Inspection on 04/05/05 for Rainbow House (Holiday Centre)

This inspection was carried out on 4th May 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rainbow House (Holiday Centre) 22/01/08

Rainbow House (Holiday Centre) 12/06/06

Rainbow House (Holiday Centre) 04/01/06

Rainbow House (Holiday Centre) 27/10/04

Rainbow House (Holiday Centre) 13/07/04

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Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

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Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 Rainbow House (Holiday Centre) 15 Hooks Hill Road Sheringham Norfolk NR26 8NL Lead Inspector Lella Andrews Announced 04 May 2005 09:30 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 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 Stationary 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. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Rainbow House (Holiday Centre) Address 15 Hooks Hill Road Sheringham Norfolk NR26 8NL 01263 823170 01263 825560 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BREAK Mrs June Knowles Care Home 12 Category(ies) of Learning Disability (12), registration, with number Older people with a learning disability (12), of places Physical Disability (12), Older people with a Physical Disability (12). Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Those accommodated with a Learning or Physical disability may be children. 2. No unaccompanied child under the age of 5 may be accommodated. 3. No unaccpmpanied individuals may be accommodated during the weeks set aside for family groups. 4. No one person to be accommodated for more than 28 days within a twelve month period. Date of last inspection 27 October 2004 Brief Description of the Service: Rainbow House is owned and managed by the BREAK organisation which is a charity based in Norfolk and provides a variety of services to children and adults. Rainbow House (referred to throughout the report as the “Centre”) is a large detached house situated in a residential area of the seaside town of Sheringham. To the front of the Centre is a large, heated indoor swimming pool and an enclosed garden. The Centre provides holiday stays for children and adults with a wide range of disabilities. The bookings are arranged so that there are either groups of children or groups of adults staying at any one time. The service users are referred to throughout the report as “guests”. The Centre has recently reduced the registered number of places to twelve (12) and from April 1st 2005 the number will be reduced to nine (9) which will enable all guests to have a single room. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspection was announced and took place between 9.30am and 4.50pm on Wednesday 4th May 2005. The recently appointed manager of the Centre had provided the required pre inspection information and also provided information throughout the Inspection. One of the volunteers, an agency member of staff and one of the permanent members of staff spoke to the Inspector on an individual basis. The Inspector spent some time in the dining room sitting and chatting to guests. A selection of records were seen and the medication system was looked at in detail. A tour of the premises was undertaken. Six completed comment cards were received from relatives/carers and one from a health professional. The Operations Director was present for the feedback provided to the manager at the end of the Inspection. Since the last Inspection (October 2004) there have been several changes within the management structure of the organisation. The manager of the Centre left in December and a new manager was appointed in January 2005 but is not registered with the Commission. Due to retirements the organisation has also appointed a new Operations Director and Head of Care within the last two months. What the service does well: The staff work hard to provide the guests with an enjoyable holiday. The aim of the Centre is to provide guests with the opportunity to take part in activities that they enjoy and which they may not usually have to opportunity to do. Staff offer choices to the guests whenever possible. The staff team are able to provide a holiday to guests with a range of needs and to both adults and children during separate weeks. The guests spoke highly of the staff and said that they are kind, helpful and friendly. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: It is disappointing to see that one of the requirements made during the previous Inspection has been repeated in this report and that two of the recommendations from the previous report are now requirements in this report. The Statement of Purpose needs reviewing to ensure that it provides accurate information to whoever might wish to know about the service provided by the organisation at the Centre. Although there have been some improvements to the application forms which provide the basis for the care plan and risk assessments these still need further work to ensure that risks are adequately identified and that clear guidance is provided to ensure that staff are able to meet guests needs in a consistent manner. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 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. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 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 standard(s) 1,2,5 The Service User Guides provide clear basic information to prospective guests about the service that the Centre provides, however the Statement of Purpose is not accurate enough to provide detailed information to prospective guests or their representatives. The amended application forms provide more detailed assessment information than previously, however in some circumstances, there is still a need for additional guidance to be available to staff in order for them to be able to meet the guests needs effectively. The guests application forms clearly provide details about the terms and conditions of a guests stay at the centre. EVIDENCE: The Service User Guide is provided in a laminated booklet format which contains symbols and photographs as well as simple sentences about the service provided at the Centre. The booklet can be sent to prospective guests prior to their stay and is there is also one in each of the bedrooms. This is an improvement since the last Inspection. