Inspection on 12/10/07 for Rose Manor

This inspection was carried out on 12th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rose Manor 23/01/07

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

CARE HOME ADULTS 18-65 Rose Manor 18 Bensham Manor Road Thornton Heath Surrey CR7 7AA Lead Inspector David Halliwell Key Unannounced Inspection 12th October 2007 09:30 Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rose Manor Address 18 Bensham Manor Road Thornton Heath Surrey CR7 7AA 020 8239 7518 020 8239 7518 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Rosenmanor Ltd (T/A Rose Manor) Mr Kris Nagalingum Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd January 2007 Brief Description of the Service: Rose Manor is a large house in Thornton Heath, well situated for access to the centre of Croydon and its many community based facilities, and good transport links. The property comprises of 2 day rooms (lounge and dining area) on the ground floor, and a smoking room in the conservatory. There are 5 single bedrooms, all fitted with hand basins and shower facilities. There are 2 WCs including a bathroom. Some off-street parking is provided to the front of the house. The stated aim of the home is to provide rehabilitative care for people with mental health problems over a 2-year period. This may be extended as required and in agreement with the clinical teams. The acting Manager told the Inspector that the standard / basic fees of a placement are £770 per week. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit of the service at Rose Manor. The Inspection covered all the key standards and involved a tour of the home, a review of all the homes records and formal interviews with 2 staff and the acting Manager and the 5 service users who are now residents at Rose Manor. The acting Manager is in the process of registering with the Commission for Social Care Inspection as Manager. No requirements have been made as a result of this inspection. 3 good practice recommendations have however been made. Feedback on the recommendations was fully explained to the acting Manager at the end of the inspection visit. The Inspector found the residents and staff most helpful and they are to be thanked for the assistance that they gave him over the course of this inspection visit. The Inspector was very impressed by the commitment and enthusiasm of the acting Manager and of the staff group and of the quality of the services being provided at Rose Manor. What the service does well: The home is able to demonstrate that it is assessing and meeting the needs of service users admitted to the home. Prospective service users, their relatives and friends are able to visit and to assess the quality, facilities and suitability of the home. The health and social care needs of service users are being well met. Service users are living in a safe, well-maintained environment, with access to safe, pleasant and comfortable facilities. Service users presented as being well settled and very happy in their environment, and very satisfied with the staff, their care support and the communal and personal facilities provided. Yvette Thomas is managing the home in an open, professional and competent manner. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The following areas were identified at this last inspection and good practice recommendations made that would assist in further improving the standard of care at Rose Manor. • That guidance be provided about PRN medications that are used for residents stating when and when not to use PRN medication and the potential side effects for the individual resident. The resident’s GPs should be involved in this process and the information placed together with a medication profile for each resident. That the Individual Personal Development / Training file is developed in order to contain the staff members’ future training needs. Also that the training needs for all the staff team should be aggregated into a training matrix that may be used by the management team to plan all future training courses in the year ahead. That a course be provided for staff to raise their awareness of mental health issues. • • • Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2, 4, & 5 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Prospective service users may be fully assured that their needs are assessed and that their individual aspirations and wishes will be taken into account in the assessment process. They may also be assured that they will be offered an opportunity to visit and to “test drive” the home. Each service user has an individual written contract and is provided with a copy. EVIDENCE: Standard 2 – Since the last inspection 3 new residents have been admitted and the home is now full with a total of 5 residents living at Rose Manor. The Inspector reviewed the files of the 3 new residents and found that all had received a full and comprehensive pre-admission needs assessment that was carried out with skill and sensitivity by Rose Manor staff to the needs of the people concerned. The acting Manager also told the Inspector that staff ensure a needs assessment and care plan is obtained from the referring authorities for each new resident placed at Rose Manor. Evidence of this was seen by the Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 9 Inspector on the resident’s files and the combined information from both sources form a comprehensive information base for each resident from which accurate and relevant care plans can be drawn up. The acting Manager explained to the Inspector that the needs assessment process is about ensuring that staff can meet the identified needs of the prospective resident in that they have the appropriate skills, training and knowledge to enable them to do so. Before agreeing admission to Rose Manor the acting Manager allocates a key worker to each resident who will work with them on developing the home’s care plan and making sure it meets the identified needs. Residents concerned were seen by the Inspector to have been involved in the assessment process having had the opportunity to express their wishes and preferences and to comment on their identified needs. Signatures of the residents