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Inspection on 15/12/09 for Rowan Court Nursing & Residential Home

Also see our care home review for Rowan Court Nursing & Residential Home for more information

This is the latest available inspection report for this service, carried out on 15th 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service provides a comfortable, clean and well presented environment which has been adapted to meet the needs of people both collectively and individually. The home is purpose built and, as such provides single bedrooms all with ensuite facilities. The environment is “light and airy”, and communal rooms and corridors are spacious. Aids, adaptations and specialist equipment are provided. The environment helps to provide comfort for people as well as providing room for nursing care to be provided and for people to be able to mobilise and retain or regain their independence. Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.2 There is good medical support for the service where the GPs and other health care professionals are involved in the care of people living at the home. This multidisciplinary team approach helps to ensure that peoples’ health care needs are monitored. People also receive good nursing care at the home and the nursing unit is well organised. Care is person centred and activities of daily life are made flexible and varied. Peoples’ choices and personal preferences are upheld wherever possible. There is a staff training and development programme which helps to ensure that staff are equipped with the knowledge and skills to meet the needs of the people living in the home. The service is well run and is managed in the best interests of the people who live in the home. There is an open and inclusive atmosphere where people feel at ease to raise concerns. People and their representatives are listened to and any concerns they might have are taken seriously.

What has improved since the last inspection?

The service has addressed the requirements left at the last inspection. This has made improvements in the following areas – The service now ensures that the actions taken to address complaints are recorded. This demonstrates how concerns and complaints are addressed. The home was found to be warm and there have been no concerns raised about this. Fire checks are undertaken and recorded as per fire regulations. The temperature of the hot water is recorded and is maintained within the required range. The standard of the meals provided at the home has recently been reviewed with the views of the people who live in the home taken into account. The menus have been changed accordingly. There has been an inspection of the laundry during the last twelve months and, although some recommendations were made, no issues of concern about cleanliness were raised.Rowan Court Nursing & Residential HomeDS0000026963.V378817.R01.S.docVersion 5.2

What the care home could do better:

The service will need to review care practices, in particular, record keeping on the dementia care unit in order to ensure that people are safeguarded. We spoke to the managers about people who are assaulted by other people living in the home, such as being pushed over, as this had occurred on the dementia care unit the day before the inspection visit. These incidents should be included on a Regulation 37 report to CQC in order for us to be made aware. We also discussed the need for the service to monitor these incidents and to take action, where required to prevent further such incidents. This is to ensure that people are safeguarded. This unit would also benefit from adaptation of the environment in order to make this more stimulating for people, based on current best practice for dementia care. Following this inspection visit the service has sent us their development plan for the dementia care unit which will address this recommendation and help to improve this outcome for people living there. The service will need to review its policy on repairs and maintenance as the process is taking too long and having an effect on people who live in the home. This was evident where a bath has been out of order for over twelve months, resulting in people having to take a shower when their preference was for a bath. Some of the people who work for the service and two people who live at the home feel that there are times when there is insufficient staff on duty to meet the needs of people. They tell us that this sometimes has a negative effect on staff moral.

