Inspection on 23/01/08 for Rosehill Rehabilitation Unit

This inspection was carried out on 23rd January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosehill Rehabilitation Unit 08/02/07

Rosehill Rehabilitation Unit 27/10/05

Rosehill Rehabilitation Unit 04/05/05

Rosehill Rehabilitation Unit 11/11/04

Rosehill Rehabilitation Unit 06/05/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

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

CARE HOME ADULTS 18-65 Rosehill Rehabilitation Unit Lower Warberry Road Torquay Devon TQ1 1QY Lead Inspector Rachel Proctor Unannounced Inspection 23rd January 2008 10:00 Rosehill Rehabilitation Unit DS0000028792.V351233.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 Rosehill Rehabilitation Unit DS0000028792.V351233.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. Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosehill Rehabilitation Unit Address Lower Warberry Road Torquay Devon TQ1 1QY 01803 291909 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) Craegmore.co.uk Parkcare Homes Ltd Position Vacant Care Home 27 Category(ies) of Physical disability (27) registration, with number of places Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for 27 younger adult service users (aged 18 65 years) with physical disability due to acquired brain injury or a neurological disorder, who may or may not have a mental health disorder and who require a specialist service. The Home may admit one named service user over the age of 65 years. 8th February 2007 2. Date of last inspection Brief Description of the Service: Rosehill Rehabilitation Unit provides rehabilitation nursing care for people who have traumatic brain injury. The home is part of Parkcare homes limited, which is a member of Craegmoor Group limited. Rosehill is about half a mile from Torquay. It is registered for 27 Service Users. The home chooses to provide single room accommodation, which reduces their maximum occupancy to 18 Service Users. The home employs registered nurses, physiotherapists and occupational therapists. The team includes 1st and 2nd level Registered General nurses and Health Care Assistants with a National Vocational Qualification in care. A local general practitioner with a special interest in Traumatic brain injury is available. A specialist nurse practitioner in acquired brain injury provides professional support for the registered nurses. The home has a comprehensive assessment and care planning system. Developed in conjunction with the wider multidisciplinary team. The accommodation is spread over three levels, ground, mezzanine and first floor. The home has an equipped physiotherapy gym, a specially adapted domestic kitchen for assessment purposes as well as the homes main kitchen and laundry area. Specially adapted bath shower rooms and toilets are available for disabled people, including independent wheel chair users. A shaft lift is available to all areas used by people who live at the home. The grounds are wheelchair accessible and have ramps and grab rails provided for people to use. The statement of purpose and service users guide is available in the reception area of the home. The fees charges vary depending on the care needs of the resident and from £1350 base rate. Additional charges are made for hairdressing, chiropody, toiletries, magazines and papers. Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection, which took place on 23rdJanuary 2008. Four people living at the home, the deputy manager, the regional manager for the company and five staff on duty were spoken to. Two people had their care followed as part of this inspection. These people were spoken to and the individual rooms they occupied seen. A tour of the home was completed and some records were inspected. Some of the information gained from the random inspection completed in August 2007 has also been included in this report. Survey forms were received from 5 people living at the home, 3 relatives and 1 health and social care professional prior to the visit to the home. Some of the comments made during the visit and in the survey forms have been incorporated into the report. What the service does well: What has improved since the last inspection? What they could do better: Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 6 The hot water system was not working well enough to ensure hot water was available for use in all the disabled access bathrooms and peoples rooms at the time of this inspection. This disadvantages people and may put them at risk of cross infection. The disinfecting sluice machines provided are not capable of taking contents of used commode pots and bedpans. The staff have to empty these in to toilets prior to them being disinfected by the sluice. The lack of designated facilities to empty commode pots and bedpans may put people at risk of cross infection. The organisation has not registered a manager for the service with the Commission. The home has gone through a period of change with the management of the home. The new manager appointed at the time of this inspection should ensure that the staff team have clear leadership. 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. Rosehill Rehabilitation Unit DS0000028792.V351233.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 Rosehill Rehabilitation Unit DS0000028792.V351233.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): 2, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment process adopted by the competent and supportive multidisciplinary staff team at Rosehill Rehabilitation Unit ensure that people living there have the opportunity to reach their full potential for rehabilitation. EVIDENCE: Two people had their care followed as part of this inspection. One person had recently been admitted to the home. Both had comprehensive assessments of their care needs, which involved the individual and health professionals such as speech and language therapist, physiotherapist and occupational therapist. Since their admission to the home they had had a rehab programme set up with the rehabilitation team at Rosehill, which had input from the psychologist, physiotherapist and occupational therapist. Each person said they had been involved in their assessment of need and had influenced their care planning. The individual personal goals recorded reflected what the individuals wanted to achieve for themselves. The deputy manager advised