Inspection on 23/01/06 for Rochester House

This inspection was carried out on 23rd January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 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

Rochester House 12/12/06

Rochester House 25/07/05

Rochester House 31/03/05

Rochester House 14/01/05

Rochester House 28/01/04

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

CARE HOME ADULTS 18-65 Rochester House 221 Maidstone Road Rochester Kent ME1 3BU Lead Inspector Sarah Montgomery Unannounced Inspection 23rd January 2006 10:00 Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 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 Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 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. Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Rochester House Address 221 Maidstone Road Rochester Kent ME1 3BU 01634 847682 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) The Regard Partnership Limited Mrs Joanne Bungay Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th July 2005 Brief Description of the Service: Rochester House is owned and managed by The Regard Partnership; it is registered to accommodate thirteen Adults with learning disabilities, but regards full capacity being 10. There are three floors, the visitors room, administration area, laundry room and a room used for physiotherapy are situated in the basement. Service users bedrooms are on the ground and first floor; there is a lift available to all levels. The house is situated on the outskirts of Rochester town centre and public transport is easily available. Service users receive 24-hour support. The home employs a manager, a deputy manager, 2 seniors, and 13 support workers. Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Sarah Montgomery conducted this announced inspection on January 23rd 2006. The inspector spoke with the manager, deputy and service users. Information was gathered from a range of sources, this included reading care plans, assessments, quality assurance documents, activity records, and daily evaluation notes. What the service does well: What has improved since the last inspection? The home has benefited from several improvements, most notably; a new manager and deputy who are committed to excellence in service delivery, new style of care plans and risk assessments which are detailed and have clear goals, and a redecorated and refurbished environment. Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 Page 6 Shortfalls identified in previous inspections have been addressed, and the home is now in a position where they are not just meeting standards, but exceeding them. 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. Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 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 Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 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 and 2. Service users can be sure that the home provides clear information to enable them to make an informed choice about where they live. Prospective service users can be confident that their individual needs and aspirations are assessed. EVIDENCE: Both the service user guide and the statement of purpose have been updated. The statement of purpose clearly sets out the homes aims, objectives and philosophy of care, and the services and facilities available at the home. Records viewed during the inspection evidenced that the statement of purpose truly reflects the service at Rochester House. The service user guide really is an impressive document. It is totally focussed on accessibility, and explains the services provided at Rochester House in a detailed and easy to read format. Pictures support the text. Records viewed during the inspection, conversations with service users, and observations during the course of the inspection, evidenced that the service user guide accurately describes the services provided at Rochester House. A selection of service users’ files were inspected. All contained detailed preassessment documentation. Care plans and risk assessments were inspected in conjunction with pre-assessment documentation. All information gathered by professionals during pre-assessment indicated the service user matched the profile of the expected service user group as described in the statement of purpose. Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 Page 9 Care plans and risk assessments generated from the assessments clearly demonstrated a link between assessment and identified care and support needed by the service user. Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 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. Service users benefit from knowing their assessed and changing needs and personal goals are reflected in their individual plan. Service users are supported to make decisions about their lives including taking risks as part of an independent lifestyle. EVIDENCE: Two service users spoke individually with the inspector. Both talked about the changes to the home in the past few months. One service user in particular was extremely positive, and stated that the last few months have been the happiest she has ever felt at the home. She added that she feels that staff believe in her, and their positive attitudes towards her achieving her goals has changed her life. Another service user acknowledged the positive changes, but still feels slightly upset by all them. She told the inspector she was not used to being supported to set goals, or supported to achieve them. She recognises she had got into a ‘rut’, and although she finds the positive changes difficult, she doesn’t want staff to ‘give up on her’, and is excited that her life is changing and moving forward. Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 Page 11 Care plans were inspected. The manager has redesigned the format and all care plans now include a ‘strengths list’. This is a positive inclusion as it recognises that although service users may need support in some areas, this often is to enhance the strengths and skills they have already gained. The support column is very descriptive, and ensures complete clarity for service users and staff. Care plans are designed in partnership with service users, keyworkers and the management team. Input from all, including formal on-going assessment guarantees service users are receiving the correct support to enable them to move forward and achieve goals and aspirations. Risk assessments are descriptive in terms of the identified risk and management of it. Staff are required to sign all risk assessments and care plans. Review of risk assessments and care plans are regular. Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 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): 11, 12, 13 and 16. Service users living at Rochester House can be confident they will have opportunities for personal development, will be supported to take part in appropriate activities, will be part of the local community, and will have their rights respected and responsibilities recognised. EVIDENCE: The inspector spoke with a number of service users, staff and management regarding lifestyle opportunities at the home. Care plans, daily notes, and the house activity timetable was looked at. Service users described an environment in which they felt very supported individually, indicating that the staff team understood their needs and continually encouraged them to fulfil all their goals. They also spoke about living with a group of people, and how good and sometimes how difficult that could be. They gave an impression of caring for their housemates, and indicated that compromise and working things out fairly is part of everyday living at the home. Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 Page 13 One service user spoke in detail about her life in the home, informing the inspector of a range of activities she partakes in – both in house and in the community. It was clear from talking to service users, staff and reading care plans and daily notes, that all service users receive a very individual and well planned service which is entirely based around assessed needs and personal goals. Staff are highly aware of individual needs, and will research appropriate activities. All service users receive regular assessment regarding independent living skills. Care plans viewed evidenced that service users are supported and encouraged to maintain and develop independent skills. The home currently supports two service users to be completely independent in meal preparation. This includes budgeting, shopping, preparing and cooking their own meals. All service users are supported within a risk assessment framework to prepare meals and drinks for themselves and others. The home has devised a new system of offering activities to service users. Service users are offered an activity three times a day. At least one of these will involve an activity out in the community. Choices are recorded in the activity book and in individual daily notes. The activities book is checked at least weekly by the manager or deputy. If it is notable that a service user is not taking part in activities, this will be addressed and, if necessary, new activities to suit the individual will be arranged. Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 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 and 19. Service users can be confident that they receive personal support in the way they prefer and require, and that their physical, emotional and health needs are met. EVIDENCE: Service users’ personal support needs are recorded within assessment documentation and care plans. The inspector noted that care had been taken when recording these needs, and that the dignity of the individual had been upheld. The manager identified that some service users were not being supported appropriately with personal care. New guidelines and care plans have been put in place, resulting in improved support and positive outcomes. Rochester House supports service users who can present with challenging behaviour. Behavioural guidelines were inspected and found to be clear and non-confrontational. Incidents of challenging behaviour have dramatically reduced following the introduction of these new guidelines. This has had a positive effect on both service users and staff. Observations of staff interacting with service users evidenced a staff team competent and knowledgeable about the emotional needs of service users. Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 Page 15 Conversations with service users were natural and flowing, and the inspector noticed that responses from staff to service users were measured, thought out, and mirrored specifics noted in care plans. The art of conversing in such a way is a difficult skill to achieve, and staff can only be praised for interacting so naturally with service users while clearly following directions for agreed responses. In addition to this, Rochester House will, when necessary, ensure that service users receive support from healthcare professionals regarding physical and emotional health. Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 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. Service users can be confident that their care is enhanced by an open, transparent and accessible complaints procedure. And that they are protected from abuse, neglect and self-harm. EVIDENCE: Service users explained the complaints procedure to the inspector. They displayed awareness of staff roles, and whom the key people are to talk to if they had a complaint or concern. From discussion with service users it was clear that concerns or complaints are aired either in general everyday discussions over dinner, or in house meetings. Service users feel comfortable with talking to their keyworker, and will mainly use this route to discuss worries or complaints. They indicated that they would freely talk to any staff, including the manager, but recognised the special relationship with their keyworker and felt natural in turning to them. The inspector asked service users if they were happy with the response from keyworkers or staff regarding complaints. All service users indicated they felt listened to and valued by staff, and were satisfied with responses to complaints. Most complaints are dealt with informally – by talking things through and coming to a resolution, which is acceptable. However, service users are aware that complaints can be formal, and can include written notes, and involve care managers and other professionals. All service users said they prefer to sort out complaints informally, but would be confident to explore the formal route if necessary. Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 Page 17 The home has an adult protection policy. In addition to this the Manager has written guidelines for staff in lieu of training. The majority of the team are trained, and training form new staff is being arranged. The manager and deputy both displayed significant knowledge of adult protection, not just in terms of protocols, but also in recognising and upholding good practice in working with vulnerable adults. Through coaching and supervision, the manager ensures that all staff follow good practice guidelines when working with service users. Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 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, 28 and 30. Service users benefit from living in a home that is homely, comfortable and safe. EVIDENCE: The environment at Rochester House has changed dramatically. All communal areas and most bedrooms have been redecorated and refurbished. Obvious care has been taken in the style and colour, resulting in a calm, homely effect. Service users expressed to the inspector how proud they are of their home, and that living in a home that looks nice and is clean and tidy makes them feel better about themselves. Clearly, the improved environment has had a positive effect on service users. They feel valued and know that by being consulted about the changes, their opinions not only matter, but also are important. All areas of the home were clean and hygienic. The home’s cleaner has an NVQ in cleaning and is knowledgeable about all health and safety requirements. A clear job description and a daily cleaning checklist all ensure the home is kept clean and hygienic. Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 Page 19 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, 35 and 36. EVIDENCE: The inspector spoke to staff about their roles and responsibilities at the home. Staff talked about working in an enriching, supportive and creative environment in which their needs and skills as staff members are recognised and responded to by the management team. They described a detailed induction programme, which included a mix of practical work in which shadowing of shifts took place, and of reading policies, procedures and care plans. During induction, training needs are identified and all staff are expected and supported to undertake relevant training, including NVQ training and training specific to the service user group. Service users spoke highly of the staff team, indicating that they felt they were being supported by a group of staff who understood them, respected them, believed in their aspirations, and would do all they could to assist them in leading fulfilling and enriching lives. Inspector observations on the day echoed the comments of service users. The inspector sampled staff files. All files looked at evidenced a thorough recruitment procedure, which fully protected service users from harm. Staff receive regular monthly supervision. This is goal orientated, and concentrates on outcomes for service users. Training needs are identified Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 Page 20 through the supervision process, and all staff have training profiles. Staff have recently received training on; report writing, CPI, food hygiene and first aid. The manager records all training and any gaps are quickly identified. Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 Page 21 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 and 39. Service users benefit from living in a home that is well run, and can be confident that their views underpin all self-monitoring, review and development by the home. EVIDENCE: The home has recently had a change of manager. The inspection process has evidenced significant changes to Rochester House in every area inspected. The positive report owes much to the hard work put in by the manager and her team. Rochester house is a home that is focussed on the needs of service users, and strives for excellence in service delivery. The manager displayed in depth knowledge of the service user group, of individuals within that group, and of management skills required to manage a staff team, and skills needed to bring all the knowledge together to translate them into a home which people want to live in, and is forever evolving and changing in response to service users. Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 Page 22 Systems for review, monitoring and development are in place. Every document (care plan, risk assessment) and each policy is reviewed regularly. Input from service users is seen as crucial by the entire team, and views from service users are sought in house meetings, and 1-1 keyworker meetings. Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 Page 23 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 4 2 4 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 4 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 4 29 X 30 4 STAFFING Standard No Score 31 X 32 4 33 4 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 4 12 3 13 4 14 X 15 X 16 4 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 X x 4 X 3 X X X X Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rochester House DS0000028968.V280987.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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