Inspection on 20/11/08 for Nottingham Neurodisability Service Hucknall - Rosewood

This inspection was carried out on 20th November 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nottingham Neurodisability... 22/11/06

Nottingham Neurodisability... 08/02/06

Nottingham Neurodisability... 13/06/05

Nottingham Neurodisability... 31/01/05

Nottingham Neurodisability... 08/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Nottingham Neurodisability Service Hucknall - Rosewood Hankin Street Hucknall Nottingham Nottinghamshire NG15 7RR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anthea Richards     Date: 2 0 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Nottingham Neurodisability Service Hucknall Rosewood Hankin Street Hucknall Nottingham Nottinghamshire NG15 7RR 01159680202 01159642747 diane.eden@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Diane Eden Type of registration: Number of places registered: Four Seasons Homes (Ilkeston) Ltd care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: Service Users accommodated at Nottingham Neurodisability Service Hucknall Rosewood shall be within category PD The maximum number of service users accommodated at Nottingham Neurodisability Service Hucknall - Rosewood is 32 Date of last inspection Brief description of the care home The Nottingham Brain Injury Centre, Rosewood Unit is a 32 bed care home for service users with moderate to severe physical disabilities who need full care with nursing. The home is situated just off a main road entering the town of Hucknall, on a bus route. Within half a mile radius there are shops, superstores as well as the town centre, leisure activities, market and the parish church. All rooms are located on the ground floor. There is a designated activities room and independent living skills kitchen. There Care Homes for Older People Page 4 of 28 Over 65 0 32 Brief description of the care home are 29 bedrooms, including 3 double rooms, many with en-suite facilities and access to a garden area via a patio door from their rooms. The fees currently charged at the home range from £514.00 to £751.00 per week with additional payments of £20.00 per hour for one to one monitoring. Additional payments are required for Physiotherapy services, Occupational Therapy services, Clinical Psychology services and Podiatry services. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection of a care home for people with moderate to severe physical needs, which ended with an unannounced visit to the service. Before the visit we [throughout the report the use of we indicates the Commission for Social Care Inspection], spent four hours reviewing information received by the Commission for Social Care Inspection [CSCI] since the annual service review that took place on the 22nd January 2008. The visit took place on the 20th November 2008 and lasted seven hours. During the visit we checked all the key standards as identified in the National Minimum Standards. Care Homes for Older People Page 6 of 28 This was achieved through a method called case tracking. Case tracking means that we looked at the care provided to three of the residents. To achieve this we spoke with the staff supporting their care and looked at the records relating to their health and welfare. We spoke with the residents although some of the communication was difficult we managed to get feedback from them. With their permission the residents bedrooms were looked at. We also checked how the home was run and organised. This included looking at staff records, training and how the staff are organised. We looked at health and safety records, menus, minutes of meetings and the quality audit. The policy for handling complaints and how the home dealt with them was looked at. We looked at how prospective residents and their families are given information about the services the home can offer and whether they are suitable for them. We looked at the AQAA (Annual Quality Assurance Audit) that the home had sent to us when we asked for it. This provided us with information about the home and some numerical information about the staff and the residents. We looked at the surveys that had been returned to us by the residents and their families. During the visit we spoke with the manager, a senior manager, the staff, the residents and to visitors in the home. We were told about the results of the homes quality audit that showed that the families were pleased with the service given. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 28 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may want to use this service have good support and information to make sure that they and their family can make the right decision as to whether the home can meet their needs. Evidence: The manager completed the pre-assessment process when she visited the prospective resident wherever they were living and, where possible arranged visits to the home. This makes sure that a very thorough assessment is made and that the home can meet the persons needs and help them to improve. The manager on the day of the visit confirmed this, as did the records seen in the care plans looked at. They clearly described the residents needs giving the staff the information that they needed to care for them. The visitors spoken with and the residents, who were able to, told us that they had Care Homes for Older People Page 11 of 28 Evidence: been given good information before they came into the home and had a good assessment. Some of the residents in the home have difficulty in remembering a lot of detail because of their brain injury but most were able to tell us about how they came to the home. Members of staff spoken with told us that they always knew and understood what a new residents needs were before they moved in. The Statement of Purpose and the residents handbook contained excellent information and were easy to understand by the residents. The current registration certificate from the Commission for Social Care Inspection [CSCI], an up to date certificate of insurance were displayed in the entrance hall and the latest report from the CSCI was available. