Inspection on 28/02/08 for Cherry, Rowan and Aspen Villas Care Home

This inspection was carried out on 28th February 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cherry, Rowan and Aspen Villas... 24/01/07

Cherry, Rowan and Aspen Villas... 16/11/05

Cherry, Rowan and Aspen Villas... 29/06/05

Cherry, Rowan and Aspen Villas... 02/03/05

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Hillside

Applegarth

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Beech Lodge

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Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Cherry And Rowan Villas Care Home Oakfield Lane Warsop Nottinghamshire NG20 0JE Lead Inspector Jayne Hilton Unannounced Inspection 28th February 2008 12:45 Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherry And Rowan Villas Care Home Address Oakfield Lane Warsop Nottinghamshire NG20 0JE 01623 844 064 01623 844 034 cherryvilla@btconnect.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Oaklands Residential Home Mrs Brenda Bird Care Home 14 Category(ies) of Learning disability (14) registration, with number of places Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One named person may be over the age of 65 Service users shall be within category LD Date of last inspection 24th January 2007 Brief Description of the Service: Cherry and Rowan Villas is a care home providing personal care and accommodation for 13 younger adults who have and learning difficulties. The home provides 11 long-term beds and 2 respite beds and has dedicated beds for this purpose. The home is owned by Oakland’s (formally known as Warsop and District Mentally Handicapped Association), which is a registered charity. The home is located in a residential area of Warsop and is close to shops, pubs, the post office and other amenities. The home was opened in 1986 and consists of a 2 purpose built bungalows with a large community centre on the same grounds.11 of the homes bedrooms are single, and 3 of the bedrooms have en-suite facilities. The home is accessible for people with mobility difficulties. The home has extensive gardens that are well maintained and easily accessible. There is ample car parking available. The home has its own accessible mini bus with hydraulic ramp as well as a car to enable people to travel for appointments and outings. The manager stated on 28/2/08 that the homes current charges range from £399.00 to £450. 00. Cherry And Rowan Villas Care Home DS0000008649.V360419.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 star. This means the people who use this service experience good quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people living in the home and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection took place over 6.5 daytime hours and was unannounced. Prior to completing this visit the inspector assessed the homes previous inspection reports, the service history including complaints and adult protection referrals, and a the Annual Quality Assurance Assessment completed by the registered manager. Four completed satisfaction questionnaires were also received from relatives prior to this inspection. The main method of inspection used was case tracking, this is to randomly select people who live in the home and read their care files, examine their private and communal accommodation along with any specialist equipment they require. Their care is tracked to ensure that their needs are being met and that staff, have the skills to deliver the care they need. One person’s care files was examined in detail and one other persons care file was randomly sampled for information. The people who were “case tracked” were not able to help by giving an opinion about the care provided as they were out for the majority of the inspection. Two people who could express an opinion were interviewed and others were communicated with throughout the inspection process. Two relatives were visiting the home were spoken with and a visiting professional Four members of staff and the manager were spoken with as part of this inspection, documents were read and medication inspected to form an opinion about the quality of the care provided to the people who live at the home. Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 6 What the service does well: The key principle of the home is that people using the service are in control of their lives. Staff, are fully committed in supporting individuals to lead purposeful and fulfilling lives as independently as possible. People using the service confirmed they make their own informed decisions and have the right to take risks in their daily lives. Central to the home’s aims and objectives is the promotion of the individual’s right to live an ordinary and meaningful life, appropriate to their peer group, in both the home and the community, and to enjoy all the rights and responsibilities of citizenship. The staff team understands the importance of enabling younger adults to achieve their goals, follow their interests and be integrated into community life and leisure activities in a way that is directed by the person using the service. The service understands and actively promotes the importance of respecting the human rights of people using the service, with fairness, equality, dignity, respect and autonomy all being seen as central to the care and support being provided. The provider and manager have ensured that the physical environment of the home provides for the individual requirements of the people who use the service who live there. The living environment is appropriate for the particular lifestyle and needs of the people living there and is homely, clean, safe and comfortable, well maintained and reflects the individuality of the people using the service. Individuals are encouraged to see the home as their own. It is a very well maintained, attractive home and has very good access to community facilities and services. It has a wider range of up to date specialist equipment and adaptations to meet the individual needs of people who use the service. Prospective new residents are assessed before coming to the home to make sure that the home is able to meet their needs. Where risk assessments identify risks faced by residents these are mostly included in care plans to minimise the risk to residents. Residents’ health is monitored through observation and regular health checks. Care is provided in a way that promotes the privacy and dignity of residents. Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 7 There is a varied menu providing a choice at each meal, including a cooked breakfast and food is well presented. This means that people have a nutritious and balanced diet. The home has a complaints procedure, which is easy for most people to use. The home has policies and procedures for staff to follow if they suspect anyone is not being properly treated which makes sure that residents are protected from any form of abuse. Most staff have either completed or are working towards National Vocational Qualification level 2 and regular training is provided, which means that people living in the home, are supported by staff who have a qualification in their work and are suitably trained. The manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. She works to continuously improve services and provides an increased quality of life for residents with a focus on equality and diversity issues and promoting human rights, especially in the areas of dignity, respect and fairness. There is also a focus on person centred thinking, with residents shaping service delivery. There is a strong ethos of being open and transparent in all areas of running of the home. The manager leads and supports a strong staff team who have been recruited and trained to a good standard. Feedback letters included the following comments from respite people/relatives, ‘Thank You, our relative really enjoyed respite stay’ There has been noted improvements in their behaviour, social skills and mood’. ‘1st class cleanliness my wife and I are very impressed and please with care and attention given to our relative.’ ‘We have peace of mind when going away knowing that our relative is safe and well cared for and with dedicated staff.’ Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: Two Requirements have been set from this inspection. Consult with people living in the home or their representative and notify them of any revision in their care plans or risk assessments and obtain a signature confirming that the changes are agreed. Ensure the monthly visits undertaken by the responsible individual for the service, meet with the requirements of Regulation 26, in terms of content and the written report. Sixteen recommendations have also been made to further improve the service and outcomes for people living in the home. Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home have basic information about the home provided for them. Further development of the information in suitable formats would make the information more accessible for their and their families’ needs, using, for example, appropriate language, pictures or Braille etc. EVIDENCE: The service has developed a statement of purpose, which sets out the aims and objectives of the home, and includes a service user’s guide, which provides basic information about the service and the specialist care the home offers. The guide is made available to individuals in a standard format. The manager said she was keen to develop the documentation in other formats such as pictures and symbols to make the information more accessible for the people living and who may wish to live in the home. Two people who live in the home said, that staff, are always willing to read things for them, for example inspection reports but they would like to have more information around the home in pictures and symbol formats. Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 12 New people moving into the home are provided with a statement of terms and conditions or a contract. The document was not examined in detail at this visit, but it, was noted to be, signed by the individual. Terms and conditions should be more user friendly, in suitable formats to meet the needs of the people living in the home and need to be reviewed regularly. The manager has provided a statement in writing for the people who already live in the home that the home can meet their needs. The manager said that there had been no new admissions since the previous inspection, but she would formally write to any new applicants once the assessment process has been finalised and would keep a copy of the letter on the persons file also. There is now pre-admission documentation in place ready for use. Therefore the requirements set at the previous inspection in respect of the above are met. The assessment process focuses on achieving positive outcomes for people and this includes ensuring that the facilities, staffing and specialist services provided by the home generally meet the ethnic and diversity needs of the individual. [The six strands of diversity are: gender (including gender identity), age, sexual orientation, race, religion or belief, and disability.] Although there was evidence that one person’s cultural and dietary needs were met by the home and that staff were fully knowledgeable about these, the home’s own assessment and care planning documentation needs to be updated to include appropriate sections to embrace the diverse needs of all individuals. The admission policy for the home, the manager and people living in the home confirmed that prospective people moving in are given the opportunity to spend time in the home. An individual member of staff is allocated to give them information and to help them understand how the home is organised and run and the facilities and services available. The allocated staff member will give them special attention, help them to feel comfortable in their surroundings, and enable them to ask any questions about life in the home. Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, 8 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home have their needs met, however the care plan documentation needs to be reviewed to ensure the plan is up to date up to deliver a personalised and consistent person centred service. EVIDENCE: The key principle of the home is that people using the service are in control of their lives. Staff are fully committed in supporting individuals to lead purposeful and fulfilling lives as independently as possible. People using the service confirmed they make their own informed decisions and have the right to take risks in their daily lives. There was some evidence that the service involves individuals in the planning of care, which affects their lifestyle and quality of life. Staff members understand the importance of people being supported to take control of their own lives. Individuals are encouraged to make their own decisions and choices. Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 14 The service records the preferred communication style of the individual and some work has been achieved in using methods that enable the person to lead a full life that promotes independence and choice, for example use of Makaton, photographic menus and a new complaints procedure. Care plans are, generally person centred and contained an essential lifestyle plan, written with the individual, or their representative, and includes a range of information that is important to them, but there was no evidence that the main plans of care and risk assessments were reviewed or agreed with the individual. Two people living in the home said they were not aware of their care plans, that staff, do not show these to them and that they have not agreed to what is written in them. Therefore the requirement set at the previous inspection could not be assessed as fully met. There was some evidence that plans include reference to equality and diversity and address any needs identified in a person centred way. A key worker system allows staff to work on a one-to-one basis and contribute to the care plan for the individual. The care plan examined in detail contained a recent review and staff explained that these were undertaken regularly and as any needs change. Evidence of previous reviews were not available for inspection however, as these were reported by the manager to be archived and locked away. Although there was evidence of risk assessments within the care folders, these were basic and not all had a related plan of care or clear management strategies. For example one person had a risk assessment in place for catheter care, but no care plan in place to direct staff how this need would be met. Another person had both a care plan and a risk assessment in place for risk of choking, but this did not inform staff how to minimise the risk of choking, or contain any detail about the person’s medical condition in respect of this. Where people presented challenging behaviours, behaviour charts were in place, but no care plan or risk assessment to direct staff in how to meet the person’s needs. It is acknowledged however that there was clear action recorded for staff should the person choke, staff were fully knowledgeable about risk reducing practices and the daily reports were well written and provided evidence that staff were indeed meeting the needs of individuals and the overall outcomes for people living in the home are good. The home ensures that people living in the home are consulted regularly to gather information about their satisfaction with the home. Two people living in the home confirmed that they had completed the ‘Quality Tree’ surveys and a sample of these were viewed on the day of the inspection Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12,13, 14, 16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living in the home are able to live active and fulfilling lifestyles and enjoy a healthy diet and mealtimes. EVIDENCE: Previous inspection have evidenced that people living in the bungalows are able to enjoy a full and stimulating lifestyle with a variety of options to choose from and that this has been sustained for many years. The home has sought the views of the people living their and considered their varied interests when planning the routines of daily living and arranging activities both in the home and the community. Routines are very flexible and people can make choices in major areas of their life. The routines, activities and plans are generally person centred, individualised and mostly reflect diverse needs in the six strands of diversity: gender (including gender identity), age, sexual orientation, race, religion or belief, and Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 16 disability. They are regularly reviewed, and are very responsive to individuals changing needs, choices and wishes. The service actively encourages and provides imaginative and varied opportunities for people using the service to develop and maintain social, emotional, communication and independent living skills where appropriate. The service has very strong and highly effective methods, which focus on involving residents in all areas of their life, and actively promotes the rights of individuals to make informed choices, providing links to specialist support when needed. This includes developing and maintaining family and personal relationships. Two relatives visiting on the day of the inspection praised the home and the opportunities it had provided for their son. People living in the home told us about their many holidays and outings and of a recent trip abroad. Evidence was seen throughout the home of photographs of residents on holidays, undertaking activities and joining in birthday celebrations, as well as Christmas and Halloween parties. There was evidence of innovative methods being used, and staff actively seeking information to enable people to access education and work, including supported employment, and paid employment where they have the capacity. For example one person works in the local charity shop and told us that she had her own key. Outcomes for people are positive, and there is evidence that they are enjoying the life opportunities that they experience. The service actively supports people to be independent and involved in all areas of daily living in the home. This includes where appropriate, taking responsibility for shopping, planning meals, and meal preparation. One person said that staff supported her to be independent which she liked very much. Meals are very well balanced and nutritional and cater for varying cultural and dietary needs of residents. For those individuals who need support during mealtimes, including those who have difficulty swallowing or chewing, staff give assistance. A photographic menu book has been developed. Although the mealtime was not observed staff described the importance of being discrete and sensitive to the feelings of both the person they are helping and also to others present and that mealtimes are flexible and relaxed. People living in the home, described staff as kind, respectful and helpful, and said they enjoyed their food very much. Appropriate records are kept in respect of activities undertaken and the food eaten by people living in the home. Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 17 Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People, who live in the home, have their personal and healthcare needs met in a way that respects their privacy and dignity. The introduction of ‘Healthcare Action plans’ and medication profiles would further improve the service. EVIDENCE: A partial tour of the home and records evidenced that people have the aids and equipment they need and these are well maintained to support them and staff in daily living. People have access to health care services both within the home and in the local community. A community nurse visiting the home on the day of the inspection praised the home and said that the home is well run, that staff always follow any advice and guidance offered and that the manager and staff are very committed to ensuring positive outcomes for the people they support. Care plans viewed showed that the health needs of individuals are monitored and appropriate action and intervention taken. There are some gaps in Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 19 information [see Standard 6] but staff are able to think in a person centred way and are able to give a verbal update. The introduction of Health Action Plans, which dovetail with any medicines prescribed and which provide an up to date running history of action and interventions for all healthcare needs would improve the service provided to people living in the home. At least five of the people living at the home are aged over 60 years. It is therefore recommended that nutritional assessments and falls risk assessments are introduced within the care plan system. The manager stated that none of the current residents are able to administer their own medication and that an audit was undertaken by the ‘Community Pharmacist’ on 17th September 2007, which was fully satisfactory. Medication records were fully completed, contained required entries, and were signed by appropriately trained staff. However a handwritten entry of a prescription was not signed by the person making the entry or by a witness. Although the manager said she regularly checks the systems for medication she said she was not yet undertaking competency assessments for staff and this should be introduced to ensure each member of staff is competent to handle, record and administer medication properly. Thought has been given to providing safe but sensitive facilities for keeping medication, however the manager stated she was not aware of the new guidance for the storage of Controlled drugs or that the storage temperatures of medication need to be monitored. The home has a good record of compliance with the receipt, administration, safekeeping, and disposal of controlled drugs. Staff have completed and passed an appropriate medication course. The manager stated in the Annual Quality Assurance Assessment that home does now have a intimate care policy which inform carers in carrying out intimate care tasks with people living in the home, which was viewed on the day of the inspection and the requirement set at the previous inspection in respect of this therefore assessed as met. Staff spoken with told us that they maintain privacy and dignity by closing doors and curtains and talk to the person to promote social engagement and prompt individuals with independence. People spoken with said staff always knock and wait to be invited in and that they can lock their bedroom doors. Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home feel safe and are protected by the homes policies and practices. Further development of user- friendly complaints procedures would improve the outcomes for all people residing at the home. EVIDENCE: Previous inspections have found that the home has a complaints procedure and this is displayed in picture format in each bungalow. A pictorial poster showing whom, people could see if they were not happy was viewed at the inspection. The complaints book was also seen and did not contain any complaints. The manager recognises that the home does not have a full user-friendly format for the recording of complaints and hopes this will be undertaken within the next twelve months to ensure that information regarding complaints is appropriately recorded and people living in the home are a part of this process. The manager has also recognised that a complaints procedure in Braille needs to be accessed for a person who is partially sighted. The provider did not have an up to date a copy of the local safeguarding protocols but most staff have been provided with safeguarding adults training and others due to undertake training in March 2008. The home has a whistle Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 21 blowing policy and those care workers seen were aware of this policy and knew what action to take if they became concerned for the well being of a person living in the home. The homes service history held by the commission showed that the provider had reported an allegation in the past, made by a person living in the home to the commission and social service department. This allegation was investigated and was seen to have been unfounded. The manager said that there have not been any further allegations of abuse since 15/06/06, which was reported to the appropriate agencies. A resident stated that ‘I have never made complaint here, only good things here. I feel safer here than anywhere else and nobody can get me. I’ll be safe here for the rest of my life’. A relative told us that ‘they feel the home does everything well and there is nothing to complain about’. It is recommended however that the manager undertakes training in the new safeguarding adults protocol and updates the homes policy in accordance with the agreed local protocols. Training around dealing with physical and verbal aggression is also made available to staff as needed. Staff spoken with said they felt equipped and skilled to deal with challenging behaviours and that they were appropriately supervised and appraised. The manager stated that there had been no incidents where restraint was used and that there is an appropriate policy in place. A person living in the home confirmed she was able to manage her own money. Records were viewed of the person case tracked and were found to be in order with receipts and two signatures. The policy in place for managing people’s finances, needs to contain clear information about the legislation and use of advantage cards when shopping on their behalf. Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29 and 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People live in a safe, clean, well - equipped and homely environment, which fully meets their needs. EVIDENCE: The provider and manager have ensured that the physical environment of the home provides for the individual requirements of the people who use the service who live there. The living environment is appropriate for the particular lifestyle and needs of the people living there and is homely, clean, safe and comfortable, well maintained and reflects the individuality of the people using the service. The service finds creative solutions to issues with the environment in ways that are not necessarily dependent upon cost. The service goes that ‘extra mile’ to provide an environment that fully meets the needs of all people who use the service and plans for the diverse needs of people that might use the service in the future. Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 23 The environment is fully able to meet the changing needs of people, along with their cultural and specialist care needs. It is fully accessible throughout to people with physical disabilities, adaptations and specialist equipment are designed to fit within the homely environment. The management has a proactive infection control policy and they work closely with their own staff and external specialists to ensure that infections are minimised. Records viewed showed fifteen staff has undertaken training in infection control People livening in the home are fully involved in decisions about the décor and any changes in their communal and personal accommodation. The service is creative in how it involves people in decision-making and positively encourages people with a limited capacity to be as fully involved as possible. The home has mostly single rooms available for all people who wish to have one. One double room is to be changed into a single when a further new planned bungalow is in operation. Individual’s personalise their rooms and can use their own furniture if they wish. There is a selection of communal areas both inside and outside of the home, this means that people using the service have a choice of place to sit quietly, meet with family and friends or be actively engaged with other people who use the service. The kitchen and laundry are designed to enable and promote the involvement of people in domestic tasks and as part of developing or maintaining independence. Where there are concerns about the health and safety of anyone using the kitchen and laundry arrangements are fully risk assessed with the involvement of the person. Access is only limited when the completed assessment indicates such a need. All bedrooms promote high levels of privacy and have locks or other innovative ways of promoting privacy (such as keypads). All residents have a key to their own room unless a person centred risk assessment indicates otherwise. They also have a key to the front or outer door where this has been agreed in their plan. People say that there is always plenty of hot water and the temperature in the home can be changed to meet their personal choice, especially in their own rooms. The home was very well lit, clean and tidy and smelled fresh. Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are supported by, supervised, flexible and well trained staff. Further development of the recruitment process will ensure the welfare of individuals is always fully upheld. EVIDENCE: People have confidence in the staff, which cares for them. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. Staff members undertake external qualifications beyond the basic requirements. Managers encourage and enable this and recognise the benefits of a skilled, trained workforce. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. People who use the service and their relatives report that staff working with them are very skilled in their role and are consistently able to meet their needs. There is consistently enough staff available to meet the needs of the people using the service, with more staff being available at peak times of activity. The Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 25 staffing structure is based around delivering outcomes for residents and is not led by staff requirements. The home puts a high level of importance on training and staff report that they are supported through training to meet the individual needs of people in a person centred way. The manager and deputy manager have undertaken training in equality and diversity and although staff, have covered this topic in National Vocational Qualifications, it is recommended that specific training for staff is provided in Equality and Diversity There is a mostly good recruitment procedure that ensures that appropriate checks are in place for potential staff such as criminal bureau and POVA list checks and two satisfactory references, however records of interviews should also be kept. A tighter system/new procedure needs to be in place for crossreferencing of documentation of information supplied by candidates and information supplied by agencies. This procedure should be followed in practice with the home recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. There are clear contingency plans for cover for vacancies and sickness and the home has its own bank staff. The home has experienced little staff turnover. Staff meetings take place regularly. Supervision sessions are regular and staff said they find them helpful with a focus on improving outcomes for people using the service. Notes and action points are taken of meetings and sessions, and progress is regularly reviewed. Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,41 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of the people who live in the home and their health safety and welfare is safeguarded. EVIDENCE: The manager has the required qualifications and experience and is competent to run the home. She has an NVQ 4 in care and the Registered Managers Award and has enrolled ready to commence NVQ 5 People living in the home who, were spoken with highly praised the manager, as did the visiting Community Nurse. A staff member described the manager’s approach and support as ’perfect’ Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 27 There is also a focus on person centred thinking, with residents shaping service delivery. There is a strong ethos of being open and transparent in all areas of running of the home. The manager leads and supports a strong staff team who have been recruited and trained to a good standard. The manager was not aware however of some of the changes and current developments both nationally and by CSCI, such as the introduction of Key Lines of Regulatory Assessment, The new Safeguarding Protocol and ‘Safeguarding’ terminology. The AQAA contained clear, relevant information that is supported by a range of evidence. The AQAA lets us know about changes they have made and where they still need to make improvements. It shows clearly how they are going to do this. The data section of the AQAA is accurately and fully completed. The manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. There was evidence of quality monitoring in place with Quality Tree questionnaires viewed. Weekly residents meetings are held and relatives are actively involved in the overall running of the home as a number are members of the Board of Trustees. The responsible individual undertakes monthly visits but the content and records held on the visit do not meet with the requirements of Regulation 26 which states that the person responsible for the visit must interview people living in the home, their representatives, and staff working in the home, inspects the premises, records of events, complaints and prepares a written report on the conduct of the home. A requirement is therefore set in respect of this The service has policies and procedures in place but some such as the care plan documentation require review and update, in line with current thinking and practice. The home works to a clear health and safety policy. All staff are fully aware of the policy and are trained to put theory into practice. The home has a consistent record of meeting relevant health and safety requirements and legislation, and closely monitoring its own practice. The Environmental Health Officer visited the home in November 2007 and raised five issues around food safety. There were no health and safety issues identified, however at this inspection and the manager confirmed all areas identified by the Environmental Health Officer had been addressed. Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 28 Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 3 26 4 27 4 28 3 29 4 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 X 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 4 2 X 3 3 X Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 30 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 (c) Requirement Consult with people living in the home or their representative and notify them of any revision in their care plans or risk assessments and obtain a signature confirming that the changes are agreed. Partly met- Previous timescale 26/03/07 - Not fully met. Timescale for action 28/06/08 2 YA39 26[4] Ensure the monthly visits undertaken by the responsible individual for the service, meet with the requirements of Regulation 26, in terms of content and the written report. 28/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 31 1. 2 3 4 5 YA1 YA2 YA6 YA8 YA19 6 7 8 9 YA19 YA20 YA20 YA20 10 11 12 13 14 15 16 YA20 YA20 YA20 YA23 YA23 YA35 YA32 Review the Statement of Purpose and Service User Guide to ensure they are accessible for people, in different formats Review the assessment and care plan formats to map with Standard 2.3 and ensure that it embraces the six strands of diversity. Ensure care plans and risk assessments are in place for all identified needs and provide management strategies and clear direction for staff. Further develop communication aids and documentation in suitable formats throughout. Develop Health Action plans within the care package and ensure that the information is easily accessible, up to date, is documented in chronological order [rather than in the daily notes section] and includes follow up. Introduce nutritional assessments and falls risk assessments for people who are over the age of 60 years or if their needs assessment identifies this need. Review the storage arrangements for Controlled drugs in line with new guidance. Ensure all medication is stored at a safe temperature monitor and record any action taken. Where prescriptions have to be handwritten on the medication administration record, two signatures should be in place to evidence appropriate checks have been undertaken to minimise risk of error. Develop medication profiles within the person centred plans and ensure details of individual’s medication are current and dated. The manager should undertake and document competency assessments on staff that administer medication. Further develop the complaints procedure, which empowers all people using the service. Include information about the use of advantage cards within the policy for handling monies on behalf of people living in the home. The manager should obtain the up to date Nottinghamshire Safeguarding Protocol and seek to undertake training in the referral process under the protocol. Provide training for staff in Equality and Diversity and Bullying and Harassment. The manager should access the CSCI website regularly and ensure she is up to date with changes in guidance, policy and methodology Cherry And Rowan Villas Care Home DS0000008649.V360419.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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