread and milk have been stopped so that service users can go out daily with staff to buy these items. This means that people get out more. Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 7 The manager has made referrals for extra support. This had lead to advice about more suitable shower facilities for people and the provision of a walking aid and an adapted armchair to give a person more independence. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 8 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 Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 People who use the service experience adequate outcomes. People know that their needs and future goals will be assessed to make sure the home can support them properly. Information about the home will be improved to make it more user friendly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The company have improved their assessment process to ensure that a person’s full range of needs and aspirations are assessed and recorded. This means that the manager can establish if the home can meet the persons’ needs. This could not be tested as no new people have moved in since the last inspection. The manager said that she would carefully consider compatibility with existing service users, who have all lived at Ryder House for several years, before anyone moved in. This is to ensure that people get on and are not upset by someone new moving in. There are plans to improve information about the home to make it more user friendly. This means that people will have the information they need to make a decision about moving in. Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 10 The AQAA says that they plan to improve the information about the home by adding the views of current service users. Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience good outcomes Person centred approaches put service users at the centre for all consultation and planning, decision-making and risk taking. People are having the support they need to start achieving their goals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care planning has been improved since the last inspection. Each service user now has a support plan detailing their needs and what staff need to do to meet those needs and a person centred plan (PCP). The PCP is all about the person’s life, aspirations and personal goals for the future. Service users currently meet with their key worker each month to identify goals and review plans. This is recorded and the key worker then makes arrangements for the support needed to achieve the goal. For example one PCP showed that the person might like to go to Canterbury on the train. This goal was recorded then the key worker arranged for this to happen and recorded how it went. It was a positive experience for the service user. Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 12 One support plan was sampled in detail and we found some misleading and out of date information. For example an assessment for day activities dated August 2006 said X has no motor skills although the manager said this is not certain. This person’s health action plan said ‘we do not know what X hopes and wishes are’ Yet another file had the persons’ hopes and wishes for the future. We found some out of date information about consent in all plans sampled. The manager agreed to update plans where necessary. We found that short-term goals for this person are being identified by the key worker and are well supported. The manager said that they are finding it more difficult to identify and plan support for more longer term goals. The manager agreed that it would be a good idea to hold PCP meetings and involve all of the person’s significant others to give a broader perspective and knowledge about the person from a wider range of people. This would be especially beneficial for people who may have communication needs. Strategies to support risk taking have been reviewed. Risk assessments are in place and now have a focus on enabling people rather then restricting them. Staff were observed supporting people as detailed in their support plans. For example one staff was supporting a person to have a cup of tea and recognised when they had had enough as indicated in their support plan. Staff regularly review support plans so changing needs are identified and support can be adjusted if necessary. One plan had been reviewed recently and said during the night ‘X wakes up on occasions for no apparent reason’ The manager agreed that with closer monitoring and recording the reason may become apparent. Communication is better supported with the introduction of a communication board in the dining room. This shows colour photographs of activity choices and the menu for the day. There is also a board showing photographs of what staff are on duty each day. Communication guidelines in service user plans have been improved. They are now easy read guidelines showing what a person’s gestures and expressions may mean. This means that staff will recognise what people are trying to say. Referrals have been made for extra help with communication. The AQAA says that they could be better at supporting communication and plan to improve this by developing communication aids and tools. They plan to improve by developing cooking care plans for people who want to cook more. Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 13 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): 12,13,15,16 and 17 People who use the service experience good outcomes Service users have opportunities to develop their skills and be involved in the day to day running of the home. Relationships are supported so people can keep in touch with family and friends. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff said people are going out more and doing more. This was evidenced in daily records, observations and support plans. A service user was at college during the visit and another service user went to the local shops. Some people who use wheelchairs can only go out locally or use public transport, as the home no longer has a minibus. 