CARE HOME ADULTS 18-65
Rawleigh House The Avenue Sherborne Dorset DT9 3AJ Lead Inspector
Marion Hurley Key Announced Inspection 21st September 2006 11:00 DS0000059390.V305578.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 DS0000059390.V305578.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. DS0000059390.V305578.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Rawleigh House Address The Avenue Sherborne Dorset DT9 3AJ 01935 816630 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) Dorset Residential Homes Mrs Caroline Ann Bowen Care Home 7 Category(ies) of Learning disability (7) registration, with number of places DS0000059390.V305578.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Ensuites will be installed in each bedroom as the opportunity arises and the registered number will decrease from 7 to 6. 8th February 2006 Date of last inspection Brief Description of the Service: Rawleigh House is located in Sherborne, in a popular residential street close to the town centre. The home is registered to provide accommodation and personal care to a maximum of seven adults who have a learning disability. The home is operated by Dorset Residential Homes, a registered charitable trust that operates a number of care homes in Dorset. Service users living at Rawleigh House have access to a wide range of social and leisure opportunities and facilities, and support is provided by staff as needed, according to the individual needs of service users. Most service users use local authority day services during the week, where they have the opportunity to access further education and life-skills. Rawleigh House is laid out over 3 floors and provides a comfortable and attractive home for service users, who all have their own private bedroom and share communal living rooms; 5 of the bedrooms have en-suite facilities. A lift operates between the floors ensuring access for wheelchair users. There is limited car parking available however; alternative car parking is not far from the property. DS0000059390.V305578.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key announced inspection that took place at the home over a period of five hours. Additionally, time was spent in preparation for the visit, looking at previous inspection reports and Regulation 37 and 26 reports and other relevant documents. This inspection looked at the designated core national minimum standards. The inspection methods used included observation of residents and staff, record checks, case tracking and discussions with the manager and staff. Records relating to staff training and recruitment, care planning and daily recording, medication, health and safety were examined and were accurately being maintained. A tour of the home was completed and all areas were clean and hygienic. The bedrooms were personalised and reflected the different interests of the residents. Staff are experienced and have a good knowledge of the individual needs of the residents. This provides a confident and consistent method of supporting each resident. The residents appeared happy and relaxed and used both the communal areas of the home as well as their own bedrooms. A total of 7 comment cards were returned with positive comments, “very settled, good relationships, I let people know if I am unhappy, very please with the care, all the staff are very good.” A copy of the last inspection report is available directly from Rawleigh House s or from Dorset Residential Homes head office in Dorchester. Current fees are £987:00 but may vary according to the individual’s support needs. What the service does well:
The location of the home provides easy access to all amenities within Sherborne. The home also has the use of two vehicles, one of which is fully adapted to accommodate wheel chair users. The home offers residents a well-maintained and comfortable environment. The medication process is secure with no errors or omissions in the process.
DS0000059390.V305578.R01.S.doc Version 5.2 Page 6 Risk assessments are in place, which details how care is to be delivered, this promotes the health and welfare of both resident and care staff. Health care is well monitored with close liaison with other health professionals. The home is clean and hygienic, with staff having protective clothing available enabling the protection of residents and staff in the home. The manager communicates appropriately with official bodies such as the Environmental Health Officer, Fire Officer and CSCI. Safe working practices were evident throughout the inspection, with evidence of a number of routine tests of fire safety equipment being made on a regular basis. A number of other routine tests are performed regularly to ensure residents’ safety in the home. The manager and staff demonstrated good relationships with the residents living at the home, and have a good understanding of individual needs. Multiagency reviews confirmed this. Records are up to date at the home, that clearly demonstrate the needs of each resident and how staff at the home provide support as needed. Those residents spoken with were, once again, indicated they were very satisfied with all aspects of living at the home and thought their needs were covered. They thought they were listened to and if they had a “grumble” it would be properly sorted Residents particularly liked all the outside activities and trips. What has improved since the last inspection?