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The well informed and trained staff meet the health and care needs of the residents safely, with knowledge of their needs and how they wish to receive them. Evidence: The case tracked care plans were found to have good descriptions of the care needs of the residents. This included a regular assessment of the residents weight and their nutritional needs. There are records of the involvement of G.P.s, chiropodist, optician and dentist present, giving evidence of thorough health care being provided for the residents. There are good descriptions in the care plans about the residents illnesses and brain injury that help the staff to understand them and how to care for them. The care plans show that they had been put in place by the resident and their key worker so that it was clear how each individual wanted to be treated. The staff and the records confirmed that the residents received good medical care when they needed it. Care Homes for Older People Page 13 of 28 Evidence: Two of the residents spoken with said that they were happy with the doctors who gave them care. The daily record of care is thorough and up to date which makes sure that the residents receive the right care and the staff know what has happened to them during the day or night. The staff were seen to be giving care with dignity and privacy. One of the case tracked residents rooms had notices on the back of it reminding staff about bowel charts. This is not very dignified for the resident and other methods should be found to remind staff. The manager told us that she would make sure that this happened. The trained nurses in the home give the medicines and they told us that they have regular updating and were audited, to make sure that they give them safely. This was confirmed by the manager and by the records seen. Medication records for the case tracked residents were in order. The staff spoken with were knowledgeable about the medicines and where to obtain information. They were aware of the requirements for the receipt, storage and disposal of medicines. Medicines are stored in locked storage in the home. The controlled [dangerous]drugs were checked and found to be correct, there were two signatures for each entry. There is a regular audit of the medicines and record sheets completed by the manager. The above process makes sure that the residents are protected with the correct medicine administration. There is a policy for residents who can look after their own medicines, but there were no residents responsible for their own medicines on the day of the visit. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff support the residents in their different activities whilst making sure that their nutritional and spiritual needs are met as they wish them to be. Evidence: The care plans and records looked at contained thorough information telling us how the residents needs were identified and their choices are made. Some of the areas covered, included information about what they wanted to be called and when they wanted to get up or go to bed. The care plans have all the information that is needed and describe each individual residents needs and wishes and have been developed with their keyworkers and other members of the team. There is evidence in the care plans that makes it clear that the residents have been involved in developing their care plans and have agreed with them. They told us that they had been involved and agreed with them and that they were happy with what was in them. Key workers are members of staff who have particular responsibility and interest in an Care Homes for Older People Page 15 of 28 Evidence: individual resident. They make sure that they have all that they need and that they have their activities and care needs met. There is information made available for the residents to obtain an advocacy service if they wish it. There are risk assessments in place where there may be a risk to the resident either in an activity or in the environment. This allows the staff and the resident to be aware of the possible risk and protects them whilst allowing the resident to continue with the activity. Reviews of the care plans took place as often as there were changes but at least monthly. The residents took part of these reviews and where they could they signed to say that they agreed with the decisions. The residents have regular meetings to discuss choices in the home such as activities and menus and they and the staff make choices on a daily basis. This was seen on the day of the visit when a variety of lunches and activities were being chosen. The residents are supported to become as independent as possible given their disability. They are helped to make their own breakfast, do their own laundry, go out into the community to theatres the pub, restaurants, the hairdresser and to church. There was good evidence in the care plans, from our observation and from the residents and their families, that daily occupation, leisure activity and therapy are being provided for the residents. The activities organiser provides activity for the residents and on the day of the visit was helping some of the residents with craft work. Peoples sexual needs and differences are recognised. There was an individual programme of activities for each of the residents that is planned with them and their relatives, in partnership with the team in the home. This is designed to develop the resident to his or her full potential. The staff were seen to be treating all of the residents as individuals and recognised their different personalities and behavioural needs. We enjoy the activities and are looking forward to the new television one of the residents told us. A wide screen television was being installed whilst we were there. The residents and the families spoken with were happy that their needs were being well catered for and that they were treated with dignity and respect. Care Homes for Older People Page 16 of 28 Evidence: The activities are recorded in well documented care plans which are regularly reviewed as the residents needs change. Relatives and friends are encouraged to take part in activities and are able to visit at any time. The residents have a choice of meals that are prepared in the homes kitchen the residents spoken with were mainly happy with the food and the choices that they had. Special, soft and liquid diets are provided, as they are needed. A soft diet seen on the day of the visit was presented in an appetising way. Meal times were flexible to suit the needs and the activities of the residents. The staff were seen to be sitting with those who needed help with their meal. Birthdays and special occasions are celebrated. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good systems in place to support and protect residents and staff are aware of how to manage the processes. Evidence: There is a very thorough complaints policy in place, which gives the details of how to complain and who to complain to if the residents or their families needed to. This needs to be updated to give the Social Services contact details and the new details for the Commission for Social Care Inspection. The manager told us that they would be able to print it in other formats or languages if it was needed. There have been no complaints received by the home or by the Commission for Social Care Inspection since the Annual Service Review on 22nd January 2008. The forms that were seen to be completed if a complaint was received were clear and provided all the information that was needed. The staff spoken with were aware of how to handle a complaint if they received one. The residents and the visitors spoken with were able to tell us who they would complain to if they ever needed to and were happy that it would be dealt with properly. The staff receive training in safeguarding adults from abuse during their induction period and this is updated regularly. The staff spoken with were able to describe how they would deal with an allegation of abuse and were able to tell us in which areas abuse may happen. The manager, the records seen Care Homes for Older People Page 18 of 28 Evidence: and the staff spoken with confirmed that they had had training. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are well protected by the policies and procedures in the home, which provides a safe, clean, homely and suitable environment for them to live in. Evidence: Rosewood is a purpose built home on a site with two of the other Nottingham Neurodiability in Hucknall, Nottingham. The home was warm and welcoming and found to be very clean in all areas. The lounge and dining room were bright, well decorated and with suitable furnishings. The kitchen that adjoins the dining room was clean and well-equipped. The bedrooms that we looked at, with the residents permission, were designed for each individuals needs and had been personalised with the residents belongings. The bedrooms all had patio doors that led out onto the garden. I can have my room as I like it a resident told us. All of the bedrooms have en-suite facilities and there are adapted bathrooms for those with a mobility difficulty. Care Homes for Older People Page 20 of 28 Evidence: These were found to be clean and free from hazards. Two of the residents told us that since the fire closers had been put onto the doors that they had difficulty in opening them. There were many aids in the home for the residents to help them to be comfortable and safe. These included wheelchairs, hoists and special mattresses. The staff spoken with had received health and safety training and were aware of how to handle chemicals. These were all stored in a locked cupboard. The hot water temperature testing was found to be up to date. There were no outstanding safety or maintenance issues noted on the tour of the premises. There was a pleasant, well maintained garden with a patio area that the residents could enjoy. The registration certificate from the Commission for Social Care Inspection [CSCI] and a current insurance certificate were displayed in the entrance hall. The inspection reports from the CSCI are available. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment, numbers and training of staff make sure that the residents are protected from harm and that their needs are met well. Evidence: We looked at two staff files and all of the required information was complete in them. This included evidence of identification, adequately completed application forms, two written references, Criminal Records Bureau and protection of vulnerable adults [POVA first]checks. Staff spoken with confirmed that they had not started work until all the paperwork was complete. The home has a thorough induction programme in place for new members of staff that includes the specialist needs of this client group. This gives new staff good knowledge for caring for the residents. The manager and the records seen told us that only two of the care staff either have completed National Vocational Qualification [NVQ] level 2 or above, there are four more about to start. This number is below the levels required by the national minimum Standards. The National Vocational Qualification is a qualification for care staff to make sure that they receive appropriate training in the needs of the resident group whom they are caring for. Care Homes for Older People Page 22 of 28 Evidence: Records show that the staff have had training on many subjects relevant to their work. Staff members spoken with were happy with the amount of training that they were given by the home and told us that they had training in safeguarding adults, challenging behaviour, as well as moving and handling, first aid, health and safety and medicine updating. The home employs a range of staff with different experience that includes Registered Nurses, senior care staff and care assistants, supported by domestic and catering staff. The staff told us that they have regular, formal supervision and there were records available. This process gives the staff and their line manager the opportunity to have individual discussions about work and training needs. The staff rotas and the staff on duty on the day of the visit showed us that there were enough staff members to meet the needs of the residents. Staff members spoken with said they had enough time to complete their work and the residents and the families told us that there were always enough staff. There were good levels of staff on duty and the home always employs agency staff if they do not have enough of their own. On the day of the visit half of the staff on duty were agency staff. They and the manager told me that they try to get the same staff and that they have an induction in the home before working. The agency nurse who was on duty told us that she had to have an induction and be supervised several times giving the medicines before she could work on her own. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents live in a home where their individual needs and wishes are supported, in an environment that is run in their best interests. Evidence: The manager was available for the whole of our visit, she is registered with the Commission for Social care Inspection and has many years experience in the care given in this home. The staff and the residents told us that they are very happy with the manager and thought that the staffing levels and the care had improved since she had been there. The residents and relatives have regular meetings with the manager when their views are discussed and areas such as meals and activities are decided. There is an annual questionnaire sent to the residents and their families that were very Care Homes for Older People Page 24 of 28 Evidence: positive about the care given in the home. The home has clear and thorough policies and procedures, which are up to date and have recently been reviewed. The residents personal accounts were found to be correct, there were two signatures for each transaction and the receipts for each one were kept. The records for fire alarm testing and fire training were seen and found to be up to date. Regular staff meetings were held, which was confirmed by the staff and by the minutes of the meetings. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 22 22 The registered person shall ensure that all elements relating to complaints are fully documented which will include the outcome and actions resulting from complaints. 05/01/2007 Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 28 18 [1][a] That the manager 30/06/2009 makes sure that the required numbers of staff have achieved or are enrolled to complete a National Vocational Award at level 2 or above. To make sure that the staff are suitably trained to care for the residents Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 10 16 That instructions to the staff are made whilst maintaining the persons dignity. That the complaints policy is updated to include the details for Social Services and for the Commission for Social Care Inspection. That the doors used by the residents are made easier for them to open. That the manager makes extensive efforts to recruit permanent staff for the home. 3 4 19 29 Care Homes for Older People Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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