Inspection on 03/08/06 for Rawlings House

This inspection was carried out on 3rd August 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rawlings House 25/03/09

Rawlings House 30/12/05

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Rawlings House 45 Rawlings Crescent Colchester Essex CO4 9FB Lead Inspector Kathryn Moss Key Unannounced Inspection 3rd August 2006 09:30 Rawlings House DS0000062568.V306845.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 Rawlings House DS0000062568.V306845.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. Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rawlings House Address 45 Rawlings Crescent Colchester Essex CO4 9FB 01206 842550 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) Rowans Care Limited Mr Edward Don Care Home 7 Category(ies) of Learning disability (7), Physical disability (7) registration, with number of places Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 30th December 2005 Date of last inspection Brief Description of the Service: 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.). Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place on the 3.8.06, lasting seven hours. The inspection process included: • • • • • • Discussions with the manager; Discussions with two staff; Discussion with one service user, and brief contact with the other three service users; an inspection of the premises, including the laundry; inspection of a sample of records; feedback questionnaires received from three relatives/friends. 27 Standards were inspected, and 3 requirements and 12 recommendations have been made. On the day of this inspection, the home was maintained in a good condition, and service users were receiving good care and support. Relatives consulted had no concerns, and one reported that they were ‘thoroughly satisfied’. What the service does well: What has improved since the last inspection? On this inspection it was noted that the home was now consistently providing a level of staffing that met service users’ needs, and which met their individual needs for one-to-one time with staff. This was good to see, and helped to promote a good quality of life for service users. Care plans had significantly improved since the last inspection, and the care plans viewed were very comprehensive, containing good information and clear strategies for supporting peoples’ needs. As some service users were not able to communicate their needs and preferences, detailed care plans are important for ensuring that staff understand and meet their needs. Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 6 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. Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 7 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 Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had information available to help service users make a choice about where to live. The home ensured that prospective service users’ needs were assessed prior to admission, and that the home could meet their needs. EVIDENCE: A copy of the home’s ‘statement of purpose’ and ‘service user guide’ had previously been provided to the CSCI and met regulatory requirements. However, the statement of purpose did not include room sizes (just a reference to a floor plan, which was not included), and this should be added. The service user guide included a pictorial version of the complaints procedure, but the whole document was not yet available in alternative formats and the home should explore ways of providing information in different formats. One service user had only recently come to live in the home. The preadmission assessment process was discussed with the manager: this was very thorough, involving contact with the service user and with the health and social care staff involved in the person’s referral to the home. The manager had produced a clear record of this assessment, covering all relevant aspects of the individual’s needs. Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 9 From records seen and discussion with manager and staff, it was clear that the home made sure they could meet someone’s needs before admitting them. Staff received training relevant to the needs the home aimed to meet. It was noted that the home currently provided a service for four people with quite challenging needs, and appeared to have clear strategies in place for meeting these needs. Rawlings House DS0000062568.V306845.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. Assessed needs and personal goals were reflected in care plans. Service users were assisted to make decisions, and risks were appropriately assessed. EVIDENCE: Care plans viewed for two new service users were comprehensive, covered all relevant areas of need (e.g. safe environment, personal care, eating and drinking, mobilising, communication, working and playing, etc.), and identified any risks and the action required. Additional risks specific to the individual were recorded on a separate risk assessment form. In both cases files included a detailed ‘Behaviour Management Strategy’ for specific behaviours that the service user needed support with. Both individuals had only come to live in the home in the last six months, and so individual care plans had not yet been reviewed. Not all care plans and risk assessments had been dated when they were implemented, and the manager was advised to ensure this is done. One of the service users had the ability to be involved in the development of their care plan, and it was good to see that they had signed these to confirm that they had discussed them and had agreed to them. Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 11 The identification and management of risks was clear throughout the care planning process, with clear procedures for managing individual behaviours that could put the service user or other people at risk. Most of the service users had quite limited verbal communication and limited capacity to make decisions about their lives. The way staff offered choices and helped individuals to make decisions was discussed, and staff spoken to showed good knowledge of individual likes and dislikes, and of how service users indicated their wishes. Care plans also covered communication abilities and needs, but from discussion with staff the home did not appear at present to have explored any alternative methods of communication with service users (e.g. Makaton, picture boards, etc.). With one service user there was good evidence of how the manager had involved them in various aspects of their life in the home (e.g. their care plans, menus, etc.) and had made efforts to ensure they understood this. Rawlings House DS0000062568.V306845.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): 13, 14, 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. The home supported service users access the local community, and to engage in appropriate leisure activities. The home encouraged relationships with family and friends. The home promoted choices and flexible daily routines, and provided suitable meals. EVIDENCE: Due to the level of support they currently require, none of the service users at Rawlings were able to engage in any paid or voluntary work opportunities at the time of this inspection, and most lacked the capacity to engage in further education or training. Standard 12 has therefore been considered not applicable at this current time at Rawlings. Most of the activities taking place at Rawlings were therefore leisure activities. There was a weekly activities programme for the home, incorporating minibus rides, shopping, walks, art and crafts, cookery, relaxation, Gateway Club, visit to the pub, foot care, TV and videos. The manager explained that the current Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 13 individuals and their particular needs, wishes and abilities limited the activities that could take place. The home was well equipped with TV and video facilities (including Sky TV), and had also provided some gym equipment, a snooker table and a play station for one resident who spent a lot of time in the home. As this is the first year that the home has been operational, no holidays have taken place to date, but staff stated that they hoped to provide opportunities for holidays in future. Although the home is non-smoking, it was good to see that the home had gone to some effort to provide facilities (a fire-proof shed to the rear of the property) for one service user who smoked. The home supports contact with families, encouraging visitors and inviting families to the home (e.g. for birthdays, etc.). Staff supported service users to keep in touch with families (e.g. assisting them to send birthday cards, and enabling one person to make daily telephone calls to their family). A service user spoken with was looking forward to a visit from their brother, and was clear that they could contact their family. Opportunities to make relationships outside of the home were limited by service users’ individual capacities, but three of the service users regularly attended a social club (Gateway Club). Daily routines appeared flexible, with service users able to spend time where they wanted around the home, to do what they wanted, to get up and go to bed when they wanted, and (where able) to be involved in planning menus. A service user spoken with was clear that they could choose what to do within the home. The group of service users had quite a diverse range of needs and abilities, and the daily lifestyle in the home reflected these. Any restrictions were noted in individual plans. Whilst service users were encouraged to assist with domestic tasks, this did not appear to be a significant part of their daily routines (through choice or ability), and was primarily the responsibility of staff. The home used local community resources (e.g. shops, bowling, etc.). A sample of menus viewed contained an appropriate range of meals, had been developed with the involvement of one of the service users, and aimed to provide a balanced diet. The manager stated that although choices were offered where possible (and most of the service users were able to indicate if they did not want something), the menu was mainly based around staff knowledge of individual likes and dislikes identified through the assessment process. A service user spoken with was happy with the meals provided. Menus for each week were maintained, showing any changes made to the planned menu. It was recommended that staff record on the menu the vegetables served each day, to ensure a better record of nutrition provided. No service users had any specific dietary requirements. Rawlings House DS0000062568.V306845.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. The home provided personal support in the way service users preferred and required, and ensured that healthcare needs were met. The home had appropriate procedures for the administration of medicines, but not all aspects of the recording of medicines was satisfactory. However, based on previous knowledge of the provider the CSCI is confident that appropriate action will be taken to address medication issues identified. EVIDENCE: Care plans reflected the support or assistance that individuals required for their personal care, including any preferences; staff showed good knowledge of individual needs in relation to supporting their personal care, including promoting independence. Most of the home’s staff were male, reflecting the gender of the group of service users; senior staff and more experienced staff acted as key workers, and the manager stated that there was a key working policy (not viewed) and that they ensured that staff had the abilities to meet service users’ needs. The home showed good liaison and partnership working with specialist support services involved with one service user. Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 15 Most of the current service users were unable to make decisions about their own healthcare needs, but the manager had extensive knowledge in this area and reported that good support arrangements had been established with the local GP. One person had epilepsy, and the manager stated that staff had received training appropriate to this person’s needs (evidence not inspected on this occasion). Files were seen to contain a record of healthcare appointments, and records relating to health care issues (e.g. record of people’s weights, etc.). The home has a policy and guidelines on the administration of medicines, covering storage, administration and recording of medicines. This described appropriate practices and procedures; it is recommended that it should also include guidance on returning unused medication to the pharmacist (including retaining medication for seven days in the event of a death). Medication dispensed to the home was stored in secure lockable storage facilities. The home did not have a controlled drugs cabinet as no service users were on any controlled medication; the manager was aware of the need to provide one if the need arose. A bottle of liquid medication viewed had not been dated on opening: the manager advised that normal practice would be to date bottles of liquid medication. This should be monitored to ensure that staff follow this practice. Medication administration records (MAR) were printed by the pharmacist to show medication details and administration instructions: where some additional medication details had been entered by hand by staff, several entries seen had not been signed or dated by the person making the entry, and the quantity of medication received by the home (or carried over from the previous month) had not been entered. This needs to be addressed in order to reflect who has been responsible for entering these instructions, and to monitor the quantity of medication being held. Records of medication administered were satisfactorily maintained. Rawlings House DS0000062568.V306845.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. The home has procedures for listening to and responding to concerns. Practices and procedures in the home protect service users from abuse. EVIDENCE: The home has a clear complaints procedure that is described in the service user guide, which also includes a pictorial version. The manager advised that an audiotape version was also available. A service user interviewed was clear who to speak to if he had any concerns, and felt able to do so. No advocates were currently involved: the manager stated that all four service users had outside family or representatives who were involved with them and would advocate on their behalf. Three service users’ representatives completed feedback forms as part of this inspection: two confirmed they were aware of the home’s complaints procedure, and all three had either not had cause to complain, or if they had they had been happy with the way the home dealt with it. As one person was not aware of the home’s complaints procedure, it was recommended that families of new residents be given a copy of this. The home has a policy and procedure on ‘suspected abuse’. This included definitions of different types of abuse (it is recommended this should include institutional abuse), indicators of abuse, and procedures to follow in the event of suspicion of abuse (including reference to clear recording). It was good to see that the procedures incorporated referral to social services or the police, and referred to guidance published by the Essex Vulnerable Adults Committee. It is recommended that the procedure should also include the requirement to notify the CSCI of any abuse concerns. Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 17 All staff apart from the newest member had attended Protection of Vulnerable Adults (POVA) training; the manager stated that POVA issues were discussed in staff meetings and staff reminded to report any queries or concerns and to question all accounts of injuries. Two staff files viewed showed evidence that the staff members had attended training in Understanding Challenging Behaviour; staff were also in the process of attending training workshops in ‘Non-Violent Crisis Intervention’, and the manager stated that staff were not allowed to deal with incidents of aggression until they had received this training. POVA issues were not specifically discussed with staff on this occasion. Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 18 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, 25, 26, and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a homely, comfortable and safe environment, which is clean and hygienic. Bedrooms provide sufficient space and facilities to meet service users’ needs and lifestyles. EVIDENCE: The home was purpose built, and provides level access ground floor accommodation for up to eight residents, all with individual bedrooms. It is located on a housing estate in the community, within easy access of local shops and a few miles from the town centre. On the day of this inspection, the premises were clean and safe, comfortable, and in a satisfactory state of decoration. As the home was only registered last year, premises issues were not inspected in detail on this occasion. Bedrooms were spacious and contained appropriate furniture and fittings; seven of the rooms have ensuite shower facilities. The manager reported that staff had not yet attended any specific infection control training, but confirmed that the home had policies and procedures relating to infection control practices, including hand washing and the disposal Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 19 of clinical waste. Staff had attended food hygiene training. The home has a laundry area that is away from areas where food is stored or prepared, and was equipped with appropriate washing and drying facilities. Procedures for dealing with soiled linen were not specifically inspected on this occasion. On the day of the inspection the home was free from any offensive odours. Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 20 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, 33, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff were appropriately trained, and the provider was progressing plans to ensure that staff achieved suitable qualifications. The home provided sufficient numbers and skills of staff to meet service users’ needs. The home’s recruitment practices protected service users, but not all documentation was satisfactory. However, on the basis of previous experience of this provider, the CSCI is confident that action will be taken to address any issues identified. EVIDENCE: On the day of the inspection it was noted that there were four staff on duty, and rotas showed that this was the usual staffing level for current residents, with one waking and one sleep-in staff member at night. The high level of staffing reflected the particular needs of current residents and the fact that all of them had some one-to-one staff time allocated each day. It was therefore good to see these needs being met. However, it was noted that to cover staff absences over the summer period, some staff (including the manager) were working up to four consecutive long days each week: the manager was advised that these hours were excessive, and that staff health and welfare should be closely monitored. Staff spoken to felt that they could manage these hours, and it was acknowledged that the Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 21 needs of residents were such that consistency of staff was important. Staff are commended for their commitment in this, but the home should work towards having a sufficient pool of staff to ensure that staff absences can be covered without excessive additional pressure on remaining staff. It was noted that further recruitment was in progress. The file of one new staff member was inspected for evidence of recruitment practices. This contained a completed application form incorporating employment history and a declaration of criminal record. It was noted that there was a significant gap in the employment history, and the manager was advised of the need to ensure a written explanation of any gaps. Recruitment evidence included two written references (including the last employer), evidence of identification, and photo, and a satisfactory Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) check. The manager stated that POVAfirst checks were also often obtained first on new applicants, although he preferred wherever possible to wait for the full CRB to be returned. The manager was advised to ensure that there is a record of when the home receives notification of any POVAfirst checks, as this was not currently being recorded. At the time of this inspection the home employed nine care staff: three of these had already completed NVQ level 2, and the manager stated that the remaining six were due to enrol on this training soon. As the home is still within its first year of being operational, it was acceptable that plans were being progressed for staff to attain suitable qualifications. The manager stated that new staff complete an initial five-day induction (recorded on a checklist showing the issues covered) followed by the Learning Disability Award Framework Induction and Foundation programme (evidence not viewed on this occasion). The file of a new member of staff was viewed, and provided evidence of the five-day induction checklist: this had not yet been fully signed off, and the manager was advised to ensure that evidence is complete. Training records took the form of certificates on individual files: there were not yet any individual training profiles in place to easily monitor the training completed and identify training needs, but it was recognised that whilst the home is so small this can be easily monitored by the manager. On the sample of files inspected there was good evidence of training already completed by staff (e.g. one carer had attended training in seven topics this year). It was noted that several key training areas were covered during a one-day workshop, and the manager is advised to ensure that this provides sufficient input on each subject area, and also to ensure that individual staff learning outcomes are achieved from this (as people differ in their learning styles, and this course provided a very intensive input of information over a very short time). The manager confirmed that most staff had attended all key training, that POVA, Food Hygiene and moving and handling were planned for new staff, and that staff who had not already completed training in ‘non-violent crisis Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 22 intervention’ were due to attend this in August. The manager showed a commitment to ensuring that staff were appropriately trained. Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 23 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. There were no significant weaknesses in areas relating to health and safety issues or management. Service users benefit from a well run home, and health and safety practices promoted service users’ safety. Although there was insufficient evidence to demonstrate formal quality assurance processes to underpin the review and development of the home, as the home is still within its first year of operation, the CSCI is confident that the provider can manage this area of improvement. EVIDENCE: The Registered Manager has extensive previous training and experience, with both healthcare and higher management qualifications that exceed the requirements of the National Minimum Standard. He demonstrated an open and transparent approach to running the home, and staff reported that he was approachable and supportive. Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 24 The home had a quality assurance questionnaire for use with parents/relatives of service users. It was noted that most current service users would be unable to respond to questions about the service, and it was recommended that the manager and staff explore other ways of gaining ‘feedback’ from service users, and of evaluating the quality of life provided to them at Rawlings. The manager stated that care reviews form part of their quality assurance, providing a forum where care managers and families could comment on the service, and that parents ‘advocated’ for service users: the home should explore whether any other forms of advocacy support are available. It was clear that Rawlings encouraged and invited feedback on the service, and that service users’ needs were central to the service. However, the home needs to develop formal quality assurance processes, and to explore other ways of evaluating the service from a service user perspective. The home did not have an annual development plan: the manager explained that they had not developed one whilst the home was in its first year of operation and had few service users. He stated that their main aim this year had been to progress NVQ and LDAF training, and that a development plan would be established in due course. The manager carried out internal monitoring through supervisions, staff meetings, working alongside staff, carrying out periodic spot checks and monitoring health and safety issues; no specific monitoring records were made from these activities at present, other than supervision and team meeting records. The home had a health and safety policy that described employer and employee responsibilities. Staff training records showed that staff attended relevant health and safety training (e.g. food hygiene, moving and handling, fire safety, first aid, etc.). The home appeared safe and well maintained on the day of the inspection. Records viewed showed that appropriate internal and external checks on utilities and equipment were carried out (e.g. gas and electricity, fire equipment, hoists, electrical equipment, bath temperatures, fire drills, etc.). The home had a Legionella policy and the water had been tested earlier this year. However, there were no other formal systems for controlling risk of Legionella (e.g. monitoring of central hot water storage temperatures, running unused shower heads, etc.). It was suggested that the home should seek advice with regard to this, and include this issue in the home’s risk assessments. The manager stated that shower temperatures were pre-set to a safe temperature; it was noted that radiators had low temperature surfaces. The home had a range of relevant risk assessments covering safe working practices, although these needed dating on implementation. Hazard sheets were available for chemicals in use in the home, but risk assessments did not cover the use and storage of chemicals, and this was recommended. Only the policies and procedures referred to in this report were inspected on this occasion. Other than the complaints policy, other policies and documents relating to service users (e.g. service user guide, care plans, etc.) were not yet available in any alternative formats. The home should explore methods for Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 25 trying to make key information more accessible to service users. It was noted that the home had obtained a computer programme for using supportive symbols to illustrate information. Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 N/a 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 27 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. 1 Standard YA20 Regulation 13 Requirement It is required that all medication details and administration instructions entered by staff onto the medication administration record are signed and dated by the person making the entry, and include the quantity of the medication received by the home or carried over from the previous month. The registered person must ensure that there is a written explanation of any gaps in the employment history of staff being recruited by the home. The registered person must develop formal quality assurance processes in the home, and establish ways of evaluating the quality of the service received by service users. Timescale for action 30/08/06 2 YA34 19, schedule 2 20/08/06 3 YA39 24 31/12/06 Rawlings House DS0000062568.V306845.R01.S.doc Version 5.2 Page 28 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 YA1 Good Practice Recommendations It is recommended that the home’s statement of purpose and service user guide reflect how the home meets the premises standards identified in Standard 1.1, and includes room sizes (ref Reg 4, Schedule 1.16). Where service users have limited verbal communication skills, staff should explore ways of developing alternative forms of communication. It is recommended that daily menus (records of food served) include details of the vegetables served with main meals). It is recommended that the relatives of new service users are given a copy of the home’s complaints procedure. It is recommended that the home’s policy/procedure on responding to suspicion of abuse include reference to notifying the CSCI. It is recommended that staff receive training in infection control issues and practices The registered person should ensure that there are sufficient staff employed by the home so that staff do not have to work excessive hours, and should monitor the health and welfare of any staff working long hours. The registered person should ensure that there is a written record of when the home received a POVAfirst check, in any instances where a new carer starts work prior to the full CRB/POVA check being received. It is recommended that all staff have an individual training and development assessment and profile, in order to inform the planning of the individual and the staff team. It is recommended that the registered person implement and annual development plan and systems for internal monitoring/auditing, as part of the home’s quality assurance processes. It is recommended that the home explore the development of relevant information in formats that are more accessible to service users (reference also Standard 1). It is recommended that the home’s risk assessments on safe working practices include control of risk of Legionella, and the safe use of chemicals within the home. DS0000062568.V306845.R01.S.doc Version 5.2 Page 29 2 3 4 5 6 7 YA7 YA17 YA22 YA23 YA30 YA33 8 YA34 9 10 YA35 YA39 11 12 YA40 YA42 Rawlings House Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. 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