Inspection on 23/02/09 for Rodney House

This inspection was carried out on 23rd February 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rodney House 15/07/09

Rodney House 26/05/09

Rodney House 26/02/08

Rodney House 05/06/06

Rodney House 25/10/05

Rodney House 06/01/05

Rodney House 19/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rodney House 4-6 Canning Street Liverpool Merseyside L8 7NP     The quality rating for this care home is:   zero star poor 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: Helen Carton     Date: 2 3 0 2 2 0 0 9 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. that people have said are important to them: They reflect the things 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 38 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Rodney House 4-6 Canning Street Liverpool Merseyside L8 7NP 01517093883 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): EBS Services Ltd Name of registered manager (if applicable) Mrs Sheila Gilroy Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 2 named males and 1 named female service user under 52 years of age within the overall number of 56 No more than 56 persons shall be accommodated at any one time. One named service user in the category Mental Disorder, excluding learning disability or dementia under 52 years old may be accommodated Date of last inspection Brief description of the care home Rodney House is a large former hotel, situated in a conservation area close to Liverpool city centre. Both of Liverpools cathedrals, shops, libraries and museums are within walking distance of the home. Accommodation is provided in single rooms (56), Care Homes for Older People Page 4 of 38 care home 56 Over 65 0 53 0 28 0 2 Brief description of the care home on three floors with lift and stair access. There are two lounges and a designated smoking room on the ground floor with dining rooms situated on the ground floor and the basement area. On street parking is limited. Rodney House is registered to provide care and support to older people. Many of the service users are self-caring, though they need support and reminding to maintain personal standards of health and hygiene. A copy of the most recent inspection report by the Care Quality Commission is available from the manager. The current scale of weekly charges is 270.00 to 390.00 Care Homes for Older People Page 5 of 38 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: zero star poor 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: As part of the inspection process we sent Rodney House an Annual Quality Assurance Assessment (AQAA) document, which was completed prior to our visit to the home. This document was to provide information about the service at Rodney House and to tell us where they felt they had made improvements to the way they support service users and the staff team. As part of the inspection process surveys were sent to 56 service users, 7 care managers, 5 health care professionals and 6 members of the staff team, a total of 15 responses were received. The last inspection on this service was completed on 26/02/2008 Care Homes for Older People Page 6 of 38 We visited Rodney House to enable us to look at records and to discuss how the home supports service users in all aspects of their lives. Part of this process involved speaking with the manager, members of the staff team and spending time with service users to find out their views on living at the home. We spent approximately 9 hours at Rodney House. What the care home does well: What has improved since the last inspection? What they could do better: The statement of purpose and service user guide do not give clear and relevant information about Rodney House, resulting in prospective service users and their families having insufficient information on which to make a considered choice as to whether the service can meet their needs and support their individual lifestyle choices. Usually before a service user moves into Rodney House an assessment of their needs is carried out. Examination of records show, little consideration is given to specialist care needs of service users or the skills, ability or knowledge of the staff team that will be caring for them. Resulting in service users with specialist needs living at Rodney House receiving poor quality of care through the lack of a trained and knowledgeable staff team. A selection of care plans were looked at and provided the following information: Information held in plans is not detailed, in some plans information about specific care needs such as depression, schizophrenia and alcohol dependency are so generalised it would be difficult for the staff team to effectively monitor service users well being. Care plans are not being effectively reviewed with management and support plans for identified challenging and risky behaviours not being produced or implemented. This results in service users individual needs not being met and on occasions a safe environment not being maintained. Service users spoken with during the inspection visit made the following comments: No one is aggressive to me. But there have been arguments between staff and residents. Staff they have a tough job, they are kind, they find it hard to control people who are Care Homes for Older People Page 8 of 38 drunk. It is a bit rough living here some residents are pretty rough and some can be drunk the staff do a good job to the best of their ability. The staff team do not adequately record healthcare issues within individuals care plans and there is little or no evidence that regular health monitoring takes place. The staff team do not have the skills, experience or training to meet the health care needs of service users. Resulting in service users healthcare needs not being effectively monitored and the risk of deterioration of specific conditions increasing. The majority of service users medication is administered through a monitored dosage system. We looked at a sample of service users medication and the accompanying medication administration record sheets. These records were not up to date and