that the company had introduced a core care planning system. This followed the older persons, person centred approach to assessment and clearly identified the self-care ability and the goal of the individual for each activity of daily living assessed. The regional manager who visited the home during the inspection; advised that the home staff with the Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 9 support of the clinical governance team were working towards developing a person centred template for assessment and care plan for the brain injury. During the inspection Physiotherapist and Occupational therapist were providing treatment and assessment for the residents. Psychological assessments were also being completed for some people living at the home. The person completing these assessments said that the assessments are used to help build a therapeutic plan to enable the person to cope with their changed abilities, which would fit in with their physical rehabilitation programme. The staff rota confirmed that the home employs full and part time therapists to provide treatment. The physiotherapist advised that they had developed exercise programmes with the individuals that would help them improve their dexterity and ability to mobilise. They confirmed that their assessments are completed with the cooperation and consent of the individuals. Two people whose care was followed said the physiotherapist had worked with them to set out a plan, which had already helped them to improve. One of the people whose care was followed had been at the home at the last inspection. They had a record of their care review recorded, which showed the improvements they had achieved. The person said they were pleased with what they had achieved so far with the help of the staff team at Rosehill rehabilitation unit. Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 10 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): 6,7,9, 10. Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The way people’s care is managed encourages them to develop and improve their skills for independent living where possible. People can have confidence that any information about them is handled appropriately and confidentiality will be maintained. EVIDENCE: The two people whose care was followed had comprehensive plans of care in place that were linked to their rehabilitation programme. One person who had been admitted to the home recently had a clear care plan, which identified their personal goals within the rehab programme. Each element of the plan of care had evidence that this had been discussed with the person. The person confirmed that staff had spoken to them about what was important to them. And what they hope to achieve from the rehab programme, which had been set up for them. The therapy staff, rehab assistants and registered nurses were spoken to during the inspection. They confirmed that any rehabilitation plans were built around the needs and abilities of the individual. How individuals care programs and rehabilitation are reviewed was discussed. An Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 11 example of a six monthly review was shown. This contained information from the therapy staff who had been treating the person the persons opinion and the rehab staff who had been providing their care. This also gave an overview of what the individual had achieved and a summary of the plans for the future. One person spoken to who had been at the home of the last inspection said staff regularly talked to them and their family about how they are progressing. Two people spoken to during the inspection who had been receiving rehabilitation at the home confirmed that they were encouraged to make decisions about their personal goals. The Person centred care planning process in place provided clear information about the individuals goals for each area of care. Some of these goals were long-term and others were shortterm. One of the people whose care was followed said the rehab programme they had worked with had helped them to regain their ability to walk. The physiotherapist spoken to during the inspection advised that they had devised a rehabilitation program that would help this person to increase their strength and ability and enabled them to walk. Four of the staff spoken to during the inspection said they were really pleased with what this person had been able to achieve with their support. The assessment and care planning process in place enable staff to encourage people to take responsible risks, ensuring they have good information on which to base their decisions. The care plans view during the inspection had comprehensive risk assessments in place for the activities the individual had chosen to take part in. One person who had been identified as the risk of falls had a clear assessment completed and the care plan which identified the measures staff and the person should take to reduce the risk. At a random inspection completed in August 2007 the way confidential information was being handled would not fully protect information held for individuals. At this inspection new systems and processes had been put in place that should ensure confidential information held for individuals is kept securely. The regional manager advised that all staff had received information regarding maintaining confidentiality and their roles and responsibilities to the organisation and to the individuals they were caring for. The deputy manager confirmed that staff had received refresher training for maintaining confidentiality and had signed a new confidentiality statement. Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 12 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): 12,13,15,16,17, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People living at Rosehill rehabilitation unit are given the opportunity to reach their rehabilitation potential and develop personally by a skilled staff team. EVIDENCE: The deputy manager advised that none of the people living at the home were currently taking part in any external education courses. She also confirmed that the abilities of the current people living at the home have meant they were at present enable to look at opportunities for employment or volunteering. The staff at Rosehill rehabilitation unit have a clear commitment to helping people develop their skills through rehabilitation. Each person at the home has a plan of care that identifies how they have improved and what goals they are working towards. One person living at the home said they would not have Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 13 achieved as much improvement in their ability particularly walking with out the help of the staff team at the home. One of the senior rehabilitation staff advised that they had responsibility for two individual people as their key worker. This meant they were responsible for ensuring the person had what they needed. The home has a wheel chair accessible mini bus and employs a driver. People are able to go out to community events and local leisure facilities with staff. An activity programme is displayed in the reception area of the home. The staffing rota shows that sufficient staff are on duty to enable staff to accompany individual people for activities out side the home. The two people whose care was followed had clear care plans in place that identified their leisure interests and how access to them would be facilitated. An activities co-ordinator had been employed since the last inspection. They had been in post less than a month. They advised that they intended to work with individuals to establish what they were interested in and then look for opportunities or provided things in house. Three people were making pottery pots during the inspection to make into Easter baskets. The activities coordinator advised that this helped with hand eye co-ordination and dexterity as well as giving them something they were interested in doing. The company policy is to actively encourage the support of family for individuals, unless the person does not want this. Visitors were coming and going through out the inspection. They were seeing people in their own rooms or one of the communal areas in the home. Copies of minutes of “Your Voice “ meeting were available for inspection. This showed that people were actively being encouraged to influence and express their views on the services the home was providing. The deputy manager advised that as a result of these meeting the choice of activities had been up dated and the menus had been changed. Staff were observed knocking on individual peoples rooms before entering. They were using the persons preferred form of address when they spoke to them. A system is in place for people living at the home to be assessed for their ability to benefit from the provision of key to their own room. The deputy manager who is a registered nurse confirmed that people who are able are given a key to their room. Some people had chosen to stay in their own rooms. The registered nurse advised that the people living at the home are encouraged to join in with others but they can choose to stay in their own rooms if they wish. The home has an adapted kitchen where the people who are able can prepare meals and do their own cooking. The deputy manager advised that the Occupational therapist assesses the persons ability and reviews the equipment they need to progress. The regional manager advised that helping people to Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 14 return to the community with the right support and rehabilitation was one of the main aims of the service. The meal time observed was unhurried with people eating their meals at their own pace. Those who needed assistance to eat were being given this by staff. Staff asked people if they needed help to cut their food up before they did this. The meal was attractively presented and nutritionally balanced and people were being given a choice of two main courses. Since the last inspection a new chef has been appointed. The deputy manager advised that the menus and the timing of the main meal had been changes as a result of residents meeting and discussion with individuals living at the home. The new hot cabinet, which had been provided at the last inspection, was being used. Staff said this made it easier to ensure people had their meals hot and increased choice for people. Two people living at the home said the food had improved recently. One relatives comment card indicated they would like more choice of meals for their relative. Nutritional risk assessments continue to be an integral part of the care planning process. The two people whose care plans were viewed had a record of their personal preferences and choices and any specialist dietary requirements. The deputy manager for the home advised that the company were planning to up grade the kitchen equipment. This was included as part of the ongoing improvement plan for the home. Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20, Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. People living at Rosehill rehabilitation unit continue to receive care from the staff team who try hard to meet their physical, emotional and health care needs in a way they prefer. The home’s staff team of registered nurses follow safe medication practices for medication administration storage and disposal. EVIDENCE: Two people had their care followed as part of the inspection. Both had clear plans of care, which identified their personal preferences and choices. The care plans showed that personal support was provided flexibly to promote the individuals independence. One care plan viewed showed how the person had been involved in the development of their personal goals for rehabilitation. Each element of the care planning process was person centred. One person living at the home commented that the staff had helped them to walk independently and they had achieved this by agreeing each step/goal with the rehabilitation team at Rosehill. Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 16 In addition to care staff and registered nurses the home employs physiotherapists, Occupational therapists, student psychologists and an activities co-ordinator. They all work with individuals to help them achieved their personal goals for rehabilitation. The home operates a named nurse and key worker system. One senior carer spoken to during the inspection advised that as key worker they ensured the person they were key worker for had what they needed each day. They also said that being a key worker enabled them to get to know the person they were key worker for. The pre inspection information (AQAA) Annual Quality Assurance Assessment indicated that the GP visits the home regularly. The care plans show that individuals have access to their GP and are able to see them in private. One GP commented “Communication with myself”, “Try to involve patients families also”. They also indicated that the home staff usually respect individuals privacy and dignity. One relatives survey form returned stated “ Wonderful staff- excellent have made magical improvements for (relative) after brain injury.” Another relative commented, there relative had not seen a speech and language therapist as often as they expected, however they also said “ other therapy X was receiving was very good”. A record of other health care professionals who had assessed individual people was available in their care plan. The preinspection information (AQAA) Annual Quality Assurance Assessment indicated that assessment for individuals for self-medication could improve. The GP who responded indicated very few of the current people living at the home were able to self-medication. Discussion with the deputy manager revealed that self-administration of medication was discussed and planned with the individual as part of the person rehabilitation. A system for recording receipt of medication was in place. Two individual peoples medication records seen had the receipt of medication initialled by the registered nurse checking the medication. The home uses a local pharmacy for the supply of medication. The deputy manager explained how the medication was stored and how stock rotation was maintained. The medication being stored showed that the home staff had a good system of managing stock of medication for individuals with in the home. The home has a medication policy in place for staff use. The registered nurses are responsible for monitoring and administering peoples medication. A clinical waste company takes responsibility for the disposal of medication no longer required. Records of medication disposed of in this way were being kept. This listed the medication disposed of and the signature of the nurse disposing of them. The registered nurses spoken to were aware of the need to keep medication for seven days when a person had died. Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 17 The controlled drug register was checked. This had been completed in line with the recommended practice. All entries had been signed and dated and the number of tablets/ medication left recorded. At the time of this inspection none of the people living at the home needed controlled drugs. Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 18 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): 22,23, Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. People who live at Rosehill rehabilitation unit can have confidence that their concerns will be listened to by a caring staff team. Safeguarding procedures and policies in place should protect people living at Rosehill rehabilitation unit. EVIDENCE: Completed survey forms were returned form five people living at the home and three relatives. Four of the five people who live at Rosehill responded that they knew who to speak to if they had any concerns. One commenting that they could speak to most staff. Two of the three relatives who responded indicated that they knew who to speak to if they had concerns. One relative commented that the only person they felt they could trust was the home manager who had responded appropriately to their concerns. The Commission has been made aware of four complaints since the last key inspection in February 2007. One referred to the protection of confidential information and two were referred to the safeguarding teams. The company took appropriate action to ensure peoples confidential information will be protected in future. At the time of this inspection both safeguarding concerns had been resolved to the satisfaction of the person who had raised them. Discussion with the safeguarding team revealed that they were satisfied with the way the home manager at the time had responded to and dealt with the issues raised. Records were being kept of complaints received and the action taken in a locked filing cabinet in the office of the home. Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 19 The deputy manager provided a training matrix, which showed that the majority of staff (88 ) had received protection of vulnerable adult training by December 2007. She further advised that adult protection training was due to be provided for the remaining staff. The training matrix also showed that key staff had received training for managing challenging behaviour. The company has developed a clear policy for the protection of vulnerable adults, which was available for staff and people who use the service. The company has a policy for dealing with allegations of abuse in place. Recruitment practices in place should protect people from unsuitable staff. Staff files viewed during the inspection had all the pre employment checks completed prior to the person starting work at he home. This included obtaining references and police checks The way individual’s money was handled was discussed with the administrator responsible for keeping records of expenditure. Records were checked against the money held of one-person as correct. The administrator advised that only they or the manager had access to the safe. A petty cash float was made available for staff to use on peoples behalf. Receipts of expenditure form the petty cash were being kept for individuals. Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 20 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): 24,27,30, Quality in this outcome area is adequate, This judgement has been made using available evidence including a visit to this service. The continued problems with hot water supply to one of the disabled access baths means that people are still unable to use this recently refurbished bathroom. This has limited individual choice. The designated cleaning facilities for used commode pots and bedpans could put residents at risk from infection, as staff do not have access to hand wash sinks in the sluice areas and the commode pot needs to be emptied before using the sluice machine. This detracts from an otherwise pleasantly decorated and well-maintained environment for people to live in. EVIDENCE: Since the last key inspection major refurbishment of the environment at Rosehill has taken place. An open day in the summer which people living at the home took part in was organised to celebrate the works