Inspection on 08/02/06 for Nottingham Neurodisability Service Hucknall - Rosewood

This inspection was carried out on 8th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nottingham Neurodisability... 20/11/08

Nottingham Neurodisability... 22/11/06

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 09/07/2008.

CARE HOME ADULTS 18-65 Nottingham Neurodisability Service Hucknall Rosewood Hankin Street Hucknall Nottingham Nottinghamshire NG15 7RR Lead Inspector Steve Keeling Unannounced Inspection 8th February 2006 10:00 Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 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 Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 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. Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Nottingham Neurodisability Service Hucknall Rosewood Hankin Street Hucknall Nottingham Nottinghamshire NG15 7RR 0115 9680202 0115 9642747 Address 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) Four Seasons Homes (Ilkeston) Ltd Vacant Care Home 32 Category(ies) of Physical disability (32) registration, with number of places Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users shall be within category PD Date of last inspection 13th June 2005 Brief Description of the Service: The Nottingham Brain Injury Centre, Rosewood Unit is a 32 bed care home for residents 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 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. Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over a 5-hour period and involved one inspector. The main method of inspection was case note tracking, this is a method of selecting service users within the home and discussing with them their expectations and experiences of living within the home environment. The case tracking method also analyses the records of the service users to ascertain if the service users identified needs are being addressed appropriately within the home setting and to establish that their safety and well being is being maintained. On this occasion two service users notes were case tracked and two service users were spoken with, the inspector also discussed the care afforded to service users at the home with a qualified nurse and a care assistant to further evidence the care afforded to the service users at the home. At the time of the inspection a total of 25 service users were accommodated at the home. The acting manager and staff within home were very helpful and cooperative thus ensuring that the inspection process progressed in a professional and efficient manner. What the service does well: It was evident that the acting manager has a full understanding of all the resident’s needs. It was evident that the residents are satisfied and contented at the home and the service users spoken with stated that they feel well cared for by a professional and competent team of staff. The manager and staff at the home ensure that residents are actively involved in the running of the home and their personal wishes are taken into account. Service users are encouraged to take risks in an attempt to achieve optimum independence. Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Minor shortfall were evident in relation to the care planning process and further detail within the care plans is required to ensure the holistic needs of the residents are met at the home. An examination of staff files highlighted a shortfall in relation to the recruitment practices utilised at the home and did not meet the standards within the National Minimum Standards (2000). It was evident that some members of staff have not received appropriate training opportunities over the past 12 months which could compromise the safety of residents at the home if not addressed in the near future. Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 7 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. Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 8 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 Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1. 2. Prospective residents and relatives have information about the home to enable them to make an informed choice about where they live. EVIDENCE: The Statement of Purpose displayed in the foyer of the home has been revised in response to a requirement from the previous inspection. The revised Statement of Purpose now specifies the individual name, skills and experience of the acting manager of the home and provides appropriate information appertaining to the facilities and services provided at the home. The pre-admittance assessments provided from a variety of sources such as social services and hospitals, within the two case-tracked notes were detailed in identifying the specific needs of the service users. It was evident that an appropriately trained individual at the home also conducts an independent assessment of the residents to ascertain their individual needs and aspirations in an attempt to promote optimum independence. The assessment documentation is clear, concise, signed and dated by the assessor. Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6. 9. Care plans for short-term care and long term care are consistent and, on the whole, provide sufficient information to meet the resident’s needs, although one case tracked service users who had been assessed as “at risk” of pressure ulcer formation had not had a care plan formulated to manage the risk effectively. Service users are supported to “take risks” in an attempt to achieve optimums independence and well-being. EVIDENCE: It was evident that an effective plan of care is based on the initial assessment performed at the home but it was also evident that the changing needs of one case tracked service user had not been addressed effectively. The service user had been assessed as being “high risk” in relation to the formation of pressure ulcerations and it was evidenced within the service users daily records that on 04.02.06 that a ”small broken area” was apparent on the sacral region. No care plan was