Key inspection report CARE HOMES FOR OLDER PEOPLE Rowan Court Nursing & Residential Home Silverdale Road Newcastle Staffordshire ST5 2TA Lead Inspector Yvonne Allen Key Unannounced Inspection 15th December 2009 09:30 DS0000026963.V378817.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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 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 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. Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.2 Page 2 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 Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rowan Court Nursing & Residential Home Address Silverdale Road Newcastle Staffordshire ST5 2TA Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01782 622144 01782 625301 rowancourt@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd Deidre Sara Griffiths Mrs Rachel Lisa Simpson Care Home 76 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (19), Old age, not falling within any of places other category (76), Physical disability (76) Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) 19 Old age, not falling within any other category (OP) 76 Physical disability (PD) 76 The maximum number of service users who can be accommodated is: 76 13th December 2006 2. Date of last inspection Brief Description of the Service: Rowan Court is a care home providing personal care including nursing care for up to 76 elderly service users. This includes personal care of people with a mental disorder over 65 years of age and care of elderly people who have physical disabilities. The service is privately owned by Southern Cross Healthcare Services Limited. The home is located within walking distance to the Staffordshire town of Newcastle-Under-Lyme with its array of amenities. The home is relatively new having been purpose built in recent years and consists of two floors served by a passenger lift. There is ample car-parking facility at the entrance car park. Gardens are accessible around the home to people including people who use wheelchairs. The accommodation provides for single bedrooms, all of which have en-suite facilities. There is ample provision of communal and seating areas throughout the home. There are three units within the home. On the ground floor there are two units - one that accommodates people needing personal care and the other accommodating people who have mental health care needs. The second floor accommodates people requiring nursing care. All units are staffed and managed separately. A full breakdown and explanation of fees can be obtained by telephoning the home and speaking to one of the two Registered Managers. Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that the people who use this service experience GOOD quality outcomes. The inspection process commenced several weeks prior to the visit. The visit to the home was carried out over two days by one inspector. Prior to the inspection visit the Providers had completed a self-assessment tool, which is known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to under-take a self-assessment, which focuses on how well outcomes are met for people using the service. This AQAA was detailed and gave us information about the services offered. All of the Key minimum standards were assessed and for each outcome a judgement has been made, based on the evidence gathered. These judgements tell us what it is like for the people who live in this home. The ways in which in we gathered evidence to make our judgements were as follows – We looked at any information we had received about the home since the last Key Inspection. This included any complaints and Safeguarding referrals we had received. We spoke with the people who live in the home including their representatives. We spoke with the staff who work at the home Discussions were held with the Registered Managers. We examined relevant paperwork and documentation at the home. We walked around the home. At the end of the inspection visit we discussed our findings with the Registered Managers and the Area Manager. What the service does well: The service provides a comfortable, clean and well presented environment which has been adapted to meet the needs of people both collectively and individually. The home is purpose built and, as such provides single bedrooms all with ensuite facilities. The environment is “light and airy”, and communal rooms and corridors are spacious. Aids, adaptations and specialist equipment are provided. The environment helps to provide comfort for people as well as providing room for nursing care to be provided and for people to be able to mobilise and retain or regain their independence. Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.2 Page 6 There is good medical support for the service where the GPs and other health care professionals are involved in the care of people living at the home. This multidisciplinary team approach helps to ensure that peoples’ health care needs are monitored. People also receive good nursing care at the home and the nursing unit is well organised. Care is person centred and activities of daily life are made flexible and varied. Peoples’ choices and personal preferences are upheld wherever possible. There is a staff training and development programme which helps to ensure that staff are equipped with the knowledge and skills to meet the needs of the people living in the home. The service is well run and is managed in the best interests of the people who live in the home. There is an open and inclusive atmosphere where people feel at ease to raise concerns. People and their representatives are listened to and any concerns they might have are taken seriously. What has improved since the last inspection? The service has addressed the requirements left at the last inspection. This has made improvements in the following areas – The service now ensures that the actions taken to address complaints are recorded. This demonstrates how concerns and complaints are addressed. The home was found to be warm and there have been no concerns raised about this. Fire checks are undertaken and recorded as per fire regulations. The temperature of the hot water is recorded and is maintained within the required range. The standard of the meals provided at the home has recently been reviewed with the views of the people who live in the home taken into account. The menus have been changed accordingly. There has been an inspection of the laundry during the last twelve months and, although some recommendations were made, no issues of concern about cleanliness were raised. Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.2 Page 7 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. Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,3 and 4 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information about the service and undergo an assessment of their needs before being offered a place at the home. Most peoples’ needs are being met as assessed. However, records cannot always evidence this. EVIDENCE: Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 10 People who are interested in coming into this home are given information about the home and the services offered. This information is also available in large print. People are only offered a place at the home following an assessment of their needs. This pre-admission assessment of needs is usually carried out by a representative of the home who is suitably trained to do so. People are met in their home surroundings or are visited in hospital by the staff member from the home. Very often this process also involves Social Services and/or doctors and health care professionals. People who live at the home and their representatives are generally satisfied that their needs are being met at the home. They told us – “The nursing care is excellent” “They look after you well” “The service they give here is very good” “Overall very satisfied with the care provided to my mother” Prior to this inspection visit we had received a safeguarding referral from Social Services in relation to the care of a person accommodated on the dementia care unit. This alleged that the needs of this person were not being met as assessed. We met this person during our visit and we looked at her assessment of needs and care plan details. We identified that there had been an initial failure to follow the care plan and some of the care had not been recorded as having been carried out as planned. This had included failure to administer prescribed medication and failure to monitor and record the person’s health and well being following her admission to the home. At the time of the inspection visit these initial failings had been addressed by the service and recording of care had improved. However, following our inspection visit a second review of this person’s needs by Social Services had identified further failings in record keeping, identifying that the service was still unable to evidence that the person’s needs were being met as assessed. The Safeguarding investigation had not reached a satisfactory conclusion and was therefore still on going at this time. Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and nursing care is planned and delivered with dignity and respect and care is person centred. The service will need to ensure that care plan records are accurate and demonstrate that peoples’ assessed and agreed needs are met. EVIDENCE: We looked at the care people receive on all of the units throughout the home. Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 12 On the dementia care unit we followed the care of two people closely and met two visitors. Both of these people have been the subject of recent safeguarding allegations. As highlighted in the previous outcome, there had been an initial failure by the service to record that a person’s assessed needs were being met as agreed and planned. This included poor documentation in relation to the monitoring of weight and not giving medication as prescribed due to failing to order the drug. This person is a very vulnerable elderly lady with dementia. At the time of the inspection, however, the service had started to address the issues of concern and documentation in the person’s care plan had started to improve. The lady appeared generally well cared for. The GP had seen this lady within the first week of admission to review her health care needs. Other health care professionals are involved in the care of this lady. The lady also has an advocate who is specially trained to advocate for people with reduced mental capacity. This will help to ensure that the lady’s rights are upheld and that she has a “voice”. When we met the lady she appeared contented, although very confused, and she was walking around the unit and we visited her bedroom with her. We met with the person’s relative who was visiting the home. She told us that, on the whole she is satisfied with care her relative is receiving at the home. She did have a concern about the poor cleanliness of the lady’s dentures and said that she was unable to find a toothbrush. She had raised this concern with the unit manager. We met with another lady who has recently been the subject of a safeguarding referral. We visited the lady in her bedroom and spoke with her at length. It was noted that her Call bell was in place and within reach. We asked her if this was ever removed or not within reach and she said “Oh no I always have my bell there.” The lady’s television was plugged in and she had the remote to this in her Zimmer frame bag. She showed us how to work this and demonstrated this for us. We asked her if the plug was ever taken out and she said “No never.” We asked this lady if she sees the doctor and she told us “The doctor comes yes and he is very good.” She also told us - “I am well cared for and the girls are good but they won’t give me a key to my room and it doesn’t feel like my room.” The lady’s care plan states that she “Locks the door herself when she is in her bedroom”. All of the above were concerns included in the Safeguarding referral and have obviously been addressed. The lady’s care plan demonstrates that her personal care needs are planned and includes her personal preferences throughout. The care plan also demonstrates that her health care needs are monitored and met and record visits from various health care professionals. Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 13 We spoke to another visitor who was visiting her mother and she told us that she had no complaints and is happy with the care “I would say if I wasn’t happy.” We looked at the process of medication on the dementia care and nursing units and identified that nurses and care staff are trained to deliver medication safely. The Safeguarding referral we have made reference to identified that this person’s medication had not been administered for a sustained period of time and we have made a requirement for medication to be administered as prescribed. We were told that nobody currently self medicates but there is a policy in place for this which ensures that people are able to do this following a suitable risk assessment. We looked at the delivery of personal and nursing care on the nursing unit and identified that personal and nursing care is delivered as planned. Daily care charts are completed showing evidence of regular input of care. People told us – “Oh yes I am very happy with the care I get in here” People looked well cared for with attention to individual appearance as documented in their care plans such as hair done and make up on. Where required, people are nursed on profiling beds and special mattress to aid pressure relief. People’s risk of developing pressure sores is assessed and monitored and where necessary advice and treatment is sought from the Tissue Viability Specialist nurses. People’s’ nutrition and fluid intake are assessed and monitored. We saw that fluid intake is recorded where necessary and people are helped to maintain an adequate fluid and nutritional intake. This sometimes involves advice from a dietician. We also saw evidence of adequate drinks available for people around the unit People told us - “Most of the staff are very good” When we looked at the care plans of people on the nursing unit we identified that records supported peoples’ needs. Care plans are individual and person centred. The plans reflect personal choices and preferences through the activities of daily living. There was plenty of evidence of the involvement of health care professionals. We spoke with a number of people living on the unit and they had various comments Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 14 “I am treated with dignity and respect. I expect nothing less” “I know how to complain and would do so” “The nursing care here is excellent” Staff working on this unit were observed to be professional and spoke to people with dignity and respect. We also noted a good rapport between staff and visitors, especially with the unit manager. We observed that the atmosphere on this unit is open and transparent, where people are kept informed and there is good communication. Staff are trained to meet the needs of the people who live in the home. We were concerned to note that a bath has been out of order at the home for many months and this meant that some people who prefer a bath were unable to have one. “My aunt has to have a shower as the bath has been out of order for months” “Get repairs from outside contractors done more quickly. 18 months without a bath is too long by anybody’s standards” Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All of the above standards. People using the 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 activities of daily living are made flexible and varied and people are helped to exercise choice and control. EVIDENCE: The service employs two people to oversee activities and entertainment in the home. We met with both of these people. They run an activities programme on each unit and organise social events and entertainment in the home. At the time of the inspection visit they had organised a craft session with some of the people who live on the dementia care unit. They told us about the various activity sessions they do on all three of the units. They also organise trips out to local venues, using wheelchair taxis for this. They also carry out one to one Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 16 therapy for some people who prefer not to join in activities or who are unable to do so. People are also encouraged to continue with previous hobbies, we met with a lady who was knitting and she told us that the staff support her to do this. For people living on the dementia care unit activities are adequate but the social and therapeutic needs of people are not met as well as they could be. We spoke about developing this further with the manager by adapting the environment on this unit to make it more stimulating for people, based on current best practice for dementia care. Following this inspection visit the service has sent us their development plan for the dementia care unit which will address this recommendation and help to improve this outcome for people living there. Spiritual needs are met well people told us this and the service confirmed that they have various church representatives visiting the home. This is also documented in care plans. Regular services are held in the home. The home benefits from good community links and is close to the town centre with all its amenities. People are offered three main meals per day with drinks and snack available in-between. We saw the current menus and the manager explained that a recent audit of these had been carried out where people who live in the home were encouraged to air their views and tell the home what they wanted included on the menus. The results of this were more local dishes, such as oatcakes and lobby and more plain food. The menus had been adapted accordingly. We observed lunch being served. This offered a choice of main meal. The meals are well presented and served in dining rooms which are pleasant and provide a congenial setting. People are encouraged to come to the dining rooms for meals but can have these served in their own rooms if they wish. Special diets are catered for and the nutritional needs of people are monitored. People are given assistance to eat their meals and to drink where needed. We received mixed comments about meals and activities from people who live at the home and staff who work there – “They don’t know how to cook food here” “I have porridge for breakfast – they make nice porridge” “At times the activities could be more appropriate for people, especially in the mornings” “The home could provide a more varied diet with easier access for people to have a snack outside kitchen working hours” Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 17 “The home could provide a better quality of activities suited to peoples’ abilities” “The selection of food is very good and always looks nice” “Parties are quite often set up for birthdays and festivities” “The activities programme is excellent and most people seem to take part. I have been impressed with the level of participation as people with dementia are sometimes difficult to engage” “Excellent food” “The home could provide more trips, even if only a walk for my mother to get some fresh air” “My wife is eating well and I have found the food to be well cooked and tasty” Kitchen staff and care staff receive training in Food Hygiene. Some staff have trained in diet and nutrition with a long distance course People with dementia care needs were observed eating their lunches. Some people got up half way through their meal and wandered off. Staff tried to encourage people to finish their meals but this can be difficult. People with dementia care needs are sometimes more likely to eat “foods on the go” and finger foods and it is recommended that this is introduced by the service. Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. People using the 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 any concerns about the service they are listened to and taken seriously. People are supported to raise any concerns they might have. The systems in place on the dementia care unit should be reviewed in order to help ensure that people are safe. EVIDENCE: The service has a written complaints procedure in place which is displayed around the home and is contained in the Service User Guide. The managers of the home address complaints they receive within the timescale laid down in their procedure. We saw the log of complaints where these are recorded, along with actions taken. The service also addresses complaints at Regional level where necessary and offers support to the Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 19 managers of the home in their investigations. The service also audits complaints it receives. There is an open culture at the home where people are encouraged to air their views and raise any concerns they have. This was especially evident on the nursing unit where visitors and people who live in the home were coming to speak with the manager about concerns and also to make general enquiries. There was a comfortable atmosphere noted and people told us that they know how to raise concerns and who to go to. We, the commission have not received any complaints directly about the service but have been made aware recently of three Safeguarding referrals for the dementia care unit. We have discussed and highlighted two of these, where it has been identified that, for one person, there was some issues of concern upheld regarding assessment of needs and care planning records. The service will need to review care practices, in particular, record keeping on the dementia care unit in order to ensure that people are safeguarded. It was also identified, during this inspection visit, that this same lady had been pushed over by another person on the unit the previous day. We spoke to the managers about the necessity to include this on a Regulation 37 report to CQC in order for us to be made aware of these incidents. We also discussed the need for the service to monitor these incidents and to take action, where required to prevent further such incidents. This is to ensure that people are safeguarded. The second Safeguarding referral allegations, for another lady, could not be upheld during the inspection visit as all the issues of concern were found to be satisfactory at this time. The third Safeguarding referral was to do with inappropriate behaviour by a staff member and was being addressed by the Service at the time of the inspection visit. The service has co-operated fully with Safeguarding procedure investigations. Staff are carefully selected to work at the home and the recruitment procedure is robust. Staff undergo stringent checks including Criminal Records Bureau (CRB) and Protection Of Vulnerable Adults (POVA) checks. Staff receive training and instructions in POVA and are aware of their responsibilities in this area, as are managers. The managers have also received training on the Deprivation Of Liberty Safeguarding and are aware of how to refer a person regarding this. Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 People using the 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 service provides a safe, clean environment which is homely and adapted to meet the needs of people who live there. Development of the dementia care unit is needed in order to ensure that peoples’ needs are met here. EVIDENCE: Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 21 The service provides a comfortable well presented environment which has been adapted to meet the needs of the people who live in the home. We walked around the home and visited all the communal areas and a selection of bedrooms on all the units. Bedrooms are personalised and adapted to meet personal needs. One lady told us -“Most people can choose what they put into their rooms” “The bed linen is always clean” “Her room is light and airy and pleasant” “Excellent accommodation” “I feel that any tasks that are undertaken by outside contractors are taking too long to repair. This has stopped the residents enjoying all of the garden facilities” The service complies with the regulations regarding food hygiene and health and Safety at work. The service had an inspection from the borough council on 12th November 2009 where there was “in general broad compliance with legislation” with some recommendations which have been addressed by the service. The service has also been visited by the local area Inspector of Health and Safety who carried out an announced inspection on 5th November 2009. The laundry was inspected and recommendations made which have been addressed by the service. The dementia care unit was clean and well presented. There were no mal odours noted at the time. As highlighted previously in this report, the unit would benefit from being made more stimulating in order to meet the needs of people with dementia care, based on current best practice for dementia care. The service has sent us a copy of their action plan for this unit which will help to improve this outcome. The nursing unit was clean and well presented throughout. More profiling beds have been purchased since the last report. We visited several people in their bedrooms and noted the plentiful supply of specialised beds, mattresses, cushions and other equipment. Bedrooms are personalised and adapted to meet the needs of people and people have easy access to their nurse call Buzzers. As previously highlighted, there has been a bath in the home which has been out of action for well over twelve months, resulting in some people having to take a shower when they would prefer a bath. The service will need to review its policy on repairs and maintenance as the process is taking too long and having an effect on people who live in the home. Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All the standards for this outcome. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are carefully selected to work at the home and are equipped with the skills and training to meet the needs of people who live there. Some people feel that, at times there are insufficient staff on duty to meet peoples’ needs. EVIDENCE: At the time of the inspection visit there were 37 people accommodated on the nursing unit. The manager was in charge and had two nurses working with her and eight care assistants with various experience and training including three with NVQ level three and two with NVQ level 2. The service has a high percentage of care staff trained to NVQ level two and above. There was a good atmosphere on the nursing unit. We heard nurses speaking to people in a very professional manner. The unit manager addressed visitors Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 23 and people who live in the home extremely well, creating an atmosphere of calm and order. We looked at the recruitment process. This was found to be robust. Wes examined staff files and found that the required information had been obtained prior to staff being offered employment at the home. We spoke to staff members and they confirmed the above and were satisfied with their induction and support. There is a staff training and development programme in place. Staff receive regular mandatory training as well as training in other areas to ensure that the needs of people who live in the home are understood, recognised and met. Staff are happy with the training and support they receive and told us “Staff have regular training sessions” “The home ensures that all staff are up to date on training” “The home tries to accommodate staff with their working hours by being flexible where possible” At the time of the inspection visit there appeared to be sufficient staff on duty to meet the needs of people living in the home. However people have mixed feelings about staffing levels “They need to provide adequate staff for units so that more time could be spent with service users looking after their emotional needs” “They should listen to staff who are stressed through workload” “It would make more sense to carers to have fresh staff coming on at 6am and 6pm to help with getting people up or putting them to bed.” “There is a reluctance to provide agency staff even when we are working short staffed. No adequate cover and relies on the same staff members to come in even on their days off causing ill feeling and stress” “Rowan Court is a good place to work but we do tend to work short staffed quite a lot, especially at the weekends. Team work is not as good as it used to be” People who live at the home told us – “The home does provide very good care even when understaffed” Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 24 Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32,33,35,36 and 38. People using the 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 managed in the best interests of the people who live there. Management of the dementia care unit should be reviewed in order to improve outcomes for the people who live there. Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 26 EVIDENCE: The management structure had changed since the last inspection in that one of the two Registered Managers had left and the unit manager from the dementia care unit had taken over this role. There is a new manager on the dementia care unit who was previously a senior care assistant on the same unit. There is also a new manager on the nursing unit and the previous manager has become the night manager. The same manager as before is still in post on the residential care unit. Both registered managers were present throughout the inspection and were present for feedback at the end. We were also joined by the area manager. Rachel is a nurse who has many years experience as a manager of this home and has worked in this post at the home for several years. Dee is a trained care assistant who has management experience of the Dementia Care unit, having worked there for several years. They told us that they complement each other and work well together. People we spoke with were complimentary about the management of the home. There is a unit manager on each unit. Management of the Dementia care unit is adequate but this should be reviewed as recent concerns have been raised with three safeguarding referrals for this unit. People feel supported by the managers of the service - “Managers are always prepared to help residents and staff with their open door policies.” Regular meetings are held where staff and people who live in the home are listened to. The Company have their own Quality Assurance programme where each service is assessed on a regular basis. The home is in the process of changing the menus and has taken peoples’ views into account about adding local dishes. We saw customer satisfaction surveys which had been completed in respect of menus and meals. We looked at the way the service manages peoples’ personal allowances and keeps these safe. This process has not changed since the last inspection and is a safe and secure procedure. Staff receive on going formal supervision and told us that they feel supported. Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 27 There is a Health and Safety policy statement in the home with the managers having ultimate responsibility for overseeing this. The service employs a full time maintenance person who has worked at the home for many years. Generic and individual risk assessments are carried out and reviewed. Equipment used at the home is regularly serviced and inspected. This includes the fire safety equipment. Staff receive regular training updates in mandatory Health and Safety subjects. Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 3 Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4 OP7 Regulation 17 (1)(a) schedule 2 13 (2) Requirement Timescale for action 20/01/10 2 OP9 Documentation within care plans must show that peoples’ assessed needs are being met, as agreed on admission. Medication must be administered 20/01/10 to people as prescribed and must not be omitted. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP19 Good Practice Recommendations The service should review the arrangements for repair and maintenance. This is in respect of the bath being out of order for over twelve months and people having to take a shower when they prefer to have a bath. The service should review its staffing levels, ensuring that there are always sufficient staff on duty to meet peoples’ needs. Incidents of physical assault should be reported to CQC. The service should also monitor these incidents and take action, where required to prevent further such incidents. This is to ensure that people are safeguarded. DS0000026963.V378817.R01.S.doc Version 5.3 Page 30 2 3 OP27 OP18 Rowan Court Nursing & Residential Home Rowan Court Nursing & Residential Home DS0000026963.V378817.R01.S.doc Version 5.3 Page 31 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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