Inspection on 07/10/08 for Roanu House

This is the latest available inspection report for this service, carried out on 7th October 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Roanu House 22/05/06

Roanu House 01/12/05

Roanu House 06/09/05

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 19/12/2008.

CARE HOME ADULTS 18-65 Roanu House Roanu House 2 Grosvenor Avenue Carshalton Beeches Surrey SM5 3EW Lead Inspector Lee Willis Key Unannounced Inspection 7th October 2008 Roanu House DS0000063202.V362856.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 Roanu House DS0000063202.V362856.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. Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roanu House Address Roanu House 2 Grosvenor Avenue Carshalton Beeches Surrey SM5 3EW 020 8647 6366 020 8669 1766 tordarrach@yahoo.com 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) Rashot Ltd Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Of the six service users, all six may have dual diagnosis of mental illness and learning disability. Of the six service users, two may also have a physical disability but must not be wheel-chair bound. Of the six service users, two may also have a sensory impairment. Only one service user at any one time may have a high level of care needs. The bedroom that is less than twelve square meters and does not have en-suite facilities cannot be used. 21st August 2007 Date of last inspection Brief Description of the Service: Roanu House is registered with the Commission for Social Care Inspection (CSCI) to provide accommodation and support for up to six generally older adults (i.e. 65 ) with a dual diagnosis of learning disabilities and mental ill health. Up to two residents who have a physical disability or sensory impairment may also reside there. Mrs Ayodele Obaro remains the homes owner, but is no longer in operational day-to-day control following the appointment of Mr Andre Downer in April 2008 – the homes new acting manager. Roanu House is situated in a leafy suburb of Wallington within half a mile of the town centre with its wide variety of local shops and other community based services and facilities. The home also has its own transport and is relatively close to two local train stations and several bus stops with good links to Sutton. This large Victorian property is made up of six single occupancy bedrooms - all with en-suite toilet facilities. Communal areas include a main lounge, large open plan kitchen, and a well-maintained garden at the rear of the property, which has a large patio area and vegetable patch. There is also a small office, staff sleep-in room, cellar, and laundry facilities located in a small out-house. There is ample space for parking vehicles at the front of the house. The philosophy of care and principle objectives of Roanu House are based upon recognising that people with learning disabilities and mental ill health have the right to a normal pattern of life. The weekly fees range between £1,000 and £1,800. Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 2 stars. This means the people who use this service experience good quality outcomes. This marks a significant improvement on its one star rating given at its previous Key inspection in August 2007. From all the available evidence we gathered during the inspection process it was clear the service now has significantly more strengths than areas of weakness. All the major shortfalls identified in the homes previous report have been acknowledged by the relatively new acting manager and appropriate action taken to address them. The new manager has also introduced a number of new initiatives to improve the outcomes for the residents. We spent five and a half hours at the home. During the visit we met all four of the people who currently live at Roanu House, the acting manager, two support workers, and a visiting activities coordinator. We also looked at a number of records and documents; including the care plans for the homes two most recently placed residents. We selected their cases to track as part of the inspection process. The remainder of this site visit was spent touring the premises. None of our ‘have your say’ comment cards about the home were returned to us, although the acting manager did complete the homes Annual Quality Assurance Assessment (AQAA). This tells us what he believes the service does well, has improved, and what it could do better. What the service does well: All the verbal feedback we received from the residents was extremely positive about the home. Typical comments included, “staff make me feel at home here and are always very kind to me”, “I like the new manager”, and “the garden is beautiful - I like watching the wildlife and its fantastic I can grow my own vegetables”. We feel the new acting manager is good at responding promptly to the changing needs and wishes of the residents and ensuring all the relevant health and social care professionals are involved as and when required. Throughout the course of this inspection we saw all the staff interacting with the residents in an extremely kind and caring manner. Staff always take their time to answer residents questions. With three members of staff working across most of the day current staff to resident ratios compare very favourably with other residential cares of a similar size and nature. Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 6 Finally, the atmosphere remained extremely relaxed and pleasant throughout the course of this visit. We agree with comments made by the manager in Roanu’s AQAA that the house has a ‘very homely non-institutional feel about it’. What has improved since the last inspection? The general consensus of opinion expressed by all the residents and staff met during this visit was that the new manager was very approachable and had done a lot to improve the service since his arrival in April 2008. The new manager clearly has a hands-on approach to running the home, which is proving very popular both the residents and staff. He also has a clear vision about what direction he wants to take the home in and has made a number of significant improvements to its overall performance in a relatively short period of time, including addressing all the requirements identified in the homes previous inspection report (see below): All new residents have their needs fully assessed prior to admission so