CARE HOME ADULTS 18-65
Rosedene 22 Rosewarne Road Camborne Cornwall TR14 8BE Lead Inspector
Lowenna Harty Unannounced Inspection 25th April 2006 09:30 Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 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 Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 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. Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Rosedene Address 22 Rosewarne Road Camborne Cornwall TR14 8BE 01209 714238 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Alcwyn Samuel Henry Parker-Price Mrs Gwyneth Helen Parker-Price Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users must be aged 50 years or over upon admission to the home. 4th October 2005 Date of last inspection Brief Description of the Service: Rosedene is a registered home providing accommodation and personal care for up to 5 adults with a learning disability who must be aged 50 years or over when they are admitted. It is owned and managed by the registered providers, who provide most of the necessary care and support to the service users themselves. Two part-time carers assist them. The home is close to the centre of the town of Camborne and within easy reach of local shops and services. The home is able to provide transport for service users should they need it. The home is a detached, two-storey, family dwelling with a spacious front garden and a patio. Service users private accommodation is situated across both floors. The upper floor is reached via a staircase. All of the service users are provided with single, furnished bedrooms. Two of the bedrooms have wash hand basins. The home has three bathrooms, two on the ground floor and one on the first floor. There are two lounges and a separate dining room. Service users have some access to the kitchen, but this is limited because it is quite small. They have tea and coffee making facilities near to their lounge. The aim is to provide service users with care in a comfortable and homely setting and to encourage them to be involved in a wide range of activities in the local community. All the service users attend day care and/or college placements during weekdays; they are helped to get to social clubs and resources in the local community during evenings and weekends. Fees range from £292.00- £602.00 per week, according to information provided by the registered providers to the Commission, which was received on 4 May 2006. There are no additional charges made to service users. Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection, which was unannounced. It took place on 25 April 2006 and lasted for approximately seven hours. The purpose of the inspection was to ensure that service users’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that service users’ placements in the home result in good outcomes for them. The inspection included interviews, held in private with each of the service users who consented to be interviewed and telephone or face-to-face contact with relatives and representatives of two of them. A member of staff was interviewed and there were opportunities to directly observe aspects of service users’ daily lives in and out of the home. Other activities included an inspection of the premises, examination of care, safety and employment records and discussion with the registered providers during the day. The principle method of inspection was “case tracking”. This involves interviews with service users; staff caring for them and their representatives, where possible and examination of records relating to their care. This provides a useful impression of how the home is working for service users overall. Three service users were case tracked at this inspection. Service users and their representatives expressed continuing satisfaction with the care and services provided to them at the home, particularly in relation to the food provided to them and opportunities to travel. They had recently returned from a two-week holiday in Tunisia, which they had very much enjoyed. Overall the home is providing a very good quality of care to the service users placed there. What the service does well:
New residents are assessed before they are admitted to the home, to ensure that it will be suitable to meet their needs and that they will fit in well with the other the residents in the home. Each of the residents has an individual, written care plan, which clearly sets out the goals of their placement in the home, to help them to develop their skills and independence. They are encouraged to make decisions about things that are important to them, for example whether or not they wish to access the community independently and what activities they would like to participate in. The registered provider helps them to take safe risks in order to help them to achieve their goals. Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 6 Residents have access to a wide range of activities. They all attend different day centres/work or college placements during the week. At weekends they either visit their families or accompany the registered providers on day trips to places of local interest. The registered provider takes care to ensure that residents regularly access activities to celebrate their Cornish Heritage. Residents make use of the full range of community facilities available locally. Those that feel confident, go out independently, for example to the local pub and local fish and chip shop. Where they lack confidence, the registered providers accompany them. Residents regularly have contact with their families. They are supported to develop and maintain appropriate relationships with people at their work placements and with each other. They attend social clubs during evenings and weekends, which the registered providers help them to access. Residents and their representatives are informed of their rights and responsibilities through their placement contracts and copies of the homes service users guide, which are explained to them. The registered providers ask them about how they wish to spend their personal money and respect their decisions on this. All of the residents said that they very much enjoy the food that is provided to them at the home. They assist with shopping in choosing meals, prepare their own breakfasts and are able to access healthy snacks and drinks when they wish. On special occasions, the registered providers take them out for meals otherwise they are served with home-cooked meals, using fresh, healthy ingredients. Meals served to them reflect their cultural backgrounds, individual tastes, health needs and choices. Residents are able to access and make use of bathrooms in private and are helped with their personal care in ways