were seen on the assessment paperwork confirming their involvement in the process. Family and close relationship needs of both the service users files inspected had been included in the assessment and care planning processes. When the Inspector spoke with one of the residents it was clear from what she told the Inspector that she had been and is still fully involved in the process and that she is very satisfied with the outcomes of her care package at Rose Manor as a result. Standard 4 – The acting Manager told the Inspector that all prospective residents are encouraged to make a preliminary visit to Rose Manor in order to familiarise themselves with the home and to provide them hopefully with enough information from which they may decide to go to live there. Following this visit prospective residents are offered a 6 weeks trial period over which they can better decide if Rose Manor is right for them. Families and friends are said to be encouraged to visit the home over this period. At the end of the trial period there is a meeting with the prospective resident and their clinical team which has referred them and the staff at Rose Manor and a decision is then made as to whether the placement will proceed or an alternative resource found. Residents confirmed to the Inspector the process above and said that they had found it very useful in helping them to decide whether they wanted to live at Rose Manor or not. They decided they did wish to and remain happy with this decision. Standard 5 – Each resident’s file inspected contained a written and costed contract which specified all the terms and conditions as set out under Standard 5 of the National Minimum Standards. Residents had signed their agreement and they have a copy of the contract on their own handbook that is kept in the Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 10 resident’s own bedrooms. The acting Manager is reminded that these contracts will need to be renewed each year. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7, & 9 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Residents may be assured that their assessed and changing needs and personal goals will be reflected in their care plans. They may also be assured that they will be able to make decisions about their daily lives and be enabled to take risks as part of developing a more independent lifestyle with support, as they need it. EVIDENCE: Standard 6 – through the course of this inspection it became clear to the Inspector that the central focus of the services provided at Rose Manor are on the residents and how their needs, wishes and preferences can be most effectively be met where-ever possible. Residents were seen by the Inspector to be fully involved in the needs assessment and care planning processes. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 12 Care plans seen by the Inspector were based on the needs assessments that had been drawn up both from the Care Programme Approach needs assessment and Rose Manor’s own needs assessment. Inspection of the care plans seen by the Inspector evidenced this and the Inspector was impressed with the quality of the care plans seen. They had been clearly divided into sections (relating to the identified needs) with care plan objectives and action plans which addressed the needs and set out identified milestones, so that clear monitoring and review could then be achieved. Monthly reviews by the care staff team were evidenced on the files and involvement of each of the residents in these reviews was also evident. They confirmed their involvement in the review and care planning process at interview that was a part of the inspection process. Inspection of the review reports showed that changing needs of service users had been identified and that appropriately revised care plan objectives had been drawn up together with the service user. Key workers were seen to actively provide 1:1 support; to revise the care plans as necessary and to keep the residents informed. Formal 6 months reviews are planned and held with the clinical teams and the residents. The five residents at Rose Manor have their own key workers and the acting Manager told the Inspector that residents can choose their key workers if they wish. Residents confirmed to the Inspector that they are happy with their key workers and find them helpful, supportive and friendly. Standard 7 – Over the course of this inspection the Inspector saw that staff asked residents what they wanted to do and to make decisions about their daily lives. The acting Manager told the Inspector that residents do have their own residents meetings and that meetings are minuted. The minutes of these meetings were shown to the Inspector by the acting Manager. The records show that meetings are held every 2 months, they indicate who has attended the meetings and what issues have arisen and been discussed. Standard 9 – The care planning process includes the use of risk assessments that were seen and inspected on each of the resident’s files. They are evidently used as a pre-admission assessment tool and following admission, being used to assist residents to be appropriately supported to take risks as a part of developing a more independent lifestyle wherever possible. Any identified risks are managed positively to help the residents lead the sort of lives they aspire to as much as is realistically possible. These risk assessments are agreed with the resident and the relevant professionals. So residents can be assured that they will be supported to take risks as part of developing a more independent lifestyle wherever this is possible. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 & 17 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users may be assured that they will be able to take part in appropriate activities, some of which will be based in the local community. That they will be supported to maintain appropriate personal relationships with family and friends; and that their rights will be respected and their responsibilities recognised in helping them to construct an appropriate programme of activities in their daily lives. EVIDENCE: Standard 12 – The acting Manager told the Inspector that in order to ensure that each resident is involved in daily activities appropriate to their needs and wishes, the staff at Rose Manor maintain daily activities sheets. These record the activities of each resident and link the activities with their care plan objectives and what they say they want to do. Inspection of 3 of the resident’s files at Rose Manor show that the resident’s care plan objectives do identify activities that are appropriate to the resident’s age and cultural needs. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 14 Residents interviewed by the Inspector said that they participate in the activities they wish to do. Residents told the Inspector that if they wanted to do an activity, staff support them to do so. The actual range and scope of activities undertaken by the service users however is limited by the extent of the resident’s mental well health and wishes at the time. The acting Manager told the Inspector that as a part of trying to maintain continuity for the residents in their daily lives and to support their rehabilitation, where ever possible previous interests, pastimes, hobbies and relationship are encouraged and are built into the daily activities plan for residents. Residents who spoke to the Inspector said that they do much more at Rose Manor than they had done at previous homes they had lived in. As a part of the care plan review it was evident that significant relationship links for the residents are recorded in the care plans and that the importance for the residents of these links is not underestimated. One resident is encouraged to maintain her relationship with her boyfriend and visitors are made welcome when they come to the home. Information about local activities was seen on the notice boards within the home and staff who were interviewed by the Inspector said how they will support residents, in their capacity as care support workers, to take as much of an active role in the community as is appropriate for residents. One member of staff at the time of the inspection was engaged in completing a referral form for one of the residents to attend a local social club and talked to the Inspector about the importance for the residents to get out and about and socialise with other people and to have a chance to talk to other people. Another resident told the Inspector that she had expressed a wish to attend church regularly in order to meet her faith needs. She is now supported by staff to attend church on a regular basis. So it seems to be that service users are supported and enabled to take part in appropriate activities and that they are able to express their wishes and be listened to and responded to with active and appropriate support. Standard 13 – The service at Rose Manor actively encourages residents to develop and maintain social, emotional and independent living skills where ever possible. Staff at Rose Manor were seen by the Inspector to be actively supporting residents to make informed choices about the things they want to do and the activities they need to do. The central location of the home in Croydon makes access relatively easy for those residents who are able and want to use public transport. However at present only a few of the residents currently living at Rose Manor actually do so. The other residents are either not able to do so as a result of their disabilities or do not wish to or use taxis and private transport options as an alternative. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 15 Two residents said that they are looking forward to being able to make use of some day centre provision in and around Croydon and the acting Manager told the Inspector that if their applications are agreed then staff would support the residents to attend. The acting Manager informed the Inspector that all residents are registered to vote and are encouraged to use their votes. Residents confirmed with the Inspector that they are supported and enabled to vote. The acting Manager told the Inspector that relations with the local neighbours are good with no problems arising up to this point in time for the home or for the neighbours. Residents do seem to be engaged as much as is possible with their local community and that this will be likely to expand as their skills and abilities increase. Standard 15 – Interviews with 4 of the residents confirmed that where possible they do maintain regular contact with members of their families and either go out to visit their relatives or receive them at Rose Manor. Residents told the Inspector that they are enjoying the opportunities that they experience at Rose Manor. Staff interviewed by the Inspector said that they encourage these visits and are sometimes involved in helping their resident’s sort out difficulties that they experience their relationships with their relatives as this often has a direct bearing on the mental well being of the resident. Visitors to the home are encouraged and use the visitor’s book to sign in. The Inspector saw information made available within the home about local activities for residents to take up if they wish. Standard 16 - Policies seen by the Inspector to be established within the unit ensure that service users rights to privacy, respect and dignity are respected. 4 residents who were interviewed also confirmed that they felt staff respected these rights. Residents said that they have a key to their own bedrooms, that staff use their preferred form of address and that staff do knock on their doors before entering. The Inspector observed staff to be interacting with residents in a friendly and respectful manner and staff confirmed in interview that they understand how to respect the privacy and dignity needs of the residents. The acting Manager explained to the Inspector that all incoming and outgoing mail is logged into a record book and where residents need some assistance in Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 16 opening and reading their mail, the resident is always asked first if they do want this assistance on that occasion. The acting Manager showed the Inspector the logbook and regular and up to date entries were seen up to the date of the inspection. Residents also confirmed to the Inspector the practice explained