there were gaps in recording medication administered to service users. Service users living at Rodney House, have a wide range of care and social needs. Care plans provide only general information about individuals social and leisure preferences, with little detailed information to assist the staff team to develop social and activity plans for those service users who would benefit from this type of structure. There are very few planned activities throughout the week with many service users choosing to engage in activities, which have a negative impact on other people living at the home. The management team do not appear to have developed any strategies to engage with those service users to support them to redirect their energies into more positive social activities. Service users spoken with and comments made in returned surveys provide the following information: There are no activities arranged by the home that I can take part in. There are no activities that I could take part in at the moment. Sometimes activities are put on that I like. Rodney House has a complaints procedure that is in an easy read format and is displayed on the notice board situated in the entrance hall. Services users spoken with and information gained from returned service user surveys suggests they know how to make complaints and who to go to if they are unhappy. However service users spoken with during our visit, raised concerns about incidents of aggressive behaviour taking place. They did not view these incidents as something they could complain about. This may be due to poor in-house procedures or that service users have become accustomed to aggressive behaviour in their daily lives. There is a lack of knowledge and training around the use of restraint and its different forms, resulting in service users being subject to physical restraint, which may be inappropriate and unsafe. Care Homes for Older People Page 9 of 38 The physical environment does not always meet the specialist needs of service users and the assessed needs of some service users being supported can not be met. Staffing levels do not meet the needs of the service users currently living in at Rodney House this results in their health and welfare being adversely affected. Rodney House does not recognise the importance of individualised person centred support and views personal care needs as the limit of the support provided. This results in service users receiving a one size fits all approach to their care needs. We looked at staff training records and service users care files and spoke with members of the management and staff teams. Information gained indicates the staff team are not skilled to meet the specialist needs of service users effectively and safely. This results in poor outcomes for service users with regard to their physical, mental, emotional and psychological wellbeing. Rodney House does not appear to have a clear sense of direction with quality assurance monitoring not regarded or implemented as a core management tool. This results in service users receiving a generalised care service and the needs of those who do not particularly challenge the service being less of a priority. This leads to an inequality in the care and support being provided. With no evidence that there is a clear understanding of person centred thinking in the home. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 38 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 11 of 38 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users cannot be confident the home can identify or meet their individual care needs and personal aspirations in a safe and supportive environment. Evidence: The statement of purpose and service user guide do not give clear and relevant information about Rodney House. Neither document offers prospective service users an accurate reflection of the services and facilities they can expect to access once they have moved into the home. Resulting in prospective service users and their families having insufficient information on which to make an informed choice as to whether Rodney House can meet their needs and support their individual lifestyle choices. The AQAA document completed by the home gave us the following information about some of the care and health needs of the people who currently live at Rodney House: They have mental health needs, physical disabilities, alcohol dependency and visual Care Homes for Older People Page 12 of 38 Evidence: impairment. Currently the staff team do not have the necessary skills and competencies to meet this wide range of needs, resulting in service users receiving ad hoc and generalised care rather than person centred care. Usually before a service user moves into Rodney House an assessment of their needs is carried out. However examination of records show little consideration is given to the specialist care needs of service users or the skills, ability or knowledge of the staff team that will be caring for them. The meeting of individual needs seems to be a low priority of the assessment process. This results in service users with specialist needs living at Rodney House receiving poor quality of care through the lack of a trained and knowledgeable staff team. The service does not provide intermediate care. Care Homes for Older People Page 13 of 38 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users personal and healthcare needs are not being met. This results in them receiving a poor service, which has a negative impact on the quality of their lives. Evidence: A selection of care plans were looked at and provided the following information: Information held in plans was not detailed, in some plans information about specific care needs such as depression, schizophrenia and alcohol dependency were so generalised it would be difficult for the staff team to effectively monitor service users well being. Care plans were not being effectively reviewed with management and support plans for identified challenging and risky behaviours not being produced or implemented. This means that service users individual needs were not being met and on occasion