Inspection on 08/10/08 for Rockwell

This inspection was carried out on 8th October 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rockwell 29/05/08

Rockwell 28/11/07

Rockwell 25/08/06

Rockwell 18/08/05

Rockwell 26/01/05

Rockwell 18/08/04

Rockwell 10/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rockwell Corbett Close Lawrence Weston Bristol BS11 0TA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sandra Garrett     Date: 0 9 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Rockwell Corbett Close Lawrence Weston Bristol BS11 0TA 01179825693 01173772448 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Bristol City Council care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: One named individual under the age of 65 may be admitted for regular periods of respite care. Date of last inspection Brief description of the care home Bristol City Council own and run Rockwell. It was registered with the Commission for Social Care Inspection in March 2003. The home gives personal care only to a group of up to thirty people living with different types of dementia. The home is in the residential area of Lawrence Weston. It has a square layout with long corridors around a central courtyard. It has two floors with lift access, one large dining room and three small lounges (one of which is for smokers). It also includes activities and reflexology rooms, plus a tea room for people living at the home to meet with their relatives. A large garden, mostly laid to lawn, surrounds three sides of the home. The full weekly fee for Bristol City Council dementia care homes is 619.71 pounds per week (for 20089). Hairdressing, chiropody, reflexology, newspapers and toiletries are charged as extras. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading Care Homes for Older People Page 4 of 36 Over 65 30 0 Brief description of the care home web site at www.oft.gov.uk http:/www.oft.gov.uk Copies of recent inspections including the last three, were seen pinned up in the entrance lobby. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before the visit, all information the Commission for Social Care Inspection (the Commission) has received about the service since the last inspection was looked at. We then drew up an inspection record to prepare for the visit. This is used to focus on and plan visits so that we can concentrate on checking the most important areas. Because people with dementia arent always able to tell us about their lives, we use a formal way of watching them to help us understand better. We call this the Short Observational Framework for Inspection (SOFI). This means using a methodical and structured way of watching people living their lives at the home. We did this for two hours in both a lounge and the dining room and recorded peoples experiences frequently. We looked at their wellbeing, how they get on with other people living there Care Homes for Older People Page 6 of 36 and staff. We also looked at how they use the environment to make sure its accessible for them. Information from the SOFI exercise is included throughout this report. We also looked at a range of records at the visit itself. These included: care, complaints, staff training and supervision and health and safety records. We spoke with staff both individually and in a group. We spoke with relatives and spent time with the management team, discussing our findings. What the care home does well: What has improved since the last inspection? What they could do better: Only one requirement was made. This was following a general inspection of the City Councils personnel department. We had found that from several local authority services including Rockwell, copies of staff qualifications hadnt been sent in following recruitment. This doesnt show that people are cared for by properly qualified new staff. Three good practice recommendations were made. They included: making sure help with assessed needs in care plans (such as mouth and dental care) were recorded when help is given, otherwise people may not get the care they need, Too much recording of bodily functions (that had been mentioned in previous reports) denies people dignity and is overly institutional. Such recording should only be done on an individual basis where a clear medical condition shows the need for it and: Care Homes for Older People Page 8 of 36 The manager should continue to find ways of meeting peoples individual religious needs, rather than using a one size fits all approach. Person-centred ways of helping people continue to worship according to individual faith should be adopted. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Satisfactory arrangements for people coming into the home make sure their needs are met. Suitably trained and experienced staff make sure the specialist needs of people with dementia are picked up and met where possible. Evidence: We followed up a requirement from the last visit. This was about displaying copies of the current inspection report for people to look at if they wish. (Copies are also available on the Commissions website). In the entrance lobby we saw several different inspection reports pinned up. They included the last report, the one before that and the one from 2006. Also displayed was a copy of the homes Statement of Purpose, the certificate of registration, visitor fire procedures and a list of first aid trained staff. Care Homes for Older People Page 11 of 36 Evidence: From case tracking the records of four people living at the home (this means thoroughly checking all the information about a sample of people living at the home. This way we can assess whether the care given overall is adequate and meets peoples needs), we saw pre-admission assessments that had formed the basis of current care plans. The assessments and records of review meetings held four weeks after people came into the home, showed that the home was suitable to meet their needs. People have specialist needs either because they are older, or because of their dementia or because of ill-health. Work had been done to make the home more accessible for