Inspection on 22/05/07 for Phoenix Lodge

This inspection was carried out on 22nd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Phoenix Lodge 18/10/07

Phoenix Lodge 05/09/06

Phoenix Lodge 22/12/05

Phoenix Lodge 17/05/05

Phoenix Lodge 20/12/04

Phoenix Lodge 02/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Rosehill House 30 Rougemont Avenue Torquay Devon TQ2 7JP Lead Inspector Michelle Finniear Unannounced Inspection 22nd May 2007 09:00 Rosehill House DS0000018418.V332796.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 Rosehill House DS0000018418.V332796.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. Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosehill House Address 30 Rougemont Avenue Torquay Devon TQ2 7JP 01803 615538 01803 615538 rosehill.outreach@craigmoor.co.uk info@craegmoor.co.uk Parkcare Homes Limited 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) Vacancy Care Home 4 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4), Physical disability (4) of places Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection January 2007 Brief Description of the Service: Rosehill House cares for 4 people with physical disabilities and/or mental disorder. It specialises in caring for people who have suffered a brain injury and is owned by a subsidiary of Craegmoor Healthcare Limited. The house is in a residential area of Torquay and near to community amenities. Rosehill is wheelchair accessible with level access throughout and adapted shower rooms and a bathroom with an electric in bath hoist. There are four single bedrooms, an office/staff room, lounge, dining room, kitchen and laundry room. The garden to the back of the house is ramped with a patio area and seating. Fees range from £1100 to £2200 per week. Copies of the most recent inspection report are available at the home. Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is a summary of a cycle of Inspection activity at Rosehill House since the last inspection visit in January 2007. To help CSCI make decisions about what it is like to live at Rosehill House the owner gave us information in writing about how the home is run; documents sent to us since the last inspection were looked at, along with what we found when we last visited; a site visit of 7.5 hours was carried out without saying when we were coming; we talked to the manager and staff on duty; we looked at some of the records the manager keeps, such as medication records; and we looked at the house to see if it was clean and in a good condition. We also looked at the records about the people who live at the home and their experience of care was ‘tracked’ looking at how well the home understands and meets their needs, and the opportunities and lifestyle they experience. Time was spent with some of the people who lived at the home, and some completed questionnaires about what it is like to live at Rosehill House. We also sent questionnaires to doctors and nurses who visit the home, and to the relatives of some of the people who live there. This is so that we could get as many peoples views as possible about how the home is run. 2 people living at the home, 2 relatives and 4 members of staff completed and returned questionnaires. The site visit took place six weeks after a new manager was in post. Her plans for improving the services at the home were discussed. What the service does well: What has improved since the last inspection? Since the last inspection a new manager has been appointed. She is experienced and has a clear vision for the future development of the home. This should help to ensure that standards improve and that the service is clear about what it has to offer and to who. Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 6 There is a new overall training plan for the staff group, which includes training in head injuries, adult protection training, moving and handling, and infection control. Mental health training is planned for June. This helps staff to be able to better address the needs of the people living at the home. The new manager has commenced a programme of supervision for staff. Supervision is a system that helps staff to work to their full potential, and may help identifying new training needed or skills that could be used better. What they could do better: Each resident must have a thorough assessment prior to admission to ensure Rosehill House can meet his or her needs before they make a decision to live there. An application must be made to register the manager. This is so that there is someone legally recognised to be in day to day charge of the home. A service user guide must be provided to ensure all people living at the home or thinking about living at the home can have information about Rosehill House in a format they can understand. Any restraint or restrictions on people living at the home should be part of a formal written plan, including all actions to be taken to decrease any behaviours before any intervention is carried out. It should be agreed by a multi disciplinary team, involving the person themselves wherever possible, and involve information on any risks involved. No physical restraint should be used on a service user unless full records are kept of any restraint, including what was done and by who. This is to make sure that peoples rights are protected and that any action taken to prevent the person hurting themselves or someone else is the least that will stop the behaviour. A full quality assurance system must be implemented to look at and improve the quality of care at the home for the people who live there. The Home’s Statement of Purpose should be updated to show the changes to the type of care the home is going to offer. Care plans should clearly state what support is needed and how it is to be given. Plans should be drawn up with the person concerned, and should be goal focussed with timescales set at regular reviews. This is to ensure that care is delivered in the same way by all staff and is given in the way the person wishes. Goals help people focus on improvements, with something to aim towards. Rosehill House should have an equality and diversity policy. This is to reduce any risks of discrimination. Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 7 Residents should be as involved as much as possible in the management of their own finances, based on an assessment of need. This is to make sure people are as independent and have as much control over their lives as possible. The complaints procedure should be accessible to residents, so that everyone can understand how and to who complaints should be made. Staff should not handle medication before it is given to the person for whom it is prescribed. This is to avoid medication becoming contaminated. Medication administration sheets should only be completed when the person has taken the medication to avoid the risks of medication not being taken being wrongly recorded. Every effort should be made to ensure that services provided meet all the cultural needs of the people accommodated, including familiar foods. This is so that people can lead their lives in ways that are familiar to them. The provision of an accessible vehicle to meet the needs of all the client group accommodated should be considered. This is so that all people living at the home can have access to the homes own transport, not just those that are independently mobile. Consideration should be given to replacing the kitchen and re-siting the refrigerator out of an area where laundry is washed. This is to reduce any risk of contamination. Repairs should be undertaken to the damaged area of the bath surround and broken tiling in the bathroom. This is so that people living at the home can live in pleasant and hygienic surroundings. Cleaning materials should be stored safely, and data sheets be available in case of accidental misuse. This is so that people know what to do in use of accidental misuse. Statements of terms and conditions of residency should be made available to people living at the home. These should reflect what the home aims to achieve and the type of care being offered. This is so that everyone can have access to correct information about the home, the fees being paid for their care and what they can expect to receive in exchange. 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 Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 9 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 Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 10 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, 5. Quality in this outcome area is poor. Assessments made prior to admission were not specific to this home and information about the home is not up to date or accessible to the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Rosehill House has a statement of purpose which describes the aims and objectives of the home, and this is on display in the entrance hallway. There is no service user guide available, which is a document written for the people living at the home or people thinking about moving in. This information is important as it helps people make a decision about whether the services on offer at Rosehill House will be right for them. Files for all four service users were seen. Files contained information on the service users needs and an original assessment, but these had been carried out when service users had been admitted to another home in the group, from where service users had transferred to Rosehill House. No information was seen in files to determine why specifically this transfer had happened, and the current manager was not in place at that time so was unable to explain the process that had been followed. The manager confirmed that as the future plan Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 11 was for Rosehill House to be more of a ‘stand alone’ unit a full admission process would be followed for any future admissions. Pre-admission assessments are important as they ensure that the home is the right place for the service user and that the home can meet their needs. One person living at the home who was spoken to had a fair understanding of why they had moved to Rosehill House, but felt they had no clear plan for their future identified . No contracts or accessible statements of terms and conditions could be found between people living at the home and the owning company during the site visit. However contracts and service specifications were available between the placing authority and the organisation. These statements of terms and conditions explain for people living at the home what fees are being paid for them to live there and what they can expect in return. They also explain any ‘rules’ such as periods of notice and reasons why someone may be asked to leave. This helps people understand their rights. Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 12 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, 9 Quality in this outcome area is adequate. Care plans seen were not clear, and did not all reflect goals for people living at the home or how these were to be achieved. People living there have a say in the running of the home, and are enabled to take risks. Their rights are not supported by the homes lack of clarity in restraint procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans for all four service users were seen. Care plans are important as they identify where a person living at the home needs support to lead a full life and how that support is to be given. They should lead to care being given in a consistent way. Plans seen on the site visit were not presented in a consistent format, and contained historic information as well as current information so current needs were not easily identifiable. However plans did show a good level of information about people living at the home, including some information on Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 13 life histories, and a care worker was able to explain how they were used in practice. It was not clear how much people living at the home were involved in drawing up these plans and plans did not have goals or milestones set, with regular reviews of achievements made or an emphasis on retained skills. However they are invited to formal reviews that occur if they wish to participate, as are relatives or other supporters. Relatives who completed questionnaires both expressed frustration that reviews had not lead to improvements in care. One said that they had attended a recent review but had not received any feedback on any changes that had been made. Daily recording was undertaken to reflect how people living at the home spent their time, and discussions with staff indicated that they were clear about information in the plans. However observations of one service user showed that a behaviour management plan seen in a file was not being used consistently by all the staff on duty. There was no restraint policy, multidisciplinary agreement or risk assessment available to document the limited restraint procedures seen to be occurring during the visit. These are put in place to protect the rights of people living at the home, and to make sure that any restrictions on the person are needed, appropriate and understood by staff. Care plans contained assessments of risk, including descriptions of ways to minimise risks to people who live at the home whilst still ensuring they have opportunities to develop new skills and receive new experiences. People who live at the home are involved in daily routines and have attended “your voice” house meetings, the last of which was in December 2006. The new manager plans to re-implement these as a formal way of involving people who live in the home in the way it operates. Staff spoken to were clear about the rights of people who live at the home and could be seen consulting with them during the site visit. People living at the home do not have clear documented assessments of support needed to manage their own finances. The manager demonstrated the system for managing money held in trust by the home and could show receipts kept for any purchases made on behalf of people living there. Entries balanced correctly. Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 14 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): 12, 13, 15, 16, 17 Quality in this outcome area is poor. People who live at the home have limited opportunities to participate in the local community, maintain friends and family relationships and experience opportunities to develop new skills. Cultural needs are not always being addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the course of this unannounced site visit, one service user spent the day out of the home sailing and then having a picnic lunch followed by a pottery class. The other three people remained at the home. One of these people had a staff member dedicated to their care due to issues of challenging behaviour, and they spent time with them in the homes garden or lounge. They then watched television. The two other service user spent time resting in their rooms or in the garden. One person had a daily planner on their wall which showed the activities they were involved in each day. Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 15 One person living at the home spoke about how they spent their time and the limitations their disability placed on their ability to do as they pleased. The people living at Rosehill have very different abilities and for at least one person this proved frustrating. Likewise for relatives there was a frustration about the amount of activities and active rehabilitation being provided. One wrote their relative “has only been taken out on very few occasions….. he absolutely adores being out in the open”. Another commented that they were hoping for their relative to be in a more independent living setting so they would be able to be more in the community. Service users have some opportunities for participation in the local community, although this is limited for some by the lack of the home having a wheelchair accessible vehicle. The home has a people carrier, which is accessible to people without mobility problems. Taxis are used for people who need accessible vehicles and it is understood that the home pays for these if they are for healthcare appointments, but the person living at the home would pay if it was for leisure purposes. Some opportunities are available for people to have access to friends and family, and evidence was heard of contact being encouraged, although this is sometimes limited by distance. Rooms were personalised and had photographs where available. One persons family have apparently expressed concerns over a limited access to people of the same cultural background and the manager discussed ways in which this may be supported. Service users have access to a daily choice of foods on the menu which is decided every few days to allow as much choice as possible. Photographs are available of food so that service users can be supported in making choices in advance. An area of the kitchen is accessible to service users under supervision to assist in the preparation of some snacks and hot drinks. The menu had a balance of foods, and the home keeps a record of what each person actually eats to ensure they receive adequate nutrition. Service users who completed questionnaires or were spoken to said they enjoyed the food served, however a relative commented on the cultural appropriateness of the meals available. They bring in food on occasion, and the manager is going to ask for copies of favourite recipes so that familiar foods of their choice can be cooked for this person and others within the house. Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 16 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, 20 Quality in this outcome area is adequate. Peoples healthcare needs are being met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at Rosehill House have access to community nursing services to carry out nursing tasks such as dressings and wound care, and this is documented in peoples files. Speech therapists, occupational therapists and physiotherapists have visited Rosehill House from another home in the group, but the manager aims to move towards more independence for this unit and be more in line with introducing people living at the home to a more community based service, such as they would experience on leaving the home. Community psychiatric nursing and healthcare support is accessed when needed, and evidence of this could be seen in files and this was confirmed by a person who used the service. Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 17 Facilities within the home have been professionally assessed as satisfactory to cater for the current people living there, and these include specialist beds, ramps and a bath hoist. Discussion was held with the manager on a recent wheelchair assessment which had been undertaken, which although now positive meant a long wait before delivery of the chair and frustration for the service user. This was confirmed by a relative. One service user expressed dissatisfaction with the service provision, and felt that as they did not fit into any specific ‘category’, services were not available or appropriate to meet their individual needs, both inside the home and in the community. Discussions with staff and management indicated that they had a awareness of this persons frustrations and concerns and were seeking solutions. Medication systems were seen, and two members of staff were observed giving medication to people living at the home when it fitted in with their daily routine. Records showed one service user repeatedly refused certain medication and staff respected his rights to do so. Another had chosen to reduce certain prescribed medications with medical agreement, and the home had supported them in this. This demonstrates that staff are respecting service users rights. Staff were seen to be dispensing tablets into their hand from a blister pack which gives opportunities for contamination, and medication was being signed for before being given. Staff have received training in medication administration and have reference material available to look up information quickly if needed. There is no controlled drugs register, which records a balance of particular medication which needs additional precautions due to it’s strength or potential for misuse. Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate. Policies are in place to protect people living at the home from abuse and to address any concerns or complaints that may be raised. However responses to complaints may not always improve the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Rosehill House has a complaints procedure on display in the homes dining room, but it is not in an accessible format for some of the people currently living at the home. In this instance the home would have to rely on the interpretation of gesture, behaviour, and vocalisation to determine dissatisfaction. Other people would be fully able to raise any concerns either formally or informally. The people at the home who completed questionnaires indicated that they were clear about who they would talk to if they were unhappy about something, and that they felt safe at the home. Relatives who completed questionnaires stated they had complained repeatedly about the service but felt little progress had been made. The home has on display a whistle-blowing policy for any staff concerned about anything they see at the home or during the course of their work. This helps to increase protection for people living at the home by ensuring that staff have information about what to do if they suspect abusive practices. Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 19 No complaints have been received by The Commission for Social Care Inspection in the last year about the home. One complaint had been made to the home manager which was fully recorded and resolved internally. Staff receive training in adult protection and the home has a policy and procedure which complied with local guidance and protocols. A member of staff spoken to could outline the action they would take if an allegation had been made. This showed a good understanding of the system and should therefore help protect people living at Rosehill House from abusive practices. Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 20 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, 30 Quality in this outcome area is good. Rosehill House provides a comfortable and adapted home for the people who live there, This judgement has been made using available evidence including a visit to this service. EVIDENCE: Rosehill House is set within a residential area of Torquay, close to the hospital and access roads into the main town area. A tour was made of all areas of the home, which is on a single level, with parking and an enclosed garden. Each service user has a single bedroom, all of which are individually and furnished and decorated to suit each service user interests and preferences. Where aids and adaptations for a specific disability have been required efforts have been made to ensure rooms keep a homely feel. Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 21 There is one bath with an in bath electric hoist and a level access shower, so that people living there can have some choice of where they bathe. There is however no mobile hoist available. The end of the bath and some tiling is damaged, and therefore cannot be easily cleaned and disinfected. The home has risk assessed hot surfaces and provided water temperature regulation to baths and showers. This means people living at the home are protected from scalding, as water temperatures are automatically controlled to ensure they do not exceed 43 degrees centigrade. Basins tested at random were within this limit. Communal areas are bright and comfortably furnished and all areas seen were warm and odour free. There are appropriate arrangements for the storage and disposal of clinical waste, which support peoples privacy and maintain control of any odour or infection risks. The home has an attractive garden and patio area, which is accessible to people who use a wheelchair. This is an area where people living at the home can smoke and there is seating and protection from the sun. This was being very well used independently by people living at the home during the site visit. There is a laundry to the rear of the home, which has machines capable of achieving a good standard of infection control. However the refrigerator for service users food is also situated in this area. The homes kitchen is in a poor condition with door fronts being damaged and not easily cleanable. Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 22 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): 32, 34, 35, 36. Quality in this outcome area is adequate. Staff have the skills to care for service users, and are recruited in a way that protects people living at the home from being cared for by people who are unsuitable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels seen on this inspection site visit were satisfactory for the number and needs of the people living at the home. The manager confirmed that a gender balance was needed on each shift due to the specific needs of some service users, and to this end a male member of staff had been “borrowed” from another home in the group for that day. They were familiar with the needs of the people living at the home and the person they were supporting. Recruitment and training files were seen for three staff members. Files seen contained evidence of a full recruitment process being carried out, including the home taking up two references, a criminal record bureau check and evidence of the persons identity. No information was available for the staff Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 23 member on loan from the other home for the day, but it was understood that a full recruitment process had been completed by the company on their employment. Staff files also contained information on the training needs of staff. There is a new overall training plan for the staff group, and certificates could be seen for training that staff have undertaken. This included recent training in head injuries, adult protection training, moving and handling, and infection control. Additional training on Mental health needs is due in June. The home has only 25 of their staff with an NVQ level 2 or above. This means they have not achieved the national minimum standard of staff with this award, which is a national award recognising the skills of staff in their working role. One member of staff was a qualified nurse from outside of the UK. The new manager has commenced a programme of supervision for staff, which when completed will meet the recommended six times a year. Supervision is a system that helps staff to work to their full potential, and may include identifying new training needed or skills that could be used better. Staff who completed questionnaires said that they had not all yet received supervision – one commented “New manager in place so not had opportunity to do yet”, but others confirmed they had received it, and had also been involved in staff meetings. Staff spoken to were clear about their roles and were complimentary about the home and it’s atmosphere. Comments such as “This is a really nice place to work” were typical. They were also keep to develop a clear sense of identity for Rosehill House. People living at the home who commented or completed questionnaires said the staff treated them well, cared for them well and respected their privacy. Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 24 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, 39, 42 Quality in this outcome area is adequate. The home is being well managed, but systems for assuring the ongoing quality of the service for people who live there are not yet in place. The current manager is not yet registered. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection a new manager has been appointed, and at the time of the inspection had been in post for six weeks. She is not currently registered, but it is understood an application has been completed and will be submitted in the following few days. She is an experienced service manager and trained nurse. She has also achieved her registered managers award, which is a specialist qualification in managing care homes. Discussions with her Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 25 indicated she is aware of current shortfalls in the service and has planned strategies for managing improvement. Some movement has taken place on instituting a quality assurance system for the home, and some questionnaires have been sent out. However no collation has occurred with these and there is no quality assurance report for the home. A full quality assurance system will identify areas where the home is working well and what needs to improve. It will also help stakeholders such as people who live at the home, relatives, staff and purchasers of services influence the way the home runs. Discussion was held with the manager on health and safety at the home. The house is generally well maintained and there are environmental audits and risk assessments as well as a maintenance plan to ensure that this continues. Water temperatures are restricted and window locks maintain security. The home has been checked for legionella bacteria in the water system and for asbestos in the building. Some cleaning chemicals were not being stored securely and there were not data sheets available for all of them to explain what to do in the case of accidental misuse. Staff receive training in first aid and food hygiene, but there is not a first aid risk assessment available. Fire tests, drills and instructions were generally satisfactory, however the weekly fire test and recording had lapsed. Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 26 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 1 2 2 3 3 4 x 5 2 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 3 25 3 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 1 x x 3 x Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 27 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 YA2 Regulation 14 Requirement Each resident must have a thorough assessment prior to admission to ensure Rosehill House can meet his or her needs (Previous Timescales 04/03/06, 01/10/06 & 31/03/07- not met). An application must be made to register the acting manager (Timescale 07/12/06 & 28/02/07- not met). A service user guide must be provided to ensure all people living at the home or prospective people living at the home can have accurate information about the home in a format they can understand. No restraint should be used on a service user unless there is evidence to show that restraint of the kind employed is the only practicable means of securing the welfare of that person or any other service user. Full records must be kept of the circumstances of this, including the nature of the restraint. A full quality assurance system DS0000018418.V332796.R01.S.doc Timescale for action 30/06/07 2. YA37 8 30/06/07 3. YA1 4, 5 30/07/07 4 YA7 12 30/06/07 5 YA39 24 30/08/07 Page 28 Rosehill House Version 5.2 must be implemented to maintain and improve the quality of care at the home 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. 2. Refer to Standard YA1 YA6 Good Practice Recommendations The Home’s Statement of Purpose should be reviewed in light of the changed purpose of the Service. Care plans should clearly state what support is needed and how it is to be given. Plans should be drawn up with the person concerned, and should be goal focussed with timescales set at regular reviews. Rosehill House should have an equality and diversity policy. Residents should be as involved as much as possible in the management of their own finances, based on an assessment of need. The complaints procedure should be accessible to residents Any restraint procedures should be part of a multidisciplinary framework, fully documented with risk assessments and full records of interventions and how they are to be carried out. Evidence of all prior interventions should be available to show that all other approaches have been tried before a physical intervention is undertaken. Staff should not handle medication before it is given to the person for whom it is prescribed. Medication administration sheets should only be completed when the person has taken the medication. A controlled drug register should be obtained. Statements of terms and conditions of residency should be made available to people living at the home. Every effort should be made to ensure that services provided meet all the cultural needs of the people accommodated, including familiar foods. The provision of an accessible vehicle to meet the needs of DS0000018418.V332796.R01.S.doc Version 5.2 Page 29 3. 4. YA7 YA7 5. 6. YA22 YA7 7. YA20 8. 9. 10. YA5 YA17 YA13 Rosehill House 11. 12. 13. YA30 YA24 YA24 YA42 all the client group accommodated should be considered. Consideration should be given to replacing the kitchen and re-siting the refrigerator out of an area where laundry is washed. Repairs should be undertaken to the damaged area of the bath surround and broken tiling in the bathroom. Cleaning materials should be stored safely, and data sheets be available in case of accidental misuse. Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. Extracts may not be used or reproduced without the express permission of CSCI Rosehill House DS0000018418.V332796.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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