Inspection on 06/04/09 for Roberta House

This is the latest available inspection report for this service, carried out on 6th April 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Roberta House 17/10/05

Roberta House 31/05/05

Roberta House 15/02/05

Roberta House 05/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Roberta House 99-103 Island Road Upstreet Canterbury Kent CT3 4DE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mark Hemmings     Date: 0 6 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 34 Information about the care home Name of care home: Address: Roberta House 99-103 Island Road Upstreet Canterbury Kent CT3 4DE 01227860704 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : bobbie@robertahouse.com Mr Rodney Gilbert Tarry,Mrs Roberta Dorothy Cooper Tarry care home 17 Number of places (if applicable): Under 65 Over 65 17 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 17 The registered person may provide the following category of service only: (PC) ot service users of the following gender: Either Whose primary care needs on admission to the service are within the following categroy: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Up to 17 older people can make their home in Roberta House (the Service). In practice all of the bedrooms that can be used for double occupancy are only used as singles. This means that in effect only 13 people can be accommodated in the Service. The building is three older terraced properties that have been joined together. The accommodation is on the ground and the first floor. There are two stair-lifts that give step-free access around the place. These are special chairs that go up and down the two flights of stairs on runners. Each bedroom has got a private wash hand basin. There are two bathrooms and theres a total of four toilets. Theres a call bell system. Care Homes for Older People Page 4 of 34 Brief description of the care home This has call points in each of the bathrooms and toilets. There are also call points in all of the bedrooms. This means that people can ring for assistance. The Service is only a short walk from the centre of Upstreet. This is a small hamlet that has a village store. The nearest shopping centre is at Canterbury. This is about 10 miles away. The Service is set back a bit from quite a busy road. In the front rooms of the property there is some traffic noise. At the back of the property there is quite a large raised patio. This looks out on a large and well kept garden. There is some limited off street car parking. The Service has its own car. The Registered Providers are private individuals. One of them is also the Registered Manager. They run another larger residential service thats just down the road to Roberta House. If you want to find out more about the Service and about the fees charged, you can phone the Service and speak with the Registered Providers. Care Homes for Older People Page 5 of 34 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 that the people who use this Service experience good quality outcomes. Since 1 April 2006, we have developed the way we do our inspection of care services. This inspection of the Service was Key Inspection. We arrived at the Service at about half past eight in the morning and we were there for about eight hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Providers in their self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since our last inspection. During the inspection, we spoke with five of the people who live in the Service. We also spoke with both of the Care Homes for Older People Page 6 of 34 Registered Providers, with the Service Development Manager and with two of the support workers. We walked around parts of the accommodation and we looked at a selection of key records and documents. Before we called to the Service, we asked ten of the people who live there and 10 members of staff to fill out a questionnaire for us. We wanted them to tell us what they think of Roberta House. Three of the people who live in the Service and six members of staff kindly filled them in and sent them back to us. Later on in our report, well tell you what people are saying in these questionnaires. The Registered Providers have done their own questionnaires. These cover both Roberta House and the other service that they run nearby. These ask the people who live in the services, their relatives, members of staff and care managers (social workers) what they think about different aspects of how things are going. In most instances theres no way of knowing which of the questionnaires relates to the individual services. A total of 18 people who live in the services filled in a questionnaire, 11 relatives did and 10 care managers took part. Well tell you some of what theyre saying in their answers as we go through our report. What the care home does well: What has improved since the last inspection? What they could do better: The complaints procedure needs to be altered. This is so that people are told about their right to tell us direct if there is something thats concerning them about the Service. Care Homes for Older People Page 8 of 34 The system used to record how complaints are dealt with needs to be strengthened. This is so that there is a full account of what has been done by the Registered Providers to investigate and resolve any complaint that might be received. Theres some general wear and tear around the accommodation that needs to be put right. The quality assurance system doesnt fully involve all of the people who live in the Service. This is important because theyre the experts on what it is like to live in Roberta House. They need to have a direct say in how things are going. Also, they need to be told what is going to be done to respond to any improvements they may come up with. An engineer needs to certify that the gas cooker remains in a serviceable condition. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 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. People who are thinking of moving in are asked about what support they need and how they want this to be done. If people want to leave the Service to become more independent they will be supported to do so. Evidence: The Service Development Manager asks people who are thinking of moving in about what support they need and want. This is done so that everyone can be confident that moving in to Roberta House is the right thing for them. She also talks with family members, care managers and with medical staff. All of this information is collected so that she can build up a really good picture of how the persons needs can best be met. After shes got all of this information, she and the Registered Providers can then decide if the Service can support the person in a way thats right for them. We looked at the information that has been collected for one person who has recently Care Homes for Older People Page 11 of 34 Evidence: moved into the Service. We wanted to see what sorts of things are being considered. There is lots of useful information. This includes things such as the way they need to be supported to organise themselves to do everyday things. It also includes the sorts of physical assistance they need. The Service Development Manager says that when she gets the information she shares it with the support workers. This is done so that they know in advance about what support they will need to provide. The Assessment says that each person has a Keyworker. This is a support worker who takes a special interest in making sure that everything is okay for the person concerned. We asked two support workers about how all of this works out in practice. They say that the Keyworker system is helpful. They also say that they are indeed told about people who are about to move in. They observe that as a team they discuss how best to help the person in the first few days, while they get to know them better. The Service Development Manager recognises that moving into a residential setting is a big step for anyone to take. She says that she wants to do everything possible to put the persons mind at rest. We agree that this is really important. She says that as part of the introduction process, people are invited whenever possible to visit Roberta House. This is so that they can see what the place is like first hand. During these visits, people can ask any questions they want. There are also some written documents that say about the Service in quite a lot of detail. These are called the Service Users Guide and the Statement of Purpose. The Guide is written in a new easy-read question and answer way. People can ask to see both of these documents if they want. The Registered Providers are quite happy for them to take away a copy if they want to have a look at them at their leisure. In our questionnaire we ask people who live in the Service, did you receive enough information about this home before you moved in so you could decide if it was the right place for you? One person says that yes they did and two people dont answer. When we were in the Service one person said to us, when I came here I visited first of all to see what the place was like and I liked it. It felt homely and I knew that I could get on with (the Registered Providers). I also liked the kind attitude of the staff. I thought that the staff were patient enough to put up with me! I have been quite okay here since and the staff really are that kind and take care of me. The Registered Providers intend to gradually change the focus of the Service. This is so that it will increasingly support people who have special needs due to them having misused alcohol. This might mean that in future, some people may be able to be supported to become more independent than they were when they first move into the Service. The Service Development Manager says that when this happens, people will be assisted to move on to more independent living situations. Care Homes for Older People Page 12 of 34 Care Homes for Older People Page 13 of 34 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. People are provided with the personal and health care they need. Medicines are handled safely. People are treated with kindness and respect. Evidence: The people who live in the Service say that the support workers offer them all the assistance they need. There is a written individual plan of personal support for each person. These are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to support workers so that they know what to do. We looked at three of these plans. They give a clear account of who needs to do what and why. For example, there is useful information about things such as health care, helping people in the bathroom and about keeping people safe. In more detail, one person needs to be helped to get themselves up and about and not to spend too much time resting. Someone else needs special help to manage their continence. We asked two workers about some of these things. We wanted to know what all of this Care Homes for Older People Page 14 of 34 Evidence: written information means in practice. They know all about it. In our questionnaire for members of staff we ask, are you given up to date information about the needs of the people you support (for example in the support plan)? Everyone says that they always are. In our questionnaire for people who live in the Service we ask, do you receive the care and support you need? Everyone says that yes they do. One person adds that, the girls are all very kind. The Registered Providers questionnaire asks, are you happy with your care? Sixteen people answer yes, one doesnt answer and one says no but then doesnt say anymore. The support plans are kept up to date so that they are accurate. This involves support workers making daily notes about how things are going. There are then monthly reviews. This is when the Service Development Manager or the Manager checks out with the person concerned and with the support workers how