The home continues to provide a good service. Two residents by their own choice have “swapped” bedrooms and this has worked well for all concerned. The staff continue to be well supported by the registered manager which significantly impacts on the quality of care provided to each resident and is reflected in their flexible and busy lifestyles. Staffs is looking to the future as residents become older and have started researching age specific occupations and amenities, which might meet the social and leisure interests of the residents. DS0000059390.V305578.R01.S.doc Version 5.2 Page 7 What they could do better: 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. DS0000059390.V305578.R01.S.doc Version 5.2 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 DS0000059390.V305578.R01.S.doc Version 5.2 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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ support is based on an assessment of their individual needs and goals. EVIDENCE: Residents have lived together at Rawleigh House for a number of years and there have consequently been no new admissions for a considerable period. Pre-admission assessments are used by the home for all admissions according to the organisations’ (Dorset Residential Home) policies and procedures, though none have been completed recently, as no new resident has been introduced to the home. All contracts terms and conditions must have the correct CSCI address included and where possible be signed by the resident or their representative. Where a resident has changed bedrooms this should be reflected in their contract, which should specify their bedroom. DS0000059390.V305578.R01.S.doc Version 5.2 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, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have life and support plans/care plans that focus on their individual needs. Plans are reviewed regularly at staff meetings. Risk assessments are used to help residents make choices, take risks and ensure their needs are met. EVIDENCE: Two files were looked at and both contained life and support/care plans. Each plan sets out all aspects of the care to be provided by the home. The plans covered all essential requirements in relation to medication, physical well being, hobbies, and occupation, risk assessments. These documents demonstrated that residents’ needs are being monitored and appropriate levels of support provided to ensure their individual well being.
DS0000059390.V305578.R01.S.doc Version 5.2 Page 11 Residents’ independence is encouraged. Residents are supported and encouraged to participate in individual and shared chores e.g. clean their own bedrooms, wash and dry dishes, lay the tables for mealtimes. Each resident has a key worker who spends one to one time with him or her. One resident has been successfully linked with an advocate. Staff specifically working with the three older residents have started researching alternative amenities, which might be more age appropriate. The residents have attended an Age Concern Special meal and an older persons’ forum. DS0000059390.V305578.R01.S.doc Version 5.2 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): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have an independent lifestyle, which is free from “institutional rules”. Residents’ activities within the local community, contact with relatives and friends all contribute to a positive lifestyle. The quality of the meals is good providing a well balanced and healthy diet. EVIDENCE: The records indicated a range of activities on offer to residents. Residents are encouraged to be part of the community and this was clearly illustrated from conversations with both residents and staff and from reading details in their individual files. Residents have enjoyed both planned holidays and impromptu days out.
DS0000059390.V305578.R01.S.doc Version 5.2 Page 13 Summer holidays have been enjoyed at Centre Parcs and another went to Jersey and for some residents this was their first experience of flying. The home adopts a very flexible and positive approach to the lifestyles and aspirations of the residents. Throughout the inspection process staff were observed speaking with residents in a sensitive manner, with consideration being given to the promotion of their privacy and dignity. DS0000059390.V305578.R01.S.doc Version 5.2 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, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ receive good personal support with their physical and emotional health needs met on an individual basis. Residents are protected by medication policies and procedures. EVIDENCE: Personal support is offered on a flexible basis, support plans reflect the abilities and needs of the residents. For example one record stated that the resident likes to get up early so they can have a long bath and not be hurried. This is good attention to detail and valuable information for the staff when supporting this resident. The monitoring of residents’ weight is undertaken and regular visits from medical staff and GPs is undertaken flexibly. The life and support plans have a section for medical/clinical matters and there was clear evidence of routine health checks and assessments.
