Inspection on 08/12/09 for Rosebank Lodge

This is the latest available inspection report for this service, carried out on 8th December 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.

Extracts from inspection reports are licensed from CQC, this page was updated on 14/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Rosebank Lodge 82-84 Mitcham Park Mitcham Surrey CR4 4EJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jon Fry     Date: 1 5 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Rosebank Lodge 82-84 Mitcham Park Mitcham Surrey CR4 4EJ Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Patience Quarcoo Type of registration: Number of places registered: care home 13 Rosebank Lodge Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: 1. The registered person may provide the following category/ies of service only: Care home only Code PC 2. The maximum number of service users who can be accommodated is 13 to service users of the following gender:Either whose primary care needs on admission to the home are within the following categories: Learning disability Code LD Date of last inspection Brief description of the care home Rosebank is a residential care home providing care and support for up to thirteen people who have a learning disability. The home is situated in a residential area of Mitcham close to shops and public transport facilities. Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 0 13 0 Brief description of the care home Accommodation is provided on the ground and first floors of the home. There are eight full en suite single bedrooms, four full en suite single bedrooms with kitchenette and a self contained flat. People also have access to communal lounge, kitchen and dining areas and to a large garden area with a sensory cabin. Information about fee levels can be obtained directly from the service. Care Homes for Adults (18-65 years) Page 5 of 25 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: One inspector made an unannounced visit to Rosebank Lodge on the 8th December 2009. A further short unannounced visit was made on the 15th December 2009 to look at records and other documentation. We spoke with two people who live at the service, three staff members and the manager. The service sent us their Annual Quality Assurance Assessment (AQAA) when we asked for it. This gives us information about outcomes for people who use the service as well as some numerical data. Care Homes for Adults (18-65 years) Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 25 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. A persons individual needs are assessed before they come to live at Rosebank Lodge. Evidence: Rosebank Lodge opened in October 2009 and the first person moved in soon after. The AQAA told us that leading up to people moving in they have a full assessment and opportunities to come and visit Rosebank Lodge. The assessment is completed by a member of the companys Placement Team, together with the Home Manager and will include the views expressed by the individual as well as their family carers and anyone who has a significant input into their lives, such as their current key worker or professional carer. The two files we looked at contained full assessments that looked at the persons support needs around areas such as personal care, health and wellbeing, sleeping and leisure interests. We saw that people had been visited in their previous home by staff to help them make these assessments. Records confirmed that each individual was also able to make visits to Rosebank Lodge to see if they liked it. Care Homes for Adults (18-65 years) Page 9 of 25 Evidence: Transition meetings are then held for the person once a decision has been made that they are to move in. These meetings bring together all involved parties and a plan is drawn up to help support the person around the move and their first weeks at the home. The AQAA states when people move in they have a review after six weeks, three months and six months. The guide about the service was still being worked on when we visited. It is important that this document is made user friendly and we recommend that it includes lots of pictures of key people and places. Alternative formats should also be drawn up. The home should additionally make sure that the guide covers key areas such as the aims, objectives and purpose of the service, the facilities that are available for care and support, how care, treatment and support is reviewed, the cost of the services, where charges are applied, how to raise a concern or complaint about the service, and how it will be dealt with and details of local advocacy services. This will help to ensure that the service meets new essential quality standards in force from October 2010. Care Homes for Adults (18-65 years) Page 10 of 25 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Draft care plans are in place for each person and these are under development. Evidence: The home told us in the AQAA that all residents have an individual care plan and risk assessment. In developing the care plan, views are sought from the resident by an identified key worker who also liaises with Care Managers, Day Centre staff, families, friends and other relevant professionals and carers. We looked at the care files for two people and saw that draft care plans had been drawn up for each individual but were clearly a work in progress. One plan contained some really good information about the person and how they liked staff support in areas such as eating, bathing and taking medication. Risk assessments are drawn up to help keep people living and working within the service safe. The AQAA told us that these will be reviewed every six months. Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: We talked to the manager about making more detailed guidance available for staff about how to deal with different behaviours. This is particularly where risks are identified within assessments and actions need to be taken to reduce these. The manager had looked at this area by the second day of our visit and we have included this as a strong recommendation for the future. Care Homes for Adults (18-65 years) Page 12 of 25 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 people who live there are supported to take part in activities of their choosing. Evidence: The AQAA said we support individuals to access community activities of their choice, such as college, leisure centres, cinema, places of worship and local and main shopping centres. We will also support activities within the home including art and craft and music and sensory sessions. The records we saw contained reference to people going out swimming, shopping and for days out. Weekly planners have been drawn up and these were on the two files we looked at. We saw people going out with staff shopping, on day trips and for a walk when we were visiting the home. The AQAA said we are developing our understanding and relationship with the people Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: who currently live at Rosebank Lodge. Plans for the year ahead are to hold regular Residents meetings so that they are able to have a say in the running of the home and to continue to find out all local facilities available to residents so that they can make choices about their daily life. A four week revolving menu is used to plan the meals and pictures are available to help people make choices about