that staff are aware of their needs. The assessments are kept under review and up dated accordingly to reflect any changes in circumstances. Residents’ care plans have been made far more person centred and now cover every aspect of their unique personal, social, and health care needs and wishes. Risk assessments have also been made more comprehensive ensuring staff have all the information they need to support the residents to life their lives as independently as possible while keeping them safe. The homes medication handling practices have significantly improved and no recording errors were noted on any of the residents medication administration records sampled at random. All staff met demonstrated a good understanding of safeguarding procedures and have all recently up dated their recognising, preventing, and reporting abuse training. As required in the last report the home is now kept pleasantly warm at all times. In addition to the requirements identified in the homes last report being met several other areas of practice have also improved since the appointment of the new manager: Residents meetings are now being held on a monthly basis. The range of activities and choice of meals available in the home has significantly improved in the past six months. It was very pleasing to note that activities coordinators visit the home on a regular basis and that all the Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 7 residents are actively encouraged to grow their own vegetables in the back garden. One resident told us there was always a vegetarian option at mealtimes. 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. Roanu House DS0000063202.V362856.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 Roanu House DS0000063202.V362856.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, 2 & 5 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Overall, the residents and their representatives have access to most of the information they require to make an informed decision about what facilities and services the homes can offer them. The needs of prospective new residents are fully assessed prior to admission so the individual, their representatives, and the home can be sure the placement is appropriate for them. The homes current arrangements for charging residents and their representatives for any additional facilities and services not covered in the basic cost of their placement is not very clear and will need to be improved to make the process more open and transparent. This will enable people who use the service to determine whether or not they are getting value for money. Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 10 EVIDENCE: The acting manager was able to produce a recently revised Statement of Purpose and Guide for the service, which included the majority of facts’ the residents and their representatives would need to know about the home. However, we recommend these documents be amended further to include more detailed information about how the service intends to meet the needs of those people who may have a physical disability or be sensory impaired. As required in the homes previous inspection report the acting manager was able to produce full needs assessments undertaken by senior staff who work at Roanu House and professionals representation the relevant authorities who placed the homes two most recent admissions. The acting manager demonstrated a good understanding of best practice regarding accepting new referrals and was very clear that no one would be placed at the home unless they were compatible with the others already living there. The manager also gave us a good example of how he had got various health and social care professionals to review one residents needs, which had significantly altered in the past year, and for a more suitable placement to e found for them. We commend the acting manager for the way he handled this matter in such a prompt and sensitive manner. The manager produced costed contracts for those residents who care was being case tracked. These documents were very clear how these individuals would be charged for basic items such as accommodation and food, but it was not always clear what services and facilities were covered by their placement fees and what were not (e.g. so called extras like toiletries for which there is an additional fee). Roanu House DS0000063202.V362856.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 & 9 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Improvements made to the way the home develops care plans ensures these documents are more person centred thus reflecting what is important to the individual, what their capabilities are, and what support they need to achieve their personal goals. The homes arrangements for assessing, managing and reviewing risk are sufficiently robust to ensure the residents are kept safe, while their rights to develop their independent living skills are not restricted unnecessarily. Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 12 EVIDENCE: We looked at the care plans for the two people we had selected to track. As required in the homes previous report improvements had been made to the way the service developed care plans to make them more person centred. The two viewed were person centred and set out in detail what support these individuals required to ensure their personal, social, and health care needs were to meet, and what their strengths, wishes, and aspirations wishes were. Both plans had been reviewed in the past six months involving all the relevant people, including the person for who it was intended, and up dated accordingly to reflect any changes in provision. One resident spoken with at length told us she had a keyworker, whom they liked. One member of staff informally interviewed was very clear about their keyworker responsibilities. It was positively noted that the acting manager has reintroduced residents meetings each month which are well attended by residents and staff. The minutes of the homes last meeting revealed menu planning, in-house and community based activities, and holiday destinations for the autumn had all been discussed and a plan of action agreed. One resident told us they enjoyed attending these meetings and felt they were very useful. As required in the homes previous report care plans now contain a far more comprehensive set of assessments and associated management strategies to minimise identified risks and hazards. These tools cover every aspect of residents life’s, are being reviewed on a quarterly basis and up dated accordingly to reflect any changes in need. It was evident from the information included in these assessments and comments made by the relatively new acting manager that he is committed to ensuring the residents are able to take ‘responsible’ risks to enable them to maintain and develop their independent living skills. Where limitations are imposed an assessment of risk justifying the measure was made available on request. Roanu House DS0000063202.V362856.