people with dementia (see below for information about improving the environment). Further, staff had had training in working in more person-centred ways. This means care that looks at a persons whole life, history and needs. It recognises and values them as an individual with rights and choices, rather than just focussing on meeting basic physical care tasks. From all our evidence gained over the two days of the visit it was clear that people are cared for in this way and their needs and wishes respected. Staff we spoke with commented on having more confidence in being able to work with people and showed clear evidence of their skills. Further, from our close observations of peoples lives we saw that staff were assisting people with specialist needs such as help with eating, in more person-centred ways that increased their dignity. Care Homes for Older People Page 12 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good documentation of care plans that include regular checks, makes sure that staff are given the information they need. However, failure to pass on essential information about care needs could mean people arent always protected. People living at the home are looked after well in respect of health and personal care needs. However, too much emphasis on bodily functions shows institutional care practice. People living at the home are looked after well in respect of their medication needs and they benefit from changes in care practice that reduces their reliance on medication. Improvements in being treated with dignity and respect benefits people living at the home. However using terms of endearment that may not be respectful to people could rob them of dignity. Care Homes for Older People Page 13 of 36 Evidence: We followed up seven requirements made at the last visit. Of these six out of seven had been met. One good practice recommendation also made at the last visit had been adopted. We case tracked four people in detail by both use of the observation tool and looking closely at care records. Our findings showed that: Care plans had improved and were more person-centred. Staff responded properly and with respect when giving help and attention. All four people had opportunities to engage with activities if they wished or respected if they did not. Staff that filled in our Have Your Say surveys before this visit commented: Information is good. Care plans are revised and up to date. All aspects of information are available and correct, I am always given up to date information on a persons care from the managers, reports before a shift, from care plans and other members of staff passing information over and: Yes. Up to date information is given on care plans and risk assessments and we are told of any changes also written in daily records. Care plans, whilst written in person-centred ways from the persons own viewpoint, did however show that outcomes werent always followed through in the same way. Use of I gave a feel for the persons own wishes but use of You e.g. you will feel etc took this away, making it more institutional. This was discussed with the manager and officer staff. A care plan sent to us after the inspection was properly written in a more person-centred way throughout. A requirement about detail in monthly care plan reviews hadnt been fully met. We saw that care plans were being looked at regularly but often they showed just a tick. Care plans should show how any changes are being handled. A further requirement about making sure care plans are fully looked at yearly involving the person and/or their relatives was partly met. We saw messages about arranging reviews or relatives attendance at them, in the managers message book. The manager said they were being done but there were few completed review sheets. Those that had been done had been written up properly. The review showed whether the person who was subject of the review had joined in or was unable to do so. From watching peoples experiences we picked up an issue of a person that had been very unwell, had lost a lot of weight and wasnt eating much. Because of her/his frailty, pressure areas were at risk. Although assessed as needing a pressure relieving cushion, staff had failed to make sure this was in place to avoid discomfort at all times for the person. During the visit s/he was often seen without it. At times s/he clearly showed and was able to express discomfort. Some staff spoken with were unsure Care Homes for Older People Page 14 of 36 Evidence: about whose responsibility (e.g. the homes or relatives) it was to provide the cushion and others didnt know that it must be used at all times. The care plan didnt reflect any of this and didnt mention the pressure areas at all. We required the manager to produce a revised care plan. This was sent to us the next day and properly recorded the actions to be taken to keep the person comfortable and protected. Further, staff were clearly told told of the need for the cushion to be used at all times. Records were in place to show peoples weights are checked regularly, although recording may not always be right. New digital, sit on scales had been bought and were in use. We picked up a substantial drop in weight for one person that wasnt consistent with all the other records or the record of food intake kept for her/him. Staff regularly check the new weighing scales so weights recorded should be correct. Therefore the weight could have been recorded wrongly. Staff now record everyones food and fluid intake each day. This is in the form of a checklist although it only shows if theyve actually eaten and drunk each day. Where people have clear eating or drinking difficulties separate charts are kept in the kitchen to record type and amount of food and fluid taken. A bowel monitoring chart had been reinstated (against our recommendations about this made at previous inspections). Each persons bowel movements were being checked and a stool chart was also seen that showed the look, colour and consistency from a scale of 1-7. Staff were recording this for each person. We discussed this with the manager