Inspection on 23/04/07 for Rock House Residential Home

This inspection was carried out on 23rd April 2007.

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

The inspector 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

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

CARE HOMES FOR OLDER PEOPLE Rock House Residential Home Bawtry Road Tickhill Spital Doncaster DN11 9EZ Lead Inspector Sarah Powell Key Unannounced Inspection 23rd April 2007 08:30 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 Rock House Residential Home DS0000069114.V334910.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. Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rock House Residential Home Address Bawtry Road Tickhill Spital Doncaster DN11 9EZ 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) 01302 750225 01302 750225 rock.house@tiscali.co.uk www.rockhouseresidentialhome.com Mr Andrew Pass Vacant post Care Home 41 Category(ies) of Dementia - over 65 years of age (41) registration, with number of places Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection New service Brief Description of the Service: Rock House is registered to care for 41 older people with dementia. It is situated in it’s own extensive grounds, within easy reach of Tickhill and Doncaster. The original part of the building overlooks the main road into Tickhill, and is in character with the locality. There are a number of lounge/dining areas that accommodates all service users comfortably. A staircase leads to the first floor bedrooms. A chair lift provides access to this area. A single storey extension has been added to the main building, and has a high specification providing the service users with single room accommodation. The bathrooms are of extremely high standard; the facilities include walk in/wheel in shower, and baths with hoists. All bedrooms are tastefully decorated and service users have personalised them to their own tastes. The fees at Rock House at the time of the inspection were £410 to £460. These fee charges only applied at the time of inspection, more up to date information may be obtained from the home. Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the homes first key inspection since it was re-registered with a new provider. The home also has a new acting manager. The inspection was unannounced and took place over one day on 23rd April 2007 at 08:30 and finished at 16.30. As part of the inspection process the inspectors spoke to 14 residents, 5 visitors, 6 staff, 2 visiting professionals, the provider and the acting manager. Four service user questionnaires were also returned. A partial tour of the building took place, observing staff and practices. A number of records were examined these included medication, service users care plans, staff rotas, recruitment, accident, service users finances and training. Feedback was given to the manager when the visit was completed. What the service does well: What has improved since the last inspection? The service has re-registered with a new provider and a new acting manager so is a new registration. Many comments received from staff, service users, relatives and visiting professionals were that the care provided in the home had improved with the new management. Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 7 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 Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 8 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): 1, 2, 3, 4 & 5. The home does not provide intermediate care. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The needs of people who lived at the home could be met. EVIDENCE: The service user guide and statement of purpose were available in the home and all service users had received a copy, these will need to be updated when the manager is registered with Commission for Social Care Inspection and the new staffing structure is confirmed. The acting manager had recently drawn up new contracts and terms and conditions, for all the people who live in the home these were excellent. The acting manager and administrator had obtained information and advice from the office of fair-trading and the contracts and terms and conditions contained all the required information. Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 9 Service users were only admitted following a full assessment of their needs, which could determine if the home was able to meet those needs. The assessments were seen in the plans of care and the acting manager had improved these to ensure all service users who lived at the home had their needs met. Trial visits were also offered to prospective service users. Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 10 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, 10 & 11. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users health and personal care needs were met. EVIDENCE: During the adult protection investigation care plans were found to be extremely poor did not identify the needs of people who lived at the home and could not show if needs were being met. The acting manager had in the last six weeks following the adult protection investigation reviewed and re-written all service users care plans. A number of plans were seen at the inspection and they had greatly improved they clearly identified the needs of the service users and gave clear instructions on how to meet the needs. Risk assessments had also been reviewed and had improved although some still required more detail. Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 11 The inspector spoke to two district nurses who visited the home they said previously care staff had used poor moving and handling techniques for the service users, however this had improved over the last few weeks with the home providing more equipment to help the staff move and handle the service users appropriately. Care and comfort were given to service users who were dying and their wishes regarding this had been recorded in the plans of care. Medication procedures had much improved since the pharmacy inspection in January 2007, all the requirements and recommendations that had been made had been addressed by the acting manager ensuring service users were safeguarded. Service users and relatives spoken to say that staff were lovely and that there had been a lot of improvements in the home since the new provider and acting manager had taken over. They also said staff respected their privacy and maintained their dignity. Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 12 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 & 15. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. More stimulation is required to meet service users needs. Personal autonomy and choice had improved. EVIDENCE: The new acting manager was aware the routines in the home were not as flexible as they could be and had improved the routines for the people who live there. Service users and relatives spoken to all said that routines in the home were not as rigid as they had been and were more flexible meeting their needs. Activities were provided ten hours a week by the newly appointed activities coordinator, this was usually group activities. It did not allow enough time for 1 to 1 activities for the people who did not want to join in group activities or were unable to. This was discussed with the acting manager and agreed more hours were necessary to meet the needs of all service users. Many service Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 13 users and relatives told the inspector there was lack of stimulation and nothing to do but watch television, however they were aware that an activities coordinator had been appointed and were hopeful this would improve. Carers did try to provide some activities when they had quiet periods and were seen reading to service users. The lunch was observed at the inspection the meal was well presented and a choice was available if required. Carers were observed with one knife and fork going from person to person cutting up the food this was not a sensitive approach to giving assistance, seconds were not offered even when a service user stated they were still hungry and one service users did not want the pudding offered and was not given an alternative. Time was given for people to finish their food and care staff asked if they had finished before taking the plates. Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 14 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, 17 & 18. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Systems had been improved and should now protect service users from abuse. EVIDENCE: Three adult protection referrals were received in March and April 2007 following the initial investigation and strategy meeting it was decided by Doncaster Council to place an admissions embargo on the home until they were satisfied measures had been put in place to safeguard the people who live at the home. The home received confirmation on 19th April that the embargo had been lifted with some conditions. The acting manager and staff had worked very hard to ensure measures were put in place to safeguard the service users. Staff had not always received training in adult protection and as such were not fully aware of the importance of the policies and procedures. The new acting manager had started to address this and some staff attended training in April and the remaining staff should be included in the training planned for May 2007. Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 15 The adult protection policy and whistle blowing policy had been re-written by the acting manager and was very comprehensive. Staff spoken to were aware of the new policies and were awaiting training in order to understand what to do if abuse was suspected. The acting manager had also updated the homes complaints procedure this was displayed in the entrance hall and was available in the service users guide. Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 16 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, 23, 24, 25 & 26. People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a clean safe environment for the service users. EVIDENCE: The inspectors carried out a partial tour of the building during the visit. The standard of cleanliness observed was excellent; the rooms were well decorated and maintained to a high standard. The new provider had improved the environment further since he took over and was looking at also providing a vertical passenger lift to access upstairs. The only access to upstairs at present was the stairs and a stair lift, which restricts the access to the upstairs room Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 17 for the service users. The provider has included the need for a passenger lift in the homes business plan and is looking to provide this in the next 18 months. The home had a programme of routine maintenance and renewal. The grounds were safe, attractive and accessible to all service users. Service users spoken to said the home was always very clean and well looked after. Visitors told the inspectors that the rooms were maintained to a high standard and were always very clean. Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 18 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 & 30. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Sufficient staff were provided to meet service users needs, robust recruitment procedures were in place however staff training was out of date. EVIDENCE: The acting manager had maintained the staffing numbers to ensure adequate staff were on duty to meet the needs of the people who live at the home. The numbers of staff on duty were increased after the adult protection investigations and extra staff were put on night duty as this was identified as a time when service users needs were not being met. The acting manager had registered 11 care staff on NVQ level 2 training when they have completed the training the home will have above 50 qualified, however the acting manager still intended to put all staff through the training. Recruitment procedures were very good and protected service users. A number of staff files were looked at as part of the adult protection investigation and all contained the required information, including criminal record bureau checks, references and interview records. Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 19 Staff training was out of date with many staff had not completed mandatory training for a number of years, however the acting manager had addressed this and had all staff booked on mandatory training courses, which staff will have completed by the end of May 2007. The inspector saw confirmation of training dates and staff attending. Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 20 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, 32, 33, 34, 35, 36, 37 & 38. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Health safety and welfare of people who live had the home has improved over the last six weeks and is now being met. EVIDENCE: The home was re-registered in February 2007 with a new provider and a new acting manager was appointed. She is currently going through the process of registering with The Commission for Social Care Inspection. The acting manager had completed the registered managers award and NVQ level 4 and Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 21 had been in a senior position in the home for a number of years so had relevant qualifications and experience to manage the home. The staff spoken to told the inspector that the acting manager was approachable and listed to any concerns you wanted to raise and ran the home very well and her management approach created an open, positive and inclusive atmosphere. The acting manager was aware of the need to have quality monitoring systems in place in the home to ensure it is run in the best interests of the people who live there. The home had previously not had these systems in place so she had taken advice from the General Social Care Council and had purchased a pack, which gives guidance and information on implementing quality monitoring systems, and she is hoping to have it implemented by June 2007. Service users were safeguarded by the financial and accounting procedures in the home and service users who chose to have their money looked after by the home were also safeguarded by well documented records that are regularly audited. Systems for recording valuables had been improved however the home still needed a procedure implementing and valuables looked after by the home for service users should be properly documented to ensure valuables are not lost. The acting manager had drawn up a supervision programme and had commenced supervision of all staff, when the new staffing structure is in place with a deputy and senior care staff, they will also be trained to carry out supervision ensuring staff are appropriately supervised at least six times a year. A full audit of accidents was carried out during the adult protection investigation it was found that they were not recorded properly, recorded a few days after the event, accidents reported in daily log but not on an accident form and no records of accidents reported to The Commission for Social Care Inspection. A high proportion of the accidents had occurred with the night staff at busy periods when they were putting service users to bed or getting them up. Following discussion with the acting manager she increased the staff on nights to four carers and has carried out weekly accidents audits. The increased staffing seems to have reduced the falls during this period. The acting manager has also reported the accidents to the Commission for Social Care Inspection in accordance with regulation 37 notifications. All health and safety procedures in the home were up to date ensuring safety and welfare of service users was protected. Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 22 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 2 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 4 4 3 4 4 4 4 STAFFING Standard No Score 27 3 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 2 3 3 3 Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A 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 Requirement You must meet the social and recreational needs of all service users by providing more activity hours. You must take into account service users wishes and feeling and provide sensitive support at meal times. Ensure staff are appropriately trained to prevent service users being placed at risk or harm of abuse. 50 of care staff must be trained to NVQ level 2 or above. Ensure all staff are appropriately trained in order that they are competent to carry out their jobs and meet service users needs. The quality monitoring systems must be implemented. Records must be kept of all service users valuables handed over to the home for safekeeping. Timescale for action 01/07/07 2. OP15 12 01/06/07 3. OP18 13 01/06/07 4. 5. OP28 OP30 18 18 01/12/07 01/06/07 6. 7. OP33 OP35 24 17 01/06/07 01/06/07 Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 24 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 OP1 Good Practice Recommendations It is recommended that the statement of purpose and service users guide be updated with the new management structure in the home. Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Rock House Residential Home DS0000069114.V334910.R01.S.doc Version 5.2 Page 26 - 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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