Inspection on 08/02/07 for Rosehill Rehabilitation Unit

This inspection was carried out on 8th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosehill Rehabilitation Unit 23/01/08

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 8th February 2007 10:30 Rosehill Rehabilitation Unit DS0000028792.V306809.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.V306809.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.V306809.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) info@craegmoor.co.uk Parkcare Homes Limited Vacant Care Home 27 Category(ies) of Physical disability (27) registration, with number of places Rosehill Rehabilitation Unit DS0000028792.V306809.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. 27th October 2005 2. Date of last inspection Brief Description of the Service: Rosehill Rehabilitation Unit provides rehabilitation nursing care for Service Users 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. A 1st level Registered Mental Health nurse with several years experience manages the team. This 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 Service Users, including independent wheel chair users. A shaft lift is available to Service Users areas. The grounds are wheelchair accessible and have ramps and grab rails provided for Service Users 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.V306809.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 key inspection, which took place between 10 am and 4 pm on 8th February 2007. The inspector spoke to residents and the acting manager and some staff on duty. Two residents had their care followed as part of this inspection. These residents were spoken to and the individual rooms they occupied seen. A tour of the home was completed and some records were inspected. Comment cards were received from resident, relatives and health and social care professionals prior to the visit to the home. Some of the comments made have been incorporated into the report. What the service does well: What has improved since the last inspection? Since the last inspection the acting manager has increased the commitment to short intensive rehabilitation packages for the residents admitted to the home. The staffing levels and multidisciplinary staff team employed reflect the change of emphasis for Rosehill Rehabilitation unit. Senior Physiotherapist and Occupational therapists assess the residents for their rehabilitation potential. A clinical psychology assistant assesses the resident’s physiological needs. Registered nurses employed come from varying health backgrounds including general nursing and mental health nursing. The home staff team have the support of specialist community practitioners i.e. speech and language therapist, dieticians and specialist nurses. The majority of the homes external and internal environment has been redecorated and some new carpets and furniture provided. The dining room is a none smoking area, which some residents told the inspector they really appreciated. The laundry flooring around the washing machines has been replaced. A full time maintenance man and gardener are employed. The gardener has created raised flowerbeds, which will enable wheel chair users to work in the garden if they wish. A patio area with a ramp to the garden has been created since the last inspection. This is easily accessible for residents from the lounge and dining room. New disabled access baths have been fitted in existing bathrooms and an easy access shower/wet room created form one of the existing bathrooms. These have given the residents more choice and will enable residents who were previously unable to access the bathrooms to use them. Rosehill Rehabilitation Unit DS0000028792.V306809.R01.S.doc Version 5.2 Page 6 What they could do better: 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.V306809.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.V306809.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 ensure that the residents have the opportunity to reach their full potential for rehabilitation. EVIDENCE: Two residents had their care followed as part of this inspection. Their plans of care were viewed and the residents spoken to. These plans of care had comprehensive risk assessments for the resident’s daily activities and their care needs. One resident who had recently been admitted to the home had a copy of their health and social services care plan and assessment on file. This gave very clear information about the residents care needs and their care goals. The homes own assessment of care needs had been partially completed for this resident. The registered nurse spoken to advised that the care plan and assessment provided had given them enough information to start caring for the resident and they were in the process of assessing their rehabilitation potential. This resident appeared to be setting in to Rosehill. The nurse confirmed that the resident had been visited in hospital prior to their admission and their care needs discussed with them and their partner. Rosehill Rehabilitation Unit DS0000028792.V306809.R01.S.doc Version 5.2 Page 9 An assessment had been carried out for the type of bed this resident required. The inspector saw a specialist bed, which was capable of being easily height adjusted available in this resident’s room. The nurse advised that their physiotherapy assessment showed that if the bed was at the right height they could be independent getting in and out of bed. During the inspection the Physiotherapist and an Occupational therapist were providing treatment and assessment for the residents. The staff rota confirmed that the home employs full and part time therapists to provide treatment for the residents. One of the residents 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. This resident had attended a local college to learn computer skills. The resident showed the inspector a new keyboard that had been provided for them. The nurse in charge advised that staff were assisting this resident with their computer skills. The home records and care plans continue to include assessments, which identify triggers for challenging behaviour for residents at risk. Their plans of care also include actions staff should take to support the resident. They also included care management agreed with the resident and staff to help them manage their challenging behaviour. One senior NHS employee commented, “Rosehill has worked very well with some of my complex cases. I have been very pleased with the outcome” Rosehill Rehabilitation Unit DS0000028792.V306809.