4 staff said in their comment cards that service users would benefit and have more opportunities if the home had a minibus that could accommodate wheelchairs. Activities are arranged in house and this was observed so people have an opportunity to join in when at home. Some people go out to further education Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 14 classes at college. One person said he enjoys his photography class. The home supports life long learning so people have continuing opportunities to develop through life. People are planning their holidays; a service user said he is looking forward to his holiday In a support plan sampled we found that a referral has been made to support a service user to go to hydrotherapy. The manager said this is positive for the person as they like water but have not been submersed in water for a long time due to no suitable bath at the home and not attending hydrotherapy for some years. Each person has an individual activity planner covering morning and afternoons Monday to Friday. Evenings and weekends are not included so activities could at best be ad hoc. Staff said people do go out during evenings and weekends and they could add this to individual planners. We found that relationships are supported with details of family and friends recorded in support plans. One person said they have been to visit their friends recently with staff support. The home employs a cook to prepare and cook the main meal. Service users have support to make drinks and snacks in the kitchenette. Local meat, eggs and fresh vegetables are delivered daily with service users going out with staff to buy fresh bread and milk. The meals of the day are displayed in the dining room so people know what they are having. We found that a choice of main meal is not displayed so people may not have the choice of an alternative option. Service users are more involved in planning and preparing meals giving people more control and involvement. We observed staff supporting people with their meal discreetly and respectfully giving them the time they need. Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience good outcomes. People have support they need to take more control of their personal care, health and medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal care needs are recorded in each person’s support plan. This means that people should be supported in the way they prefer. Work has started to convert a ground floor bathroom to walk in shower. This was a requirement of the last inspection to make sure people have a choice of a bath or shower. When the work is completed service users who currently have to have bed baths will have the opportunity of a shower. The manager has sought advice from occupational health to make sure the new shower will be suitable for everyone’s needs. Health action plans have been completed for all service users. This means that people’s health needs are detailed so staff know what to do to keep people healthy. Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 16 There was a health emergency during the inspection, which staff and the manager worked together on to support the person involved calmly and appropriately. The service user had to go to hospital and was supported on a one to one basis by a staff member. Medication is now stored in individual service users’ rooms. This means that medication can be administered in private with service users being more involved and therefore having more control. A service user said that it is better that they have their medication in their room. We found that records of administration and receipt are in order. Some people have medication to be given on a when needed basis. Some people cannot say when they need the medication so clear guidelines are needed so staff know when the medication may be required. As found previously, some guidelines are not clear so staff may not know when to give a when needed medication. Information about signs of pain was in another place to the support plan so staff may not have the information to hand. The manager agreed to look at this and improve it. Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good outcomes. Service users know that their complaints will be listened to and acted on. Service users are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has a complaints procedure that meets the National Minimum Standards and Regulations. The procedure is up to date and is displayed on a notice board in the home. Each person has a copy in his or her support plan file. The procedure is mostly written with some pictures and photographs showing what to do if you are not happy about something. Improved training for staff and improvements made to support communication means that service users have better support to raise concerns and speak out. The AQAA says they plan to improve the complaints procedure by making it more user friendly. This means it will be more meaningful to service users. The manager said there have been no complaints since the last inspection. There is a policy and procedure to safeguard people from abuse and harm. When asked staff knew where this was and were aware of the content. Two staff were able to give signs of abuse and say who they would report to. This means that staff know how to recognise abuse and what to do if they suspect abuse protecting service users. Staff attend safeguarding adults training on a rolling programme. Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 18 Records of income and expenditure are in order with good systems in place to protect against financial abuse. Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience adequate outcomes. Service users live in a clean safe home. Some areas to could be improved to enhance service users experiences and opportunities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector had a look around the home and we found that the home is clean and generally well maintained. The manager said that bedrooms are all now single but none have en suite facilities. This means that people share bathrooms and toilets. Work has started to convert a bathroom to a walk in shower. This will give all the service users the opportunity to have a shower. Some parts of the home need attention for example some door frames and walls have chips and marks on them, the manager is aware of this as she inspects the home regularly with the maintenance manager. The manager said there is planned redecoration programme to enhance the home for service users. Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 20 The AQAA says they plan to improve the garden for service users. A service user showed the inspector their room, which is personalised making it, feel like home. Rooms have a lockable cupboard but the locks are not suitable for service users to operate. No bedroom has a suitable locking device fitted that people can operate so currently, and as previously found, people cannot keep their precious things and rooms safe. Staff said some people go into other peoples’ rooms without their permission. Assessments have been carried out to establish if people can use a standard door key, which most cannot. This should be kept under review with regular consultation with service users and other devices considered, to ensure privacy and dignity is maximised. Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People who use the service experience good outcomes Service users can feel certain that the staff team will understand and support their needs, and that staff have had all the necessary safety checks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Changes in care planning has allowed newer staff to get to know the people better in a shorter time period – which removes stress levels for service users. A new member of staff spoke with knowledge about service users needs. They spoke about their comprehensive induction, which includes achieving the Certificate in Working with People with a Learning Disability (CWPLD). Staff said ‘my induction was good’ Training is more focused around service users needs and person centred support. The staff team can therefore meet the current service users specific needs. Staff said staff numbers are increased at peak times for example there are more staff on duty on a night when service users go to a local disco. This means that service users have extra support when they need it. The AQAA said Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 22 there has been some staff sickness, which the manager has covered with the use of bank, and flexi staff from other Robinia homes. This means that service users have the support from staff they know. There were 4 staff on duty including a team leader and a cook for 6 service users on the day of the visit. Recruitment processes are solid and gather all the data necessary to make sure service users are protected. Prospective staff have a trial day at the home to get to know service users and staff. Staff files were sampled and we found that staff have regular supervision meetings with a line manager and have the opportunity to attend staff meetings. Following a requirement made at the last inspection any staff health issues have been assessed to ensure staff and service users health and safety is protected. The AQAA says that there are plans to include staff meetings on the rota so more staff will attend, involve service users more in recruiting staff so that they have a say about who will potentially support them and ensure that mandatory training for all staff is up to date. Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience good outcomes. The home is run in service users best interests. Service users know their health and safety will be protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for just over one year and is now the Registered manager. This means that she has passed the registration process and established that she is a fit person to manage the home. The manager has support from an area manager by having supervision meetings and attending management meetings. We observed that the manager was calm when managing quite stressful situations on the day of the visit. She was positive and approachable when staff and service users needed support. Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 24 The manager plans to consolidate her work knowledge and experience by completing the required qualification of an NVQ at level 4 in care and management. Staff comments cards had comments including ‘I think the manager is approachable and professional’ ‘The manager encourages us to read new material about care practices’ The manager completed the AQAA, which showed an understanding of equality and diversity issues. The manager has identified that a barrier to improvement has been staff vacancies and sickness. She has thought creatively about how to overcome this to ensure the home improves for service users. The AQAA showed some evidence that the home is value for money. For example for the approximate weekly fee of £1,000 service users have the support of trained staff, have access to external providers and know that the views of their relatives and friends will be sought about the service. An area manager carries out monthly audits of the service, which means checks are made to ensure service users are safe and receiving the support they need. Other audits related to training, health and safety and finance are carried out by the company. There is more focus on outcomes for service users during these audits. The area manager was at the home during this visit and was observed interacting with service users and staff. The AQAA showed that the required health and safety checks are carried out protecting service users. Staff have now all taken part in a fire drill as required previously so they know what to do when the fire alarm goes off. Staff are trained in areas relating to health and safety. Incidents and accidents are recorded and reported, as they should be. Service users views are sought at one to one meetings with key workers and at residents meetings. Questionnaires are also sent to families and friends to complete so they can give their views about the service. Improvements have been made based on these views including providing a large board in the dining room showing pictures of meal and activity choices and the provision of a kitchenette so people can make their own drinks and snacks. Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 25 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 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA13 YA12 Good Practice Recommendations So that everyone has opportunity to access the local and wider community the home should have suitable transport especially for wheelchairs. To ensure service users privacy and dignity is maximised and people have safe places for their valuables, suitable storage and suitable lockable devices on rooms should be fitted in line with the Minimum Standard. To consolidate her knowledge and experience the manager should complete the required qualification of an NVQ 4 in care and management. The manager should consider gaining a qualification relating to service users needs. To ensure that service users have a choice an alternative to the main meal should always be offered and made known to people. 3. YA37 4. YA17 Ryder House DS0000023532.V365524.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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