by the acting Manager. Interviews both with staff and residents confirmed that residents participate in household chores as a part of the rehabilitative process and this participation was supported in the residents care plans. Following recent legislation on smoking, smokers now have to use a covered area outside the house and there are appropriate policies regarding drug and alcohol taking on the premises. Standard 17 – Food menus shown to the Inspector indicate that menus are well balanced, nutritional and cater for the varying cultural and dietary needs of the residents. Menu choices are provided and the acting Manager told the Inspector that some residents assist in the drafting of the food menus. A 4week rolling programme is used within the home. No complaints about the meals arose during the inspection in fact both those residents interviewed said that they like the food provided at Rose Manor. It was noted that a wide range of meals were listed which cater for the multicultural needs and wishes of the residents. The Inspector asked the acting Manager if a dietician is used to advice on the menu planning in order to ensure that the food provided is always healthy and nutritious. The acting Manager said that a dietician is used in some cases where there is a specific need but not as a general rule. The acting Manager showed the Inspector a detailed food record that is kept for each resident and that is useful to help ensure that the service users maintain an appropriate diet that is healthy and nutritious. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19, & 20 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users may be assured that they will receive personal support in the way they prefer and require, they may also be assured that their physical and healthcare needs will be appropriately met. Service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Standard 18 – Residents who were interviewed at this inspection confirmed with the Inspector that they receive their care in the way they prefer. They said that they are able to decide themselves about their daily routines and this was backed up by care staff who were also interviewed by the Inspector. Staff ensure that care support at Rose Manor is person led, flexible, consistent and is able to meet the changing needs of the residents. It was confirmed by the staff and the residents that they are able to choose when they get up, when they go to bed, when they have a bath, what they wear and what they will do during the day. A member of staff interviewed Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 18 explained how when drawing up the weekly activities chart, which is based on the care plan, they always sit down with the resident and go through the programme in order to gain the residents approval and to understand their choices. Standard 19 - The acting Manager informed the Inspector that where possible the residents are encouraged to manage their own healthcare and appointments with healthcare professionals are generally at their surgeries but arrangements will be made if required for professionals to visit at Rose Manor. The acting Manager told the Inspector the residents are registered with dentists, opticians, chiropodists and community nurses in order to maintain their all round good health. Residents interviewed were able to confirm this. Information in their case files also evidences it by the recording of their contact with these services. It was confirmed that annual healthcare checks are routinely carried out by GPs. Standard 20 – The home’s policies and procedures manual contains appropriate policies for the control of medication. The Inspector reviewed the records for the administration of medication to residents (MAR sheets) and these were seen to be appropriately completed and in line with the home’s policies and procedures. Photographs of the residents were attached to the MAR sheets, which helps to ensure that staff administer medications to the right resident. It is recommended that guidance be provided about PRN medications that are used for residents stating when PRN medication should be used and the potential side effects for the individual resident. The resident’s GPs should be involved in this process and the information placed together with a medication profile for each resident. The Inspector did a spot audit check on the stock control system and this proved satisfactory with the levels of medications being as stated on the control sheets. A check on the storage facilities for the medication was seen to be appropriate and although controlled drugs are not currently in use within the home there is appropriate provision for doing so i.e. there is a lockable metal cupboard within a locked metal cabinet. There is also a refrigerated cupboard for those drugs requiring cool conditions. Boots the chemists provides training in medication; the acting Manager informed the Inspector that this is mandatory training for all staff. The staff interviewed said they had both received this training. At present residents are unable to administer their own medication. The home actively supports service users who wish to self medicate and appropriate facilities (e.g. lockable cabinets bolted to the walls) have been installed in each bedroom. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22, & 23 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users may be assured that their views will be listened to and that they will be protected from abuse, neglect and self-harm. EVIDENCE: Standard 22 – The 4 residents who spoke to the Inspector all individually confirmed that they feel their views are listened to and acted upon. They said that if they had a complaint they know the procedure to be followed and would do so if they needed to. Staff interviewed confirmed with the Inspector that the residents were all aware of the complaints process and that the whole staff group took any issues raised by residents seriously. The homes’ complaints policy was inspected and the contact information for the CSCI that was found to be incorrect at the last inspection has now been amended correctly. The recommendation therefore made at the last inspection has been met. The Inspector asked the acting Manager to see the home’s complaints record. 