Inspection on 03/07/07 for Rockleaze

This inspection was carried out on 3rd July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rockleaze 21/04/09

Rockleaze 06/05/08

Rockleaze 01/08/06

Rockleaze 12/12/05

Rockleaze 27/06/05

Rockleaze 07/01/05

Rockleaze 13/07/04

Rockleaze 09/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Rockleaze 56 Lower Hanham Road Kingswood South Glos BS15 8QP Lead Inspector Paula Cordell Key Unannounced Inspection 3rd July 2007 09:30 Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 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 Rockleaze DS0000003352.V337772.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 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. Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rockleaze Address 56 Lower Hanham Road Kingswood South Glos BS15 8QP 0117 9673395 NONE 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) Mr Jonathan Short Mr Jonathan Short Care Home 13 Category(ies) of Learning disability (13), Mental disorder, registration, with number excluding learning disability or dementia (13), of places Old age, not falling within any other category (13) Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 13 persons aged 25 years and over who may have learning disability and/or mental disorder 14th March 2007 Date of last inspection Brief Description of the Service: Rockleaze is a large double fronted Victorian property, which has been significantly extended. It is in an elevated corner position on the Lower Hanham Road and provides excellent views over Bristol from first floor rooms. The buildings and gardens are well kept and the front garden provides seating for residents. Considerable work has been undertaken internally over the last two years. The rooms are furnished to a high standard and the home is pleasant and comfortable for the residents. Local shopping and other amenities in Hanham are within walking distance and the Kingswood shopping area is a short drive away and enjoyed by residents. The home is on a bus route accessing both places and the centre of Bristol. The home also has its own transport with an easy access vehicle, enabling either small or larger groups to go on trips from the home. The fees at the time of publishing this report were from £427 to £527 per week. Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit as part of a key inspection. The purpose of the visit was to review the progress to the requirements and recommendations from the last key inspection in August 2006 and the random visit in March 2007 and to monitor the care provided to the individuals living at Rockleaze. There has been no other regulatory activity since the visit in March 2007. The home has demonstrated compliance to the requirements and recommendations from previous visits. The inspection methods used include record checks, case tracking, observations and discussions with the manager, the staff on duty and people who use the service. The home has been sending information in respect of regulation 37 notices of events affecting the well being of the people who use the service and these were used as a focus for the site visit. Along with the annual quality assurance assessment completed by the home and the surveys completed by people who use the service (8) and relatives (2). The visit was conducted over a period of five hours and ended with structured feedback. What the service does well: What has improved since the last inspection? Individuals have available to them information about the home in the form of a statement of purpose, service user guide and a contract of care. Documentation has been expanded and reviewed to ensure compliance to the legislation and the National Minimum Care Home Standards. Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 6 The home has a policy on the assessment process for prospective new individuals, which is in accordance with the National Minimum Standards. Individuals living at Rockleaze can be confident that they are protected by a robust recruitment procedure. Individuals can be confident that the home will respond to allegations of abuse in accordance with the Department of Health’s guidance on “No Secrets”. 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. Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 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 Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals have information available to them to make a decision on whether to move to Rockleaze. Individuals assessed needs are being met. EVIDENCE: The manager forwarded a copy of the statement of Purpose to the Commission for Social Care Inspection shortly after the visit to the home in March 2007. This was reviewed and a letter was sent confirming this met with the Care Homes Regulations and the National Minimum Standards. This was not further reviewed during this visit. All completed surveys from people who use the service and relatives, confirmed that they had information about the home and that they had been involved in the decision process. The home has recently admitted two new individuals to the home. From care records, and speaking with one of the individuals, the manager and staff it was evident that the process of admission had run smoothly. Copies of the placing authorities assessment and care plan were read in conjunction with the home’s care plan and it was evident that the individuals’ assessed care needs were Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 9 being met. From reading care records, other professionals had been involved in the process of admission including where relevant families. From talking with the manager both individuals had been encouraged to visit the home to ensure that it was appropriate and to ensure that they were compatible with the existing group. The manager was able to provide evidence that the terms and conditions of residency (contract) between the provider and the individual had been updated and reviewed to ensure compliance with the Care Homes Regulations and the National Minimum Standards. Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals can be confident that their care needs are being met less apparent is they involvement in the reviews. Individuals should be supported to take risks as part of an independent lifestyle based on their abilities and aspirations. EVIDENCE: Care Plans have been updated and a more person centred planning system has been introduced. It was evident from the information sought that the individual had been consulted on the content. Care plans were being reviewed routinely every 3 months by the staff. Less apparent was how the individual was involved in the review process. The manager stated that individuals attend individual program meetings if they attend day centres, however it was not apparent this formal system was in place in the home for those that did not attend a day centre. Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 11 Individuals were evidently happy living in the home and with the support from staff and the manager. This was evidenced via discussions with the individuals and completed surveys. Individuals confirmed that they had a plan of care that they could access on request. Risk assessments were in place. However, these were similar in content for the three individuals whose care path was tracked. It was noted each person had a risk assessment for the use of equipment in the kitchen and that this must be done with staff supervision. However from reading one individual’s care records and risk assessments, they had previous to the move to Rockleaze accessed the kitchen independently without staff support. A risk assessment should not curtail independence and should reflect the skills and abilities of the individual. Another risk assessment was read in respect of an individual who accesses the community independently. From reading the risk assessment this level of independence was not made clear and made reference to staff ensuring that the individual used appropriate crossings. Risk assessments must be reviewed to ensure reflects the skills and abilities of the individual. Individuals confirmed that they were consulted on day-to-day issues including decoration, activities, holidays and how to spend their time. House meetings are organised every two to three months. Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are supported to lead active lifestyles based on their preferences and choices. Friendships are maintained. Individuals have a healthy balanced diet. EVIDENCE: Individuals were keen to share with the inspector the activities that had recently taken place which has included an annual holiday to Burnham on Sea, a trip to Minehead and a ride on a steam train, entertainers that regular visit the home and trips to the local shops or cafes. It was evident from talking with individuals, staff, the manager and viewing care records that these were regularly taking place. Some of the individuals attend day centres in the local area and college courses whilst some of the others stated that they had retired and were enjoying a more relaxed pace of life. One individual stated that although he Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 13 had retired he continued to go out to the local shops either on his own or with staff support. One individual stated that in the evenings they could watch television, play games or do arts and crafts. Another individual stated that trips are organised to the local pub and another attends a local luncheon club. Staff stated that two of the individuals regularly attend church whilst others prefer to watch Songs of Praise on the television. It was evident that from all the conversations that if someone expressed an interest in going somewhere this would be supported. It was evident that the individual’s cultural needs would be met. From talking with staff it was evident that they were aware of the diverse needs in the home and that each person was an individual with different interests and needs. Completed surveys from relatives stated that the individual’s diversity and equality needs were being met. People who used the service stated in the surveys that they could choose how to spend their time throughout the day, evenings and at weekends and staff treat them well. The individuals’ rights and responsibilities are respected and recognised in their daily lives. It was evident that individuals were encouraged to attend house meetings, some of the individuals attend people first meetings and one of the individuals had access to an independent advocate. Individuals were supported with their finances based on the individual’s ability. One individual has total responsibility for their money, however there was concerns raised that this individual was not saving and consequently was being subsidised by the provider for holidays. The provider and the individual have devised an agreement for this to be paid back over a period of time and to enable the individual to save in the future. Documentation was in place detailing the support plan and the decision process and who was involved. Individuals have available to them a mini bus which is funded by the provider. Previous the individuals contributed a nominal amount but the provider stated that this is now inclusive of the fees. In addition the provider pays for all the entertainment that is offered in the home, which happens fortnightly and includes singers and people playing musical instruments. From conversations with the individuals it was evident that they enjoyed these evenings. Records confirmed contact with friends and relatives. One individual stated their friend regular visits the home and stays for coffee or lunch. It was positive to see that the two new individuals are supported to maintain contact with their previous placements including visits to the local area that they lived Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 14 prior to moving to Rockleaze. From talking with staff and the manager it was evident that that this was seen as a fundamental part of the care service. Menus were viewed and demonstrated that a healthy diet was provided. Staff were observed offering individuals a choice at lunchtime. The records confirmed that individuals are supported to make choices and their preferences are catered for. Individuals spoken with stated that the food was good. Drinks were available to individuals throughout the inspection and a large fruit bowl was placed in the dining area for individuals to help themselves. Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individual’s personal and health care needs are being met. There are some shortfalls but the home is addressing these. Individuals are generally safeguarded by a robust medication system, however individuals could be at risk if staff are not assessed as competent. EVIDENCE: Care documentation included how the person wanted to be supported with their personal care, the home maintained a clear record of when and who had supported them. Individuals have access to GP, Chiropody, dentist and opticians and the local community learning disability team. Plans clearly detailed the reason for the appointments, the outcome and any further action required. However, it was noted that two individuals had recently had a blood test and the information indicated that the result were to follow within seven days. There was no record of the outcome of the blood tests. In addition two recently admitted individuals Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 16 appear to need a dental appointment. The manager stated that this was being arranged. Staff were knowledgeable on the health and personal care needs of individuals. Staff have attended training in manual handling and first aid. Other training included a distance learning on the administration of medication and introduction into learning disabilities. From conversations with staff, individuals and through observations it was evident that the individuals were treated with respect. Records relating to stock administration were found to be satisfactory. All medication was stored appropriately. Each person had a medication profile. The information was informative and detailed to enable new staff to support individuals. The home has a policy for the safe administration of medication and the home has demonstrated compliance to a requirement by including guidance for staff in the event of an error. Whilst seven of the staff have completed a distance learning in the safe administration of medication there was no evidence that staff’s competence is routinely checked. The manager stated that he regularly observes staff administering medication but no records are maintained. This would be good practice. Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals are confident that they concerns would be listened to and addressed. The home is failing to ensure that safeguards are in place to protect individual’s belongings. EVIDENCE: The home has a complaints policy and this is clearly displayed in the hallway of the home. Individuals confirmed that they were aware of the policy and would speak with staff or the manager. All completed surveys from people who used the service stated that they were aware of the complaint procedure and whom they could talk with. The home’s record of complaints was viewed. There have been four complaints in the last twelve months. Two related to concerns raised by one individual about another living in the home, one about smoking and one related to water temperature. It was evident that these were addressed and resolved and discussed with all relevant parties. From the records it was evident that all complaints are taken seriously and acted upon appropriately. Staff were spoken with at the last visit and had a good knowledge of the Whistle Blowing Policy and what constitutes abuse and the procedure to follow in the event of abuse. Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 18 The Policy on Adult Protection has been amended to reflect the role of Social Services and the Department of Health’s “No Secrets” guidance. As noted at the last inspection the home has the local authorities guidance on Safeguarding Adults Procedure. Eight out of the nine Staff have attended training with the local Council on Protection and Safeguarding Adults Procedure with further training planned in August for the ninth staff member. It was noted that there was no inventory of the individual’s belongings or a record of what the manager had for safekeeping for example cheque books or birth certificates etc. This must be addressed. There were records of individual financial transactions and receipts. Amounts held for safekeeping corresponded with records. Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are provided with a homely and comfortable place to live which is meeting their needs and lifestyle. EVIDENCE: Rockleaze is a large extended double fronted Victorian property, which is positioned in an elevated corner of the Lower Hanham Road. The home is in keeping with the local area. Furniture, fittings and décor of the home were of a good standard, which were clean, comfortable and created a homely environment. All individuals have a single bedroom. Presently the home is registered for thirteen persons but there is only one vacant room as the provider has utilised the other bedrooms as part of their private living quarters. It would be recommended that the provider de-commissions these bedrooms in light that these cannot be used. The provider is of the understanding that these Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 20 bedrooms do not meet with the National Minimum Standards and have been deemed too small. Individuals confirmed that they had a key to their bedroom door and that this is their private space. Toilets and bathrooms were all furnished to a high standard of finish, with clean baths, shower areas, modern tiling and functional flooring. All bathrooms and toilets had locks and offered privacy. Communal areas and the kitchen were clean and homely. As noted at the last visit routine maintenance and décor is completed by the provider with contractors completing works on the electrics, plumbing or involved major building works. Evidence was seen via the Annual Quality Assurance Assessment and in records that routine electrical tests and the home’s gas certificate was current. In response to the Environmental Health Visit last year the home now records fridge and food temperatures. Handrails were seen throughout the property and a stair lift assists individuals to the first but not the second floor of the home. There are two ground floor bedrooms. Evidence was provided that the home takes and acts upon the advice of professionals including the purchase of aids and adaptations. The manager stated that all the individuals have been risk assessed in relation to radiator covers and no person or area has been identified as a high risk in relation to scalding. However, the long-term plan is to install radiator covers. The home has demonstrated compliance to risk assess radiators in respect of potential hazard. The manager stated that all windows have been fitted with restrictors. Water temperature is regulated to 43°c to prevent scalds in bathrooms and bedrooms. The manager stated that staff complete random checks on bathing temperatures and the plan is for all water outlets to be checked and a record maintained on a monthly or quarterly basis depending on the risk. Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient staff that are suitable trained are available in the home to meet the needs of the individuals. This would be enhanced if staff completed an induction in accordance with the Skills for Care Council guidance. Whilst staff are supported in their day-to-day role formal one to one supervision is lacking. EVIDENCE: The rota, conversations with individuals, staff and the manager provided evidence that the home is staffed in accordance with the needs of the individuals accommodated in Rockleaze and the statement of purpose. There are usually three staff working during the day including the manager with one staff providing night waking cover. Two nights per week there are two staff working at night in the absence of the manager who lives on the premises. This is commendable and it was evident that the manager is committed to meeting the needs of the individuals without comprising their safety. Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 22 There was a commitment for staff to complete their National Vocational Qualification 2 in care; two staff were in the process of enrolling to complete an NVQ 3 in care. Five out of nine staff have obtained their NVQ 2. This exceeds the government target of 50 . Records for the recruitment of staff were seen and evidence was provided that the home has responded to a requirement to ensure that all satisfactory checks are completed prior to staff taking up employment. The home has recently employed two new staff and their inductions were seen. One has been working in the home in excess of six months and this had not been completed, the other remains within the timescale. The two staff that are responsible for assessing the inductions are no longer assessed as competent as their training is only valid for twelve months and expired in December 2005. This requires updating every twelve months. The home has completed all statutory training including first aid, food hygiene and manual handling. Three staff have completed an introduction to learning disabilities. Seven of the nine staff have completed a distance learning module on infection control. In addition staff have attended training with the local Community Learning Disability Team on the specific needs of one particular individual as the provider through the initial assessment process had identified this. This demonstrated that staff would attend training relevant to the individuals based on their assessed needs. It was evident that regular staff meetings were now taking place. These were now taking place every six to eight weeks. Whilst staff confirmed they were supported and met with the manager on a regular basis. It was noted there was no formal supervision records demonstrating that these were taking place at least six times per year or a staff appraisal system. This must be addressed. Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed well. Individuals’ health and safety is paramount. EVIDENCE: Mr Jonathon Short is the registered owner and the provider of Rockleaze. Mr Short has completed his National Vocational Qualification at level 4 in management. Staff and people who use the service spoke very highly of the management of the home. Staff described an open approach to the management of the home. It was evident that staff felt valued and had specific roles within the home. People who receive a service stated that Mr Short will support them to do whatever they wanted and “nothing was too much trouble”. It was evident that Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 24 Mr Short is a “hands on manager” working alongside his staff team and supporting the individuals living at Rockleaze. The home is in the process of developing a quality assurance tool, which includes seeking the views of the individuals living in the home, their relatives and staff. In addition audits were being completed care planning, staffing, menu planning and the environment. These were still in the early stages of being implemented and will be followed up at the next visit to the home. Fire Records demonstrated that fire equipment checks, fire drills and training was all up to date. A fire risk assessment was in place. Information relating to food safety was all in place and from observations and discussions evidently formed part of the practice of the home. Records relating to food, fridge and freezer temperatures were routinely being recorded. External contractors were involved in the checking of the electrical appliances, stair lift and the fire equipment. A safety gas check had been completed. This demonstrated that routine checks were being completed in accordance with the legislation ensuring the safety of the individuals. A discussion at the last visit with Mr Short hinted that the business might have been struggling with the three vacant bedrooms. This has since resolved and the home now only has one vacancy. It was evident that the provider was taking steps to ensure the business will continue to be viable, and it was evident that the individuals’ care would not be compromised whilst living in the home. From conversations with Mr Short he strives to provide a safe homely environment where the individuals could lead full and fulfilling lifestyles. Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 3 3 X X 3 x Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 26 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. 2. 3. 4. Standard YA9 YA23 YA23 YA35 Regulation 15 (1) 13 (4) 17 (2) Sch. 4.9 17 (2) Sch. 4.10 18 (1) (c) (i) Requirement Timescale for action 03/09/07 Expand on the generic risk assessments to ensure pertinent to the individual. To maintain a record of valuables 03/08/07 held by the home. For each person to have a record 03/09/07 of valuables an inventory of their possessions. To ensure that staff have an 03/08/09 induction within the timescale and within the guidelines of the Skills for Care Council. 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. 3. Refer to Standard YA6 YA36 YA20 Good Practice Recommendations For all care documentation to be dated and signed, including where possible a signature from the person receiving a care service. For care staff to receive a minimum of 6 supervisions per year with records maintained. For the manager to be assured of staff’s competence in relation to the administration of medication with records DS0000003352.V337772.R01.S.doc Version 5.2 Page 27 Rockleaze maintained. Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Rockleaze DS0000003352.V337772.R01.S.doc Version 5.2 Page 29 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!