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 10 The Statement of Purpose has been updated since the last Inspection, however, there are still inaccuracies and omissions in this document. The requirement to provide an appropriate Statement of Purpose is repeated in this Inspection report for the sixth time. It is required that the Statement of Purpose contains the information listed in Schedule One and Schedule Five of the Care Homes Regulations. The guests application forms contain the assessment of individuals needs. These are completed by the guest, parents or carers and a request for updated information is sent prior to every stay. The form has been updated so that it now requests information about a more extensive range of needs. There are questions about how a guest communicates important things such as if they are happy, sad, in pain etc. The form also asks questions about issues such as whether a guest likes the light on at night and how many pillows they like. These seemingly minor questions are very important to ensure that the guest has an enjoyable stay. Staff contact parents/carers for additional information if they feel that the form does not contain enough detail. Staff were seen to contact carers for further information about a situation that had arisen during a guests stay. However, there are still areas on the application forms seen by the Inspector that do not contain enough information to form the basis of the care plan for the guests stay. Parents/carers/guests are asked for additional information on their arrival. One of the completed comment cards from a relative advised that they might prefer to do this somewhere more private than the dining room. It is recommended that the senior staff enquire whether guests/carers may prefer to see staff in private when the guest first arrives. Due to the distance that most guests live from the Centre it is not the usual practice for staff to visit prior to a first stay and undertake an assessment. It is recommended that the organisation considers enabling senior staff to visit guests prior to their first stay to undertake an assessment. This would enable staff to ask direct questions at the time rather than having to phone for further details. It would also enable the staff to observe how a guests needs are met at home. Guests may also feel happier arriving for their first stay if they have already met one of the members of staff. The need for accurate assessment information at an early stage is important as the bookings are agreed on the grounds of the mix of guests having been assessed by the manager as having high, medium and low needs. The manager now has access to the booking system via the computer which has Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 11 made it easier for information to be passed between the bookings administrator and the manager. Staff advised that there are still times when the mix of guests has not been successful but that, in general, the new booking system has improved this. It may be that more detailed assessment information, particularly for those guests who require assistance with full personal care and those with behaviours which may be challenging, will lead to more effective mixes of guests. The guests application forms which they are sent prior to every stay contains clear information about the terms and conditions of their stay. Guests are also sent a letter confirming the dates of their stay and of the fees for this. The organisation may wish to consider sending a copy of the terms and conditions in a format which the guests are able to keep as they return the application forms to the organisation. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9 The care plans and risk assessments do not contain enough detailed guidance to staff, in all cases, to ensure that the guests will receive support in a consistent and appropriate way. The guests are consulted about what they would like to do during their holiday but recent staffing difficulties has meant that these choices cannot always be honoured. EVIDENCE: The care plans were seen for all of the seven guests currently staying at the Centre. Three care plans were also seen for guests who had previously stayed at the Centre and were assessed as having “high” needs. The application forms form the basis of the care plans and a risk assessment is undertaken for all guests based on this information. Currently there is some confusion about the risk assessment and a care plan. The risk assessments seen often contained information about how to meet a need rather than an assessment of the risk and details about steps taken to reduce the risks. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 13 For some guests the risk assessments did not contain information about risks that were detailed within the application forms. For example, one guests risk assessment did not highlight that the guest is allergic to certain colourings. The risk assessments do not provide detailed guidance to staff and so there is a need for the manager to review the use of these so as to ensure that there are detailed risk assessments and also detailed plans of how to meet individual needs. This was a recommendation made during the previous Inspection It is required that risks are recognised and adequately assessed with clear guidance to staff about how to effectively manage the risk. It is required that clear guidance is provided to staff so as to enable them to meet the needs of the guests in a consistent and effective way. The staff complete notes in the guests records at the end of each shift. Information relating to all guests is also contained in the handover book. It is required that information relating to guests is not kept in one book as guests records should be individual. Staff advised that they read the guests records for the forthcoming week prior to guests arriving. Agency staff also confirmed that they are asked to read the guests records. However, currently these do not provide detailed enough guidance, in some cases. The high usage of agency staff that is currently in place makes the need