a safe environment not being maintained. Care Homes for Older People Page 14 of 38 Evidence: Records show that Rodney House is currently supporting a large number of service users with complex needs which regularly results in incidents of both verbal and physical aggression and other forms of risky behaviours. Daily records show these types of behaviour are considered a normal part of the culture of Rodney House. However the impact these behaviours are having on other service users is not being acknowledged. This is leading to a lack of awareness by the service of the impact of living in an aggressive and unpredictable environment can have on their emotional and mental wellbeing. Records show training had not been provided to the staff team to enable them to manage aggressive incidents effectively and safely. We discussed this with the manager who told us he was currently arranging for this type of training to be provided by an external training agency. We advised him this training should be provided as a matter of urgency to help ensure the health and safety of both service users and the staff team. Members of the staff team spoken with told us at times they feel unsafe and feel physically threatened by some of the service users currently living at Rodney House. Service users spoken with during the inspection visit made the following comments: There is a group of people who live here who cannot hold their drink Z thinks he is a big man scaring the girls who work here shouting at them and running at them he frightens the frail ones who live here he does not bother me No one is aggressive to me. But there have been arguments between staff and residents. Staff they have a tough job, they are kind, they find it hard to control people who are drunk. It is a bit rough living here some residents are pretty rough and some can be drunk the staff do a good job to the best of their ability. The staff team do not adequately record healthcare issues within individuals care plans and there is little or no evidence that regular health monitoring takes place. The staff team do not have the skills, experience or training to meet the health care needs of service users. This means that the service users healthcare needs not being effectively monitored, and the risk of deterioration of specific conditions increasing. The majority of service users medication is administered through a monitored dosage Care Homes for Older People Page 15 of 38 Evidence: system. We looked at a sample of service users medication and the accompanying medication administration record sheets. These records were not up to date and there were gaps in recording medication administered to service users. There was no information sheets about prescribed medications to enable the staff team to recognise possible side effects. On the occasions when service users had refused medication or it had been withheld by members of the staff team advice from the GP had not been sought. This showed that service users medical conditions are not being effectively monitored and supervised and the opportunity to discuss with healthcare professionals alternative treatment plans being missed. Discussions with members of the staff team indicate there is a lack of awareness that this type of poor practice could be viewed as neglectful or abusive. Care Homes for Older People Page 16 of 38 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service does not value or respect the views and wishes of service users. Resulting in service users being supported by a generic care service that does not meet their individual needs and aspirations. Evidence: Service users living at Rodney House, have a wide range of care and social needs. Care plans provide only basic information about individuals social and leisure preferences, with little detailed information to assist the staff team to develop social and activity plans for those service users who would benefit from this type of structure. There are very few planned activities throughout the week with many service users choosing to engage in activities, which have a negative impact on other people living at the home. The management team do not appear to have developed any strategies to engage with those service users to support them to redirect their energies into more positive social activities. The service seems to be task orientated and little importance is placed on spending Care Homes for Older People Page 17 of 38 Evidence: time with service users to promote their mental and emotional wellbeing. This may result in service users experiencing feelings of isolation and an inability to make friends within the home community. Service users spoken with and comments made in returned surveys provide the following information: There are no activities arranged by the home that I can take part in. There are no activities that I could take part in at the moment. Sometimes activities are put on that I like. The leisure facilities within the home are limited with only one television in the large lounge being available for service users to access. Service users spoken with expressed a desire for a television to be provided in the small lounge. The manager told us he had requested one be purchased before Christmas however it had not been provided. There is little consideration given to supporting service users individuality and preferences this was clearly evidenced by speaking with service users, plus examination of care records. It was positive to find that those service users who maintain contact with their families are supported to do so. There are two dining areas a small one on the ground floor and a larger dining room in the basement area offering service users options as to where they would like to have their meals. Service users spoken about the quality and quantity of the meals, provided mixed comments with some commenting they had no complaints about the meals offered while others felt they would like to see an improvement in the quality and quantity of the meals provided. Records show that some service users have been prescribed nutritional supplements it