Inspection on 28/07/08 for Roann House

This inspection was carried out on 28th July 2008.

CSCI found this care home to be providing an Adequate 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.

Other inspections for this house

Roann House 19/02/08

Roann House 27/06/07

Roann House 30/05/06

Roann House 11/10/05

Roann House 10/05/05

Roann House 15/11/04

Roann House 05/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Roann House 91 Bouverie Road West Folkestone Kent CT20 2PP Lead Inspector Mary Cochrane Unannounced Inspection 09:30 28th July 2008 X10015.doc Version 1.40 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 Roann House DS0000057418.V367658.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 Older People. 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. Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roann House Address 91 Bouverie Road West Folkestone Kent CT20 2PP 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) 01303 253705 01303 255057 roannhouse@onetel.com Roann House Ltd Mrs Sursatie Sanicharie Pieries Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One (1) Service User with DE whose date of birth is 24/04/1951. Date of last inspection 24th April 2008 Brief Description of the Service: Roann House (the Service) is registered to provide accommodation and personal care for 17 older people and one younger adult who experiences difficulties with aspects of comprehension. The home is a family run business. The property is a detached three storey house. There is a passenger lift that gives step-free access to the parts of the accommodation occupied by the people in residence. When full, there is provision for one of the bedrooms to be shared by two people. In practice, all of the bedrooms are used for single occupancy. Each bedroom has a private wash hand basin. There is a call bell system that enables people to summon assistance should it be needed. There are various aids such as a hoist to help those people who have difficulty getting about. There is a relatively small lounge and dining room. To the rear aspect, there is a large conservatory. At the back of the property there is an enclosed garden. The Service is located in a quiet residential street that is quite near to Folkestone town centre. This means that there is ready access to shops and public transport services. There is a limited amount of off-street car parking and there is also local on-street parking. People who might want to move in can get information from several sources. There is a Service Users’ Guide. This is a brochure that outlines the principal features of the facilities and services available in the Service. There is also a document called a Statement of Purpose. This gives a more detailed account of the provision in place than does the Guide. The Registered Provider ensures that a copy of the most recent Inspection Report from the Commission is available for reference. The range of fees charged currently for each person’s residence in Roann House, runs from £323.86 to £400.00 per week. Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This visit to the service was an unannounced “Key Inspection” which took place over one day. There were 2 inspectors and an expert by experience at the site visit. The expert by experience is a person who has received or had direct experience of care service. They looked at the social care and support that the people living at Roann House receive. All the core standards were looked at. We took into account information provided by Mrs Pieries who is the Registered Manager. We also spoke with Mr Pieries. He is the Responsible Individual. Mr. and Mrs Pieries daughter, who is an administrator and carer, also gave information to us. The people living at the home and the staff on duty were helpful and co-operative throughout the visit. To collect evidence for this report we spoke with residents in private and had discussions with the management team and staff. We observed how staff supported residents during the day and when offering care support. We looked at and discussed residents individual support plans and their risk assessments. We also looked at staff training records and the homes quality assurance. During this visit, we saw the majority of the home. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was also used in the report. The service had also sent us an improvement plan following the last key unannounced inspection. This was also taken into consideration. We also looked at information we have about concerns and complaints and how these have been managed. We also took into account the things that have happened in the service, these are called ‘notifications’ and are a legal requirement. In September 2007 a safeguarding adults alert was raised at the home. The local adult protection team subsequently have undertaken an investigation. Further visits by social services have continued to the home to monitor for improvement. At the present time social services have taken steps to prevent any admissions to the home, which are funded by them until their investigations are completed. Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 6 The commission also did a random inspection to the home in April 2008 to investigated concerns. What the service does well: What has improved since the last inspection? There have been no recent admissions to the home but the service is going to introduce a new assessment format. This should make sure that all prospective residents have been fully assessed before they come to stay at the home. This will ensure the home will only offer a place to someone if they can be sure they can give the support and care the person needs. Some of the staff have recently received training on support/care planning and risk assessments. They told us they will now be reviewing and changing the way they offer and give support to people at the home to make sure that all the residents needs are met in a way that is personalised and individual. The home has a choice of menus, which are nutritious and healthy. Residents told us that they enjoy the meals and they are offered a choice at meal times. Residents said,” The food is good. We do get a choice. Sometimes there is too much”. The systems to assist people to raise concerns and complaints have been reviewed and residents have received the information they need to make a complaint. However feedback was they were not sure they would use it. Some environmental work has been undertaken. The home is a more conducive and pleasant place for people to live. These improvements need to continue to ensure that residents live in a home that is well maintained homely and comfortable. Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 7 The service has now completes all security checks on staff before they come to work at the home. Residents are protected by the homes recruitment procedures. All staff have received the required training to make sure they have the skills and knowledge to look after people safely and effectively. All health and safety checks have been completed. This will ensure that residents live at a home that is as safe as it can be. What they could do better: All residents need to have a care/support plans and risk assessments. These need to be individualised and person centred. The plans need to focus on what people can do for themselves and the input they need from staff when they need support and assistance. The staff need to have clear guidance and direction so residents needs can be supported and met consistently in the way that they prefer. This will promote independence and autonomy for residents while keeping them as safe as possible. The medication practises and procedures need to be tightened up to make sure that the residents receive their medication safely as possible. Activities and leisure pursuits need to be further developed so as to allow and encourage people to have meaningful and active life that suits their preferences and capabilities. The registered manager needs to make sure that staff competencies are regularly checked to confirm staff remember how to do things as they have been trained. All staff need to receive specialist training to make sure they can identify peoples needs and care for them in the best way. Interaction and communication between some staff and the residents needs to be improved. Staff need to approach residents in a caring and supportive manner. The service needs to develop a maintenance and renewal programme to make sure that they have identified the areas within the home that need work. They can then continue improving the environment to ensure it is maintained to a good standard for the people who live there. Areas of the home like the garden need to be improved so people have a pleasant place to sit in the better weather. The quality assurance system need to be further developed to ensure the home is improving the service it offers to the residents. Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 8 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. The summary of this inspection report can be made available in other formats on request. Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use the service experience adequate quality outcomes in this area. Existing residents have not been fully assessed prior to coming to live at the home. Future residents will now receive a full and thorough pre- assessment by a person with the necessary skills and knowledge before they are offered a place at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no new admissions to the home since the last key unannounced inspection in February 2008. This is because there is a safe a guarding adults alert in progress and social services will not be placing anyone at the home until they have completed their investigation, although this does not prevent people who are privately funded from accepting the service of the home. Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 11 The service have reviewed their pre-admission procedures and have recently received training. The service has now purchased an assessment format which looks at the person as a whole. At the time of the visit the home had not received the the new format so we were unable to see it. But we did speak to the trainer/consultant who delivered the training. She told us that the tool will identify the persons care/support needs and also looks at all aspects of their lifes. It will also give information about their past, their likes and dislikes, pastimes and preferences. The home have already gathered some of this information from exsisting residents so that it can be used in support and care planning. This will be used as baseline information to monitor whether people improve or deteriorate after they have come to live at the home. As the home have not yet received the new format and have had no new admissions the pre-assessment tool is yet to be tested. The service does not provide intermediate care Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People who use the service experience adequate quality outcomes in this area. Residents cannot be sure that all their needs will be identified and met and that all risks are minimised. The homes medication procedures need to fully protect the safety of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the visit the home were awaiting the paperwork to transfer the care plans of the residents onto a new format. We were able to see one plan, which had been started. The responsible individual who is also a carer, the registered manager and the administrator/carer recently received training on support /care planning and Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 13 risk assessment. The new plans are more person centred and look at all aspects of support and care