for clear written guidance even more important. Talking to staff and reading guests records show that staff are not always clear about providing a consistent approach to some situations. Staff were heard to offer guests choices in a variety of situations, for example, about what they would like to do in the Centre, where they would like to go that afternoon, what they would prefer for lunch. Staff advised that the main aim of the Centre is to provide guests with an enjoyable holiday and that being able to offer guests choice about what they do is an important part of this. Information gathered from staff on the day of the Inspection and also from reading records show that staff have been concerned that, due to staffing difficulties, they have not always been able to provide guests with as many choices as they have previously. Usually guests are asked, on the first day of their holiday, where they might like to go and a weeks plan is put together. When there is a heavy reliance on agency staff and volunteers then guests have still been able to go out but the choices are reduced to ensure safety of all involved. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 14 Guests said that they can choose when they go to bed, and also, when they get up. They also advised that they are always asked what they would like from the menu at mealtimes. The menus show that there are always three choices at mealtimes as well as the option of having sandwiches, jacket potatoes etc if a guest does not want what is on the menu. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15, 16 The recent staffing difficulties have meant that the range of activities available and the involvement of guests in the planning of activities has been reduced. Guests are supported to keep in contact with relatives/friends during their stay at the Centre. EVIDENCE: Guests are encouraged to bring in any activities, toys, CDs, DVDs, that they wish to. The Centre has a range of toys, board games, computer games and videos available for use although the playroom was not in use on the day of the Inspection as it was being redecorated for use as a general arts and crafts room. The Centre has a sensory room and a softplay room which can be accessed by guests when they wish to. The swimming pool is situated next to the Centre but currently the opportunities for guests to swim are limited due to recent changes in insurance requirements which now require a fully trained life guard to be present. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 16 The permanent members of staff have a good knowledge of what activities are available within the local community and further afield. Staff are aware of the need to consider the age range and interests of the guests when planning weekly activities. There is also a need for flexibility, for example, the mornings activity had to be changed due to the weather. As previously mentioned in this report, staff have been disappointed that they have been unable to provide as much choice to the guests as they would normally do with regard to activities due to the staffing difficulties. Staff advised that the reduction in the number of guests to nine has meant that they are able to offer guests more alternatives rather than guests all having to go out together. Guests are encouraged to send postcards to their family and friends during their stay. One of the staff assisted a guest to write their postcards after lunch. One of the guests said that they know where the phone is and that they would use it if they wished to contact their family. The Service User Guide contains the number of the Centre and of the payphone if relatives/carers wish to contact the guest. The six comment cards completed by relatives/carers all said that they are able to visit their relative/friend in private if they wished to and that the staff always welcome them at the Centre when they arrive. They also all said that they are kept informed of important matters affecting their relative. The bedroom doors do not have locks on. Two of the guests said that they much prefer to have their own room, which is possible now that the maximum number of guests is nine. The manager advised that, if known, then they will try to arrange that guests who are friends are able to stay at the Centre at the same time. The tour of the Centre showed that some of the guests had brought in personal items with them to personalise their room during their stay. Guests said that they can choose whether to spend time in their rooms or to use the communal areas. Staff were seen to spend time talking to guests throughout the day. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 17 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 standard(s) 20 The written medication procedure and risk assessments need additional information to improve the safeguards already in place for guests with respect to the administration of medication. EVIDENCE: The medication procedure was seen, as was the risk assessment for one of the guests who was partly self medicating. The procedure seen initially was out of date and the manager provided an up to date copy which was more appropriate. The last Inspection report had recommended that the procedure relating to homely remedies is included in the medication procedure. This has not been done and is now a requirement. It is necessary to provide guidance to staff with respect to the administration, or not, of homely remedies. It is required that the procedure for the use of homely remedies is included in the medication procedure. The risk assessment did not identify the risks attached to a guest being responsible for administering their own medication and did not provide adequate information to staff about this. The requirement to ensure improved risk assessments has already been made in this report. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 18 The application forms sent to guests clearly states that medication must be provided in the original packaging and the manager advised that this mainly happens now. Senior staff complete the medication records when a guest first arrives and checks these with the guest/relative/carer. One of the guests application forms showed that their relative had clarified the administration dosage as there was an discrepancy between the application form and the administration instructions on the medication. The night staff complete a daily audit of the medication in the cupboard. This is good practice and should quickly identify any problems/errors. Two staff are usually involved in the administration of medication which is also good practice. It was seen that the medication for one of the guests had been omitted, in error, on the previous day. Whilst it was recorded on the back of the administration record this note did not contain the reason for the omission, nor was it recorded on the guests record or the handover book. It is required that all medication errors are recorded and that the records are available for Inspection Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 19 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 standard(s) 22,23 Guests knew how to make an informal complaint but there is a need to ensure that guests/relatives/carers are aware of the formal complaints policy so that they can be confident that their views are listened to and acted on. There are written procedures in place with regard to the protection of vulnerable adults and children but there is a need to make these more clear and to ensure that the senior staff are confident about actions to take following an allegation of abuse in order to improve the protection of guests. EVIDENCE: Two of the guests said that they would tell the staff if they were not happy about something and that they felt that the staff would sort the situation out for them. The Centre has a written complaints procedure which contains the names of those involved in the process. It is recommended that the complaints procedure makes it more clear that a complaint can be made to the Commission at any time All six of the completed comment cards from relatives/carers stated that they had not had to make a complaint but four of these also stated that they were not aware of what the complaints procedure was. The manager advised that there have not been any complaints made since the last Inspection. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 20 The Centre has extensive procedures relating to the protection of vulnerable adults and children, however these are not all accurate and did not contain a copy of the ACPC procedures as stated within the procedure. Discussions with the manager and deputy evidence that training is needed to ensure that they, and other senior members of staff, are confident that they will be able to respond to an allegation of abuse in the appropriate way which protects the guest, staff and any investigation which may be undertaken. The training records were not seen during this Inspection but the pre inspection information indicates that all permanent members of staff received training with regard to the protection of vulnerable adults in December 2004. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 21 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 standard(s) 24 The centre provides a comfortable and safe environment for guests to enjoy their holiday EVIDENCE: A tour of the Centre was undertaken and several areas of improvement were noted. All of the bedrooms are now single and the majority have been redecorated. Many of the rooms have new laminated wood flooring and several have new beds which replace the old metal beds. New pictures were being put up in the bedrooms on the day of the Inspection. The bedroom on the second floor is badly in need of redecoration. It is difficult to ensure that the bedrooms are homely as different guests use them each week. The Centre has bedside lamps, televisions and music systems which can be put into rooms as needed. It is required that the bedroom on the second floor is redecorated and recarpeted. The playroom is in the process of being redecorated and refurbished to provide an arts and craft room as well as a play area. The fundraising team have been Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 22 involved in some of the redecoration and the soft play area has had murals painted around the room. The dining room has in the process of being repainted and has attractive new blinds/curtains fitted at the windows. The manager advised of plans to refurbish the dining room with cupboards, dishwasher, fridge and sink area. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 23 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 36 The current staffing difficulties have meant that the guests have not always been offered the usual choices in how they spend their time. The reliance on agency, trainees and volunteers has meant that guests have not been supported by an effective staff team. Staff have not received formal supervision on a regular basis and this may have added to their sense of frustration. EVIDENCE: Minutes of meetings and conversations with staff show that staff are feeling frustrated at the lack of consistent staffing. The difficulties with staffing include the length of time it takes to recruit new staff and also periods of high sickness levels amongst staff. Consequences of reliance on inexperienced staff include limiting the range of activities available to guests and permanent staff having an increased workload as well as lack of consistent staff working with the guests. It has also meant that the manager and deputy manager are more involved in supporting guests and therefore have less time to undertake management tasks. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 24 The organisation uses volunteer staff who live in and the staffing structure at the Centre has always been made up of two permanent staff and two volunteers on each shift. There are certain tasks that volunteers do not undertake, such as medication and supporting guests to go out alone. The Centre also employs two “trainees” who are also restricted with regard to the tasks that they can undertake. This has made the staffing situation more difficult. The high usage of agency staff was highlighted during the previous Inspection (October 2004) although at that time the agency staff were as a replacement for volunteers and so the situation was not so serious as it currently is. Guests said that the staff are kind and helpful. Staff were patient and respectful when talking to the guests. The frustrations that staff feel arise from the wish to provide a good quality service. It was noted from the rota and pre inspection information that one of the night staff is twenty years old and has been undertaking night duties with one member of agency staff. The manager advised that the permanent member of staff has the responsibility for the Centre at this time. The standards state that no member of staff under the age of 21 should be responsible for the Centre. The records show that on one occasion one of the guests was unable to receive support with their healthcare needs due to the lack of staff with appropriate training on duty. It is required that adequate staff are on duty to meet the needs of the guests. The manager advised that there were very few guests staying at the Centre for some of the preceding weeks and therefore the effects of the staffing difficulties were reduced during those weeks. The rotas are not an accurate reflection on the staffing provided at any one time and there are poor records kept of the agency staff used. The manager advised that the previous recommendation has not been met with regard to obtaining written confirmation that the agencies have undertaken appropriate references and CRB checks although she did chase this up during the Inspection. It is required that the rotas are an accurate reflection of the staff on duty in the Centre It is required that the manager has evidence that the agencies providing staff have undertaken appropriate checks on their staff Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 25 Three staff personal files were seen and one did not include the necessary Criminal Records Bureau check or proof of identity. It is required that the information listed in Schedule Two of the Care Homes Regulations are kept for all members of staff Supervision records show that staff have not been receiving formal supervision on a regular basis. The manager and deputy manager have both received training to carry out supervision. They have started to carry out supervision sessions within the last month. Staff advised that they can always ask to speak to the manager or deputy manager if they have any concerns and that they feel supported by them. Team meetings take place on a monthly basis. However, regular, formal supervision carried out with privacy would be a chance for staff to discuss how they feel and how they are managing to carry out their role in difficult circumstances. This may also reduce some of the frustrations felt by staff. It is required that staff receive formal supervision and that this is carried out six times per year. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 27 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 x x 3 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x x Standard No 11 12 13 14 15 16 17 x 2 3 2 3 3 x Standard No 31 32 33 34 35 36 Score x 2 1 2 x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Rainbow House (Holiday Centre) Score x x 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 28 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 1 Regulation 4 Requirement It is required that the Statement of Purpose contains the information listed in Schedule One and Five of the Care Homes Regulations. THIS REQUIREMENT IS OUTSTANDING FROM THE PREVIOUS FIVE INSPECTIONS It is required that risks are recognised and assessed appropriately with clear written guidance avialable to staff to ensure that the risks are managed effectively It is required that the care plans contain detailed guidance for staff with regard to meeting indivdual guests needs. THIS WAS A RECOMMENDATION FOLLOWING THE PREVIOUS INSPECTION It is required that the guests records are kept on an individual basis and not together in one book It is required that the medication procedure contains information relating to the use of homely remedies It is required that a record is kept of all medication errors and Timescale for action 30.06.05 2. 9 13(4) 30.06.05 3. 6 15 30.06.05 4. 6 17 05.06.05 5. 20 13(2) 05.06.05 6. 20 17 Immediate Page 29 Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 7. 8. 24 23 23d 13(6) 9. 10. 33 33 17(4) 18(1a) 11. 34 19(1b) 12. 36 18(2) that this record is available for Inspection It is required that the bedroom on the second floor is redecorated and recarpted It is required that the manager and senior staff receive training with regard to actions to take following an allegation of abuse It is required that the rotas are an accurate reflection of the staff on duty It is required that there is an effective staff team on duty to meet the health and welfare needs of the guests It is required that the information listed in Schedule 2 of the Care Homes Regulations is kept for all members of staff and that confirmation is obtained form the agencies that they obtain references and crb checks for their staff. It is required that staff receive formal supervision at least six times per year 31.07.05 30.06.05 Immediate Immediate 30.06.05 30.06.05 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 5 Good Practice Recommendations It is recommended that the guests, or their representatives, are provided with a copy of the terms and conditions of their stay at the Centre in a format which they can keep It is recommended that the senior staff are able to visit guests to undertake an assessment prior to their first stay at the Centre It is recommended that guests and their relatives/carers are given the option of talking to staff in private when they arrive on the first day It is recommended that the complaints procedure makes it I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 30 2. 3. 4. 2 2 22 Rainbow House (Holiday Centre) clear that a complaint can be made to the Commission at any time during the process. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 31 Commission for Social Care Inspection 3rd Floor - Cavell House St Crispins Road Norwich NR3 1YF 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 Rainbow House (Holiday Centre) I55 Rainbow House 217184 (an) 040505 Stage 4.doc Version 1.40 Page 32 - 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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