things are going and what might need to be changed. In our questionnaire for people who live in the Service we ask, do staff listen and act on what you say? Everyone says that yes they do. Sensible steps are taken to ensure that people do not have any avoidable accidents. For example, some people are a bit unsteady on their feet. They are accompanied by a support worker so that they dont lose their balance. Also, careful thought is given to whether or not someone might need to be accompanied when they go out. Some people are helped to manage their cigarettes so that they dont put themselves and other people at risk of a fire. People are helped to keep healthy. Support workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Since our last inspection, people have seen their doctors as and when necessary. There have also been contacts with specialist hospital based medical staff. We looked at some of the records about how quickly doctors are being called after the need for medical attention is first noted. Its being done straightaway. In our questionnaire for people who live in the Service we ask, do you receive the medical support you need? Everyone says that they always do. At the moment, none of the people who live in the Service have chosen to manage their own medication. They prefer that support workers do it for them. There is a system to check that the correct medicines are received from the chemist. Once in the Service, they are stored securely. Theres a procedure for administering medicines. This is designed to double check that the right medicines are given to the right people at the right time. We saw a support worker correctly following parts of the procedure. There is a record kept each time a medicine is given out. We examined two sets of these records for a period of several recent days. They are being correctly completed Care Homes for Older People Page 15 of 34 Evidence: each time a medicine is given. We looked at two medicines in more detail. This was done to see if the remaining stock matches what should be there. Again, we found things to be in order. There are special arrangements in place for medicines that need to be stored extra securely. People say that the support workers are courteous and attentive. When we were in the Service we talked with people a lot about this. They are very positive about the support workers. Several people summarise the general mood in their comments to us. One says, I get treated really well here and the girls are kind even when I nag them about things. I get on okay here and Ive no complaints at all. Another person says, Oh, I like my home here, Ive been here a long time and I have my own ways like we all do I suppose. I get along okay and the staff well theyre like family to me. I dont know what Id do without them, I really dont. The Registered Providers questionnaire for people who live in the services asks, are the staff helpful and courteous? and do they respect your privacy and dignity? Everyone answers yes to both questions. Support workers are relaxed and informal in how they are. Things are orderly without being too much so. If someone needs help in the in the bathroom the door is closed first. Members of staff knock and wait before going into peoples bedrooms. People are helped to wear neat and clean clothes so that they can present themselves how they want. They are given their post promptly. Also, they are helped to deal with it if something is difficult for them. People can use the telephone whenever they want. Care Homes for Older People Page 16 of 34 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. There are some interesting things for people to do. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: The Service Development Manager says that the plan is that there is an organised social thing that people can do on most days. Some people go up to the other residential service that the Registered Providers run. There they do a range of things such as group activities, gardening and trips out. For those who prefer to stay at home, there are other things to do. Most afternoons, the support workers offer to do things such as bingo, dominoes and quizzes. Some of these events can be in small groups and some of them are done an individual basis. Some of the activities have an occupational element to them. For example, there is a new Community Duty Rota. This is where people are encouraged to help out with household tasks, for example with laying the table. The Assessment says that it is hoped that people who use the Service will want to become increasingly involved in this sort of thing. At the moment, there isnt a clear record of who is choosing to do what activities. The Assessment says that the range of social activities will be kept under active review. Care Homes for Older People Page 17 of 34 Evidence: This is so that new and additional things can be offered in the future. As part of this commitment, the Service Development Manager intends to strengthen the recording system. This is so that she can double check that everyone is indeed being offered a wide range of social things to do. In our questionnaire for people who live in the Service we ask, are there activities arranged by the home that you can take part in? One person says that there always are, one person says usually and one person says sometimes. The one who says always, then adds, I feel wanted here as they let me take part in preparing the meals and laying and clearing the tables and washing and wiping up. The person who answers usually adds, I prefer to keep myself to myself. I know there are trips and outings but I prefer to stay here. I like playing cards and bingo. The Registered Providers questionnaire for people who live in the services also asks about social activities. Twelve people say that theyre fulfilling, three people say that theyre adequate and three people say that theyre lacking. When the care managers are asked about this same subject, 9 of them say that