who said that the GP had asked staff to keep it to avoid invasive examination if people were constipated. A good practice recommendation is made that bowel charts for any person should only be kept if there is a clear medical reason for doing so and not for each person as a matter of course. Although there are charts as described above we saw no record of how peoples dental hygiene is managed. A number of people have dental or mouth care recorded as needs in their care plans. However we saw nothing to show if or when care is given and staff checking that peoples mouth hygiene is kept up. From the homes own quality assurance survey done in July this year, a couple of comments from relatives about the issue were seen i.e. Dental needs of residents appear not so good. I have to take time off work to take my relative to the dentist and: oral hygiene can be overlooked. Staff should therefore record when they give mouth care and whether a visit to or from a dentist is needed. We advised the manager to review the overall number of different charts kept for people to make sure theyre not just being kept for staff, health professionals or an inspectors benefit. However, where care plans show a need for e.g. dental care, it Care Homes for Older People Page 15 of 36 Evidence: should be recorded when such care is given so that its clear peoples needs are met. A requirement about risk assessments had been met and they were in place for each person in respect of moving and handling. All had been recently reviewed. Specific risk assessments were also in place e.g. for pressure area care and behaviours. Peoples healthcare was being managed well. People see the GP and district nurses regularly. The GP that visits the home had done a full medication review on each person. One of the assistant managers in charge of medication had worked to make sure that no one should ever run out of medication. (This had been a requirement from the last inspection). The check of medication showed all were correct, with no gaps in administration sheets, no overstocking or lack of sufficient medicines. Case tracking confirmed that management of peoples health and personal care had improved to the extent that everyone had had their night sedation reduced or stopped and daytime medication also reduced where found to be unnecessary (i.e. for controlling behaviours). This showed that improvements in activities and person-centred care were now having a good effect. Medication was given to people in a discreet manner with the right assistance given. They were given a drink, and encouragement and support as needed. The medication fridge was checked. The temperature was being recorded but not the actual one. This was high - above the recommended point. We advised staff to record the actual temperature and turn the fridge thermostat up as the room exceptionally warm. All creams, nebulisers and eye drops are applied in the medication room. Opened bottles and tubes that only last a short time were all dated when opened and refrigerated where necessary. A sheet was seen for staff to sign when applying creams and lotions. These showed some gaps and the deputy manager said that staff were finding it hard to follow the new system. We advised that all medicines given including creams and eyedrops should be signed for on administration sheets in the same way as tablets are. From our observations staff treated everyone with dignity and respect. More attention was paid to them when they needed it and they werent controlled when they wanted to move around e.g. in the dining room at mealtimes. All staff were heard speaking kindly and quietly to people in respectful ways. However, some staff use terms of endearment such as sweetie and gorgeous that could be patronising or infantilising to older people. This should be discouraged as inappropriate. Care Homes for Older People Page 16 of 36 Evidence: Care Homes for Older People Page 17 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People now enjoy more opportunities to have a stimulating life where various formal and informal activities happen regularly. The location of the home doesnt enable much community contact for people living there and peoples religious needs arent fully met. People living at the home now benefit from being able to live their lives in a relaxed way with few restrictions. An improved dining room experience gives people more pleasurable and relaxed meals with discreet assistance offered. Evidence: A list of activities was pinned up in the entrance lobby. These included: musical entertainers visiting regularly (three different ones), a Halloween party, a bonfire night party and: the homes Christmas party. On the second day the manager showed people some photographs of a recent garden Care Homes for Older People Page 18 of 36 Evidence: party. People laughed, smiled and commented about themselves and each other in the pictures and enjoyed this experience, reminiscing about the day. Magazines and books were in the lounge and the TV was on. Those people in the lounge were watching and enjoying it and the company of each other. No distress or anxiety was seen at any time. Mid morning tea was served and the right assistance was given. For all of the timeframes people were watched they experienced positive states of wellbeing, engaged with a number of tasks and staff interaction was good. Changes had been made to the ground floor area e.g. the small lounge near the front entrance had been made into the activities room. People were seen using the room for singalong sessions on both days of our visit. Paintings they had done and pottery figures they had decorated were seen in their bedrooms. The activities record showed lots happening that included games, music, exercise and baking. Activities happen daily and people have lots of opportunities to join in if they wish. People we met were smiling and engaging with staff, their surroundings, objects and us. We saw that some people showed signs of recognising us from our previous visits. Hardly anyone was walking round and round the corridors as they had been last