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): 11, 12, 13, 14, 15, 16 & 17 People who use the service experience excellent quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. The residents are involved in meaningful daytime activities of their own choice and according to their individual interests and capability, which are ‘age’ appropriate. Meals are varied, well balanced, and reflect the specific dietary wishes and tastes of the residents who are actively encouraged and supported to grow their own vegetables in the garden and eat more healthy. EVIDENCE: It was positively noted that on arrival the homes independent activity coordinator was engaged with a hand eye coordination game with a number of the residents. One resident told us they enjoyed these games and looked forward to the activity coordinator visiting the home. During the course staff Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 14 were also observed actively encouraging and supporting residents to get involved in an art class, participate in a game show on the television and go for a short walk in the local community. As suggested in the homes last report the acting manager keeps an accurate record of all the activities the residents participate in each day, which includes helping out with household chores. The record showed the residents have a lot of opportunity to engage in all manner of in-house and community based activities, which was reflected in each resident’s weekly activity schedules. One resident told us they were going to go on holiday with staff next month, which they were looking forward too. As reflected in one resident’s weekly activity schedule, the manager told us they regularly took this individual to church every Sunday. In addition to this a religious group also visits the home regularly to hold prayer meetings for anyone who wishes to participate. A member of staff politely told us to sign the visitor’s book on arrival. The manager told us the home operates an open visitors policy with no restrictions made on ‘reasonable’ visiting times. The manager is commended for arranging for one resident to go with staff and stay over night with their next of kin who lives in North West England. During the visit a number of residents were observed tidying away cups, plates and cutlery they had just used. The manager told us residents are encouraged to go shopping with staff. One resident told us they liked to go clothes shopping with their keyworker and often helped staff bake bread. The manager told us the residents have a choice of newspapers to read each day. One resident spoken with at length told us they were a vegetarian. This specific dietary requirement is reflected in the individuals care plan and the published menus, which are conspicuously displayed on a board in the kitchen. It was also very pleasing to note that the new manager actively encourages the residents to grow some of their own organic food in the recently created vegetable patch in the rear garden. The service is highly commended for its imaginative approach to promoting healthy eating and independent living skills in this way. The homes only vegetarian resident told us they loved growing their own vegetables in the garden. Two residents told me they liked all the food served at the home. The meals served at lunchtime on the day of this inspection included beefburgers and and a vegetarian option of cauliflower cheese. All the meals advertised on the weekly menu were nutritionally well balanced. The menu contained a lot of traditionally British style cuisine, which seemed to reflect the tastes of the entirely white British resident group, although Mediterranean and Asia dishes were also available. One resident told us their favourite food was fish and chips, which advertised on next weeks planned menu. The manager told us the residents are asked what they think about the forthcoming weeks menu plan every Sunday and again at residents monthly meetings. Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 15 It was positively noted that both cereal and a cooked breakfast were made prepared for one resident who had chosen to sleep-in as a type of brunch. The home is commended for having such a flexible approach to mealtimes, which is clearly based in the wishes of the residents and not staff. Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 16 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 & 20 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Suitably robust arrangements are in place to ensure the residents service receive personal support in the way they prefer and require, and that there unique physical and emotional health care needs are continually recognised and met. Policies and procedures for handling medication are in the main sufficiently robust to keep the residents safe. EVIDENCE: All the residents were dressed in well maintained ‘age’ appropriate attire that was suitable for the season. The acting manager has introduced new ‘my health’ records for each of the residents that set out in detail individual’s unique health care needs and the support they require to have them met. Both the health care records examined in depth contained up to date information about all the outcome of all the Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 17 health care appointments these individuals had attended with various health care professionals in the past 6 months. One resident spoken with at length told us they had recently seen their GP and dentist. As previously mentioned in this report the manager is commended for getting one individuals GP and the district nurse to reassess this persons changing needs. The homes accident and incident books showed no ‘significant’ events involving the residents had occurred within the