is not clear if these are being given as directed by the GP or other healthcare professionals involved in supporting service users. Leaving them at risk of not having their nutritional needs monitored effectively and safely. Care Homes for Older People Page 18 of 38 Care Homes for Older People Page 19 of 38 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users views and opinions are sought however they are not always appropriately acted upon. This can result in them not feeling able to voice concerns and leaves them vulnerable to neglectful and abusive care. Evidence: Rodney House has a complaints procedure that is in an easy read format and is displayed on the notice board situated in the entrance hall. Services users spoken with and information gained from returned service user surveys suggests they know how to make complaints and who to go to if they are unhappy. However service users spoken with during our visit, raised concerns about incidents of aggressive behaviour taking place. They did not view these incidents as something they could complain about. This may be due to poor in-house procedures or that service users have become accustomed to aggressive behaviour in their daily lives. Complaint records show issues of aggression are not documented as complaints with little information held as to the action taken to resolve thesesituations. This issue has been referred to the local safeguarding team. The following comments There are clear policies and procedures about safeguarding adults and they are readily available to the staff team. However information held in daily records and in notified Care Homes for Older People Page 20 of 38 Evidence: incident forms sent to us shows the staff team lack awareness of abuse and its many forms. This results in service users not receiving support in a manner that focuses on their protection and wellbeing. There is a lack of knowledge and training around the use of restraint and its different forms, resulting in service users being subject to physical restraint, which may be inappropriate and unsafe. The service has a lack of understanding about human rights and there is poor practice in the areas of respect, dignity, autonomy and fairness. Care Homes for Older People Page 21 of 38 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Rodney House is poorly maintained and does not provide a homely, comfortable and safe environment for service users to live in. Evidence: The physical environment does not always meet the specialist needs of service users, and the assessed needs of some service users not be met. Rodney House is registered to accommodate 56 service users however in the two main lounges there are only 20 seats available. This means service users ability to choose where to sit and with whom is restricted. Information provided in the AQAA document suggests there is an ongoing maintenance programme, however following a tour of the building it appears essential maintenance is only carried out when a problem has already arisen. A large number of the windows are in a poor state of repair resulting in communal areas, toilets, bathrooms and shower rooms being cold. During our visit we noticed the heating system was programmed to come on at certain times of the day. However due to the poor state of repair of the windows the period of time the heating was on was not sufficient to maintain a comfortable temperature within these areas of the home. Service users spoken with in the lounge areas told us they felt cold and it had been cold in the Care Homes for Older People Page 22 of 38 Evidence: lounges for a few weeks. We noticed that in the smaller lounge there was a large television cabinet, which following discussions with service users and the manager we became aware it did not house a television. Service users told us they would like to watch television in this room and the manager acknowledged this and said he had requested a replacement since taking up the post of manager in December 08. Access to the front of the building can be difficult for service users with mobility difficulties. A portable ramp has been purchased to support service users to access and leave the building it is not fitted with grab rails which some service users raised as a concern however overall this will benefit service users with mobility needs. Rodney House does not operate in a person centred way, resulting in service users quality of life being made worse by the environment they are living in. Care Homes for Older People Page 23 of 38 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are not supported by a trained and skilled workforce resulting in service users receiving a generalised care service that does not meet their individual needs. Evidence: Staffing levels do not meet the needs of the service users currently living in at Rodney House, resulting in their health and welfare being adversely affected. Rodney House does not recognise the importance of individualised person centred support and views personal care needs as the limit of the support provided. This results in service users receiving a one size fits all approach to their care needs. We looked at staff training records and service users care files and spoke with members of the management and staff teams. Information gained indicates the staff team are not skilled to meet the specialist needs of service users effectively and safely. This results in poor outcomes for service users with regard to their physical, mental, emotional and psychological wellbeing. The manager provided us with information that showed he had been seeking out information about external training courses however at the time of the visit none had been formally commissioned. Care Homes for Older People Page 24 of 38 Evidence: We looked at a selection of staff files and found all necessary safety checks including taking up references and a Criminal Records Bureau checks are completed prior to a person starting work at Rodney House. This helps to ensure all reasonable recruitment precautions have been taken to safeguard service users living at the home. Since the last