time. A part of the dining room had been made into a cosy area with armchairs and a flat screen TV on the wall. People were sitting in these chairs as well as in other lounges. We looked at the activities records. They included much more detail. Activities included: going for walks, reminiscing, singing and playing percussion instruments, Watching Royal Ascot, the Olympics and Strictly Come Dancing on TV, manicures, dancing, a barbecue, quizzes, bingo and watching old films. Records were all good and clearly showed how people enjoy themselves. Managers check the records and if something should have been recorded elsewhere e.g. a persons daily record, a note to this effect is written in the activities book. Staff told us that since all the changes have been made people have stopped going into each others rooms as much as before. Staff said they believe this is because people get so much more stimulation with events going on. However staff commented in our survey that they would like to: have more time with the service users and look at angles from their point of view and not just from the people that think they know and: give people more days out. Care Homes for Older People Page 19 of 36 Evidence: Staff take people out for walks around the area, to shops and down to the pub at the end of the road. They are also taken out to lunch in nearby Shirehampton. Records showed their enjoyment of these outings. The manager said she is trying to get a local Roman Catholic priest to come and hold services. However not everyone is Catholic so efforts should be made to offer a wider choice of religious involvement. The manager said she had contacted other groups that offer services in care homes and was waiting for their replies. One person is deeply religious and we saw evidence of this in her/his bedroom. However it wasnt clear if efforts were being made to help her/him keep up with e.g. bible readings as the person now needs e.g. a picture bible so that s/he can continue to gain comfort from it. The manager said she would try and find one. From all the above people clearly have lots more choice and interest in their daily lives. We didnt see any signs of behaviour that challenges staff and the atmosphere was calm, relaxed and happy. We saw a two-week written menu on a notice board for people to know what meals were available each day. On the same board staff were recording peoples fluid and food intake on a chart. This is not the right place to have private information on display and should be removed and put in a more discreet area. A picture menu board with photos of meals and alternative choices for the day was on display in the dining room and this prompted discussion amongst people of what they liked and disliked. People were heard saying: The food here is lovely, I enjoy my food If we dont like it we have something else. We spoke with a visitor who told us: There is much more going on, my relative has been involved in making cakes, there is always something to do, but only if they want to, staff dont make anyone do anything they dont want or are unable to do. The dining experience was much more pleasurable for people. The meal was served at a relaxed pace and the atmosphere was calm and pleasant. Staff engaged with people politely. They spoke with warmth and kindness and supported people on an individual basis e.g. some people were assisted with eating. This was done in ways that drew little or no attention to the person concerned, time was taken and people were encouraged to do what they were able for themselves. Support was given at peoples own pace and they werent rushed. Support given was in line with information seen on care records and the wishes and choices of people who live at the home. Care Homes for Older People Page 20 of 36 Evidence: People were given patterned tabards and paper serviettes in order to keep their clothing clean. We saw that different meals were given to people when requested. Further, when staff noticed people didnt enjoy the meal given they offered something else and encouraged people to make a choice. We also noted that one of the kitchen staff came out and spoke with people asking if they enjoyed their meal, checking if they were ok, engaging in a positive manner and actively encouraging people to give feedback about their meal. People were treated with dignity and respect and as adults with valued opinions. Some people chose to get up during their meal. They walked across the room or went to another table. On all occasions staff saw this happening, no attempt was made to make them return to their seats. People were therefore able to move freely around the area at their own pace. We saw that plate sizes had been reduced so that people dont feel overwhelmed by the amount of food in front of them. However, this should be done on an individual basis, not as a one size fits all. We noticed that one person ate large amounts of everything (including sandwiches with the main meal). The person was loud and clear in her/his wishes to have more food and staff simply gave her/him whatever s/he wanted. We discussed this with the manager as the person isnt very mobile and does little exercise. We recommended the person be given an average sized plate and advice gained from a dietician about a more suitable diet. Further, we noticed the person eating sweet rice pudding with the main course (stew) and discussed this also as it could be a cultural issue that is being ignored. Care Homes for Older People Page 21 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Satisfactory complaints management and recording ensures people living at the home are kept safe. Proper management of abuse issues keeps people protected from risk of harm or abuse happening to them. Evidence: We looked at the Complaints log. No complaints had been made since the last visit although one person had written expressing dismay at the home closures. Several compliment letters were in the file. The complaints leaflet is displayed in the entrance hall. This isnt accessible for people with dementia as each persons need may be different. We