the activities are fulfilling and one says that theyre adequate. People are encouraged to make their bedrooms their own private space. They are asked to bring in things for their own homes so that they can have personal items around them. We saw lots of examples of this. For example, people have their own photographs and ornaments so that their bedrooms feel more like being home. One person is keen on computers. The Registered Providers have helped them to get their equipment sorted out so that it works okay. People say that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant affair. One of the questions we ask in our questionnaire for people who live in the Service is, do you like the meals? Two people say that they always do and one person says that they usually do. When we were in the Service, people chatted with us about the catering arrangements and they were very complimentary. One person says, the meals are very good indeed, I always have enough to eat and its good food really. Certainly we always have enough and Ive no complaints about the grub. Another person says, we have a choice of things at lunch and we choose the day before or at the time. The foods good and I have as much as I want. The main meal of the day is lunch. On most days there is a choice of the main dish that people can have at each meal time. We looked at the variety of meals provided over a period of two or three days. There is a reasonable balance. The lunch time dishes include things like fish fingers, sausages and roast turkey. Support workers say that people can have drinks and snacks throughout the night. This is important. Care Homes for Older People Page 18 of 34 Evidence: Otherwise, it can be a long time for some people between the late evening milky drink and breakfast the next day. Care Homes for Older People Page 19 of 34 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. There is a mistake in the complaints procedure. Parts of the arrangements used to manage complaints need to be strengthened. There are arrangements in place to safeguard people. Evidence: There is a written complaints procedure. This explains how to go about making a complaint or raising a concern about something. Its best for complaints to be sorted out informally at a local level whenever possible. This is so that things can be put right with the minimum of fuss. Indeed, the Registered Providers have a duty to do this. However, people also have the right to tell us about their concerns. This isnt clearly explained in the current procedure. The Registered Providers are going to sort this out by 1 June 2009. Since our last inspection, the Registered Providers have assisted Kent County Council to look into two formal complaints. The first of these concerned an allegation from someone who lived in the Service that a support worker had been inappropriate towards them. The second thing was about an allegation by one of the people who live in the Service that another person living there had been unkind to them. We understand that Kent County Council did not consider either of the complaints to be justified. We wanted to look at the record of the investigations and of the role played in them by the Registered Providers. There should be a clear written account so that Care Homes for Older People Page 20 of 34 Evidence: we can check that everything is in order. However, none of the relevant records can be found. The Registered Providers have assured us that the missing records will now be found. They also say that all future complaint investigations will be properly recorded. In our questionnaire for people who live in the Service we ask, do you know how to make a complaint? Everyone says that yes they do. We also ask, do you know who to speak to if youre not happy. Two people say that they always do. One person answers that they sometimes do. They then say that they can talk with their care manager if they need to. We asked several people about making complaints. They say and show by their relaxed manner they would feel quite okay about raising a complaint should they need to. One person says, I can say what I want and the staff are always fine about helping me. I havent got anything to complain about really. I know that the staff are trying to help me even when I dont agree with them. I know that I can trust them to do whats best. The Registered Providers questionnaire for people who live in the services asks, are you happy. Seventeen people answer that yes they are and one person says that they arent. This latter person doesnt say anymore about their answer. Its very important that people are confident that theyre safe from being taken advantage of. The Assessment commits the Registered Providers to guarding against this. We asked some of the support workers about this matter. They know what to look out for. One support worker says, the residents come first here and nothing would be allowed that got in the way of their wellbeing. (The Registered Providers) are always very definite about this and none of the staff would tolerate anyone being unkind in any way to any of the residents. Im completely confident that people are safe and well here. Its a homely home. In our questionnaire for members of staff we ask, do you know what to do if a service user, relative, advocate or friend has concerns about the home? Everyone says that yes they do. We also asked people who live in the Service about this general subject. None of them have any concerns about how things are going. One of them says, the staff are like family and that says it all. The Registered Providers questionnaire for relatives asks, do you have any concerns about your relative/friend. Everyone says that they dont have any concerns. Care Homes for Older People Page 21 of 34 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. The accommodation is comfortable and homely. There is a modern fire safety system. The kitchen is well equipped. There is a suitable laundry. Evidence: The building is