site visit three members of the staff team have been dismmissed. The induction process is very limited and it would appear that information gained from the Skills for Care organisation gained at the time of the last inspection visit has not been implemented. Information gained through the AQAA dataset indicates the management team acknowledge work is required on this procedure to ensure it is fully supportive to newly appointed staff and enables them to support service users effectively and safely. Care Homes for Older People Page 25 of 38 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration systems within the home do not promote the health, safety and welfare of service users. This results in service users being vulnerable to receiving inappropriate care and support in an unsafe environment. Evidence: The manager Mr Trevor Howard has been working at Rodney House since December 08 and has over twenty years experience of working in a variety of care services. Rodney House does not appear to have a clear sense of direction with quality assurance monitoring not regarded or implemented as a core management tool. This results in service users receiving a non individualised care service and the needs of those who do not particularly challenge the service being less of a priority. This leads to an inequality in the care and support being provided, with no evidence to show that there is an understanding of person centred thinking in the home. Care Homes for Older People Page 26 of 38 Evidence: We looked at a sample of financial records, and found they were adequately maintained. Service users made no comments suggesting they were unhappy with the financial services provided. Discussions with members of the management and staff team and examination of records show, further training is needed to enable the staff team to provide appropriate, safe care and support to service users. Members of the staff team spoken with felt the manager was very supported of them and service users, and that the service had started to improve since his arrival. We looked at a number of health and safety records. Some such as the household electrical appliances was adequately maintained, and others required attention such as fire procedures, which records show had not been reviewed since 09/06/05. Risk assessments do not provide enough detailed information and guidance to adequately enable the staff team to maintain service users health and safety. Rodney House is poorly maintained which impacts on the quality of life of service users. Care Homes for Older People Page 27 of 38 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 1 6 The statement of purpose 30/05/2008 must accurately reflect the services and facilities being provided at Rodney House. With particular regard to the service user categories. 2 3 14 Prior to admission to Rodney 30/04/2008 House a full assessment of needs must be carried out. This is to ensure the staff team posses the skills and experience to support them with the individual needs. 3 7 15 Care plans and risk 30/06/2008 assessments must be produced in consultation with residents, other professionals and where appropriate their representatives that accurately reflect their holistic needs. This is to ensure a person centred approach to an individuals care needs is adopted rather than a generalised approach to their care. 4 9 13 Medication procedures must effectively safeguard residents ensuring they 30/04/2008 Care Homes for Older People Page 28 of 38 receive their prescribed medication at the stated times and intervals. 5 12 16 A programme of activities to 30/06/2008 promote residents mental, emotional, intellectual and physical wellbeing must be provided. This is to ensure residents are offered a range of options to engage in positive social activities. 6 12 12(4)(b) Staff members employed at 30/05/2008 Rodney House must be provided with a basic understanding of the cultural needs and historical events that have impacted on residents? lives. This is to ensure the staff team have the skills and knowledge to engage with residents in all aspects of their lives. 7 27 18 The training programme for 30/07/2008 the staff team must be reviewed. To ensure they have the knowledge and skills to support residents with more specialised needs such as alcohol dependency, cognitive impairment and learning disabilities. 8 30 18 The induction programme currently used must be reviewed to ensure more detailed information is provided about residents? needs and key policies and procedures such as safeguarding and equality and diversity issues. 30/07/2008 Care Homes for Older People Page 29 of 38 Care Homes for Older People Page 30 of 38 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 1 4 The statement of purpose must accurately reflect the range of needs that Rodney House is intended to meet and the services and facilities to be provided. This is to ensure prospective service users, their relatives or supporters can have sufficient information on which to make an informed choice/decision. 14/05/2009 2 3 14 A full assessment of needs must be undertaken prior to an offer of placement being made to a prospective service user. This is to ensure Rodney House is confident it can meet the identified needs and lifestyle choices of a prospective service users and that they do not have a negative impact on the people already living at the home. 30/04/2009 Care Homes for Older People Page 31 of 38 3 4 14 Where specialist care needs 30/04/2009 are idenfied in the assessment process the home must be able to evidence they have the skills and expertise to meet these needs. This is to ensure service users and their representatives have confidence that the home they enter will meet their needs. 4 7 15 Care plans must accurately 01/06/2009 reflect the care needs of service users and provide detailed information to enable the staff team to support them effectively and safely. This is to ensure service users needs are met in a safe and supportive manner. 