spoke to relatives that visited the home who told us: The staff here are totally wonderful and: Things are so much better here than they ever have been. They also told us that the home keep them informed about the wellbeing of their relatives, that staff are very approachable and they listen. They knew who to speak with if they had any concerns or complaints but said they didnt have any. Care Homes for Older People Page 22 of 36 Evidence: Staff also commented about complaints in our survey: Give advice about policies and direct any query to the officer on duty, A comment card is available for them. The manager is also available for meetings, If anybody has any concerns about the home I will advise them to take their concerns to the officer on duty or manager and to discuss it with the appropriate people, Speak to the manager or show them the complaints procedures booklet, which is situated as they enter the unit and: Theres information in the reception area. We saw from training records that regular training in safeguarding adults from abuse is done. This makes sure staff are kept up to date and refreshed in their knowledge of what to look for. Incidents between people that had happened recently had all been treated as abuse under the safeguarding adults policy and quick action had been taken to manage behaviour that challenges others. We had been notified of each of these and the safeguarding adults co-ordinator had been contacted. An issue about mismanagement of peoples money that we picked up at the last visit had been dealt with by an independent investigation and changes to procedures. We had been kept informed of all changes and saw evidence of this in place. Care Homes for Older People Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvement in the homes environment gives people with dementia a more homely, fresh and accessible place to live, which is kept clean and hygienic. Evidence: Lots of redecoration had been done since we last visited including: corridors, entrance hall, some bedrooms and lounges. Corridors had been painted in pale neutral colour and heavy curtains had been removed, making them lighter. Lots of new prints and paintings were on display in corridors and also new cosy furniture was seen. We commented on this to the manager who told us all had been found locked away in existing store rooms in the home. An old-fashioned wind up gramophone complete with a number of vinyl records was in the entrance hall. This still works and staff regularly wind it up for people to listen to. The area has been completely refurbished together with the office. The office door is open all the time and lots of office furniture has been removed making it a more welcoming place. The manager said people come in and do bits of office work that they may have been used to in their past lives. All bedroom and other doors were unlocked and accessible to people. The flooring is still shiny in corridors, that throws pools of light. Pieces of furniture from peoples Care Homes for Older People Page 24 of 36 Evidence: homes were seen in the corridors that made them look homely. Several cupboards in corridors had been emptied, doors removed and the areas re-painted as cosy nooks for armchairs. Staff said that people often sit in them and rest or just to have a chat with each other. A room upstairs had also had the door removed and furnished as a little sitting room with easy chairs. In bedrooms more pictures were on display together with lots of photographs of family members or from bygone days. Some of these had been put up with regard to the height of the person so that they could see them easily. Photos often had names on them so that the person would be able to tell who they were. However, in other rooms photographs were either placed too high or were on shelves that were too high. These should all be placed at heights suitable for the people concerned. A requirement about pictures on doors was partly met. A photograph that clearly showed the room to be a bedroom was on each door together with a smaller photo of the person - as they look now. However as people with dementia may not recognise themselves as older people and each bedroom photo looks the same, they still may not be able to find their own rooms. We saw one person looking for her room and going into someone elses, unaware that hers was next door. In individual rooms peoples interests were clearly seen from collections of ornaments, soft toys and pictures. Therefore pictures that people can recognise should be put up on each door so that they help people find their rooms more easily. A requirement about re-decorating bathrooms was met. All had been painted, repaired and made safe and furnishings improved. This made them look homely and welcoming. Records showed that people enjoy their baths and the rooms now add to their enjoyment. Bedrooms each had different wallpaper and furnishings and each had a fake fur nonslip rug that again made them look comfortable and welcoming. As mentioned above, the increase in activities has reduced the number of times people go into other peoples rooms and take things, as they are no longer bored or frustrated. The key culture that was reported in previous inspection reports, i.e. an emphasis on staff carrying large bunches of keys around and locking most of the rooms in the home, had completely gone. Almost all the rooms were unlocked including all bedrooms and bathrooms. However some substances that could be hazardous to people such as shampoos, bath essence etc were seen in bathrooms. These should be removed to keep people safe. Care Homes for Older People Page 25 of 36 Evidence: The garden area had been cleared and made safe. One person took us out for a walk around the garden and smiled a lot at the plants and garden decorations put up. Benches and plant pots had been moved to create pleasant places to sit and overgrown bushes cut back to reveal a spacious area for people to enjoy. The whole home was exceptionally clean and hygienic. It smelled fresh and pleasant and staff were seen cleaning all areas. We saw information to