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Inspection on 25/03/09 for Rawlings House

Also see our care home review for Rawlings House for more information

This inspection was carried out on 25th March 2009.

CSCI found this care home to be providing an Good service.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Rawlings House 45 Rawlings Crescent Colchester Essex CO4 9FB The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Neal Cranmer Date: 2 5 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 31 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Rawlings House 45 Rawlings Crescent Colchester Essex CO4 9FB 01206842550 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Rowanscareltd@tiscali.co.uk Rowans Care Limited care home 7 Number of places (if applicable): Under 65 Over 65 7 7 0 0 learning disability physical disability Additional conditions: Persons of either sex, under the age of 65 years, who require care by reason of a learning disability, who may also have a physical disability Date of last inspection 0 3 0 8 2 0 0 6 Care Homes for Adults (18-65 years) Page 4 of 31 A bit about the care home Rawlings is a purpose built two-storey building situated within a residential area to the west of Colchester town centre. The service users accommodation is all set out on the ground floor and is made of 7 single bedrooms, 6 of which have en-suites, a large bathroom with ceiling tracked hoist and wet room shower, kitchen, dining room and lounge. Staff facilities and the laundry are accommodated on the first floor. The building is set in a large enclosed garden with secure gates. The home has a service user guide that provides information about the home, and which is available to service users and visitors. Information provided by the provider in January 2006 (in a pre-inspection questionnaire) indicated that the fees in the home are £1200 per week, with additional charges for personal items (hairdresser, toiletries, personal clothing and belongings, etc.). Care Homes for Adults (18-65 years) Page 5 of 31 Care Homes for Adults (18-65 years) Page 6 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 31 How we did our inspection: This is what the inspector did when they were at the care home This unannounced inspection visit was carried out on the 25th March 2009, with the assistence of the Registered Manager and Co-owner. The inspection visit was conducted between the hours of 9:00 am and 3:30pm. The inspection involved a tour of the home, looking at records and documents, and talking with four people who live in the home, the Registered manager, CoOwner and three members of the staff team. In addition three service users surveys were circulated and returned, and information received in these has been included within the main body of this report. Care Homes for Adults (18-65 years) Page 8 of 31 The Annual Quality Assurance Assessment (AQAA, is a self audit tool that the home uses to tell us what they do well, and identify any areas for improvement) was good, well laid out and contributed positively to the overall inspection visit report. At the end of the inspection, feedback was given to the Registered Manager of the home regarding the inspection visit. What the care home does well The home uses a person centred approach to ensure that it provides individual care for people living in the home. Service users are supported to make choices, and are actively encouraged to decide how they spend their time. Care Homes for Adults (18-65 years) Page 9 of 31 The home provides good facilities, with plenty of room for service users (e.g. good sized bedrooms with en-suite facilities). The home has a stable staff team and staff turnover is low, which ensures that staff are well aware of the likes and dislikes of the people they support. The environment in the home was homely and welcoming, and the atmosphere was pleasant. Care Homes for Adults (18-65 years) Page 10 of 31 What has got better from the last inspection The homes medication practice has been improved, so that records relating to administration and ordering of medication are now in order. The homes recruitment practice has been improved. Gaps in employment history are now explored with staff during the recruitment process. The homes Quality Assurance process has been further developed to ensure that there is now a process in place for evaluating the information received. Care Homes for Adults (18-65 years) Page 11 of 31 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Neal Cranmer CPC1 Capital Business Park Fulbourn Cambridge CB21 5XE 01223 771350 Care Homes for Adults (18-65 years) Page 12 of 31 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 13 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 14 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who may use the home and their representatives can expect to be provided with the necessary information to enable them to make an informed choice about the homes ability to meet their assessed needs. Evidence: The home had a Statement of Purpose and Service Users Guide, which provided perspective service users with information regarding the structure of the service, the qualifications of staff, and the facilities provided by the home. The document also included information on the homes complaints and admission processses. The Service Users Guide was available in pictorial format tho make it more user friendly to those service users who were less able. Both documents were comprehensively detailed and together provided perspective service users and their representatives with a good level of information to enable them to decide if the home would be able to meet their needs. Three service uses surveys that were returned indicated that service users were provided with enough information about the home before they moved in. There has been one new admission made to the home since the last key inspection. The assessment process included visiting the person in their current accommodation, Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: and covered a number of areas including: the reason for the referral, any specific requirements, mobiity, eating and drinking, communication, medication and how to support the person in maintaining a safe environment. All assessments are carried out by the Registered Manager or the Co-proprietor (Both of who have extensive experience of supporting people with a learning disability). The home does not accept emergency admissions. The Registered Manager reported that following the assessment trial visits to the home are arranged. Following admission to the home reviews are undertaken after the initial six weeks in residence. The