needed by the residents. They are easier to follow and focused on what people could do for themselves. The areas where personal care and support is needed will give clear guidance to staff. The plan also included other areas such as social, behavioural and cognition. These areas will need to be further developed so that staff have the guidance and direction on how to best look after the people in the home. The management told us that they are going to ask the trainer/consultant to assist them in getting all the plans transferred over so the process can be completed as soon as possible. The trainer/consultant reported she had not yet been asked to do this but will wait for the registered provider to contact her. It will be up to the provider to make sure the plans are used effectively. Four other plans were looked at. Information was available on residents’ likes dislikes and preferences. There was also profiles that gave information about peoples pasts and how they liked to live their lives. The quality of information in plans did vary. The administrator/carer had gathered information about residents. This did identify some of the health and personal needs but had not moved on to the next step on how staff were to support residents to make sure their needs are met. There was no indication that residents had been involved in developing their own plan and telling staff how they would like to receive the support that they needed. The plans did not promote independence and autonomy. They concentrated on what residents couldn’t do and not what they could. Support plans should promote independence and self-esteem. The management team are aware of this and said that this will be rectified when they move on to the new system Some plans had not been up-dated to reflect the changing needs of the people living at the home. For example some people have diabetes and this was recognised in their care plans. However there was no individual information on what staff should if the persons blood sugar became too high or too low. There was no information on what signs and symptoms to look for and what action to take. The care staff have not received training on diabetes. The manager and responsible individual of the home did know the signs but other staff do not. This leaves the residents at risk. Some risk assessments are in place. There are risk assessments in place for bedrails and some residents had risk assessments in place for mobilisation and pressure areas. However not all areas of risk have been identified and what action is needed to keep risks to a minimum while allowing residents to be as independent and as possible. Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 14 The care plans are kept in an upstairs office. The plans are not being used as a daily working tool by the staff. The responsible individual writes all daily records. This was highlighted at the last inspection and also by social services. This means that information may not be accurate and precise as it is second hand. This issue needs to be addressed. The management team is working towards making the plans more concise and individualised to ensure that residents and staff use them as daily working tool. This means eventually all the needs of the residents should be met in the way that suits them best. The home does not have a person centred approach to care. At present care needs are met in a task orientated way. Plans are not up-dated to reflect the changing health needs of the people living at the home. The registered manager does make sure that all the health care needs of the residents are met. Each resident is registered with a local G.P. and any area of concern related to health is referred to the G.P. There was evidence of GP visits and also visits by the district nurses team and subsequent treatment. However care plans had not been updated to reflect the outcomes of the treatment. The registered manager accesses other specialist services when the need arises. The residents have regular appointments with opticians, a chiropodist and dentists. Medication is stored safely at the home, which uses a pre-dispensed system for administering medicines. This means that the medication is administered to residents more safely as it has been pre-packed by the pharmacist in blister packs. All staff who administer medication have received training. A sample of prescription sheets were seen all prescriptions sheets had been signed to indicate that residents had received there medication on time and safely. The home does not carry out medication audits. It was seen that some medications had been hand written on the dispensing sheets. They had not been signed or dated. Staff need to make sure that any hand written entry has been confirmed as correct and then signed by the 2 people who have made the entry. Some of the people living at the home are prescribed medication (this includes analgesia, topical creams, eye drops) on a ‘when required’ basis. There is no written instructions and guidance for staff to ensure that the medication is administered consistently and can be monitored. The effects of pain relief are not being monitored. The manager said that some special pain relief medication is given for other reasons than what it is prescribed for. Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 15 All the pictures of the residents were at the front of the file so this did not help to identify which prescription sheet belonged to who therefore did not reduce the risk of errors in giving the wrong medication. We were told that some residents did not want to have their picture taken. The home needs to document this. Through observation and from talking to the residents and staff there was evidence to show that some staff were aware of and upheld the privacy and dignity of the residents. Some staff were observed assisting the residents in a caring and supportive manner and were seen treating them with respect and understanding. Some members of staff were observed demonstrating good body language and communication skills when interacting with the residents. Other staff were observed paying little attention to the residents. During her time at the home, the expert by experience reported that a member of staff did not talk or interact with the residents “I saw no evidence of the staff member talking to residents, only to the family visitor when she was given a cup of tea”. Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 14,and 15 People who use the service experience adequate quality outcomes in this area. The home needs to evidence and demonstrate how it offers more diverse choices to people so they are supported and encouraged to be independent and in control of their life’s. Family links are encouraged and maintained wherever possible. Residents are able to make some choices in regard to their lives, but this needs to be developed and reflected in the residents’ care plans. People are free to spend the day as they wish. The home provides nutritious and varied meals for the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does have an activities programme in place. There was evidence that some activities do take place but this seems to be on an adhoc basis. Residents reported that they sometimes have exercise sessions and bingo. The Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 17 home does not keep a record of the activities that have been organised and undertaken. There was little evidence to show what activities people had done during the day. There was no clear system to show what activities had taken place. There was nothing to say if the person enjoyed an activity or not, whether they fully participated or whether they got fed up. The home does not incorporate how people would like to spend their time within their care plans. There is no evidence to show that people are being supported to do what they like to assist them to enjoy a fulfilling life as possible. Activities need to be more tailored to meet the individual needs of the residents depending on their abilities and interests. Some daily records said that residents participated in music, read magazines but this did not relate to the activities programme. The provider told us they keep the programme flexible pending on what residents want to do. There was no evidence in place to support this. The expert by experience reported that there was little to do at the home. . Care staff members told us that she did not know what happened in the afternoon, as she was never there. Another person said,” all they do is exercise sessions and not many people join in”. This feedback tells us that the home must make sure people are offered regular and interesting things to do. Relatives said they are made to feel welcome at the home at all reasonable times. There is a request that relatives avoid mealtimes but the registered manager said this is flexible. Residents are able to receive their visitors in the privacy of their own rooms or in the communal areas. The people spoken to felt they are able to have some choice in regards to their day-to-day life’s’. Examples given were that they could get up and go to bed when they liked. They could choose what to eat and where to eat their meals. Generally they felt happy with the limited choices they are offered. All residents are invited to attend residents meetings, which are held at regular intervals. The meetings give people the opportunity to express their views and make suggestions regarding their care at Roann House. There was evidence which indicated that people are listened to and do have some say with regards some activities and menus. The service told us that Roan House has four menus in rotation. All menus were devised with input from the residents and relatives. An alternative is always on offer, but the expert by experience reported that the menu on the notice board would be difficult to for those with sight problems. We did observe that the meal of the day was written in large writing on a board in the Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 18 dining room. All meals are recorded on separate breakfast, lunch and supper lists – Menus are posted on the notice board and all residents are made aware of this at the beginning of each week. Likes and dislikes are recorded in resident’s profiles and a chart of all service users likes/dislikes is also displayed in the kitchen. Breakfast, lunch and supper lists are already in place and completed daily by staff. Residents told us that they did have a choice about the menu and their preferences are considered. The home employs a cook to work throughout the week who prepares the main meal at lunchtime. The staff keep a record of meals and who has chosen what. They do not record the amount of food eaten by the residents. This means any dietary issues may not be easily identified and might be over looked. This was discussed with the management team and they said they would now record the amount of diet eaten by residents so issues can be quickly identified and acted on. A lunchtime meal was observed; this was relaxed and unhurried with residents able to take their time to enjoy the food. Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience adequate quality outcomes in this area. The home’s recruitment procedure ensures staff are suitable to work with vulnerable adults. All staff have attended a training day on ‘the protection of vulnerable adults’. There is a complaints procedure, but we are not confident that everyone feels that they can use it. The home has no involvement in the service users’ money and financial affairs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We were told that the residents have been informed of their right to raise concerns or complain. Written information about the complaints procedure and contact addresses is available to residents and on display in the home. The route to raise concerns and feel safe in a residential home needs to be open and available for all persons to use. Providers of good care services should promote that they are supporting and acting in the best interests of Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 20 people living in the home, encouraging people to feel confident to use it. Residents spoken with were aware that there is a ‘proper route’ for making a complaint if anything they raised with staff is not dealt with. It was not clear whether or not they would be inclined to use the formal procedure. Information was shared with us that residents did not feel confident that they could approach the responsible individual, who works in the home, with problems, and felt they may not be taken seriously. This is an ongoing concern, which continues to be the focus of the Safeguarding Adults (Social Services) investigation. We have further concerns about this matter this have passed this information to the local safeguarding team. Staff members have recently attended training on the protection of vulnerable adults and were aware of the home’s procedure and residents’ rights. We were told that there have been no formal complaints since the last inspection. The book for recording the nature of any complaint, the action taken and the outcome and time scale was therefore blank. The home’s recruitment procedure includes undertaking formal checks to ensure that potential employees are suitable to work with vulnerable adults. The home no longer has any involvement with service user’s personal monies or financial affairs. Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21,22, and 26 People who use the service experience adequate quality outcomes in this area The service needs to continue to improve and maintain the environment to provide people with a comfortable homely and safe place to live. On the whole the residents benefit from a clean environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked around the home. Mr Pieries is aware of the maintenance required in the home, but there is currently no formal plan in place for the renewal and redecoration to make sure the home provides comfort and safety to people who live there. We were told things get done on a when needed basis. Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 22 The home hasn’t had a cleaner for 3 months. They have advertised locally but in the meantime care staff are undertaking cleaning duties. We were invited to see some bedrooms. These were personalised and contained pictures and items that people had brought from home. Two of the bedrooms did need hovering but generally the home was clean. One bedroom light was broken. We were told that it would be fixed by the end of the week Bathrooms are bare in need of some upgrading but at the time of the visit they were clean. Cracked tiles in the bathrooms have been replaced. There are bath lifts for residents who need assistance. One bathroom was cluttered and did contain a large number of towels and other bathroom accessories like flannels and combs. We did visit resident’s rooms and they had their own individual towels and flannels, which had been used recently. Residents confirmed this. At the last inspection unpleasant odours were identified in various areas of the home at this visit no odours were detected, the home smelt fresh. The downstairs communal areas were generally clean and tidy. The conservatory was very warm and new carpet tiles had been put down. The conservatory was cluttered and there were Christmas decoration still up on the ceiling. Radiator covers been placed on most of the radiators but a few are yet to done. The garden /patio area at the back of the house is very bare and stark. The day of the visit was very warm and sunny but no one was using the garden. There was nothing in place to encourage people go and enjoy sitting out-side. The area was accessible to residents and the staff told us that sometimes people do sit out there. Mr Pieries did tell that he had recently employed a gardener who would be starting work on the garden. Paintwork and walls are chipped and marked in a lot of the areas through out the home. The expert by experience reported, “Roann House was clean although a little shabby, of the two rooms I saw both were clean but one very small” [to accommodate the persons belongings comfortably]. “The conservatory was bright and sunny but it was an extremely hot day. The lounge chairs were in good repair”. Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People who use the service experience adequate quality outcomes in this area. There are sufficient trained care staff available for most periods of the day. But with a lack of cleaner and cook at peak times, availability for social care, attention and activities may not be as it should. Staff have attended training courses and have been encouraged to undertake NVQ training to at least level 2. Staff training needs to be further developed so that all the needs of the residents are met. Recruitment procedures are in place to protect residents from risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Records show that a high level of mandatory training has recently been undertaken and staff said that they valued the training opportunities. All of the staff team, excluding Mr and Mrs Pieries, have attained, or are nearing completion of NVQ training at Level 2. (4 have completed and 1 is near completion). Staff are committed to continuing training and the home had Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 24 applied for placements for 2 staff to study NVQ at levels 3 and 4 with additional medication training in Sept ‘08. Staff have not received specialist training around diabetes, epilepsy and other specific areas that residents need support in. Staff spoken with are aware of their