show that the kitchen had been deep cleaned and regular maintenance of fixtures and fittings was done. Care Homes for Older People Page 26 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Better staffing levels and management of staff time makes sure people living at the home get the service they are entitled to expect. Adequate recruitment processes make sure people living at the home are protected from risk. People living at the home now benefit from a well-trained staff group that is able to meet their needs. Evidence: The number of people living at the home has reduced over recent months. The home is scheduled to close by summer 2009 and people moved to an adapted and refurbished home in Henbury. Therefore with only seventeen people to care for (all women), staff have more time to spend with them as staffing levels havent reduced. Agency staff are used to cover unavoidable absences or annual leave. Individual agency staff work regularly at the home and now get supervision so that people get continuing care from staff that know them. Staff commented on how much better they think the home is for people living there. They also said they get as much time as they want to spend with people and take them out more. Care Homes for Older People Page 27 of 36 Evidence: It was good to see that a number of staff were available to support people, either to help them with practical things or just to spend one to one time or to provide emotional reassurance. In all time frames there was staff involvement with people. The only time this wasnt positive was when a person was ignored. However, within the five minute timeframe another member of staff spoke with and comforted her/him, made her/him smile and turned the negative/anxious state of being into that of a positive one. Staff showed good motivation and clearly had good relationships with people living in the home. They were observed to have a sound understanding of peoples different needs and met them properly and with respect. Staff told us they have regular staff meetings and we saw minutes of recent ones held for each staff group. They are much more positive about their work and changes made. There is a commitment to making life better for people. When we talked to them they told us they are much happier, enjoy coming to work and stress levels are down as managers are there to listen and support at any stage. Staff also said that theyre working much better together as a team. They said they believe people living at the home are much happier and relaxed and a lot easier to care for. Staff said that a visitor told them how much s/he thought it had changed and for the better and that was only after two days. From our survey comments such as: Information is good. Care plans revised and up to date. All aspects of information available and correct, Now we have new management we can always go into the office and get anything we want and care plans and risk assessments are more up to date and: I am always given up to date information on peoples care from the managers, daily reports before a shift, care plans and other members of staff passing information over, shows the impact of recent changes made. Training in National Vocational Qualification (NVQ) continues. Four staff are doing NVQ 2 and enjoying it. Nine staff already have the qualification or have gained it recently. Staff also told us they had all done dementia and person-centred care training which has made them feel more confident in caring for people. From the question in our survey: Are you being given training which: is relevant to your role?, helps you understand and meet the individual needs of service users?, staff commented: I find all aspects of training are very well done and useful and to help me in my job as a care assistant, A training bulletin is available for us, The person centred care is a very good course, Yes, things change all the time, I have attended numerous courses throughout my time at Rockwell. I am still attending courses and being kept up to date with new ways of working, Yes more so now than before and: Training is always available. Manual handling is updated every 2 years plus we have in house training Care Homes for Older People Page 28 of 36 Evidence: with key mover. Staff told us they had all done dementia and person-centred care training that has given them more confidence in caring for people. On a scale of 1-10 (with 10 being the highest), they said their confidence levels were currently at 7. We had done an inspection of the local authoritys personnel department earlier this year. During this we looked at a small sample of staff records. From that inspection we found that for several services including Rockwell, copies of qualifications werent being sent to the personnel department. New staff must be asked to supply clear documentation of any qualifications such as NVQ or other relevant ones so that they can be kept on file. We also looked at records of new staff, kept in the home. Each staff members file we looked at had both a clear photograph and proof of identity. From getting better training and support and spending more quality time with people staff have found that people can do more for themselves than they realised and will tell staff this. We saw from records of staff meetings, clear evidence of disussion about tasks, training, health and safety and other matters. We were given a copy of a staff training chart. This showed the range of training including: moving and handling, dementia, safeguarding adults, person-centred care, fire safety, food hygiene, NVQ and effective recording, among others. Staff also get equalities training although not everyone has done this yet. The chart showed dates of training done for each person.It showed every staff member had done person-centred care in July or August 08 and dementia care over a range of dates from January to June 08. Staff said they would however like to do more training, particularly in First Aid. Care Homes for Older People Page 29 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Both people living at the home and the