initial three months in the home are on a trial basis, this is to enable time for the service users to decide if the home is right for them. It is also a time during which the home can further assessment that they are able to meet the needs of the individual. The assessments undertaken are used as the basis for formulating the persons initial plan of care.l Care Homes for Adults (18-65 years) Page 16 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Individuals can expect to be involved in decisions about their lives, and be involved in planning the care and support they receive. Evidence: Three care plans that had been generated from the assessments undertaken were examined. All were found to include all aspects of peoples personal, social and healthcare needs. Care plans were in place to support people with their mobility, communication, and personal hygeine and dressing. All three of the care plans examined showed that risk assessments were in place, covering a range of areas icluding: absconding and unfounded medical conditions. Each of the risk assessments had been agreed and signed by both service users and staff. The home has a key worker system in place and this helps to ensure consistency and continuity of care. Service users spoken with were aware of who their key workers were, and discussion with them indicated that they got on well. (The three service user surveys returned indicated that staff always listened to the service users and acted upon what they said). They went on to speak of how their key Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: workers supported them in a number of areas including planning holidays and outings. The atmosphere in the home was homely and inviting and the rapport seen and heard going on between service users and staff was genuine. During the course of the inspection service users were seen and heard making decisions including: what time I am going to get up, what I am having for lunch, and how I am planning to spend my day. Care Homes for Adults (18-65 years) Page 18 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service are supported to make chioces about their life styles, and are further supported to develop their life skills. Evidence: Due to the nature and level of needs of the service user living in the home, at the time of the inspection none of them were engaged in any form of paid or voluntary employment, and most it was reported had limited capacity to engage in further education and trainning. (This was confirmed by the home in their Annual Quality Assurance Assessment. Most of the activities taking place in the home were leisure activities. There was a weekly activities programme for the home in place, which incorporated minibus rides, going to the pub, bowling, walks to the park, seaside visits and eating out. The home was well equipped with television and video equipment (including Sky TV). Service users are actively supported by their key workers to maintain links with their Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: families and friends by the sending of letters and birthday cards. The home encourages visitors and to facilitate this the home has an open door policy on visiting. One service user spoken with spoke of being in contact with a close relative who visited the home on a regular basis. sampling of the homes visitors book confirmed that relatives were in regular contact with the home. Observation on the day of the inspection indicated that the daily routines in the home were flexible. As mentioned previously service users were heard deciding what time they wanted to get up, and how they wished to spend their day. Discussion with service users indicated that they were supported by the staff team to have responsibility for taking care of their own rooms (although it was clear from the discussion that this was often with reluctance). Service users were seen without exception to have free access to all comunal areas of the home, and were seen coming and going freely into the kitchen to prepare drinks and light snacks, with support where necessary. A sample of the homes menus were viewed and found to contain evidence of a varied and nutrtious diet being provided. The service users abilities to be actively involved in the menu planning process was limited. Therefore menus were mainly based the staffs knowledge of the likes and dislikes of the service users identified through the homes assessment process. One service user spoken with during the course of the inspection said that the meals were good. Care Homes for Adults (18-65 years) Page 20 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The health and personal care that people receive is based upon their individual needs, and the principles of dignity, privacy and respect are put into practice. Evidence: Information relating to how personal support for people living at the home is provided was noted in their individual plans of care. Continuity and consitency of support for service users is provided through the key worker system The care plans exaimed reflected the support and assistence that service users required to enable their personal hygeine needs to be me. Staff showed a good knowledge and level of awareness around individual needs. Most of the staff team were male, reflecting the gender group of the service users in residence. Service users care plans examined provided evidence that appropriate healthcare services are available, accessed, and fully recorded following any referrals made. Records showed that service users had access to a range of helthcare professionals including: Opticians, Dentists and Chiropodists. The homes AQAA stated that service users healthcare needs were regualrly monitored, and where changes were identified Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: referral was made to the relevant professional/s. All of the service users are registered with a local General Practitioner. The management of medication was found to be of a good standard, with appropriate records in place regarding the ordering, administration and recording of medicines given by staff. The home operates a Monitored dosage System (MDS). At the time of the inspection visit there were no service users living in the home who had been assessed as having the capacity to self medicate. Only senior care staff and those in an acting up position administer medication, and then only following training provided by the dispensing chemist. The home has in place a comprehensive policy on the administration of medicines, covering ordering, administration and storage of medicnes. Care Homes for Adults (18-65 years) Page 22 