Inspection on 22/04/09 for Rosetta

This is the latest available inspection report for this service, carried out on 22nd April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Rosetta 2 Queens Park Road Caterham Surrey CR3 5RB two star good service The quality rating for this care home is: 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: Lisa Johnson Date: 2 2 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. They reflect the things that people have said are important to them: 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 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 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20092008) 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 Information about the care home Name of care home: Address: Rosetta 2 Queens Park Road Caterham Surrey CR3 5RB 01883342454 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): mchrosetta@binternet.com Mitchells Care Home Limited Name of registered manager (if applicable) Mr Addullah Salamut Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 12 0 care home 12 learning disability Additional conditions: 1. The registered person may provide the following category of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disabilty - (LD) The maximum number of service users to be accommodated is 12 Date of last inspection A bit about the care home Rosetta is a detached house developed to provide accommodation for twelve adults with learning disabilities. The home is set in a residential road adjacent to a park, at walking distance to local shops. The ground floor has a dining room, with adjacent sitting area, with an opening around the chimneybreast to a further sitting room. In addition there is a kitchen, toilet, utility room for laundry, a bathroom with toilet. Upper floors have bathroom and toilet facilities. There is garden to the rear of the property, with a large pond and storage shed. Car parking is available at the front of the house. The weekly fees range from £497.84£1,606.81 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 health care support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The inspector arrived at the home at 9.30 This visit was unannounced therefore the manager and staff did not know that we were visiting. Before this visit the registered manager sent us some information to tell us how well outcomes are being met for people who live in the home. People who live in the home sent us some questionnaires back to tell us their views about the care and support that they receive. We also received some information to gain the views of other people who provide support to people and visit the home During this visit we spoke with the registered manager Mr. A. Salumet and we spoke to three members of staff. We spoke with some people who live in the home. We looked around the home to see if it was clean and safe. We looked at some peoples care plans and risk plans. We looked at how people receive their medication. We looked at the homes menus. We looked at some of the staff files and we looked at their training records. We looked at some of the homes policies and procedures. These tell staff how things are to be done. What the care home does well The home is very friendly, relaxed and happy. Staff spend time with people living there. People have person centered care plans which they are involved in making. People have health action plans and are supported to access lots of health care professionals. People have their own comfortable bedrooms and have their own possessions. There are enough staff on duty who know the needs of people well. What has got better from the last inspection What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Lisa Johnson 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 - 0870 240 7535 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care 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 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 excellent 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 accessible information about the home so that they can make an informed choice about the suitability of the home as a place to live and their needs are assessed before moving in. Evidence: The home provides a statement o purpose and service user guide,which has recently been reviewed and updated. This document is also made available to people in accessible formats including makaton wijit symbols . Peoples needs are assessed prior to admission to the home. Information seen for the last person admitted demonstrated that an assessment had been conducted which was detailed and comprehensive and covered the persons assessed health, personal, emotional, communication , life skills , social, cultural and diversity needs. 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. Each person has a plan of care that they have been involved in making. People are encouraged to make decisions about their lives and they are supported to take risks as part of an independent lifestyle. Evidence: Each person has a care plan which is person centred in approach. At the time of this visit we were informed that all care plans were in the process of being updated. Annual reviews are conducted where people, their representatives, health care professionals and care manager attend. Care plans contained How to support me information which provides guidance to staff. The manager was advised that where people are unable to sign to agree their care plan that these be signed by their representative as this had not been completed on two care plans sampled and also the date should be recorded when the care plan is next reviewed. A care manager surveyed said, The home gives up most attention to service users needs and implementing the care plan, health action plan and person centred plan effectively. Monthly consultation meetings take place with people using the service where their views are sought including the homes menus, staff, holidays and activities. Information supplied in the AQAA states that one person went on holiday to Euro Disney as this was their choice which was organised after their review with their advocate . The service is intending to encourage more people to join in selection and recruitment Evidence: of staff. A number of people living in the service have communication difficulties and the service have adapted a range of information in accessible formats. Although the home is advised to consider making some of this information more visual within the environment such as menus. Some people use makaton sign language, although a health care specialist said that there could be some further improvement in this area, Staff go on training but do not always use this in practice The service has implemented a range of comprehensive and detailed risk assessments and management strategies which we sampled during this visit including bathing, community access, epilepsy and behaviours which may challenge. One persons risk plan identified that they require a chopped diet and supervision at meal times as they areat risk of choking. A member of staff spoken with was able to tell us about this risk plan and staff demonstrated that this guidance was followed during the lunchtime meal. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the service are supported to take part in culturally appropriate activities and they are part of the local community. People maintain links with their family and friends and their rights and responsibilities are respected and they are offered varied and well balanced meals. Evidence: During this visit a number of people had left the home to attend day services and in the afternoon some people attended East Surrey college. A member of staff spoken with is the homes activities coordinator who told us about some of the activities that people attend and take part in. People are supported to go shopping, visit the cinema, go to the leisure centre, visit libraries and attend a friendship club Peoples religious needs are met and some people are supported by staff to attend church at the weekend and participate in a church group. There are opportunities to attend places of interest which meet peoples personal interest and preferences. The home has their own accessible vehicle and we were also informed that people are provided with support to use public transport. A person living in the service showed us their photograph album which contained photographs of activities that they had taken part in including a visit to Madam Evidence: Tussuads and their holiday. Two large flat screen televisions were seen in the sitting room and peoples bedrooms contained televisions and music centres. In house activities are provided such as games,DVDs and social events A health care professional surveyed said, Residents are clearly involved in local life such as trips to the church and pub which we hear about from the residents themselves People are supported to maintain links with families who visit the home and people are supported by staff to go to see their family and friends. We were told that one person is supported to use the telephone. Two people have appointed advocates. People are supported to take part in household activities such as cleaning their bedrooms and hoovering . We were told that one person likes to help loading the dishwasher. Good relationships were seen between staff and service users who were caring and attentive throughout. One person was asked if would like to assist in cleaning their room but expressed a choice not to undertake this, which was respected by staff. People are supported with making choices about their preferences for meals and preferred routines such as the way they like their drinks and information seen in one persons care plan recorded their preference for taking a shower in the morning. The home has a four weekly menu in place, which has been completed in consultation with a dietitian, and it is based on peoples preferences. Alternatives can be provided and any changes to the menu are recorded. The menu was varied and well balanced. People are supported to eat healthily and a range of fresh vegetables and fruit were available. At lunch time people were provided with a variety of sandwiches and refreshments andsensitive support was provided by staff . Some people were provided with specialist equipment to assist them to maintain their Independence when eating. Personal and health care 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. People receive personal support in the way they prefer and their physical and emotional needs are met. The home supports people with their medication in a safe way. Evidence: Care plans include information about peoples likes, dislikes, preferred routines and preferences for support. Each person has a health action plan in place which details their health and personal support needs. Three health care plans were sampled during this visit. One person was identified as having complex emotional support needs and requires extra support and observation including epilepsy, dietary and weight monitoring and management strategies for supporting their emotional needs which were detailed and comprehensive. This person is supported by a range of health care professionals including general practitioner, psychiatrist and advice and support has been received from speech therapy. A survey was received from a care manager who said, The home has really done well for client over a short period of time, the staff have enabled my client to have a big positive change in their quality of life and has started to walk independently and without their zimmer frame and i am really impressed. It was clear that people are supported to access health screen and checks including annual medicals, chiropody, dentist and optician. Records of all health consultations are maintained in their health action plan. Four health care professionals surveyed said that the service always or usually monitors the health needs of people Another health care professional said, Clients always appear cheerful, well dressed, clean and tidy and appear to be happy in the environment when we visit. Evidence: Information supplied in the AQAA states that staff only enter service users bedrooms only by only obtaining their permission. Surveys received from health care professionals confirmed that peoples privacy is respected. During this visit we examined the homes medication policies and practices. Medication was stored appropriately and auditing systems are in place for the receipt and disposal of medication. Staff receive medication administration training which include competency assessments. A list is maintained of staff that are trained and authorized to administer medication. Medication is dispensed using the monitored dose system (MDS) and medication administration records had been signed. Protocols were in place for the administration of As required medication. 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. If people have concerns the know how to complain and their concerns will be listened to . The home safeguards people from abuse. Evidence: The home has a complaints procedure, which is also available in the service user guide and is provided in an accessible format. The procedure includes the timescale for responding to complaints. No complaints have been received by the service and none have been brought to the attention of the Commission. People are supported to raise concerns during monthly home consultation meetings and individual meetings. The home has safeguarding vulnerable adults from abuse and whistle blowing procedures in place. During discussion with the manager the home did not have in their possession the most recent local authority multi agency safeguarding vulnerable adults from abuse procedure in their possession but obtained this document during this visit. Managers and staff receive training which was confirmed by staff training records sampled. A member of staff spoken with said that were aware of the procedures and was clear in their response about their responsibilities should they witness or be made aware of any incident where the safety of a person is compromised. Over the last year there have been no referrals made following the local authority procedures 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. People live in a comfortable, well