that support their independence and maintain their dignity. Most of them are physically healthy, fit and well. The registered providers help them to access a range of NHS healthcare providers on a regular basis so that they maintain good health. The homes procedures allow for residents to manage their own medication, if it is safe with them to do this. Systems in place for residents who require support with their medication are safe and sound, to protect them from harm due to medication errors. All of the residents expressed satisfaction with the care and services provided to them and indicated that they would have somebody outside of the home to talk to if they were unhappy about anything there. There are good systems in place to keep them safe from abuse, and all of them said that they feel safe in the home. The home is comfortable and homely and service users have a range of shared accommodation in addition to their private accommodation. They each have their own room and all of them said they like living there. There are systems and checks in place to ensure the home is safe for them. Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 7 The home was clean and tidy throughout at the time of the unannounced inspection. Staff are provided with training and guidance to prevent the spread of infections in the home. Staff are recruited on the basis that they are suitable and safe to work with vulnerable adults in a care setting. They are competent and qualified and undertake regular training to update their knowledge and skills for the benefit of the residents. Residents said that they like the staff working with them and that they provide them with good care. The registered providers are closely involved in the day-to-day running of the home. Residents and their representatives confirmed that it is well managed, for their benefit. There are formal and informal ways in which residents can make their needs, views and wishes known so that they can directly influence the running of the home and decisions made about its ongoing improvement and development. As previously stated, the home is well maintained and safe, with suitable risk assessments, safety checks and staff training in place to protect residents from avoidable harm and injuries. What has improved since the last inspection? What they could do better:
It would be useful to make assessments and care plans more distinct from each other, so that new residents have clearer information. Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 8 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. Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 9 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 Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this area is good. This judgement has been made using available evidence including a visit to the service. Prospective service users are assessed to ensure that the home will be suitable to meet their needs, but would benefit from some minor changes to help them and their representatives distinguish more clearly between assessments for admission and care planning subsequent admission. EVIDENCE: Records, interviews and observation of service users provide evidence that one service user has been admitted to the home since the previous inspection. There is good information about them and their care needs on their personal file, and evidence of professional assessment by a social worker prior to their placement in the home. There is assessment information completed by the registered providers, but this would benefit from being more separate from the service users’ care plan, with more information about their past history and previous placement. Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, & 9 Quality in this area is good. This judgement has been made using available evidence including a visit to the service. Service users have goals led, written care plans, which fully reflect and address their needs. They are assisted to make decisions about their lives and to safely develop their skills and independence to enhance the quality of their lives. EVIDENCE: There was very good evidence in the form of written records in the home, interviews with service users and their representatives, discussion with the registered providers, interview with a member of staff and observation during the inspection that service users needs are well met in ways which encourage them to develop their independence and skills. Service users sign up to their individual care plans, which fully address their care needs, including their needs in relation to their background, culture, age, ability, sex and sexuality. Their care plans provide them with very individualised goals so that they can monitor their progress and achievements during their placements in the home. Observation at the time of the inspection demonstrated how care plans are put into practise in Service Users’ daily lives. Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 12 Service users said that they are able to make choices about things that are important to them. Where necessary, the registered providers assists them, for example in accessing the community, if they lack confidence in going out alone. Service users who are more confident have their own door keys and are able to come and go from the home as they please. Service users are encouraged to participate in a wide range of activities in the local community. The registered providers had completed written risk assessments, which are very individualised and appropriate to each of the service users, depending on their individual needs, risks and abilities. Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this area is excellent. This judgement has been made using available evidence including a visit to the service. Service users take part in a range of activities, according to their diverse needs, to enhance the quality of their lives. They access the local community on a regular basis, to develop their confidence and independence. They are encouraged to develop and maintain safe and appropriate relationships with friends and relatives. They are informed of their rights and responsibilities so that they are clear about what is expected of them and enjoy a varied diet to keep fit and healthy. EVIDENCE: Evidence was available in the form of written records and interviews with service users and their representatives that service users enjoy their lifestyle in the home. Their care plans consider their diverse needs, with regard to their backgrounds, ages and abilities and daily records back them up. The service users in his home are proud of being Cornish and the registered providers help them access activities to explore their Cornish Heritage.
Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 14 Service users regularly access the local community, independently, if they wish or with the registered providers. They attend a variety of different day centres and work placements during the week and go out in the evenings and at weekends. All the service users maintain regular contact with their families. They attend a range of local day centres work placements and social clubs, where they are able to meet and develop friendships with people from outside the home. The registered providers support and assist them to develop appropriate relationships with each other and other people. Service users have signed up to written contracts for their placements, which clearly set out their rights and responsibilities in respect of their placements in the home. Where the registered providers assist them with the management of their financial affairs, there are clear records and records of consultation with them about how they would like to spend their personal funds. All of the service users said that they enjoy the food that is provided to him in the home. They are able to access the kitchen and make snacks for themselves if they wish and celebrate special occasions with the registered providers by going out to eat. They assist with shopping and choosing food and records suggest that they have a healthy varied diet. Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this area is good. This judgement has been made using available evidence including a visit to the service. Personal support is given to service users to help them maintain their independence and their dignity. Their physical and emotional health needs are appropriately met. Medication is safely managed so as to protect service users from medication errors. EVIDENCE: Evidence was available in the form of written records and observation of the home and service users. Service users appeared well kempt and appropriately dressed at the time of the unannounced inspection. They have good facilities to maintain their personal hygiene, in private. Service users said that they are able to access health care facilities when they need to, although most of them are in good physical health. There are clear records to show how they access a range of NHS health care providers for routine checkups. Only staff who have attended safe handling of medication training courses assist service users with their medication. The home has clear written procedures to assist staff manage service users medication. These include options for service users to manage their own medication, if it is safe for them
Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 16 to do so. There are suitable facilities the storage of medicines and clear records of all medication given to service users. Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 17 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this area is good. This judgement has been made using available evidence including a visit to the service. There are good systems in place to make sure that service users views are listened to, heard and acted upon and to protect them from abuse. EVIDENCE: All of service users said that they are satisfied with the care and services provided to them at the home. They all have placement supervisors or family members who can advocate for them if necessary and help them to access the homes formal complaints procedure if they are unhappy with any aspect of the care. There are no records of formal complaints made to the registered providers since the previous inspection. The home has formal written procedures to inform staff of what to do if they suspect the service user is being abused. Service users interviewed at the time of the inspection indicated that they are safe and well cared for in the home. The registered providers have both attended local multi-agency training on the protection of vulnerable adults from abuse. Staff are selected on the basis of their suitability to work with honourable adults in the care setting. Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this area is good. This judgement has been made using available evidence including a visit to the service. The home is clean and comfortable and safe to provide service users with independence, a good quality of life and adequate protection from infection. EVIDENCE: Evidence was available in the form of a visual inspection of the premises, inspection of safety records and staff training records and discussion with the registered providers. The home is a domestic style building, well situated for service users to access the local community. It is well maintained and comfortable and provides service users with a choice of communal areas, in addition to their private accommodation. There are records of appropriate safety risk assessments and equipment checks and staff training to keep residents safe from fire and other environmental hazards. The home appeared clean and tidy at the time of the unannounced inspection. All staff handling food have undertaken training in food hygiene. There are clear written guidelines for staff to prevent the spread of infections in the home
Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 19 and registered provider is planning to undertake infection control training shortly. Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this area is good. This judgement has been made using available evidence including a visit to the service. Staff are competent and qualified to care for vulnerable adults in a care setting. They are recruited on the basis of recruitment and selection procedures that are fair, safe and effective to ensure that they are suitable to work in a care setting. They have access to ongoing training so that they have the necessary skills to work with service users. EVIDENCE: Evidence was available in the form of policies and procedures, written records of staff recruitment, training and qualifications, interviews with service users and an interview with a member of staff. The home has a written procedure that promotes recruitment and selection of staff on the basis of equal opportunities. Staff are recruited according to a person specification and are provided with clear written job descriptions so that they are clear about what is expected of them. Staff have the qualifications, training and experience necessary to be able to work safely and effectively with service users, with copies of their qualifications and training certificates available. The registered provider was preparing the home’s training plan for the forthcoming year at the time of the inspection, so that staff will keep their training up-to-date for the benefit of the service users.
Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 21 Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this area is good. This judgement has been made using available evidence including a visit to the service. The home is well run for the benefit of the service users. Service users are appropriately consulted about the running of the home so that ongoing improvements are based on their views. The home is safe and secure for the protection of service users. EVIDENCE: The registered providers are qualified and experienced, having run the home for several years. Service users and their representatives said that the home is well run and the staff member interviewed confirmed this. The registered providers undertake regular training to update their knowledge and skills. They are very closely involved in the direct day-to-day running of the home. Service users confirmed that they are satisfied with the care and services provided to them at the home. In addition to regular, daily contact with the registered providers, during which they can make their views and wishes known informally, there are formal quality assurance meetings held every six
Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 23 months, with records maintained. These consider important aspects of the home’s management that affect the daily lives of the service users such as food, quality of the accommodation, holidays and activities. Records of risk assessments, regular equipment tests and checks and staff training provide good evidence that the home is well maintained and safe for service users. Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 24 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 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 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 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 YA2 Good Practice Recommendations There should be a clearer separation of assessment and care planning documentation for service users admitted to the home in the future, With more information about their background, history and previous placement. Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 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 Rosedene DS0000009087.V291281.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