completion. However one of the newly refurbished bathrooms has not been used because of problems with hot water access. The visiting company regional Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 21 representative advised that the work would be completed that week on the boiler, which would enable the bathroom to be used. They also commented that Initial work carried out by a maintenance company in the summer failed to resolve the hot water supply problem to the refurbished bathroom. During the inspection a copy of the homes development plan was provided for inspection. This showed the continued commitment to ensuring the environment and equipment meets the needs of the people living at Rosehill rehabilitation unit. A maintenance person has been employed at the unit, they regular monitor health and safety issues including fire safety. The minutes of quarterly H&S meetings were available for inspection The home has two distinct areas. One area has a disabled access kitchen for people to access with the rehabilitation team for assessment and developing their skills in the kitchen. The company provides a mini bus and driver, which enables people to attend activities and appointments out side the home with a member of staff. The preinspection information (AQAA) Annual Quality Assurance Assessment indicated 2 Vehicles are available, one of which has been adapted to meet the needs of people with a physical disability. Furnishing and fittings are as far as possible domestic in character. Some furniture and furnishings have been replaced since the last inspection. Individual rooms entered had new wardrobes and draws. Carpets had also been replaced in some rooms. Since the last key inspection one of the disabled access bathrooms has been converted to a walk in shower room. Staff spoken to say several people preferred to use the shower. The garden area was accessible from the patio decking area off the lounge and dining room. In addition to this garden area people also have access to a small garden area where hey can grow plants of their choice. This was set out with individual named plots, each having different things growing in them. One staff member advised that they were in the process of helping to make a ramp from the front access to the home to this garden area, which would make it easier for independent wheel chair users to access. The deputy manager advised that there were plans to open up more of the garden for people with ramps and raised flower beds to the front of the home. The preinspection information (AQAA) Annual Quality Assurance Assessment indicated that all individual peoples rooms have been made single occupancy. A tour of the home revealed that all the people living in the home were in single rooms. People were using rooms that had been shared occupancy. This allowed room for specialist equipment they needed to be stored in their room. This included specialist equipment the person needed such as hoists stand aids, specialist beds and wheel chairs. The size of the previously shared rooms made it easy for independent wheel chair users to move around their rooms. Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 22 A tour of the home was completed all areas were fresh, odour free and clean. Domestic staff are employed in addition to the care and rehabilitation staff. The preinspection information (AQAA) Annual Quality Assurance Assessment indicated that there are comprehensive cleaning schedules for the housekeeper and the kitchen staff. Information regarding the cleaning schedules were provided. The staff member spoken to said these enabled them to ensure staff completed the required cleaning for individual rooms on a regularly basis. The flooring in the laundry had been reviewed and access around the washing machines had been closed in. This had made it easier to keep clean, however the seals had not been put in between the flooring and the boxed in section. The deputy manager advised that this was one of the things they were waiting for the company who did the refurbishments to complete. The home has disinfecting sluices on each floor. However no facilities were provided to empty commode pots or bedpans prior to them being disinfected. Hand wash facilities were not provided in these sluices or they were difficult for staff to access. The registered nurse advised that commode pots are still emptied into toilets prior to be being disinfected in the sluices. The first floor sluice does not have hand wash facilities for staff and no hand sanitising liquid had been provided for staff use. This could pose an infection control risk. The deputy manager advised that they had requested a different type of sluice that was capable of cleaning as well as disinfecting. The regional company representative confirmed that budgets had been approved to provide an appropriate sluice machine for the staff to use. The deputy manager advised that a new sluice area was being created, which would give more space from the existing sluice and a toilet, which was no longer used. During the inspection the contractors confirmed a date for the work to start on the new sluice that week. Rosehill Rehabilitation Unit DS0000028792.V351233.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): 32,34,35, Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Robust recruitment policy ensures people are protected from unsuitable staff. The staff are friendly and supportive towards the people living at Rosehill Rehabilitation Unit. The supervision, training and support provided for staff should ensure they understand how to provide the best care for people. EVIDENCE: The staff rota showed that 20 rehabilitation staff (health care assistants) are employed at the home. The training records provided showed that 3 staff had completed an (National Vocational Qualification) NVQ 2. Two of these had also completed an NVQ 3. A further 2 staff had completed an NVQ 3. The information showed that a further 2 staff were working towards the NVQ 2. This means that five staff had achieved an NVQ 2 or above and a further 2 staff were working towards this qualification. In addition to the rehabilitation staff the home also employs registered nurses, Physiotherapists, occupational therapists, activity co-ordinator and psychology students. They provide rehabilitation assessments and programmes for the individual people in the home. Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 24 Staff spoken to during the inspection said they felt supported to do their work. Training records showed they had access to mandatory training such as manual handling, fire and health and safety. Staff survey forms returned all indicated that they would like more training specific to caring for people with brain injury. Staff spoken to during the inspection also said they would value this type of training. During the inspection the company regional representative advised that the funding had been agreed to access external specialist training for brain injury for staff. The deputy manager advised that managing challenging behaviour training was also provided for staff in the unit. Two staff spoken to confirmed this had been provided. Two of the registered nurses spoken to during the inspection confirmed they had received training for infection control. The physiotherapist, occupational therapist and psychology student all provided programmes for individuals, which enabled them to progress with their rehabilitation. Staff confirmed that they worked well as a team and worked with the goals set by the individual person and the therapists in the home. The company has clear recruitment policies and procedures in place. Two staff files for recently appointed staff were viewed during the inspection. Both contained the information required for pre employment checks for staff. These included applications form, two written references, a police check and proof of identity. Job offer letters seen in both staff files were dated after the completed police check had been returned. The deputy manager confirmed that all new staff receive induction training. Examples of the induction pack were available at the inspection. Three staff survey forms returned indicated that their induction covered every thing they needed very well. The deputy manager confirmed that copies of certificates for training completed by staff are kept with their personal file. The deputy manager advised that training and development plans for staff are linked to their annual appraisal. The company had introduced new templates for recording appraisal and staff development plans at the last key inspection. These were continuing to be used at this inspection. The deputy manager confirmed that part of her role was training co-ordinator. She provided training matrix that showed the training staff had received the previous year. She confirmed that she was working on up dating the training matrix for 2008. The deputy manager also advised that core training was competed each year and other training relevant to the people they care for was also completed. Staff appraisals included the training they had completed the previous year and what training was planed for the coming year. Two staff spoken to said they were due to have an appraisal soon but because of the changes in the management of the home the date for this still had to be confirmed. Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 25 Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 26 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): 37,39,42, Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. There was a positive open atmosphere in the home where the staff team encourage people to maintain their individuality. People living at the home are able to influence decisions about the way services are provided. EVIDENCE: The home does not have a manager who is registered with the Commission. The previous manager appointed by the company has left. The company has appointed a new manager who has previous experience to lead the staff team at Rosehill Rehabilitation Unit. The company representative advised that it was the intension to put the new manager forward as the registered manager for the Commission. Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 27 The company has a clear quality assurance system. The views of people who use the service and their representatives are sought on a regular basis. The deputy manager gave examples of how meals had changed as a result of feed back from the people living in the home. People spoken to during the inspection said they were asked their opinions about the service. The (AQAA) Annual Quality Assurance Assessment was returned to the Commission before this inspection. The company has worked towards meeting the requirements and recommendation made at the last inspection. The business plan provided showed the planed improvements. Health and safety policies and procedures were provided for staff. A system for reporting accidents and untoward incidents was in place. The Commission has been kept informed of incidents in the home, which affect the well being of the people living there. The health and safety meeting minutes were provided for inspection. These showed that the organisation and the management of the home have a clear process for ensuring health and safety was protected. There was a clear induction process, which follows Skills For Care guidelines. The deputy manager confirmed all new staff who join the staff team complete this. Although up to date training and development plans have not been completed for all staff, clear templates to record this and monitor staff learning are in place. The deputy manager advised that these are being completed for all staff. Staff spoken said they felt supported to do their work and had access to regular training. Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 28 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 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 29 Yes 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. 1. Standard YA30 Regulation 23(2)(k) Requirement There must be facilities to sluice/clean commode pots and bedpans prior to them being placed in the disinfecting sluice to reduce the risk of cross infection. Extended from 01/06/07 and 01/10/07 Timescale for action 01/03/08 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 YA27 Good Practice Recommendations Hot water should be available in sufficient quantity for disabled access bathrooms and individual rooms to meet peoples personal hygiene needs. The home should have a registered manager in post 2. YA37 Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Rosehill Rehabilitation Unit DS0000028792.V351233.R01.S.doc Version 5.2 Page 31 - 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. 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