Inspection on 27/01/09 for Rookwood Nursing Home

This inspection was carried out on 27th January 2009.

CSCI found this care home to be providing an Adequate 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

Rookwood Nursing Home 28/01/08

Rookwood Nursing Home 15/03/07

Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Rookwood Nursing Home 4 Victor Road Bradford West Yorkshire BD9 4QL     The quality rating for this care home is:   one star adequate 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: Mary Bentley     Date: 2 7 0 1 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 Adults (18-65 years) 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 Adults (18-65 years) Page 2 of 29 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 Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Rookwood Nursing Home 4 Victor Road Bradford West Yorkshire BD9 4QL 01274547597 01274549215 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): European Care Lifestyles (B) Ltd Name of registered manager (if applicable) Colin Tiernan 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 Additional conditions: Date of last inspection Brief description of the care home Rookwood is registered to provide nursing care to 20 people with enduring mental health needs. It is situated in the Manningham area of Bradford, close to Lister Park. There are bus connections to Bradford, Bingley, Keighley, and Skipton. Some parts of the home are not accessible to people with limited mobility, there is no passenger lift and the stair lift is due to be removed because it doesnt work. The bedrooms are on three floors. There are a mix of single and shared rooms. Communal space includes a dining room, a large lounge, and a conservatory. The conservatory is the designated smoking area for people living in the home. There is a small enclosed patio area at the back of the home which people can use when the weather permits. Information about the services offered is available in the home. In January 2009 the weekly fees ranged from 549.00 to 749.00 pounds per week. Items not covered by the fees include personal expenses such as hairdressing and people are asked to make a contribution to the cost of holidays and day trips. Care Homes for Adults (18-65 years) Page 4 of 29 20 Over 65 4 care home 20 Brief description of the care home Care Homes for Adults (18-65 years) Page 5 of 29 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service was carried out on 28 January 2008. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future if a requirement is repeated it is likely enforcement action will be taken. This visit was unannounced and carried out by one inspector between the hours of 09:45 and 16:15. During the visit we spoke to people living in the home, staff and management. We looked at various records including care plans and looked at some Care Homes for Adults (18-65 years) Page 6 of 29 parts of the building. Before the visit we sent surveys to the home to give out to people. These included surveys for people living in the home, staff and visiting health care professionals. In total 10 were returned. We asked the home to complete a self-assessment form (AQAA) this was returned to us in good time and contained all the information we asked for. This report includes information from various sources including the site visit, the questionnaires, the homes AQAA and information we have received about the service since our last visit. What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Adults (18-65 years) Page 8 of 29 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 Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Peoples needs are assessed and they are encouraged to visit the home before they move in. Improvements are needed to the way pre-admission assessments are recorded so that the home can clearly demonstrate it is able to meet the persons assessed needs. Evidence: Most of the people living at Rookwood have lived there for some time. There has only been one admission since the last inspection. This person came from another home owned by the company. The manager told us he had gone to see the person in the other home and completed a pre-admission assessment. He said the person had been able to visit the home on a number of occasions, for a half day, a full day and a weekend before agreeing to move in permanently. However, a record of the preadmission assessment could not be found and there was no information in the persons care records to show that they had been included in the decision about moving to Rookwood. Care Homes for Adults (18-65 years) Page 11 of 29 Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are shortfalls in the care plans which means that staff may not always have appropriate information on which to make decisions. Therefore there is a risk that people may not always get the right support to meet their needs and goals. Evidence: Everyone living in the home has a care plan. We looked at two peoples care plans in detail. There was a lot of historical information in the folders making it difficult to get a clear picture of peoples current needs and aspirations. One of the care plans we looked at belonged to a person who moved into the home approximately 6 months ago. When the person moved in there was no evidence that staff at Rookwood had completed a new assessment. The only information available about why the person had moved was in the records sent from the previous home. The care plans from the previous home were still being used. Some of these plans had been reviewed but the review record contained no information about the move or how Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: the person had been supported to deal with this. Risk assessments relating to areas such as aggression had been completed by the previous home and were still in use and where changes were recorded they were not sufficiently detailed. The other care plan we looked at had a recently completed personal profile. This contained detailed information and gave a good picture of the person, their past life and their current circumstances. This was done by the acting manager as a template to guide staff in completing a similar profile for everyone living in the home. However, other aspects of the care plan were not up to date. For example some the risk assessments had not been reviewed since 2007. We saw evidence that some people had agreed to budget plans to help them manage their money. The plans showed clearly what people had agreed to in terms of daily or weekly limits on how much money they would receive. People living in the home told us they are able to make decisions about their lives but this was not always clear in the care records. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. For the most part people are supported in making decisions and exercising choice about how they live their lives. However, this is not always reflected in the care records. People are encouraged to follow their personal interests and are given opportunities to take part in a range of social activities that are appropriate to their age and culture. Evidence: People are encouraged to take part in the social life of the home but if they prefer they can spend their time in their own rooms. We saw people coming and going during the day and a number of people told us they go to the local shops. One person told us about her busy life, which includes art classes twice a week, swimming once a fortnight, knitting, sewing and playing games such as scrabble. She Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: sees her boyfriend twice a week and she told us she had baked him a birthday cake. Along with other people in the home she is part of the bowling team. They take part in a local league and currently hold the trophy. Another person told us he enjoys going to the MIND centre in Bradford and goes most days. He composes poetry and they have provided a Dictaphone so that he can record some of his work. He told us he has had work published. There are about 4 other people in the home who also visit the MIND centre regularly. People told us they have meetings where they plan social events inside and outside the home. The home organises an annual holiday for people who want to go, this year they are planning to go to Cumbria. About half of the people living in the home usually go on these holidays. The home tries to organise day trips and other outings for those people who choose not to go. The home fund raises for a social fund and this money is used to subsidise outings and holidays so that people dont have to pay the full cost. There is information about peoples social care needs in the care records. However, the recording of how people spend their time and how staff support them in following their interests and developing their skills and confidence could be improved. This was discussed with the manager. People told us the food is good. During the week the main meal is served in the evening and people are offered a choice of light meals at lunchtime. On Saturday brunch is served for people who dont want to get up too early and on Sundays there is a traditional roast at lunchtime. The cook has a good knowledge of peoples likes and dislikes and is aware of peoples special dietary needs. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall people get the support they need to meet their personal and health care needs. However, this is not always reflected in the care records and therefore there is a risk that peoples needs could be overlooked and that people may not always be supported in the way they prefer. Evidence: There is very little information in the care plans about how people are supported in meeting their personal care needs. This was discussed with the manager. In one of the care plans we saw that the person had recently lost a lot of weight. There was evidence that this has been discussed with other health care professionals and the home is getting advice on how to deal with it. However, the home has not completed a nutritional risk assessment and the persons care plan does not provide clear information for staff on how to address this. Discussions with the cook confirmed she is aware the person needs an enriched diet. People told us they have access to a range of NHS services including chiropody and Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: eye tests and some of this is recorded. A nurse practitioner from one of the local GP surgeries visits the home and carries out routine health screening such as blood tests. Visiting health care professionals keep their own records and copies of these are available in the home. However, this information in not always recorded in peoples individual care plans. The home should make sure that each persons care plan contains up to date and accurate information about the support people are getting to meet their health care needs. We saw from the records that people get support in meeting their mental health care needs from Community mental health nurses and Consultant Psychiatrists. Medicines are stored safely and the records of administration are up to date. One person in the home manages his or her own medicines and a risk assessment has been done. On three bottles of medicine the labels were blurred making them difficult to read, this appeared to be as a result of cleaning the bottles. More care should be taken to make sure the prescription labels are legible. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. There are systems in place to make sure that complaints are dealt with appropriately and that people are protected. Evidence: People living in the home told us they know how to make a complaint if they need to. They said staff listen to them and take notice of what they say. The home has not had any complaints since the last inspection and none have been referred to us. The manager told us that any issues that come up day-to-day are dealt with as they arise. The home has a procedure for dealing with formal complaints. The manager is aware of the procedures for reporting any safeguarding (protection of vulnerable adults) concerns and has used these procedures when necessary. Most staff have had training on safeguarding. Staff told us the know how to report any concerns about peoples welfare. The manager told us there is a training DVD available for staff on the Mental Capacity Act and he is planning to organise more training on this subject. Care Homes for Adults (18-65 years) Page 19 of 29 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and safe and some improvements have been made but progress is slow. More needs to be done to make sure the home is a pleasant and suitably equipped place for people to live. Evidence: People told us the home is usually clean and fresh. When we visited most of the home was clean and there were no unpleasant odours. One room needed high cleaning to get rid of the cobwebs; staff explained it is difficult to get access to this room because the person who lives there does not like them in his room. Some negotiation should take place with the person to make sure his room can be maintained to an acceptable standard. Some improvements have been made to the environment. The manager told us that all the mattresses have been replaced and they are in the process of replacing the beds. However, most of the home needs refurbishment. The manager told us there are plans to upgrade the home, which will include decorating bedrooms and replacing carpets and furniture, however there is no agreed timescale for this work to start. Last year we asked the home to provide us with a programme for refurbishment, we have not received this. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: The home has 3 communal bathrooms and one of them has an assisted bath with a hoist. The home told us the hoist has been condemned. Plans to upgrade the assisted bathroom and convert the first floor bathroom to a shower room have been approved and the work is expected to start in the next couple of weeks. The stair lift does not work; the manager said it is going to be removed. Improvements have been made to the back garden and this now provides a pleasant and private place for people to sit outside. There is a small vegetable patch and some of the people living in the home got involved in gardening. There is also a greenhouse; however, when we visited it was being used for storage. We saw that people have lots of personal belongings in their rooms and most people have keys to their bedrooms. People are encouraged to have ownership of their personal space. One person told us they had bought new furniture and were looking forward to having it delivered. Another person said they liked to keep their room clean and tidy. There is a small kitchen were people can help themselves to hot drinks and do some cooking, however it is limited because it lacks outside ventilation. One person told us they had baked some cakes and buns. The laundry is in the basement and the steep steps mean it is not safe for people living in the home to have access. Staff do peoples laundry for them. Bathrooms, toilets and bedrooms have soap dispensers and paper towels and this helps to reduce the risk of cross infection. Care Homes for Adults (18-65 years) Page 21 of 29 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. There are enough staff to meet peoples needs. People are protected because the proper checks are done before new staff start work. More could be done to support staff in developing the skills and knowledge they need to meet peoples needs. Evidence: There are usually 3 staff on duty from 7:00 am to 9:00 pm, a nurse and 2 support workers. Overnight the home has 2 staff, a nurse and support worker. The manager is not included in these numbers and generally works Monday to Friday. The home also employs a cook, housekeeping staff and a handyman. Staff said they work well together as a team and are very rarely short staffed. During the day we saw that there was a lot of good interaction between staff and people living in the home. People living in the home told us that staff treat them well. Approximately 66 of care staff have achieved and NVQ (National Vocation Qualification) in care and 2 staff have completed the course and are waiting for results. Staff said they are up to date with mandatory training and the records confirmed this. There is little or no evidence of specialist training or training related to the needs of people living in the home. The manager said he is aware this needs to be Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: addressed to make sure staff have the knowledge and skills they need to meet peoples needs. He is currently working with the companys training department to agree the training plan for 2009 and it will include specialist training. A programme of staff supervision has been started but discussions with staff and records showed that it is inconsistent. Staff files showed that all the required checks are completed before new staff start work and this helps to make sure that people are protected. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. There are suitable arrangements in place to make sure the home is managed properly. The home provides a safe place for people to live and work. Evidence: The registered manager has been in post since March 2008. He is experienced in the area of Adult Mental Health care. He is currently doing the Registered Managers Award which is a nationally recognised qualification for managers of care services. The company has established procedures for monitoring the quality of the service. These include monthly visits by one of the senior managers and in house audits. For example, a Health and Safety audit is done every six months. Records of the monthly visits are sent to the home after the visit. The most recent record available when we visited was from September 2008; however the manager told us that visits have taken place since then. The home told us that questionnaires are sent to people using the service every year. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: None have been sent since the new manager started and results of previous questionnaires were not available. Meetings for people living in the home are held about every 6 months and this gives people an opportunity to share their views of the service and discuss plans for improvements. The records of the monthly visits which were available showed that the senior manager who visits the home spends time talking to people. Information provided by the home showed that there are suitable systems in place to protect the health and safety of the people who live and work there. Care Homes for Adults (18-65 years) Page 25 of 29 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 Adults (18-65 years) Page 26 of 29 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 6 15 Everyone living in the home 05/06/2009 must have an up to date care plan setting out how they will be supported to meet their needs and goals in relation to personal, health and social care. Whenever possible people or those close to them must be involved in drawing up and reviewing this plan. So that people get the right support to meet their needs, goals and aspirations and to make sure care and support are given in a way that takes account of peoples wishes and abilities. 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 2 Records of pre-admission assessments should be available and should show that people have, whenever possible, Page 27 of 29 Care Homes for Adults (18-65 years) been included in the process and have had the opportunity to visit the home before moving in permanently. 2 3 4 24 24 36 The stair lift should be repaired or removed as soon as possible. The Commission should be provided with detailed plans, including timescales for the refurbishment of the home. A system for monitoring staff supervision should be put in place to make sure that staff are receiving the support they need on a regular basis. Care Homes for Adults (18-65 years) Page 28 of 29 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. 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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