evident in the service users notes to demonstrate that the nursing staff at the home are effectively managing this complication. A requirement was therefore set in respect to the care planning Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 11 process to ensure that all service users holistic needs are addressed within their care plans by 31.03.06. The home maintains daily progress documentation for all service users in which elements of care identified in care plans are evaluated. Apart from the aforementioned discrepancy the daily progress information appropriately addressed to elements of care identified within the care plans. In supporting the service users to promote an independent lifestyle and take risks, Rosewood House adopts a multidisciplinary team approach to health promoting interventions and the rehabilitation process. Service users at the unit are encouraged to gain further independence by utilising a newly refurbished, purpose built kitchen facility in which they can, under the supervision of staff members, prepare food and drinks, perform domestic tasks such as washing and ironing cloths, once again to promote independence and well being. Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11. 13. 15. Service users can participate in age, peer and culturally appropriate activities. Service users maintain contact with the local community Service users can participate in appropriate personal, sexual and family relationships. EVIDENCE: Rosewood House benefits from a recently refurbished specialised independent living skills (ILS) area and activities area in which independent living skills are practiced. Service users are encouraged to plan meals, shop for the ingredients within the local community and cook the meals within the ILS area in an attempt to promote independence. The inspection process identified that a very enthusiastic activities coordinator ensures the provision of varied and stimulating social activities within the home such as small group activates, movement to music, house crafts, bingo, working with clay, and films nights for the service users enjoyment. Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 13 Transport is also available to take service users to parks, the coast, theatres, local parks, pubs and restaurants, and small animal farm within the area. Service users, if they wish, can access Hucknall town centre to shop or browse or utilise the tram service into Nottingham City Centre in accordance with agreed risk assessments. Service users spoken with also stated that the daily routine within the home is flexible and staff within the home always respects their individual choice and preferences. No restrictions are in place in relation to visiting times placed on relatives and friends of the service users. Through a discussion with a service user it was established that friends and relatives are also greeted appropriately at the home and that staff within the home always respect the service users privacy and confidentiality. Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. The manager and staff at the home ensure that all attempts are made to facilitate personal support and choice within the home in a way they prefer and require. EVIDENCE: To ensure that service users receive support in a way they prefer and require, service users are encouraged to attend service users meeting which are performed on a six weekly basis. The meetings, which are coordinated by the activities coordinator are intended to identify and discuss any issues relating to the care afforded to the service users at the home. Service users have the opportunity to include topics for discussion onto the agenda prior to the meetings and the meetings are minuted for future reference. Through discussions with service users it was established that staff at the home provides personal support in a very flexible and considerate manner, service users stated that the “key worker” system utilised at the home allows service users to further discuss any concerns or issues and that effective therapeutic relationships are encouraged between services users and their key workers. Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22. Service users spoken with stated that all staff employed within the home are approachable and would listen and act appropriately to any concerns and views they might have. EVIDENCE: Rosewood House had no outstanding complaints at the time of the inspection. A complaints procedure is on display in the foyer of the home for service users or their family and friends perusal. It was evident through discussions with staff members that they felt confident in their knowledge of the complaints procedure and how the procedure should be followed in the event of a complaint. Following a discussion with a service user it was evident that he would feel confident and comfortable to express any concerns or complaints to the care staff or management within the home although the service users stated that he could not think of any issues at the home which would initiate the complaints procedure. Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24. 30. Rosewood House offers a homely, comfortable and safe environment for service users, the home is maintained effectively and is clean and hygienic. EVIDENCE: Rosewood House has an ongoing routine maintenance programme which has recently addressed the poor facilities within the Independent Living Skills area and the Activities area. A dedicated handyman deals with any shortfalls within the home environment effectively. A partial tour of the premises was completed as part of this inspection. The accommodation was well decorated, comfortably furnished and maintained to a good standard. The gardens are attractive and accessible to service users in wheelchairs. Service users spoken with stated that they were very satisfied with their bedrooms and communal living areas. It was apparent that service users are encouraged to bring small items of furniture and personal possessions such as family photographs, televisions and stereos etc to personalise their individual rooms. Unfortunately the handyman was on annual leave at the time of the inspection and as such the documentation appertaining to some of his duties at the home Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 17 was not available for inspection and as such this standard will be inspected in greater detail at the next inspection. On examination of the documentation that was available, it was established that the handyman, as part of the induction process performs fire-fighting training for all new staff members. He also performs temperatures checks on all hot water outlets at then home to minimise the risk of scolding. It was also evident that emergency lighting and fire alarm checks are performed appropriately. Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32. 34. 35 The Registered Providers have failed to take adequate precautions to protect residents by ensuring that prospective employees have two satisfactory references prior to employment. Some members of staff had not attended statutory training events within 2005 and as such their proficiency within health care provision could be compromised. EVIDENCE: It was evident by the examination of the staff-training matrix for 2005 that staff employed at the home did not always attend the statutory training courses, together with additional training courses. The matrix indicated that one qualified member of staff who had been in employment since January 2005 has only attend one statutory training event since commencing her employment an the home although it was evident through informal discussion with the staff member that she had extensive knowledge in relation to health care provision. The acting manager of the home stated that the current provision for staff training is under review with the intention of providing a more robust and comprehensive training opportunities at the home. Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 19 To satisfy standard 35 the Commission for Social Care Inspection will require further evidence in relation to the training courses planned for the forthcoming year and evidence of the mandatory training provision planned for staff within the forthcoming year. Staff rotas evidenced that a satisfactory number of staff were employed on the day of inspection and that the skill mix was appropriate to need the needs of the service users. An examination of two staff files evidenced that the service provider prior to employment of care staff, did not always obtain two satisfactory references. Similar shortfalls had been identified at the previous inspection, an immediate requirement was made to address this deficit by 31/03/06 and the Commission for Social care Inspection will require documentary evidence to ensure that all employees have the necessary reference’s. Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37. 39. 42. The Registered Providers must appoint a Registered Manager to manage the Home to ensure residents health and welfare. EVIDENCE: The deputy manager commenced employment in March 2005. the post was subject for review to determine if the position is to be made substantive. It was established that the acting manager has withdrawn her manager’s application but will continue in post as the deputy manager. The service provider is currently advertising the manager’s post and on the day of the inspection a candidate for the managers position was being shown around the home. The management at the unit is reported by staff to be very good with the acting registered manager providing excellent support, leadership and direction to all grades of staff. Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 21 It was established that the acting manger of the home operates an open door policy to ensure that staff and service users alike are encouraged and able to express any concerns in relation to the care and facilities at the home. The acting manager of the home also performs routine examinations of the homes environment to ensure the environment is conducive to maintaining optimum safety for the service users. It was established that the acting manager attempts to provide supervision session for all grades of staff at the home but the sessions tend to be informal in nature and documentary evidence was not available to evidence that the supervision sessions had taken place. The Commission for Social care Inspection will require documentary evidence to demonstrate that all employees have the necessary supervision sessions planned for the forthcoming year. Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 22 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000058988.V282909.R01.S.doc 2 X X 3 X LIFESTYLES Standard No Score 11 3 12 X 13 3 14 X 15 3 16 X 17 X Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X X x 2 X 3 X X 3 x Version 5.1 Page 23 Nottingham Neurodisability Service Hucknall Rosewood 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 Requirement Timescale for action 31/03/06 2. YA34 19 3. YA35 18 4. YA37 8 The Registered Person must ensure care plans are updated to reflect residents changing needs Outstanding from 13/06/05 The Registered Person must 31/03/06 ensure all necessary checks are undertaken prior to employment which includes two references and proof of identity Outstanding from 13/06/05 The Registered Person must 31/03/06 ensure staff training is completed - mandatory and specialist Outstanding from 30/09/05 The Registered Person must 30/06/06 appoint a Registered Manager 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 YA36 Good Practice Recommendations Ensure staff have annual appraisals to review performance against job description and agree career development DS0000058988.V282909.R01.S.doc Version 5.1 Page 24 Nottingham Neurodisability Service Hucknall Rosewood plans Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Nottingham Neurodisability Service Hucknall Rosewood DS0000058988.V282909.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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