well maintained on the outside. The raised deck patio is neat and it looks out onto an attractive garden. On the inside, the accommodation in general is well decorated and furnished. There are lots of little touches that make the place feel lived in, such as interesting pictures. However, there are some things that take away from the homely feeling of the place. There is some damaged plaster work in one of the hallways. One of the bathrooms has got some damp stains on the wall. The carpet in the conservatory has got some black marks on it. In our questionnaire for people who live in the Service we ask, is the home fresh and clean? Two people say that it always is and one person doesnt say anything. The Registered Providers questionnaire for people who live in the services asks, are you happy with your accommodation? Sixteen people say that yes they are. The two people who say no either dont say anymore or appear to live in the other service. The building is fitted with an automatic fire detection system. This provides a high level of fire safety protection. We understand that the fire brigade people say that the Care Homes for Older People Page 22 of 34 Evidence: system meets the national standard. The Registered Providers have a system of doing regular fire safety risk assessments. This is where one of them goes around the place to check out that everything is still working in the right way. We looked at the record of the most recent one and it says that everything is still okay with the system. The people from the local Department of Environmental Health called to look at the kitchen a couple of years ago. They gave it three stars out of a possible five stars. Its report concludes that theres a, good level of legal compliance. Some more effort may be required. A small number of improvements are recommended. The Registered Providers say that these have since been done. We looked in the kitchen too. Its adequately equipped and its clean. The main lunch time meal is prepared in the main kitchen thats in the Registered Providers other service. Its then brought to Roberta House in a hot box. This means that the kitchen in Roberta House is only used for lighter meals such as breakfasts and teas. The support workers do sensible things to ensure good food hygiene. This includes making sure that the fridge and the freezer are cold enough to store food safely. There is also an arrangement to make sure that hot foods are cooked through thoroughly. Theres a stock management system. This means that individual foods dont go beyond their use-by date. People who need it are helped to get about. One of the baths is a special one. The side opens up so you can walk into it before its filled up. The other bath has a fixed chair that goes up and down in it. Theres a mobile hoist. This can be used in the lounges and in the bedrooms. This might be needed if someone cant manage to stand at all and needs to be lifted. No one needs to use it at the moment. At key places there are assistance poles. These are fitted to the wall and they are there for people to hold onto for extra support. There are frames near to the toilets. People find these very helpful when they are getting down and getting back up again. When someone moves into the Service, the Service Development Manager makes a special note of what assistance they need to get about. She looks at things such as the help someone needs in the bedroom and in the bathroom. We asked support workers about this. They know what theyre doing. We asked people how warm the accommodation is kept. They say that they are always comfortable even during the coldest weather. When we arrived in the Service the central heating was on and it was on when we left. Most of the radiators arent fitted with guards. These can be useful if there is a risk that someone might fall against their heated surfaces. The Registered Providers dont think that there is an immediate risk of this happening. Most of the hot water taps in the wash hand basins arent temperature controlled. These controls are often used so that there is less risk of someone scalding themselves. Again, the Registered Providers dont think that these Care Homes for Older People Page 23 of 34 Evidence: controls are needed at the moment. The laundry has a commercial grade washing machine. This has an extra cycle for items that need an especially hot wash. There is a large tumble drier. We looked in the laundry. Its well organised and clean. The Registered Providers say that everyones clothes are marked so that theres less chance of them getting lost or mixed up with other peoples things. This is very important because its a really basic thing to wear only your own clothes. We checked this out for two garments. We found each of them to be marked with the name of the owner. We asked people about this. They say that they do nearly always get their own clothes back from the laundry. Care Homes for Older People Page 24 of 34 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. There are enough care workers around. Security checks are completed for new support workers. Support workers know what theyre doing. However, parts of the training arrangements arent clear. Evidence: During the day and the evening, there are always two support workers on duty. At night, there are two support workers on duty and there are special security arrangements. On most days, there is a housekeeper on duty for several hours. The arrangement is that all of the support workers do various shifts in both of the Registered Providers services. This means that there isnt a dedicated team of support workers for Roberta House. In our questionnaire we ask people who live in the Service, are the staff available when you need them? Everyone says that there always are. The Registered Providers questionnaire asks, do you ever have problems getting attention? Everyone says that no they dont. In our questionnaire for members of staff we ask, are there enough staff to meet the