DS0000059390.V305578.R01.S.doc Version 5.2 Page 15 All records contained a sheet with basic personal details and information, which could be taken for visits to hospital/casualty. Medication is administered appropriately; the staff spoken with showed a good awareness of administration techniques. Medication is stored securely, the medication administration records (Mar charts) being up to date and signed appropriately. From observation, discussion and checking records, it was demonstrated that residents receive support in the way they prefer and require it. The registered manager and staff are keen for residents to maintain family links and organise twice a year to “family get togethers”. The manager stated they are very well attended. Any relative or friend, who cannot get to these gatherings, is sent photographs of the party to ensure they keep in touch. DS0000059390.V305578.R01.S.doc Version 5.2 Page 16 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected from abuse and their concerns and complaints listened to and acted upon. EVIDENCE: The home/organisation has the required policies and procedures in place. Staff spoken with have an awareness of the contents and how the procedures would be followed. There have been no complaints or concerns recorded since the last inspection. Some of the residents would be able express any concerns they had directly with staff whilst others might indicate through various behaviours. However, staff felt confident that they would be able to identify if any resident was unhappy or distressed over any aspect of living at Rawleigh. The home has a copy of the Multi-Agency Vulnerable Adult Protection document. DS0000059390.V305578.R01.S.doc Version 5.2 Page 17 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable and safe environment with their personal possessions accommodated in their bedrooms. EVIDENCE: A tour of the home was completed. All areas including bedrooms were clean, tidy and in a good state of repair and decoration. Residents are able to personalise their bedrooms. The outdoor area offers a paved area round the property and a grassed area below, though this area is largely unattractive and not fully utilised. Staff hope to develop this area of the garden so it may be fully utilised. During the inspection appropriate use of safety equipment was observed. Staff spoken with on the day were aware of COSHH (Control of Substances Hazardous to Health) procedures and were aware of cross contamination issues and how to use protective clothing, which is in plentiful supply in the home. Maintenance and up keep of the home throughout is to a good standard.
DS0000059390.V305578.R01.S.doc Version 5.2 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 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met and they are protected by the recruitment and retention of a trained and experienced staff team. EVIDENCE: The registered manager showed the inspector staff training workbooks/files, which were up to date and demonstrated a good range of training courses. Two staff are currently studying for the national vocational qualification level 2. (NVQ). Rotas showed adequate staff numbers to meet residents’ needs. Staff files contained all the relevant document and, references and statutory checks relating to recruitment. All staff multi task and undertake cleaning and cooking duties in addition to the prime task of caring and supporting the residents. All the staff spoken with on the day of the inspection were very happy with these arrangements. The registered manager stated the staff team comprised a good age and skill mix and everyone was prepared to work flexibly to fit in with training events.
DS0000059390.V305578.R01.S.doc Version 5.2 Page 19 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 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management approach promotes effective care practice in the home for residents’ care and protection. EVIDENCE: Safe were working practices were evident throughout the inspection with evidence of a number of routine tests of fire safety equipment being made on a regular basis. Fire records were examined; a current fire risk assessment is in place. A number of other tests are performed regularly to ensure residents’ safety in the home; evidence of visiting professionals assisting in this process was seen. DS0000059390.V305578.R01.S.doc Version 5.2 Page 20 The manager needs to formalise the quality assurance system ensuring that the views of residents, relatives and other significant people and professionals is sought and recorded on all aspects of the services and facilities provided. Informally residents and staff are given the opportunity to express their views on the running of the service and these need to be recorded. Minutes from the regular staff meetings are recorded. DS0000059390.V305578.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 CONCERNS AND COMPLAINTS Standard No Score 22 23 X 3 X X X 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 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 X 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43
DS0000059390.V305578.R01.S.doc LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x
Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 YA22 Good Practice Recommendations It is recommended that all staff receive refresher training in the Protection of Vulnerable Adults. Please note since this inspection a series of workshops have been arranged. The quality assurance system and consultation needs to be formalised and recorded to demonstrate the work. 2 YA39 DS0000059390.V305578.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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