CARE HOME ADULTS 18-65
Rhodelands Care Home Babbs Lane Doveridge Derbyshire DE6 5JT Lead Inspector
Vanessa Davies Unannounced Inspection 27th July 2006 09:30 Rhodelands Care Home DS0000062996.V306416.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 Rhodelands Care Home DS0000062996.V306416.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. Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Rhodelands Care Home Address Babbs Lane Doveridge Derbyshire DE6 5JT 01543 437030 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) Milbury Stuart McCallum Powell Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th October 2005 Brief Description of the Service: Rhodelands is a large detached home in a quiet secluded lane. It is surrounded by large well-maintained gardens. All areas of the home and garden are accessible to the service users. There are a number of communal areas including a large, well-furnished conservatory. All bedrooms have en-suite bath or shower room. At the time of inspection there was a large log cabin being built within the grounds, it has a sensory room, an activity room and a small canteen with a vending machine to be fitted to meet the needs and expectations of service users. The home provides long term care for adults with a learning disability. Transport to access the community is also provided. Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Information for this report was gathered before during and after the visit. Information was gathered by reading records, speaking with service users and speaking with staff. The manager was on annual leave at the time of the visit. The inspector would like to thank the service users who took the time out to provide valuable information for this report. What the service does well:
Detailed assessments of need provide valuable information assisting staff to meet the needs of the residents. Risk assessments in place ensure that service users are able to lead a full and valued lifestyle taking necessary daily risks. Positive relationships between staff and service users and detailed care plans ensure that social, emotional and physical needs are met. The manager promotes positive working relationships with both the staff team and the service user group. He has gathered valuable information within the assessments of need and developed a service user plan from this. Details of likes and dislikes are documented. Service users confirmed that they are consulted with; they have arranged activities, planned menus, completed shopping and have a choice of which member of staff to work with. Files relating to the service users are kept up to date. Family and friendship contact is supported and encouraged, each file examined had a list of friends contact numbers and addresses. Service users rights to privacy and choice are respected and the inspector observed this on the day of the inspection. Complaints are taken seriously and documented. There is a complaints procedure in place. Service users spoken with were confident that any issues they raised with staff would be dealt with appropriately. The organisation has a policy in place to train staff to manage challenging behaviour within 3 months of commencing work at the home. Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 6 Fire alarms, lighting and extinguishers are checked weekly. The operations manager completes unannounced visits and seeks the opinions of the service users during these visits. What has improved since the last inspection? 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. Rhodelands Care Home DS0000062996.V306416.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 Rhodelands Care Home DS0000062996.V306416.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): 2 Quality in this outcome area is good. Detailed assessments of need provide valuable information assisting staff to meet the needs of the residents. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: Each of the 2 service users’ files examined had a completed assessment of need, one of the files had detailed information from the previous placement and a community care assessment and review. There was evidence of regular professional reviews taking place. There was evidence of input from a variety of other professionals; community nurse, neurologist, GP and psychiatrist. The service users spoken with were aware of their files and their right to access them and it was clear that one service user who spent time with the inspector, did access his file. Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 9 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): 6,7,9 Quality in this outcome area is good. Risk assessments in place ensure that service users are able to lead a full and valued lifestyle taking necessary daily risks. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: Service users spoken with stated that the staff support them to make decisions and to take risks, this was evident when reading the care files. Service users are supported to continue contact with friends from previous placements as well as their family. Each of the files examined had risk assessments in place to meet the needs highlighted in the assessments. There is a missing persons procedure in place and service users who are at risk of wandering have an individual risk assessment on place.
Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 10 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): 12,13,15,16,17 Quality in this outcome area is good. Participating in a variety of activities within the community ensures that service users become valued members of society. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: The inspector spoke with 2 service users who confirmed that they participate in a number of activities. A number of service users have had a holiday this year and this was discussed with the service user who accompanied the inspector throughout the inspection. Information within the files evidenced activities and likes and dislikes of the service users. The member of staff spoken with stated that they try to involve service users within the local community as much as possible, with visits to the local pub,
Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 11 library, supermarket and again this was confirmed by the service user spoken with. One service user was planning a shopping trip on the day of inspection. The inspector did not examine the menus, however the member of staff stated that menus are kept. Service users spoken with stated that they decide menus between them and then do the shopping between them as well as being involved with the preparation of the food. Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 12 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): 18,19,20 Quality in this outcome area is adequate. Positive relationships between staff and service users and detailed care plans ensure that social, emotional and physical needs are met. However, lack of medication training potentially puts service users at risk. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: It was evident on the day of inspection that service users are treated with respect. Staff knock on doors prior to entering. Service users are provided with information in a simple format, eg. Photographs of staff on duty are put up on the office door with a photograph of the service user they are working with beside them, one of the service users is registered blind and information is made available to her in Braille. Service users stated that staff make appointments when necessary and take them to the appointments. It was evident in service users files that staff meet the needs highlighted in the assessments. Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 13 The home keeps a record of all medication received and administered. Medication was seen to be stored appropriately. Medication is currently not being recorded appropriately when being administered and evidence gathered on the day of inspection highlighted that medication is being administered by staff who are not trained to administer. Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 14 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): 22,23 Quality in this outcome area is adequate. Service users felt staff listened to what they had to say and this gave them confidence that the staff team would address any issues raised. Policies are in place in respect of Adult Protection, however there is a potential for service users to be at risk of abuse due to the lack of staff training in this area. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: Service users spoken with were confident that staff listened to them and addressed any issues they may have. The complaints record was not examined on this occasion. Training records examined evidenced that members of staff have received training in NVCI (Non violent physical crisis intervention) to assist them with the management of any aggressive outbursts. A number of staff need to undertake adult protection training . There is a clear policy and procedure in place relating to Adult Protection and managing challenging behaviour. Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 15 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): 24,30 Quality in this outcome area is adequate. At the time of this inspection the environment had not been maintained to the required standard to provide a safe environment for the service users. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: The inspector was invited to look at one service user’s bedroom, it was very personalised, however one of the windows was smashed and had been for a number of weeks. 4 bedrooms on the ground floor have an en-suite bath or shower and 3 bedrooms on the first floor all have en-suite; 1 with a bath and 2 with a shower. There is a large furnished conservatory, a large lounge area and a separate dining area off the kitchen. The kitchen is fully fitted and meets the needs of the service users. The hall carpet was very dirty, as was a bedroom carpet highlighted on the day and the stair carpet was torn. There was a malodour in the lounge. A member
Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 16 of staff spoken with stated that she thought the carpets were due to be replaced and the bedroom carpet would be cleaned. Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 17 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): 31,35 Quality in this outcome area is adequate. Lack of staff training potentially puts service users at risk. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: Staff spoken with were aware of their roles and responsibilities. All staff observed on the day of inspection worked very well and positively with the service users. The inspector was unable to examine staff records as the manager was on annual leave on the day of the visit. There are gaps in the staff training, as detailed earlier within this report, all staff need to complete adult protection training and medication training. Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 18 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): 37,39,42 Quality in this outcome area is good. A suitably qualified manager with support from senior management ensures that the service changes with the needs of the service users. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: The manager has relevant experience and the necessary skills to manage this service. He works with an open door policy and service users spoke with on the day of the visit were confident about approaching him with any problems they may have. There are detailed policies and procedures in place to safe guard service users. Staff are aware of these and able to access whenever necessary. Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 19 The Operations Manager completes monthly, unannounced monitoring visits, in addition to other visits throughout the month. During these visits she seeks opinions of the service users and documents them. The fire files are up to date. Alarms, emergency lighting and extinguishers are audited on a weekly basis. Fire drills are completed 2 monthly. Accident records are clear and up to date. Fridge and freezer temperatures are completed daily and within safe limits. Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 20 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 X 2 3 3 X 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 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 3 32 X 33 X 34 X 35 2 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 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES 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 YA23 Regulation 18(1ai) 13(6) Requirement The Registered Person shall make arrangements by training staff to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. (HIGHLIGHTED AT PREVIOUS INSPECTION STILL OUTSTANDING) The Registered Person must ensure that staff receive the training appropriate to the work they undertake. The Registered Person must have two written references and evidence of a criminal record certificate on file for each person working at the home. Staff must receive training in administration of medication. The home must be in a good state of repair. Timescale for action 30/09/06 2. YA32 18(1ai) 30/09/06 3. YA34 7,9,19 Sch 2(5&7) 18.1 a I, 13.2 23.2 b 30/09/06 30/09/06 31/10/06 4 5 YA20 YA30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 22 No. 1. 2. 3 Refer to Standard YA32 YA30 YA30 Good Practice Recommendations The Registered Person should ensure that staff receive training in courses highlighted within the report. The carpets highlighted on the day of inspection should be cleaned or replaced. The window highlighted on the day of inspection should be replaced. Rhodelands Care Home DS0000062996.V306416.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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