maintained home that is homely, clean comfortable and hygienic Evidence: The home s situated in a residential area close by to local shops and is an older property. During this visit the home was seen to be generally well maintained, furnished and homely A number of improvements have taken place since our last visit including the refurbishment of the upstairs bathroom and kitchen, a new boiler has been installed and external emergency lights fitted at the back and side entrance. There is a large, well maintained and accessible garden to the rear of the property which is enhanced with a pond and water feature which is made safe for people with the provision of fencing. The home has provided equipment to people with physical disabilities and can be accessed by ramps. One person has been provided with a profile bed and a specialist bath is available. Some peoples bedrooms were viewed during this visit, which were comfortable, personalised to their preferences and reflected their gender. The home was observed to be cleaned to a good standard throughout and was hygienic. One bedroom had a slight pervading odour and arrangements have been made by the manager to replace the flooring in this bedroom. There are infection control procedures and staff attend training. Separate laundry facilities are in place and the home has received a visit from environmental health which was satisfactory. 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. People are supported by appropriate numbers of staff that are competent, trained and qualified to meet their needs and they are protected by the homes recruitment policies and practices. Evidence: At the time of this inspection there were three members of staff on duty a fourth member of staff had left the home to accompany people to day services. We were informed that the home employs four members of staff during the day, three staff in the evening and at night people are supported by a waking and sleep in member of staff. The duty rota was sampled which accurately reflected the names numbers of staff on duty. We were informed that one person receives additional one to one to support which is recorded. New staff receive induction which was confirmed by a member of staff spoken with and information seen on this persons file confirmed that the induction programme follows the skills for care core induction standards. Some care staff employed in the home hold nursing qualifications and seven other care staff have acquired National Vocational Qualifications (Level 2) or above. Staff attend a range of training and development. Training records were sampled for three members of staff. Two files contained training certificates that confirmed that staff attend receive statutory training including moving and handling, first aid, health and safety, moving and handling. Certificates for a third person had been removed from their file for personal use and we were unable to confirm what training that they had received, however this information was promptly provided to us after this visit. However it is recommended that information should be maintained in the home at all times to be made available for inspection. It was also recommended that the staff training schedule is maintained in the home which records when staff are due for next refresher training. Evidence: Information supplied in the AAA states that staff have received equality and diversity training and we were informed that training is being planned in dementia awareness. Further specialist training is provided in others areas where this is required such as epilepsy awareness, autism and challenging behaviour. Information supplied in the AQAA stats that five staff have been trained in physical intervention which consists of theory and practical sessions which is verified by an external verifier. Two health care professionals surveyed said that staff have the right skills to meet the needs of people although another person surveyed, they could improve by coming on training dates that are offered. Recruitment is based on an equal opportunities policy. During this visit we sampled the personnel files for three members of staff these contained the required information including a fully completed application form, two written references and enhanced criminal records bureau (CRB) check. We were informed that no staff are employed in the service until this information received. Information was also seen to demonstrate that the General Social Care Code of conduct (GSCC) is brought to staffs attention ensure that they are aware of their role and responsibilities of working in a social care setting. 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 home is well run and in the best interests of people living there. The health, safety and welfare of people is promoted and mainly protected. Evidence: The home is run by an experienced manager who has been in post for a number of years and holds a nursing qualification and has obtained the registered managers award. The manager is supported by two deputies one of whom has also completed the registered managers award. The manager was observed to have an open approach and made them self accessible to both people using the service and staff. Staff spoken with said that there was good team work and that they felt supported by the manager and we were informed that regular team meetings are conducted. The organisation has received quality management systems accreditation and receive external audits on a regular basis. Monthly quality monitoring visits are carried out which was confirmed by written reports kept in the home . The home has systems in place for gaining and recording the views of visitors. The organisation has developed feedback surveys which they intend to provide to people using the service, relatives and other stakeholders to gain their views about the care and support provided. Environmental risk assessments are conducted and water temperature monitoring takes place. Information supplied in the AQAA indicates that routine servicing and maintenance of equipment is carried out which was confirmed by some of the certificates sampled. During a tour of the home it was observed that radiator covers had not been provided in the communal areas of the home which was not supported by a risk assessment, Evidence: therefore it is required that a risk assessment must be completed and that consultation takes place with environmental health ensuring the safety and wellbeing of people living in the home. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action 1 42 13 The registered person must 23/05/2009 ensure that a risk assessment is carried out and that consultation takes place with the local environmental health department in respect of the uncovered radiators in the communal living areas. This is to ensure the welfare and safety of people living in the service 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 32 It is recommended that staff training certificates and schedules are maintained in the home to be made available for inspection. 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. 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