what they would like to eat. Care Homes for Adults (18-65 years) Page 14 of 25 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Individual health needs are addressed. People receive their medication as prescribed but the home needs to improve its auditing around this important area. Evidence: The AQAA reported that all residents are supported to register with the local GP, dentist and optician and supported to attend any healthcare or personal care appointments. Referrals are made to specialist healthcare services when required. As stated previously, assessments and draft care plans are in place and these address individual support needs around areas such as health. We saw that records are kept around peoples weight and any individual health needs that require monitoring such as epilepsy. The manager told us in the AQAA that the residents are supported to order, receive and take their medication. At present there are no individuals who are able to selfmedicate, so members of staff complete these tasks. We looked at the medication systems in place on the first day we visited. The records Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: showed that people were receiving their medication as prescribed but improvements were needed around record keeping and auditing. Daily audits had not been always been completed and there were instances where the medication had been given but not signed for. Auditing individual medications in boxes was not always possible due to the incomplete records kept. The home made improvements by our second visit and we saw that staff are being trained to administer medication safely. We have included a recommendation that the home makes sure that a suitable audit system is in place that is able to pick up any issues quickly. Care Homes for Adults (18-65 years) Page 16 of 25 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. A complaints procedure is in place. Staff receive training around Safeguarding to help keep people safe. Evidence: The AQAA told us that the organisation has a complaints procedure in place, which is referred to in the Statement of Purpose, Service User Guide and details of contacts are available on our website. As stated previously, the guide about the service is being developed and we recommend that this includes photographs of key people within the process. The service should also look to inform family members and representatives about this important area and seek to use advocates as appropriate. We saw that an organisational Safeguarding procedure is available and the manager is aware of Local Authority guidelines about making alerts. The AQAA told us that the team are given training in SOVA and are made aware of the company policy and procedure. The staff we spoke to had received training in this important area. Care Homes for Adults (18-65 years) Page 17 of 25 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 home is decorated to a good standard and provides a clean comfortable environment for people to live in. Evidence: The AQAA stated that Rosebank Lodge has been designed to a high standard specific to individual needs: all rooms and bedsits, as well as the self contained flat have ensuite facilities with either a bath or shower. The home is new and we saw the environment provided has been decorated to a high standard. All areas of the service that we looked at were clean and provide comfortable accommodation for the people living there. Staff are working with individuals to personalise their rooms and to make the environment feel more homely. A large garden with a sensory cabin is provided to the rear of the property. Care Homes for Adults (18-65 years) Page 18 of 25 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 suitable numbers of trained staff to meet peoples needs. Evidence: The AQAA stated that ACH is committed to the training and development of members of staff so that they are able to deliver a high quality service that also meets the specific needs of individuals and The new team have all undertaken mandatory training as well as safe guarding adults, autism, epilepsy and medication training. The staff members we spoke to felt that there were enough people on duty to meet the needs of individuals living there. Staff told us they they received the training they needed to do their jobs and had regular supervision. Comments included its very professional - we have had alot of training and its a good team. We looked at the recruitment records for three members of staff. These contained all the necessary checks including a Criminal Records Bureau (CRB) check. Staff training records showed that individuals had received an induction and had also attended mandatory training around areas such as First Aid, Safeguarding Adults and Food Hygiene. We saw a member of staff completing work for a medication handling systems training course they were currently undertaking. Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: Plans for the future include more training for staff around positive approaches to behaviour, person centred planning and Makaton in early 2010. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 manager is experienced and qualified. Systems are in place to ensure that a good quality of service is provided to the people who live there. Evidence: The manager has been in post siince July 2009 and was registered with the CQC in October 2009.. She has previous experience of managing a service for people with mental health needs and is a qualified nurse with additional management qualifications. The staff members we spoke with commented we can speak with the manager - she is a very open person and she doesnt just sit in the office. Organisational quality assurance procedures are in place and this includes questionnaires for the people who live there and staff members. The manager told us that they plan to have monthly meetings for the people who live there once people have settled in. We saw that regular staff meetings are taking place already. Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: The AQAA told us that administration and audit systems are in place and working well. Health and Safety checks are working well. The records we looked at confirmed that regular checks are happening around important areas such hot water temperatures and Fire Safety. Care Homes for Adults (18-65 years) Page 22 of 25 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 Adults (18-65 years) Page 23 of 25 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 1 1 Information about the home should be made available in user friendly formats. Pictures of key people and places should be included. Care plans need to include detailed guidance for staff around dealing with different behaviours. This is particularly important for areas where risks have been identified and action is required to reduce these. Improvements should be made to the auditing process for medication to make sure that any issues are picked up quickly. Accurate records need to be kept to allow for tracking of medication quantities. The complaints procedure should be made available in user friendly formats. Photographs of key people could be included and work undertaken to ensure the people living there and other stakeholders understand this process. Advocacy should be used where appropriate. 2 9 3 20 4 22 Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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