roles responsibilities to the service and its users. The staff roster allows for three care staff and the cook on the morning, 8am to 2pm shift. Two care staff on the afternoon 2pm to 8pm and two overnight. There are currently no domestic staff. Care staff undertakes cleaning and laundry duties. The Manager needs to ensure that this is not to the detriment of service user care nor does it compromise the opportunities for choice. There was limited staff/resident user interaction observed. Although staff were engaged in responding to the inspection team on the day, resident feedback suggested that improvements in general social contact were needed. Staff records show that the recruitment practice includes references and police safety checks. These take place prior to commencement of duties. The Management team has implemented staff supervision and appraisal sessions. The Management agreed to make sure that the new staff induction programmes are up to date and based on Skills For Care. Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People who use the service experience adequate quality outcomes in this area. The providers are qualified and experienced in provision of residential care and accommodation. Residents cannot be sure the home is run in their best interests. The providers are also part of the care team and thus are in a position to support and supervise the care staff. Up to date Statutory training for staff and current maintenance certification indicates that the health safety and welfare of residents and staff is promoted and protected. This judgement has been made using available evidence including a visit to this service. Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 26 EVIDENCE: The Registered Manager and the Responsible Individual share the management of the Service, they also both work full time on shift. Both are registered mental health nurses and have operated residential homes for a number of years. They, along with another family member complete the administration duties in the home. They also undertake care support duties and at least one of them is rostered for duty on all daytime shifts. Because of this, it was reported, the opportunity arises for quality assurance issues to be identified and resolved on a more informal and immediate basis. The views of the people who use the Service and their relatives have been sought in written questionnaires. A summary of the results has been written and is kept in the office. It has now reportedly been shared with the people who use the service. Examples of changes as a result of listening to people are; Changes to the menu, smaller portions in some cases, addition of favourites such as liver and bacon, one service user is diabetic but likes a beer at lunchtime so Mr Pieries obtained a suitable substitute. These changes need to be extended beyond mealtimes. People who live at the home should be confident in saying how they would like to further improved the service. Their views should be taken seriously and acted on. We discussed that there was no self-audit systems in place this is part of quality assurance. Having this written down is important so progress and improvement can be tracked. As part of the management development, and in light of what we have found with regard to outcomes for people who live at the home, the management team may wish to develop their formal reflective practice. This may be something that independent supervision could provide. There were a number of issues noted at the last inspection relating to the continuing health and safety of the staff and service users. Records show that staff members have now attended a range of safety related training courses in addition to NVQ training. Omissions to basic safety checks have been addressed and records show that equipment and installations have up to date and satisfactory inspection certificates. Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 2 3 X 3 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X N/A 3 X 3 Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 28 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 OP12 Regulation 16(2)(m) (n) Requirement The routines of daily living and activities made available are flexible and varied to suit service users’ expectations, preferences and capacities. The service needs to evidence residents are encouraged and supported to participate. There needs to be enough staff on duty (ancillary and care staff) to meet all the needs of the residents who live at the home. All staff employed at the home need to receive specialist training to make sure they can identify and meet all the specialist needs of the residents. Timescale for action 30/09/08 2 OP27 18(1)(a) 30/09/08 3 OP30 18(1)(c) 31/10/08 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 OP7 Good Practice Recommendations Daily records need to be written by the person delivering DS0000057418.V367658.R01.S.doc Version 5.2 Page 29 Roann House 2. OP9 the care to the residents. There needs to be individual guidelines in place for residents prescribed ‘when required’ medication. Hand written prescriptions need to signed and dated by 2 staff members. The effects of pain relief need to be monitored. The provider needs to produce an action plan detailing all maintenance planned and a timescale within which to achieve this work. All staff need to have the skills and competencies to communicate and interact effectively with the people who live at the home. Staff competencies need to be checked at regular intervals. Self-audit systems need to be developed. And the management team should seek independent supervision to improve reflective practise 3. 4. OP19 OP30 5 OP33 Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Roann House DS0000057418.V367658.R01.S.doc Version 5.2 Page 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. 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