Inspection on 19/10/05 for Rockhaven

This inspection was carried out on 19th October 2005.

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

Rockhaven 21/06/05

Rockhaven 08/03/05

Rockhaven 10/11/04

Rockhaven 04/03/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Rockhaven 57 Bachelor Lane Horsforth LEEDS LS18 5NA Lead Inspector Stevie Allerton Announced 19 October 2005 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 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 Stationary 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. Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Rockhaven Address 57 Bachelor Lane Horsforth LEEDS LS18 5NA 0113 258 4984 0113 258 4984 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) St Annes Community Services Mrs GL Fryer Care Home 7 Category(ies) of Learning Disability (7) registration, with number Learning Disability over 65 (7) of places Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21 June 2005 Brief Description of the Service: Rockhaven provides nursing care for up to seven highly dependent men and women with learning disabilities, mainly the over-50 age group. The home is operated by St Anne’s Community Services, a major voluntary provider of services to people with learning disabilities in Leeds, and is managed by Ms. Gloria Fryer. The home comprises a large well maintained bungalow, a pleasant enclosed garden at the rear and good parking space at the front. All the bedrooms are well personalised and for single occupancy. There are good bathroom and toilet facilities and a comfortable lounge/dining area with a conservatory at the back. The bungalow is domestic in size and is situated in a quiet residential area near to the main shopping area in Horsforth on the outskirts of Leeds. Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was arranged in advance and was the second of two inspections planned to take place during the year commencing 1st April 2005. The previous inspection was unannounced and took place in June. Posters, comment cards and other pre-inspection material had been sent to the home in advance, so that service users, staff and relatives could be made aware of the forthcoming inspection and be invited to contribute their views. Two comment cards from relatives were returned, and one from a health care professional who has regular contact with the home. All were positive. The inspector spent time with service users and staff, looked round the building and looked at records, policies and procedures. Two of the service users were case-tracked, their care plans examined in depth and elements of their care followed during the day. What the service does well: What has improved since the last inspection? A new assessment form is being introduced, which should provide staff with a greater depth of information about new service users. Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 Page 6 A general nurse has recently been recruited to the team, who have found that her clinical nursing skills have greatly enhanced the service that can be given. The addition of an extra 35 hours per week support worker post, specifically for one of the service users, has also enhanced the level of care. The new bathroom has now been completed, again made to feel more homely by the addition of pictures and objects of interest, on a boating theme. 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. Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 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 standard(s) 2 New assessment forms being introduced should provide the staff with more indepth information about new service users’ care needs. The home is careful not to admit service users, until the equipment they have been assessed as needing is in place. EVIDENCE: There is a vacant place, which a new service user has been offered. A new assessment form has been introduced, which is to be used for this service user for the first time. It appears to be much more comprehensive, covering a wider range of topics and in more depth than the previous assessment form. The person is to be admitted once the specialist bed and ceiling tracking for the hoist have been installed in his room. In the meantime, the service user and his family have made visits to get to know the home. Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 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 standard(s) 7 & 9 Service users are encouraged to continue to make decisions about their day to day lives for as long as possible. Staff have a good understanding of the effect on individuals when these abilities are in decline and provide appropriate support. There is also a conscious effort within the team to keep emphasising the positive, whilst acknowledging that this is sometimes difficult to keep to the forefront when dealing with damaging behaviour. EVIDENCE: Two care plans were looked at in relation to Standards 7 & 9. It was noted where decisions are encouraged, even if this is in small ways, such as where to sit, what to do, which toiletries to choose when out shopping, and so on. This is very much dependent upon whether the service user still has the ability to be involved in these decisions. A discussion was held with a member of care staff who is a named key worker for one of the service users case-tracked. She described how the person communicates non-verbally and how choices are offered. Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 Page 10 One or two service users are still able to make decisions about their lives and this was seen in the care plans, one of which contained an agreement about contributing £6 per week towards the running of the vehicle, signed by the service user himself. Risk assessments are in place, although they tend to reflect nursing care needs rather than lifestyle choices. In discussion with the staff, it was clear that service users are supported to take risks in order to enjoy life’s experiences. For example, a recent holiday at a Centre Parcs in the Lake District provided service users with opportunity for a boat trip on Windermere, fully accessible to those in wheelchairs. In discussion with the staff, there was an acknowledgement that one of the service users was having difficulty in adapting to gradually losing most of his vision, with the effect that he had less control over the same things in life that he used to; for example, no longer having the freedom to move about the house independently any more and having to rely on staff. The Manager advised that staff constantly have to prevent a service user from extreme self-harming behaviour that is putting his health at risk. Staff make great efforts not to get hooked up on responding negatively (saying “No”) all the time to this behaviour, but to look for positive behaviour which can then be reinforced. Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 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 standard(s) 12, 13, 14, 15, 16 & 17 Service users are supported to take part in appropriate activities within the community as well as in the house, the staff responding to individuals’ communicated preferences when organising activities and outings. Where there are links and contacts with family members, the staff encourage these to continue, seeing them as an important contribution to the service users’ daily lives. Food provision is of a very good standard and is delivered in a sociable environment. EVIDENCE: Some of the service users still attend Learning Disability day services, or inclusive learning centres on a part-time basis. Some are too frail to attend. Staff take service users out and about in Horsforth, to local shops and pubs. One lady spoken to said she likes to buy sweets and colouring books when she Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 Page 12 goes out. Families also supplement the input that staff can give, taking their relatives out and involving them in their own families’ lives. There was evidence that the staff are responding to changes in individuals’ abilities and have been involving Occupational Therapists in trying to find appropriate games and pastimes to engage them in. A holiday is organised each year and staff spoke enthusiastically about accompanying the service users and the rewards that they get as workers from seeing individuals respond to a change in their daily routine. Four people went to Tenerife this year and one to Centre Parcs for a 3-day break. A holiday in Turkey is currently being planned for 2006. The inspector ate lunch with service users and staff, mostly sitting together round the dining room table. The menus are devised each week by the cook, based on long-term knowledge of the likes and preferences of this group of service users. Shopping is done locally, apart from fresh meat, which is delivered from the supplier. The lunchtime meal was appetising and well presented, with choices in evidence for those who wanted something else. Meal presentation and specialised cutlery, etc., was in place as described in the care plans. Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 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 standard(s) 18 & 21 The staff can provide personal care and support to a high level, including quite intensive clinical nursing interventions. The home is well equipped and resourced for this purpose. There is a very good level of awareness of rights and restraint issues in the management of care needs, particularly with regard to someone who seriously self-injures. Staff place a good deal of importance on continuity of care, whether that be from the staff team at the home or from hospital or community based health care professionals. EVIDENCE: Care plans show how individuals’ specific care needs are being met, including specialist input where required, for example the Tissue Viability Nurse. There was evidence that care plans and the outcomes of these were being regularly reviewed. For example, a medication review was requested as the staff felt a service user was over-sedated, having implications for pressure care and the person missing their meals. The care plans also contained relevant information to aid in the care of the service users, such as articles about specific conditions or pieces of equipment Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 Page 14 in use. There was also some good written information to go with an individual in the event of their admission to hospital, to aid hospital staff. Care notes reflected the collective decision made by all professionals involved in a service users’ care, regarding how to manage their extreme self-injury. It was clear that a variety of strategies had been tried in order to limit this behaviour and that there was a high level of professional awareness about issues of restraint. There had been a recent death at the home, a service user who had been with them for some years and whose needs had been assessed as still being able to be met by the home, rather than by admission to hospital. The staff team spoke with pride about their ability to have given him one-to-one attention in his last days, assured that his pain was being relieved and he was being cared for by people he was familiar with. Familiarity with professionals was a theme raised by staff during the inspection; the GP surgery has a large number of doctors working there and it is very difficult for service users to see the GP of their choice, leading to a lack of continuity. Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 Page 15 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 standard(s) 22 & 23 Service users are protected by a robust complaints procedure and adult protection procedure. Staff have a high level of awareness about restraint issues and include other professionals in discussions about strategies that may potentially restrict someone’s rights. EVIDENCE: The reports on the conduct of the home, sent by the home’s line manager in accordance with Regulation 26, show that he has recently been discussing Adult Protection procedures on his visits. The home’s Policy File contains the organisation’s procedure, along with a Whistleblowers’ policy; the procedure is detailed and makes good reference to the potential for minor violations of an individual’s rights when staff are assessing safety versus freedom. The organisation’s recruitment procedures follow good practice guidelines, including the thorough vetting of staff before employment. Adult Protection training is included in the basic training that all new staff undergo; refresher training is mandatory every 2 years. Individual care records contained minutes from meetings held with other health and social care professionals involved in that person’s care, indicating that protection and restraint issues have been thoroughly explored before recommended strategies were made to manage self-injury behaviour. The organisation’s complaints procedure was discussed with the manager. She advised that she welcomed the opportunity to address concerns before they grew into serious complaints. An example was given regarding communication between the home and one of the day care centres used by the service users, Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 Page 16 which had been resolved satisfactorily. No complaints had been received by the home in the past year, but plenty of compliments had been received. There are appropriate procedures in place for the safe management of personal allowances, the records showing that proper accounting procedures are adhered to. Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 Page 17 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 standard(s) 25, 27 & 30 Staff make a real effort to ensure the service users live in a homely, welldecorated environment. This is achieved to a high standard, despite the specialist equipment that is in place to meet service users’ nursing care needs. EVIDENCE: Most of the service users’ bedrooms were seen during this inspection. Some have recently been redecorated by the staff themselves, who felt that it is very important to reflect each person’s individuality within their own room. Each room seen was very different in style, colour and personalisation. A workman was at the home during the inspection, affixing a protective Perspex sheet to the wall adjacent to the bed in one of the rooms; this would protect the wallpaper and allow for easier cleaning and disinfection, without detracting from the decoration. A new bath with shower has now been fitted, which the staff said offered a good facility for the service users. Despite the highly technical appearance of the bath, the bathroom itself is decorated with a boating theme, with plenty of items of visual interest on the walls. Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 Page 18 Standards of hygiene are maintained, with appropriate protective equipment sited around the home, such as gloves, wipes and alcohol rubs. Written guidelines for hand washing were displayed in bathrooms, WCs, laundry and kitchen and the practice seen on the day was good. There had been a recent Environmental Health Officer’s visit that had concentrated on the kitchen. A few items were identified, which the Manager said were being resolved. Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 There is a good balance within the staff team, ensuring that the proper skills, experience and qualifications are available 24 hours a day, to meet the nursing and support needs of the service users. EVIDENCE: A new nurse had recently been recruited, who was spoken to during the inspection. She has a general nursing qualification, but has had experience of a similar client group, and has been able to bring her clinical skills to the team at Rockhaven, complementing and enhancing their existing skills. An extra 35 hours a week have been funded specifically for one of the service user’s intensive support needs. This member of staff was still supernumerary at the time of inspection, undergoing induction training. She was clear about the timetable for induction and basic training, which had been planned in for the following month, and described further foundation training that would follow from then. Another support worker said she had recently completed her foundation training; she felt that the organisation was very supportive in the training that is provided for staff. The nurses have also done some clinical training updates, which have helped in the care and management of specific conditions. Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 41 & 43 The organisation’s policies, procedures, records and administrative systems ensure the smooth running of the home and that service users’ best interests are safeguarded. Although these service users may not be able to directly influence the organisation’s self-monitoring and review, there are mechanisms in place for this to happen with users in other services that are more able, the resultant changes and developments benefiting all users throughout the organisation. Record keeping in general appeared to be accurate and up to date, although some care plans were better organised than others, making information easier to find. EVIDENCE: The home is part of a larger organisation, which has a published Corporate Plan for the next three years. There are performance indicators and objectives linked to each service’s annual Mini Plan, where the home sets out how it aims Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 Page 21 to achieve its’ set targets. Rockhaven’s annual plan has concentrated on promoting three of the core principles that guide the organisations’ work: placing service users at the centre, celebrating and promoting diversity, and being a learning organisation. The home has set out specific objectives to meet these, for example, involving service users in setting tables and choosing at mealtimes. Some service users in other homes are involved in quality, training and recruitment, but it is acknowledged that the service users at Rockhaven have limitations, due to their profound learning disabilities and serious health problems. The home’s line manager makes regular visits and reports on the conduct of the home; examination of a service review document also demonstrated that there is internal monitoring of standards within the organisation. A selection of statutory records and operational policies were inspected, including service user care plans, risk assessments, financial records, staff rotas, menus and monthly reports on the conduct of the home, completed by the home’s Line Manager. Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 Page 22 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 x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x 3 x 3 x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Rockhaven Score 3 x x 3 Standard No 37 38 39 40 41 42 43 Score x x 3 x 3 x 3 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 Page 23 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. 1. Standard 30 Regulation 16(2)(i) Requirement The registered person must ensure that all of the required actions from the Environmental Health Officers report are addressed. Timescale for action By 31.12.05 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 41 Good Practice Recommendations Some improvements could be made to the way that care plan files are organised, so that information is easier to locate. Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 Page 24 Commission for Social Care Inspection Aire House Town Street Rodley LEEDS, LS13 1HP 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. Extracts may not be used or reproduced without the express permission of CSCI Rockhaven 20051019 Rockhaven IR Stage 4 V242999 S1368 J52.doc Version 1.40 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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