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service are supported to express their concerns, and have access to a robust, effective complaints procedure. Evidence: The home had a clear complaints procedure in place which was referred to in the homes Statement of Purpose and Service Users Guide, which as already noted was available in pictorial format. All three of the service user surveys returned indicated that service users were aware of who they should speak to if they were unhappy about any aspect of the homes service provision. At the time of the inspection visit there had been no complaints made to either the home or the Commission since the last key inspection visit. The home has in place a adult protection policy, this included information about the types of abuse that might occur and the ways in which they might present, and the procedures that staff should follow in the event of an allegation being made. No adult protection referrals had been made in respect of the service since the last key inspection. The registered manager reported that all staff had received training on adult protection and that refresher training was also being provided on an annual basis. This was further confirmed by sampling of staff training records and during discussion with staff. Staff spoken with were knowledgeable about adult protection and were confident that they would know what action to take in the event of an allegation being made. Care Homes for Adults (18-65 years) Page 23 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The physical design and layout of the home enables people to live in an environment that is safe and well-maintained, and in which they can develop their independence. Evidence: The home was purpose built and provided level access ground floor accommodation to all of the seven service users in residence. All service users had their own individual bedrooms, which were spacious and well equipped, and included evidence of people being surrounded by their personal possessions. The home is situated in the centre of a housing estate, within easy access of local shops, and only a few miles from the town centre. On the day of the inspection the home was clean and safe, comfortable, and in a satisfactory state of decoration. Laundry facilties were domestic in nature, and were equipped with the necessary facilities to meet the needs of the service users in residence, including industrial style machines and hand washing facilties. Policies and procedures for the control of infection were in place, and appropriate records relating to cleaning materials were kept. Staff training records indicated that staff had received training in infection control and other health and safety related areas. Care Homes for Adults (18-65 years) Page 24 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Staff in the home are well trained and skilled, and are available in sufficient numbers to meet the needs of the people in residence. Evidence: Duty rotas for the period of the 16/3/2009 to the 5/4/2009 were sampled, and showed that there were a minimum of five staff on duty throughout the day, although it was noticed that many of the morning shifts actually had on duty six staff. Night time cover is provided by two waking night staff. The manager reported that the high staffing levels are reflective of the needs of the service users, and also takes account that all of them receive some one-to-one staff time which is allocated each day. At the time of the inspection the home employed eighteen care staff, of these seven held a National Vocational Qualification (N.V.Q) at level 2 or above. The manager assured us of their intention for more of the staff team to trained up to the same standard. The files of four staff members were inspected for evidence of the homes recruitment practice. All of the files contained evidence of all of the required information and checks necessary being carried out before staff commenced working in the home. These checks included: references, proof of identity, Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) clearance. The staff files confirmed that all Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: recruitment checks required to ensure the safety of service userss had been undertaken and were on file. The staff files also included records of any relevant qualifications. Staff and personal development files seen confirmed that they had been provided with training relevant to the diverse needs of the service users in residence, this training included:food hygeine, health and safety awareness, infection control, first ais, adult protection, moving and handling, epilepsy awareness, fire safety and Mental Capacity Act training. Discussion with staff during the course of the inspection visit indicated that access to training was good. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The management and administration of the home is based on openness and respect, and their are mechanisms in place for seeking out the views of the people living in the home. Evidence: The registered manager has extensive previous trainning and experience, and holds both healthcare and higher management qualifications that exceed the requirements of the National Minimum Standards. The manager demonstrated an open and transparent approach to the running of the home, and feedback from staff reported that they were approachable and supportive. The home has a quality assurance process in place, this includes circulating questionaires to service users, relatives and staff. feedback received from these questionaires are then analysed and are used to inform the homes improvement plan. Six surveys returned from relatives were sampled. Comments included: I am happy with the care my relative receives, Rawlings is an appropriate and homely environment. I am really pleased at the activities and social life that my relative can and does participate in regularly, keep up the good work . All of the response looked Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: at without exception were positive. The homes safe working practices were looked at by the viewing of a range of safety certificates, these included records relating to electrical installation, gas installation, portable appliance test, fire safety and legionela, all of which were found to be current and up to date. Staff training and development files included evidence on training on health and safety, infection control and other health and safety related issues. The records looked at indicated that the home was providing safe working practices. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 31 of 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!