individual needs of all the people who use the Service? Four people reply always and two people say usually. When we were in the Service we asked members of staff about this. One person sums up the tone of what was said when they observe, we have quite enough staff given the needs of the residents. Most of them like to be at home and relaxed. We run the place like its their home, everything runs okay. When we were in the Service we kept a look out Care Homes for Older People Page 25 of 34 Evidence: for things that might give us a clue about how well the place is being staffed. We noticed that people who asked for help get it straight away. We also noticed how support workers arent rushing around all the time. Instead, they take the time to chat with people about everyday things such as the weather and whats on television. The Registered Providers say that all of the shifts are being reliably filled. We looked at the written roster. It confirms what they are saying. Its very important that only honest and trustworthy people are employed as support workers. With this in mind, the Registered Providers complete a number of security checks on new support workers. These include things such as confirming their identity, taking up references and doing a police check. We looked at the records for one recently appointed support worker. The checks that need to be done have been completed. The Service Development Manager says that new support workers have introductory training before they work on their own. In our questionnaire we ask about this. We say to members of staff, did your introductory training cover everything you needed to know to do the job when you started? Five people think that the training met their needs very well and one person says that it mostly did. Theres a checklist of the subjects that new support workers are told about. We looked at one of these checklists that has recently been completed. It shows that important things are being covered. For example, they are told about the individual support plans that we spoke about earlier. They are also shown how to help people get about safely. Recently, the checklist has been extended. This has been done so that more subjects are included. Also, it has been done so that there is a clearer way to assess that the support worker concerned has learnt what they need to know. The Service Development Manager says that this initial training is just to get support workers started. Theres a lot to learn after that and support workers are expected to do further training. These courses include how to safely support people move about, basic first aid, food hygiene, keeping people safe and infection control. In our questionnaire for members of staff we ask, are you being given training which helps you understand and meet the individual needs of service users and that keeps you up to date with new ways of working? Everyone says that yes they are. One person adds,we do get a lot of training here and its been really useful. Ive done lots of courses and (the Service Development Manager) is always planning more stuff to do. We looked at the records of who has done what courses so far. In general, they show that quite a lot of training is being done. However, there are some gaps. Were not Care Homes for Older People Page 26 of 34 Evidence: sure if its just that the records are not up to date or if some support workers have missed individual bits of training. After the inspection, the Service Development Manager told us that shes going to complete a thorough audit of the records. This is so that she can be sure about who has done what training. She is then going to organise any further training that may be needed. Before deciding about the need for any further training, shes going to assess the skills and knowledge that each support worker already has in a number of key areas. This is going to be done using a national model that we think is very helpful. Theres a total of 19 support workers employed in the two services. Four of them have completed a National Vocational Qualification (NVQ) at Level 2 or 3 in health and personal care and three more are currently studying for the award. This qualification is a very good idea. This is because it helps support workers to deliver high quality residential care services. The Service Development Manager says that all new support workers will be encouraged to study for the award. At the moment, 12 members of staff including the Manager and the Service Development Manager are doing distance learning courses in a number of subjects. These are in how to promote good nutrition, in how to support people with significant problems with their understanding, in how to ensure good infection control and in promoting equality and diversity. In addition to the courses, the Manager also has one to one sessions with support workers. During these she takes a particular subject and then looks at whether or not the support worker knows enough about it. We looked at the records of one of these sessions that was about giving medication out. These show that the Manager checked that the support worker was correctly following parts of the written medication procedure. For example, the Manager established that the support worker had double checked that she was administering the right medicine to the right person. Then she was observed to have completed the required record of having given the medicine in question. We think that this sort of assessment exercise is a really useful thing to do. We spoke with two support workers to find out what they know about particular bits of the support they need to give people. As we have said earlier in this Report, they know a lot about how each of the people who live in the Service likes to be supported. More generally, they know about things such as how to help people to express themselves. They know about how to help people take care of their skin. They also know about how to respectfully help people who need assistance