5 8 12 Service users health care needs must be effectively supported and monitored. With health care professionals advice and input sought when changes in health or mental well being are observed. This is to ensure service users health and well being is promoted and maintained by the care practices of the home. 30/04/2009 6 9 13 Service users medication must be administered in accordance with the the prescribers instructions. If 30/04/2009 Care Homes for Older People Page 32 of 38 medication is refused or omitted detailed records must be kept and medical advice sourght. This is to ensure service users healthcare conditions are being effectively treated. 7 10 12 Service users must where practicable be involved in the drawing up of their care plans. This is to ensure service users wishes and needs with regard to how they are supported with their personal care is met. 8 12 16 A varied programme of activities must be provided. This is to ensure service users are able to engage in meaningful activities and build positive relationships within the home community to support them to maintain their emotional and mental well being. 9 14 12 The challenging behaviours of some service users must not continue to have a negative impact on the quality of life of the remaining service users. This is to ensure each service users rights to exercise choice and control over their lives is respected and valued. 25/05/2009 29/05/2009 15/06/2009 Care Homes for Older People Page 33 of 38 10 15 16 Nutritional supplements 27/04/2009 must be given as directed by healthcare professionals This is to ensure service users nutritional needs are supported and monitored effectively to maintain their health and general wellbeing. 11 18 13 If physical restraint is to be used on service users a detailed support plan must be produced and the staff team must receive appropriate training. This is to ensure service users safety and legal rights are protected at all times. 30/04/2009 12 18 13 The staff team must be provided with suitable conflict resolution training and protection of vulnerable adults training. This is to ensure they have the necessary skills and knowledge to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. 29/06/2009 13 19 23 A detailed risk assessment 29/05/2009 must be carried out to ensure a safe environment is maintained. Particularly with regard to damaged windows, tripping hazards and damaged plasterwork around the home. Care Homes for Older People Page 34 of 38 This is to ensure service users live in a comfortable and safe environment that meets their assessed needs. 14 20 23 Seating in the lounge areas should be in sufficient numbers to meet the needs of the service user group. This is to ensure there are opportunities for service users to spend time together if they so choose. 15 22 23 service users must be supported to be able to independently access the entance of the home or an alternative access must be made available. This is to ensure service users can independently access the community when they choose. 16 25 23 The temperature in all areas of the home must be maintained at a comfortable temperature. This is to ensure service users health and welfare is maintained by living in an environment that is warm and comfortable. 17 27 18 Staff members employed by the home must have the skills and expertise to support service users appropriately and safely. Particularly with regard to the use of physical 22/06/2009 20/04/2009 20/07/2009 30/06/2009 Care Homes for Older People Page 35 of 38 intervention and conflict resolution training. This is to ensure service users are supported in a safe and supportive manner and results in positive outcomes in their daily lives. 18 28 18 A detailed training plan must 18/05/2009 be produced, which ensures the identified health and social care needs of service users can be met. This is to ensure service users assessed individual needs can be met by a competent and skilled staff team. 19 30 18 The induction programme must be reviewed. This is to ensure service users are supported by a staff team who are confident they know how to support service users and are aware of their responsibilites as a care worker. 20 33 24 A review of the quality assurance systems in operation must take place. This is to ensure service users, their families and other stakeholders views of the service provided at the home are actively sought. So that changes and improvements made reflect their needs and aspirations. interests 29/06/2009 29/05/2009 Care Homes for Older People Page 36 of 38 21 38 12 Safe working practices must be adopted at all times. Particularly with regard to maintaining records of safety checks such as fire safety records. This is to ensure service users health and safety is maintained at all times. 20/04/2009 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 13 Service users who are engaging in anti social behaviour should be actively supported through therapeutic activities to engage in less risky and negative behaviours. A review of the quality and quantity of the meals should take place, which should include input from service users. This is to ensure meals and snacks provided reflect their dietary needs and preferences. As part of the homes quality assurance systems seeking the views of service users with regard to the accessibility of the complaints procedure should be undertaken. Further work should be carried out to make sure the bathroom and toilet areas are well maintained and homely in appearance. This is to ensure service users rights to privacy and dignity are maintained. Further work should be carried out to ensure service users bedrooms meet their individual needs and are well maintained, comfortable and homely in appearance. The floors in the toilet and bathroom areas were clean however they were very slippy this needs to be adresses to maintain service users safety. An application to register a manager in respect of Rodney House should be made as a matter of urgency. 2 15 3 16 4 21 5 24 6 26 7 31 Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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. 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. 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