3 complaints had been registered in the record book since the last inspection and all had been resolved to the satisfaction of those people who had complained. The acting Manager also told the Inspector that a monthly monitoring report that details any complaints and the actions taken in response to them is now being sent to the Proprietors as part of the home’s quality assurance system. The outcome of this practice is that the home learns from complaints in order Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 20 to improve its service and all the residents know that their complaints and concerns will be listened to and dealt with appropriately. Standard 23 - The home has an adult protection policy that links directly into the L.B.Croydon’s adult protection policy. The acting Manager informed the Inspector that all staff have now completed training in July 2007 for the next protection of vulnerable adults training course with L. B. Croydon. Staff interviewed by the Inspector confirmed that they had attended this training. This means that staff are better aware of what abuse is and the safeguards in place for the protection of the residents should they need them. Access to external agencies is actively promoted by the staff at Rose Manor. A previous recommendation made at the last inspection has now therefore been met. It was that all staff undertake POVA training at least once every two years on an authorised training course preferably offered by L.B.Croydon. The Inspector saw the allegation of abuse record; no allegations had been made since the last inspection. The acting Manager confirmed this to the Inspector. The policies and procedures manual for the home includes a whistle blowing policy and a policy on dealing with violence and aggression. Understanding the policies and procedures is a part of the staff induction process and evidence of this was seen on file, staff are asked to sign to say that they have read and understood the policies and procedures for the home. The induction process also includes the TOPPS standards and this helps to improve staff’s understanding of occupational standards required in the home. The acting Manager obviously takes the issue seriously and explained to the Inspector how staff are allocated some time each week in which they are asked to read the home’s policies and procedures. They then have an opportunity to discuss anything not understood with their supervisor in their 1:1 supervision sessions. The home does look after residents’ money and the Inspector reviewed the financial records for these transactions that all were in order. All transactions are dated and signed for by both staff and residents to confirm satisfaction by all parties. The Inspector found no anomalies. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users at Rose Manor are able to live in a homely, comfortable and safe environment. The home is also clean and hygienic and well looked after by staff. EVIDENCE: Standard 24 – A tour of the home together with the acting Manager was undertaken as a part of the inspection and the home was seen to be clean and tidy in all areas. Not all areas of the home are accessible to wheelchair users and at present only one resident sometimes uses a wheelchair. Her bedroom is on the ground floor where most facilities are accessible. The general condition of the home and the facilities is good; communal areas and bedrooms are kept clean and odour-free. The staff provide a ‘homely’ touch through supplementary decoration and ornaments / flower decorations and pictures hanging on all the walls. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 22 The Provider and the Manager have ensured that the physical environment of the home provides for the individual requirements of the residents. Also the communal living areas were found to be appropriate by the Inspector for the needs of the residents at the time of the inspection. Four of the residents who spoke to the Inspector over the course of this inspection said that they see Rose Manor as their home and that they find it a nice place and are happy living there. The home is designed to provide small group living and people who live here can enjoy independence in a noninstitutional environment. There is space within the home that may be used to entertain guests or for residents to sit quietly in. The acting Manager showed the Inspector the fire records for the home. The LFEPA last visited Rose Manor in May 2006 and the 3 requirements that were made have since been met. Records were also shown to the Inspector by the acting Manager for other safety checks that have been carried out over the last year and that are part of a regular process of checks carried out to help ensure the safety of the residents. This includes weekly hot water checks of all the hot water outlets and checks of the temperatures of the home’s fridge and freezers. The acting Manager advised the Inspector that a handyman is employed to carry out routine maintenance around the home and that a programme of repairs is kept. Standard 30 – The acting Manager showed the Inspector the home’s infection control procedure, which seems comprehensive and to be effective in practice. At the time of this inspection the home was clean and hygienic. Staff interviewed confirmed that they are issued with appropriate clothing and equipment for them to carry out their work appropriately The laundry facilities in the home are appropriate for the 5 residents who are living in the home. The Inspector was informed by the acting Manager that laundry is not taken through any areas where food is being prepared. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34, 35 & 36 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users benefit from the clarity of staffing roles and responsibilities and they can be assured that they are supported by competent, appropriately trained, qualified and supervised staff. The homes recruitment policy and procedures helps protect the residents. EVIDENCE: Standard 32 – The Inspector saw care staff working at Rose Manor to be approachable for the residents and in taking time to deal with their questions appropriately and patiently. The acting Manager told the Inspector that the training programme for staff is comprehensive and covers all the essential training required by the staff to do their jobs well and efficiently. The provision of funding for training is also said to be good and the acting Manager told the Inspector that if a training need is identified then a training course is provided. The acting Manager informed the Inspector that all the care staff have now achieved their NVQ level 2 awards. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 24 Some staff have continued their NVQ training and of the 2 members of staff who were interviewed one has just started NVQ level 3 and the other NVQ level 7. The Inspector gained the impression over the course of this inspection that all the staff are committed to ensuring that their skills and knowledge is continually being developed by appropriate levels of training so that they can best meet the needs of the residents. Training records were examined by the Inspector and evidence was seen that evidenced staff having completing the following training courses: • 1st aid • Fire safety • Moving and handling • Food hygene • Basic nursing skills • POVA • Health & safety • Safe handling of medications • Understanding dementia • Essential hygiene • Infection control The Inspector discussed with the acting Manager and the staff group the need for training on “understanding mental ill health, the signs and symptoms “ and the acting Manager said that this training had not been provided but would be very useful for staff to assist them in carrying out their jobs more effectively. It is therefore recommended that a course be provided for staff on mental health awareness. Standard 34 - The acting Manager told the Inspector that the home does have a recruitment policy and procedure and that all staffing posts are filled by application and interview. Evidence of these processes being used was seen by the Inspector on the staffing files. The acting Manager said that she, the Proprietor and sometimes a senior Care Worker constitute the interview panel. Review of 4 of the staffing files evidenced that suitable application forms are completed, that 2 references are obtained including one from the last employer. All staff files reviewed by the Inspector evidenced that proper CRB checks have been carried out for staff employed within this unit. Equally that all other documentary evidence required (under Standard 34) to be gathered for staff was seen to be held on the staff files reviewed. The result of this is that there is at Rose Manor a staff team that has a balance of the skills, knowledge and experience to meet the needs of the residents. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 25 Staff interviewed confirmed that all have a contract of employment and that they understand their terms and conditions as well as their roles and responsibilities within the home. Standard 35 – As already indicated earlier in this report the acting Manager has said that there is an overall training and development plan and budget for the home. The acting Manager informed the Inspector that a structured induction programme is offered to new staff and documentary evidence of this was seen by the Inspector and supported in interview with staff. It includes: • Safe working practices • The workers role • Meeting the needs of service users • The home’s policies and procedures. The Home’s management prioritise training and facilitate staff members to undertake training beyond the basic requirements. Internal training that is provided within the home by the acting Manager compliments the formal training offered to staff and enables the specific needs of the residents to be met in a person centred way. Training certificates were seen by the Inspector confirming that staff had attended the stated courses. The acting Manager told the Inspector that she is gong to introduce new staff development files for each member of staff. The information contained in these files will include: • A profile of the staff member • A personal development plan • A SWOT analysis • Evaluation and a review of training received • Training certificates covering all training courses attended • And a Curriculum Vitae. The Inspector recommended that the file should also contain the staff members’ identified future training needs. As well as this the training needs for all the staff team should be aggregated into a training matrix that may be used by the management team to plan all future training courses in the year ahead. This will serve a dual purpose in that it will easily inform the Manager what training the staff team have received and where the gaps in training exist. Standard 36 – The acting Manager told the Inspector that there is a properly structured staff supervision policy and procedure. Records were inspected and both the policy and the supervision tools comprehensively cover the areas that are required in order to implement an effective supervision process. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 26 Inspection of the supervision records that are held on staffing files showed that staff have received regular and formal supervision. Areas of discussion included: • Resident’s issues • The key working process • Monthly reports on progress made by key workers with care plans • Daily activities and outings for residents • Employment and training needs • Holidays and leave • Work performance issues. This means that all the key and important areas for the review and monitoring of the work being done in the home to meet the needs of both the residents and the staff groups should now be properly met. A previous requirement made at the last inspection that staff receive regular supervision using the policy and procedures already in place has now been met. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 & 42 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users can be confident that they benefit from a well run home. The quality assurance system helps to ensure that their views underpin monitoring and review of the homes developments. Service users may also be confident that their rights and best interests are safeguarded by the home’s record keeping policies and procedures. EVIDENCE: Standard 37 – The acting Manager now has nearly 2 years experience of management experience at Rose Manor. She holds her registered managers award at level 4 completed in February 2006 and has submitted her application to the CSCI to become the Registered Manager of the unit. The acting Manager told the Inspector that since the last inspection she has attained her NVQ level Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 28 7 award and the certificate confirming this was seen by the Inspector. The acting Manager demonstrates a high level of competence in the management and running of Rose Manor. The systems that are in place to ensure that the home is “fit for purpose” and meets the required standards are efficient and effective. This reflects very positively on the acting Manager and also on the Deputy Manager both of whom have developed and managed these processes well. The residents spoken to by the Inspector felt that the home is being well run and evidence seen by the Inspector supports this view. The homes records and administration systems were seen by the Inspector to be in very good order and overall the impression was extremely positive. Interviews with staff reflected a positive and caring approach towards the residents. Service users can therefore be assured that they are benefiting from a well run home. Standard 39 – The acting Manager explained to the Inspector the quality assurance processes being used within the home to ensure that resident’s views underpin all self-monitoring review and development by the home. The Manager said that there is an annual management audit undertaken that reviews all health and safety issues, statutory and legal issues, the effective implementation of the homes policies and procedures, the environment and the building, staff and employment issues and training issues. A service user questionnaire is used to gain feedback from the residents and other questionnaires have also been devised to get feedback on issues to do with quality, from friends, families and visiting professionals. Quality checks are made on the recruitment procedures used to employ staff and a room-byroom risk assessment of the building is completed annually, information from which also informs the developments to be made in the home. The Inspector saw evidence of the feedback questionnaires and it was very positive in its detail and in what the residents had to say in their fedback. At the last inspection it was recommended that the feedback gained from all these questionaires be analysed and used to inform an annual development plan for this home. The acting Manager told the Inspector that this has since been completed and the newly developed annual development plan now includes the following information: • A review of all the key stakeholders feedback information including the Residents and service users, the Proprietor and the Directors, CSCI, Social Workers and Care Managers and the Care Staff. • Feedback from the manual audit of the room by room checks, • A review of issues raised at meetings for staff and residents, Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 29 • A check on issues raised in the monthly progress reports for residents and their care plans. The previously made recommendation has now therefore been met and with the implementation of this new quality assurance tool it should mean that there is in place a very effective method of maintaining high quality standards in the home. Standard 42 – The Inspector was shown information to do with relevant Health and Safety legislation. Policies and procedures were also seen for Health and Safety, risk assessment, moving and handling and fire. The acting Manager informed the Inspector that all staff receive training in moving and handling, fire safety, first aid, food hygiene, and infection control. This was supported by staff interviewed that confirmed that they had received training in these areas. Up to date certificates were seen by the Inspector for: Boiler & Gas – 20.11.06 Fire alarms – 4.10.07 Fire extinguishers – 4.10.07 Portable electric appliances – 11.9.07 All food was seen to be stored appropriately and properly labelled with dates of opening and expiry. Records were seen by the Inspector that confirmed regular tests had been carried out for the: Fire alarm - weekly Fire extinguishers - weekly Emergency lighting – 6 monthly last on 26.9.07 Fridge and freezer temperatures records were checked and records indicate that they came within the acceptable ranges. Accident records were checked – 2 records were noted to do with residents smoking in their bedrooms. Hot water temperatures were also checked and records indicated that they also came within the acceptable range. At the time of this inspection no fire doors were seen to be wedged open and the building appeared to be secure. The acting Manager showed the Inspector a recently completed risk assessment for the building and for the communal areas. This is welcomed as it should assist in the prevention of accidents and will inform the maintenance programme for the building. Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 4 3 X 4 4 5 4 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 4 X 4 X X 4 X Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations That guidance is provided about PRN medications that are used for residents stating when and when not to use PRN medication and the potential side effects for the individual resident. The resident’s GPs should be involved in this process and the information placed together with a medication profile for each resident. That the Individual Personal Development / Training file contain the staff members’ future training needs. Also that the training needs for all the staff team should be aggregated into a training matrix that may be used by the management team to plan all future training courses in the year ahead. That a course be provided for staff on mental health awareness. 2. YA35 3. YA32 Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rose Manor DS0000066693.V350645.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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