to manage their continence. Care Homes for Older People Page 27 of 34 Care Homes for Older People Page 28 of 34 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. Things are well managed. People are asked what they think, but this needs to be a bit more organised. People are helped to buy what they want. There are reliable health and safety arrangements. Evidence: The Registered Providers in general have a good knowledge of how things are going. The Manager has both of the formal qualifications that are recommended by the Standards. These qualifications are important. This is because theyre designed to help managers ensure that high quality residential support is reliably provided. The Service Development Manager has almost completed one of the qualifications too. The support workers say that there is good team work between them. One of them says the (Registered Providers) are really supportive and helpful. They are always around and will give advice as and when its needed. You can approach them without having to worry and theyll always help. Actually, I think that this is a really good place Care Homes for Older People Page 29 of 34 Evidence: to work and Im happy here. There are handover meetings at the beginning and end of each shift. These are held so that they can be kept up to date with developments. In our questionnaire for members of staff we ask, do the ways you pass information about people who use services between staff (including the manager) work well? Five people say that they always do and one person answers usually. There are full team meetings held about once a year. In addition to this, there are smaller meetings. These are where the Manager chats with members of staff informally to see how things are going. Its really important that the people who live in the Service have a direct say on how things are going. Theyre the experts because they live there. The Assessment says that people who live in the Service are regularly asked what they think about their home as part of everyday life. There are also monthly house meetings. We looked at the records of the most recent one. They show that people talk about practical everyday things such as what they would like to see on the menu. As weve already noted, each year the Registered Providers also ask the people who live in the Service to fill in the questionnaires that we have quoted from. In general, we think that this is a very useful thing to do. However, there are some further improvements that can be made. Not everyone is completing the questionnaires. Those who choose not to do so may prefer to be asked what they think in a different way. Theres no organised system to tell people who live in the Service whats been said in the questionnaires. Also, theres no clear system to let them know whats going to be done to respond to any improvements that may have been suggested. The Registered Providers are going to look into this further to see what can be done to address these problems. The Manager is based in the Registered Providers other service. However, she calls to Roberta House regularly to see how things are going. We saw notes of a visit that she did unannounced and that was quite late in the evening. The records show that she had a good look around to satisfy herself that everything was going okay. Theres a system to help people buy goods and services without having to handle too much money. This involves the Registered Providers holding money on behalf of people and then giving it to them or spending it on their behalf. We looked in some detail at some of the various transactions involved for one person. We found everything to be in order. The sums spent are reasonable, there are receipts, the accounts add up and the paper balance matches with the cash balance. The Registered Providers are required to do regular checks to make sure that the fire Care Homes for Older People Page 30 of 34 Evidence: safety equipment remains in good working order. We looked at the records and the checks are up to date. There are regular fire drills. There is also a programme of fire training that plans to give regular instruction to every member of staff. This is very important. This is because the level of fire safety protection in the Service largely depends upon members of staff doing the right thing if there is a fire safety emergency. When we initially looked at the records, they were a bit muddled and we couldnt be sure who had done the training. After the inspection, the Service Development Manager audited all of the records. She has assured us that everything is in order. She has also assured us that in future, the records in question will be clear and that they will be kept up to date. There are up to date reports from engineers about the oil fired central heating and the electrical wiring installation. They say that everything is in good working order. There isnt an up to date engineers report for the gas cooker. The Registered Providers have now arranged for this to be done. We looked at the record of accidents that have occurred in the Service over the past few months. There hasnt been that many. Most have been minor bumps and bruises. The Manager keeps an eye on who has had an accident and what has happened. This is done so that she can do something if there is a particular problem thats causing the accidents. We dont think that theres anything obvious that needs to be sorted out at the moment. The Manager regularly checks things to do with the building and with the equipment. This is done so that if something is broken it can be repaired quickly. Shes also looking for hazards that might result in someone having an accident. She hasnt found any. We kept our eyes open when we were walking around. We didnt notice any particular hazards either. Care Homes for Older People Page 31 of 34 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 32 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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