CARE HOME ADULTS 18-65
Rockfield House Rocky Lane Liverpool Merseyside L6 4BA Lead Inspector
Christopher Bond Unannounced Inspection 17th December 2005 11:00 Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 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 Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 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. Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Rockfield House Address Rocky Lane Liverpool Merseyside L6 4BA 0151 260 4414 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) Mental Health Care (Rockfield) Limited Ms Lisa Bessal Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The number of persons for whom residential accommodation (with personal care) is provided at any one time shall not exceed ten (10) Only adults (aged 18 - 64 years) whose primary disability is learning disability maybe accommodated. 24th January 2005 Date of last inspection Brief Description of the Service: Rockfield House is a specialised service for adults who have a primary diagnosis of a learning disability. It is specifically for those people who have challenged other services and it provides a safe and secure environment for 10 residents of both sexes. The service is located in a converted school building in the Anfield Area of Liverpool. All of the bedrooms are en-suite and the home also has two separate bathrooms with specialist facilities for those with a physical disability. There are lots of local shops close by and other amenities, such as churches, cinemas parks and GP surgeries are also situated close to the home. Bus services run from close by to other parts of the city. This is a unique service and as such provides a valuable resource. Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over three and a half hours. The manager gave the inspector a tour of the home. Care staff and residents records were looked at. The inspector spoke to two of the residents. Five of the care staff were also spoken to, along with the manager and assistant manager. What the service does well: What has improved since the last inspection?
Information is now written down in more detail to ensure that daily life and specific incidents are recorded efficiently to help residents receive better care. Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 Page 6 Trained advocates are now used to assist residents who do not have anyone to represent their interests. This means that the rights of the residents are more respected. Residents and care staff are protected by more effective risk assessments. This means that residents are not exposed to undue risks that may affect their wellbeing. All of the care staff now have training in the recognition of abuse. Residents are also protected by safer recruitment checks and police checks. Care staff receive better training, which means that they are able to do their jobs more effectively. Over half of the staff now have a nationally recognised qualification in care. 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. Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 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 Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 All new residents have a full assessment completed prior to moving into the home, ensuring that the home can meet their needs. EVIDENCE: Rockfield House provides plenty of useful information for those who may wish to use the service. There is an illustrated guide to the home, which is updated on a regular basis so that the information that it contains is always current. Everyone who lives at Rockfield House has had his or her needs assessed. Many of the residents needs are very complex so good information is very important so that the correct amount of support and care can be given. Assessment is also important to make sure that the person is right for the service. All of the residents have a contract, which helps to ensure that their rights are protected and that their conditions of residency do not change without the person, or their representative, being aware of it. Those wishing to stay at the home can spend short periods of time there before a decision is made as to whether the service is right for them. Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Residents’ needs and aspirations were recorded clearly. Visitors are welcome at any time ensuring personal relationships are maintained. EVIDENCE: There is a lot of information written down about the needs and aspirations of each resident. Because peoples’ needs are very complex it is important that lots of good, valuable information is recorded about how they are progressing and how the home is meeting their particular needs. Residents all have a ‘plan of care’ which details individual needs. It would be nice to see the home moving towards the ‘Person Centred’ approach to care planning which encourages ownership of the plan with illustrations and photographs. The information available was very formal and complex. The residents should be able to understand and see what is being written about them, and be asked to contribute where necessary. It is acknowledged that this may be difficult when faced with some of the challenges that arise during daily life within the home. Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 Page 10 It was clear that the care staff supported residents to make some of the decisions that affected their lives. Where relatives were unable to help with this the home had contacted a specialist service where trained workers were able to ‘advocate’ on behalf of residents. There were residents meetings where people could talk about their lives within the home. Residents were supported to take controlled risks to further their development and there was plenty of evidence written down to support this. Care staff were also able to give some good examples of how taking risks could help people to develop their skills . Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 Page 11 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, 14, 16 and 17 Service users are supported to play an active part in their local community and there are good opportunities for personal development. EVIDENCE: Because of the challenges that are presented, some of the residents needed lots of support to develop and flourish. High staff ratio’s meant that people were able to go out into the community and use the facilities and resources that most of us take for granted. Some of the residents had charts within their rooms to show what activities they would be experiencing during the week. The care plans also held lots of evidence to show that people were going out and enjoying appropriate activities within the local community. There were some good examples seen during the inspection of how residents were consulted and respected. All of the bedrooms were private and care staff knocked before entering. The manager also stressed that care staff also needed to be respected by the residents and that there were appropriate consequences when this was not observed.
Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 Page 12 Some of the residents were able to help prepare meals and to choose what they wanted to eat. The manager and kitchen staff confirmed that the residents were offered a balanced and healthy diet. Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Care staff give personal care appropriately and considerately. Well- trained care staff handle medication safely to ensure that residents are not put at risk. EVIDENCE: There were several residents within the home who needed help with personal care and there were good facilities within the home for helping to ensure that this was given appropriately. One gentleman had a ceiling hoist in his bedroom. The care plans held information that showed that health needs (both physical and emotional) were dealt with well and that these needs were closely monitored. The residents all had the same doctor who was experienced in providing a specific service. There were regular visits by the doctor. There were good procedures and policies in place to help to make sure that medication was given properly and that residents were not put at risk. There had been training for some of the care staff in medication awareness and the pharmacist visited the home to advise on the storage and handling of medication. Only senior care staff were able to give out medication. Advice given by the inspector during the last inspection had been acted upon. Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Good abuse training and procedures protected the residents. EVIDENCE: There was a complaints procedure for the home. This was also written in the information that was available for the residents called the ‘Service User Guide’. It would be good practice for the organisation to produce guidelines on complaints in a pictorial form to help people who have learning disabilities to understand the process. Since the last inspection all of the care staff had received training in the recognition of abuse. This helped to ensure that residents were safe and not put at risk. The manager had a good knowledge of the correct procedures to follow should abuse be suspected. Criminal Records Bureau checks and Protection of Vulnerable Adult checks were evident within the care staff files. There were good procedures in place to help protect residents from harm. One of the support staff had been trained in specific techniques with regard to de-escalation. This meant that potentially threatening situations could sometimes be dealt with effectively before problems became unmanageable. There was also training given in breakaway techniques to help protect staff when faced with difficult situations. Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 28 and 30 Residents live in a safe, comfortable environment. EVIDENCE: This was a specialised service that centred on the support of people who may have challenged other services. Because of this there were measures taken to ensure that people were not harmed by the environment that they lived in. Some of the glass windows had been covered up by Perspex and some of the bedroom furniture had to be fixed to walls or the floor. Generally the rooms were large, well furnished and comfortable. Some rooms had sofas and televisions in. All of the rooms had added bathrooms. There were lots of personal possessions around and generally the bedrooms reflected the personalities of the residents who lived in them. The home was very clean and there were no unpleasant smells. One resident said, “I really like my room, its really nice.” It was clear that care staff had assisted the residents to design their rooms in a way that was most appropriate to their particular needs and interests. Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 Page 16 There was an enclosed garden area that was overlooked by all the bedrooms. Residents could sit out when the weather was nice. There were rabbits and pet cats around that gave the service a homely feel. The building used to be a school and the rooms were large and spacious. Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36 Good staff support benefited the residents. Training for staff was good which meant that people were supported more successfully. EVIDENCE: There were lots of care staff around during the inspection and the manager stressed how important it was to provide good appropriate support that reflected the specific complex needs of the residents. There was a training file that showed which of the care staff had been trained in the areas most appropriate to their role. The manager was able to confirm that over 50 of the staff had a National Vocational Qualification level 2 or 3 in care. This is a nationally recognised qualification, which helps staff to do their jobs well. New staff would benefit from training in the Learning Disability Award Framework, which helps to induct staff specifically into learning disability services. The personal files of the care staff showed that all of them had a Criminal Records Bureau check prior to being employed. Protection of Vulnerable Adult Checks were also available. This meant that residents were safer. Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: This section was not assessed during this inspection. Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 X 3 X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Rockfield House Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000025368.V273573.R01.S.doc Version 5.0 Page 20 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. 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. 1 2 Refer to Standard YA6 YA35 Good Practice Recommendations ‘Person Centred’ individual plans should be used when recording information on residents. Care staff induction should include entry into the Learning Disability Award Framework (LDAF) to ensure that new staff are familiar with learning disability services and values. The complaints procedure should be in a format more suited to those with a learning disability. 3 YA22 Rockfield House DS0000025368.V273573.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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