past year. No one has been admitted to hospital in that time and all the accidents that have occurred were minor. Too many gaps on medication administration records (MAR) was identified as a major shortfall at the homes last inspection. All the medication records used in the past two months were appropriately maintained with no recording errors noted on these (MAR) sheets. Medication records also accurately reflected current stocks of medication held in the home on behalf of the residents. All these medicines were securely stored in a locked metal cabinet kept in the office. A pharmacist representing a primary health care trust wrote in their report following a recent visit to the home that they were satisfied with the services medication handling practices. Documentary evidence was produced on request to show that the resident’s capacity to take greater responsibility for managing his or her own medication had been assessed within an appropriate framework of risk. The manager told us none of the people currently living at Roanu are willing to take control of their medication, although he will continue to review this matter with all the relevant parties. Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 18 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 & 23 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. The homes arrangements for dealing with concerns and complaints are sufficiently robust and understood by staff to ensure the residents feel listened too and safe. In the main the homes arrangements for ensuring the residents are protected and kept safe are sufficiently robust. EVIDENCE: The acting manager told us no complaints have been made about the homes operation since it was last inspected. One resident told us “they could talk to staff if they were unhappy with anything and that staff were good listeners”. The home does not have a complaints log, which the manager has agreed to introduce immediately. The two staff on duty at the time of this visit were both informally interviewed and demonstrated a good understanding of what constituted ‘abuse’ and when and to whom to report abuse if they witnessed or suspected it. One member of staff was very clear that they would notify the local Councils safeguarding adult’s team if they suspected the homes owner or manager of abusing the residents in line with Suttons safeguarding protocols. Minutes of the last team meeting revealed the manager had recently discussed recognising, preventing Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 19 and reporting abuse issues with his team. Staff have also received up to date training in this important area of practice. The manager told us he would notify us without delay about the occurrence of any significant event involving the residents. There have been no allegations of abuse made within the home in the past year. Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 20 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, 26, 27, 28, 29 & 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. The interior layout and decoration of the home, including its relatively wellmaintained fixtures and fittings, ensures the residents live in a very comfortable and homely environment. The homes arrangements for ensuring the temperature of hot water used by residents to bathe and shower in is kept at a constantly safe level are inadequate and must be improved as a matter of urgency. This major shortfall is currently placing the residents at serious risk of scalding. Overall, arrangements for controlling infection in the home are sufficiently robust to ensure the residents live in a hygienically clean environment. Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 21 EVIDENCE: The communal areas are very comfortable and homely looking. As required in the previous inspection report the home is now being kept pleasantly warm. The home was also spotlessly clean. All the bedrooms were viewed after the manager sought the permission of the current occupants. The rooms were all very personalised with lots of photographs, pictures, and ornaments noted. One resident told us “they liked their bedroom and had everything they needed”. The rear garden is extremely well maintained and includes a large lawn, patio area, and vegetable patch. As previously mentioned in this report all the residents spoken with told us they liked growing their own vegetables, feeding the birds and watching all the wildlife that frequented their garden. The temperature of hot water emanating from a tap fitted to a bath located on the first floor was found to be an unsafe 47 degrees Celsius when tested at 12.40. The relatively new manager told us he was unsure whether or not all the homes baths and shower units had been fitted with pre-set, tamper proof and fail-safe thermostatic mixer valves that prevented water temperatures exceeding a safe 43 degrees Celsius. The manager agreed to rectify this significant health and safety shortfall within a week. In the interim it was agreed staff should continue testing the temperature of hot water each time a resident has a bath or shower in line with the current custom and practice. Staff should also continue to record the outcome of any tests they carry out regarding hot water temperatures in the home. Radiators that have been assessed as placing the residents at risk of harm have been covered. The home operates a call bell alarm system, which residents and staff can activate in the event of an emergency from all the bedrooms and various communal areas. The manager told us all the residents bedrooms had recently been supplied with televisions, and that the one in the main lounge had subtitling facilities to enable a resident who has a hearing impairment to watch it. We recommend the manager seeks additional advice from nationally recognised hearing impairment associations to find out if they can suggest any specialist aids and/or equipment that would be of use to the residents with sensory impairments. Laundry facilities are located in a separate building in the rear garden, which has its own wash hand basin in line with infection control standards. However, the washing machine does not have a sluicing facility that is capable of cleaning foul or soiled laundry at appropriate temperatures. The current arrangements of bagging up foul laundry and taking it to a neighbouring Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 22 nursing home which is also owned by the provider is not only undignified for the residents, but is also a poor use of staffs time. We recommend the owner purchase a washing machine, which has a sluicing facility for the home. Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 23 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, 33, 34, 35 & 36 People who use the service experience excellent quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Residents can be sure that they will be well cared for, supervised, and kept safe because there are always more than enough suitably trained and experienced staff on duty at the home to meet their needs and wishes. Furthermore, all the staff that work in the home receive regular support from their manager through supervision, staff meetings, and day-to-day contact. EVIDENCE: Both the support workers who were on duty throughout the duration of this site visit were observed interacting with all the residents in an extremely caring and respectful manner. Typical comments made a resident and a visiting activities coordinator included, “I like the staff here”, “staff are good listeners”, and “I’ve worked in many care homes and I think the staff at Roanu are one of the best teams I’ve seen”. Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 24 The manager told us a minimum of two staff are always on duty throughout the day from 8am to 8pm. During the week the manager is on from 8am and 4pm and his hands on approach ensures there are sufficient numbers of staff on duty to meet the resident personal, social and health care needs. The duty rosters showed that three staff are employed to work at weekends. At night there is one waking and one sleeping-in member of staff on duty. The home is commended for having relatively high staff to resident ratios and a flexible approach to planning the weekly duty rosters, which are clearly based on meeting the needs and wishes of the residents and not staff. Both staff met told us there was ‘always’ enough staff on duty to meet the residents needs and wishes. No new staff have been employed since the home was last inspected and the service currently has a full compliment of staff. Consequently, the home is not reliant on any agency staff. The manager told us the homes does use a small group of bank staff on a regular basis who are required to reread the homes induction if they have not worked at Roanu for more than two weeks. The manager demonstrated a good understanding of what constituted good recruitment practice and what checks he needed to carry out to satisfy himself about the suitability of prospective new staff. Both staff met told us they had been given training that was relevant to their role. The manager has recently carried out a thorough training needs and development assessment of his staff team, which revealed very few gaps in existing staffs knowledge and skills. Documentary evidence was produced on request for the two staff on duty at the time of this visit, which showed they had received mandatory training in fire safety, manual handling, food hygiene, first aid, safeguarding, handling medication, and infection control. Furthermore, other specialist courses attended by some staff included, working with people with learning disabilities, mental ill health, and communication difficulties. 100 of the homes current staff team have either achieved a National Vocational Qualification - level 2 or above in care, or are enrolled on a suitable course. We examined the personal file of two members of staff who were on duty at the time of this inspection. Records showed they were receiving formal one to one supervision sessions with their manager at least once every two months in line with recommended good practice. Staff met told us they felt supported by their new manager who they aid was always on hand to offer them support and advice. Staff also meet on a regular basis. Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 25 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 & 42 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Residents and staff have every confidence in the home because a very competent and experienced manager is in operational day-to-day control. In the main sufficiently robust systems are in place to enable the residents and their representatives to have their say and influence the homes day to day operation and its future development. The health and welfare of the residents, their guests, and staff are being placed at unnecessary risk of harm because some of the homes current fire and health and safety monitoring arrangements are inadequate or unclear. Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 26 EVIDENCE: The relatively new acting manager, Andre Downer, has been in post for six months. He is a registered mental health nurse and has recently achieved his Diploma in social work. Mr Downer has nearly thirty years of experience working with vulnerable adults in both hospital and social services settings. At present Mr Downer is actively seeking to enrol on the recently created Leadership and Management in Care (LMC) course, which is equivalent to a National Vocation Qualification - Level 4. The acting manager was able to demonstrate he has the knowledge and skills to run a residential care service for generally adults with quite complex and diverse needs. He also has a very clear vision for the service and knows what he hopes to achieve there. Mr Downer is aware that his appointment is subject to a ‘fit’ person interview with the Commission. The acting manager told us he received a lot of support from the homes owner. Since the homes last inspection the owner has employed an independent consultant to provide the manager with impartial advice about how to meet National Minimum Standards. Documentary evidence in the form of Regulation 26 reports were produced on request to show the aforementioned consultant continues to inspect the home on a monthly basis and inform both the owner and manager of their findings. The acting manager told us the system works extremely well and helps him identify areas of practice where the home could be doing better. Residents told us the manager and staff regularly ask them their views about how the home. This is done through day-to-day contact, group meetings, and reviews. We recommend the home also seeks the opinions of the resident’s representatives (i.e. relatives, friends, care managers, GP’s. community psychiatric nurses ect…) and makes their views available to all. The manager was able to produce a fire risk assessment for the building on request. The assessment does not refer to possible problems that could be experienced by residents with a hearing impairment in the event of the fire alarm being activated. We recommend the manager seeks advice from the London Fire and Emergency Planning Authority about the possibility of installing a flashing light fire alarm system in a resident’s bedroom and identifies all the risks associated with this fire safety issue. The homes other fire records showed the fire alarm system continues to be tested on a weekly basis. The manager and staff all told us fire drills are being carried out at regular intervals. However, no records are being kept of this activity. Fire records must identify the date, time, and people involved in these drills. Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 27 Up to date Certificate of worthiness were made available on request to show that suitably qualified engineers had checked the homes gas installations, fire alarm system and extinguishers, and portable electrical appliances in the past twelve months. However, the manager was unable to locate certificates to prove the homes electrical wiring had been tested in the past 3 to 5 years and was also unclear what arrangements were in place for checking the homes water heating system for legionella. Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 1 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 4 34 3 35 3 36 3 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 3 12 4 13 3 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 1 X Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 29 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5(1)(bc) Requirement All the residents and their representatives must have up to date contracts that make it clear what facilities and services are considered ‘extras’ (i.e. not covered by the basic cost of each placement) for which they will be charged. This will ensure the residents and/or their representatives have all the information they need to know about the home in order to determine whether or not they are getting value for money. When complaints and/or concerns are made about the homes operation these must be clearly recorded. This will ensure the way the home deals with complaints is open and transparent. All baths and shower units must be fitted with preset, tamper proof and fail safe thermostatic mixer valves that ensure the temperature of hot water in the home never exceeds a safe 43 degrees Celsius. This will ensure the safety of the residents. DS0000063202.V362856.R01.S.doc Timescale for action 01/11/08 2. YA22 17(2), Sch 4.11 14/10/08 3. YA27 13(4) 14/10/08 Roanu House Version 5.2 Page 30 4. YA42 23(4)(e) & 17(2), Sch 4.14 All staff that work in the home must be involved in at least one fire drill every six months and where possible residents should also participate. The outcome of any drill carried out in the home must be clearly recorded. This should include, the date it was carried out, the names of everyone involved, and what action (if any) was taken to remedy any defects/problems found. This will ensure the safety of the residents, their guests, and staff. An Immediate Requirement Notice was issued at the time of this inspection for this major fire safety breach to be rectified within 24 hours. A suitably qualified engineer must test the homes electrical wiring system at least once every 3 to 5 years. A certificate of worthiness to show this task has been completed must also be made available for inspection on request. The homes arrangements for testing its water heating system every year must be clarified. 08/10/08 5. YA42 13(4) & 23(2)(c) 01/11/08 6. YA42 13(4) & 23(2)(c) 01/11/08 Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 31 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. Refer to Standard YA1 Good Practice Recommendations The homes statement of purpose and guide should be amended further to include more detailed information about the full range of needs the service intends to meet (i.e. sensory impairment). This will ensure prospective new residents and their representatives will have access to all the information they need to know about the home in order to decide whether or not it is the right place for them. Additional advice about specialist aids and equipment that could enhance the life’s of sensory impaired residents should be sought from nationally recognised hearingimpaired associations, such as RADAR, and the British Deaf Association, for example. The way in which the service deals with foul or soiled laundry should be reviewed, as current arrangement seem undignified for residents and unnecessarily time consuming for staff. Any person appointed to be in operational day-to-day control of a care home is subject to a ‘fit’ person interview with the CSCI, which they must pass in order to become the homes registered manager. This process enables us to determine whether or not any person responsible for the day-to-day running of a care home is ‘suitable’ to do so. The acting manager should have achieved their National Vocational Qualification Level 4 or the equivalent in management as soon as reasonably practical. This will ensure they are suitably qualified to manage a residential care home for vulnerable adults. The way in which the service ascertains the views of the residents, their relatives and other professional representatives should be reviewed in order to make the process more open and transparent. The results of any quality assurance survey undertaken by the home should be made available to any interested parties on request. DS0000063202.V362856.R01.S.doc Version 5.2 Page 32 2. YA29 3. YA30 4. YA37 5. YA37 6. YA39 Roanu House This will ensure all the homes major stakeholders can influence how the home is run and how it develops. 7. YA42 The way in which the service ensures residents with hearing impairments know when the fire alarm has been activated should be risk assessed and advice sought from the local fire authority on this matter. Roanu House DS0000063202.V362856.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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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