staff team now benefit from an experienced manager who encourages an open, person-centred style of management. Improved and more secure management of peoples finances makes sure they are protected from financial abuse. People now get consistent care from a staff team that have opportunities to regularly discuss and think about their working practices. Improved record keeping now shows the quality of care given to people living at the home. Proper management of health and safety in the home makes sure people are kept safe, and prompt reporting of accidents and events makes sure that the Commission is made aware of actions taken to protect them. Care Homes for Older People Page 30 of 36 Evidence: We looked at staff meeting minutes, staff training records, recruitment and supervision records and a training matrix which showed when staff had done essential and required training. Where we asked for them we were given copies of documents to assist us in the preparation of the report and as further evidence. We looked closely at 16 staff survey responses, all of which were positive. In particular staff said they felt more supported by the current management team and a more relaxed person-centred atmosphere has benefitted people living at the home. We discussed all standards and requirements with the manager and assistant managers on duty. It was clear from evidence seen that the newly installed management team have worked hard to improve the environment, activities, and morale of all, including staff. The manager showed clear leadership and an excellent understanding of personcentred care for people with dementia. She is trained and experienced although her permanent post is as a deputy manager. She had however, run another dementia care home for a period of up to one year in the absence of the registered manager. She is now applying to the Commission to register as the manager of Rockwell until such time as the home closes. Both the manager that had first been moved to Rockwell for a period of three months to effect change quickly, and the current team manager for the home, attended the inspection. It was clear from our visit that much work has been achieved to make sure the home is run in the best interests of people living there and in a way that treats them as valuable individuals in their own right, with choices, wishes and feelings. Five requirements made about: management of peoples finances, keeping records in good order, staff supervision, reporting of any incident that affects people and: night staff fire safety training and fire drills, were all met. Evidence was seen of all and we had been in close contact with the registered provider about making sure a safe way of handling money management records for people. This had resulted in clearer procedures and a new recording sheet. The home will be audited by the local authority in the near future. Records showed that no-one is charged for a service such as reflexology in advance of the treatment being given. Since the last inspection we had received a number of accident and incident records. These showed that issues were picked up and quick action taken to keep people safe. Care Homes for Older People Page 31 of 36 Evidence: Supervision records showed that for a poorly performing staff member observed at the last visit, regular sessions had been held with the manager and extra training given. The person was observed again at this visit and her/his attitude and behaviour showed improvement. Staff supervision records were in place for regular agency staff. Supervision records showed that staff have clear opportunities to discuss their work, any training needs they have and are encouraged to raise any matter with their supervisors. Five good practice recommendations had been adopted. However one hadnt been fully adopted because its difficult to put the service user guide and the complaints leaflet into an accessible format for each person with dementia, as each persons communication needs are likely to be different. Management staff spend more time out of the office with people living in the home and helping staff with activities. We saw in daily care records however that a correction fluid (a substance to blot out writing), had been used. We were unsure as to why this had been done. We recommend that the substance isnt used at all as care records are legal documents and nothing should be hidden or covered up. If mistakes are made they should be scored through with a pen so that what has been written is still visible to show the original intention. Health and safety records were all in good order and showed evidence of regular checking. Staff records showed that staff have regular fire safety training. Fire safety records showed that night staff are given regular updates and walk through mock fire drills to test their readiness to deal with a possible fire. Care Homes for Older People Page 32 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 33 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 Copies of new staff qualifications must be obtained and kept in each persons personnel file. This will make sure people are cared for by staff that have gone through thorough checks. 30/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Where dental or mouth care is an identified need in care plans, evidence of care given should be recorded regularly. This will make sure peoples dental needs will be regularly checked. Sensitive information about bowels should only be recorded if there is a clear and individual medical reason for doing so and not as a matter of course for each person. This will make sure that peoples dignity is respected and they arent treated in an institutional way. The manager should continue to find ways to help people to be able to follow their chosen religion in whatever way suits them. This will make sure peoples individual religious needs will be met. Page 34 of 36 2 8 3 13 Care Homes for Older People Care Homes for Older People Page 35 of 36 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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