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 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The way resident care is managed by the competent caring staff team encourages them to develop and improve their skills for independent living where possible. EVIDENCE: The acting manager advised that she was in the process of reviewing the way residents care plans are developed and recorded. One example of this was seen during the inspection for a new resident. The acting manager advised that she wanted to ensure that rehabilitation was the key to the new care planning process. The plans of care viewed during the inspection had been formally reviewed. The registered nurse advised that the residents care needs are assessed on a regular basis. These are as well as their six monthly formal reviews, which involve the multidisciplinary team, the resident and their representative if they Rosehill Rehabilitation Unit DS0000028792.V306809.R01.S.doc Version 5.2 Page 11 wish. The formal reviews had a record of the resident’s achievements and their goals for the next period. The physiotherapist and the occupational therapist had also recorded their opinions regarding the resident’s further rehabilitation potential. The administrator advised how the resident’s funds are managed. A record of individual residents money held in a bank account were being kept. When money had been withdrawn at the residents request a record had been made. A system, which recorded the amount of expenditure and kept receipts, was in place. The records of money held for two residents were checked as correct. Risk assessments remain an integral part of the care planning process for the residents. These were being linked to the residents rehabilitation programme. The initial assessment viewed for one new resident contained risk assessment for the activities they were being encouraged to participate in. This included physiotherapy and occupational therapy assessments, which set goals to be achieved with the resident. One resident who had challenging behaviour had a plan of care, which assessed the risk and had behaviour management plans in place. This plan of care had been agreed with the resident. A physiologist assistant had assessed the resident’s physiological needs as part of their care planning process. The acting manager advised that all the residents have the benefit of having their care needs holistically assessment by the multidisciplinary team at Rosehill. She further commented that Rosehill was going to concentrate more on rehabilitation and shorter length of stay for the residents. The aim being to move the residents on to independent living, when they had achieved their optimum rehabilitation potential. The home has a written procedure for unexplained absences by the residents. This guides staff regarding the actions they should take. Rosehill Rehabilitation Unit DS0000028792.V306809.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): 12,13,14,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents are given the opportunity to reach their rehabilitation potential and develop personally by a skilled staff team EVIDENCE: One resident spoken to had attended a local college to learn computer skills. They had their own computer in their room. This resident showed the inspector the new keyboard they had. The registered nurse advised that one of the staff members was continuing to assist the resident to use their computer. Since the last inspection an activities co-ordinator has been appointed. They had been in post for a short time at the time of this inspection. They advised that they were in the process of completing plans with each resident, which looked at the activities they were interested in and how these could be achieved. The inspector was advised that none of the Rosehill Rehabilitation Unit DS0000028792.V306809.R01.S.doc Version 5.2 Page 13 residents were able to progress to employment at the time of the inspection. However the activities co-ordinator told the inspector that she would be exploring work opportunities with one resident who had requested this. During the inspection some of the residents had attended the local swimming baths with the senior physiotherapist employed by the home. She advised that these sessions were used in a therapeutic way as well as providing the residents with the opportunity to enjoy community facilities. Raised flowerbeds had been introduced in the garden, which enables wheel chair dependant residents to take part in gardening. The acting manager advised that the gardener employed encourages the residents who are able and have an interest to assist in the garden. The home has a designated equipped Gym. The senior physiotherapist employed by the home advised that the equipment is used to assist the residents to achieve their optimum potential with movement and co ordination. Treatment plans were provided in the plans of care viewed. The comment cards received from the residents were completed with the assistance of a named member of staff. The majority had responded that they usually choose what they do each day. Although one commented that the activities provided did not meet their needs. The manager advised that the activities co-ordinator was beginning to address this with the residents where possible. The seven comment cards received from relatives all indicated that they were satisfied with the overall care of their relative. One commenting “how the staff had enabled their relative to improve from being unable to sit unaided to beginning to learn to walk”. The home has an open door policy for visiting and relatives are encouraged to visit at reasonable times. One relative had been enabled to see their relative in private in one of the lounges in the home. The inspector was told that residents could see visitors in the privacy of their own rooms if they wish. Staff were observed knocking on individual residents rooms before entering. They were using the residents preferred form of address when they spoke to them. The residents are assessed for their ability to benefit from the provision of key to their own room. During the inspection some of the resident’s had locked their room doors. The registered nurse confirmed that the residents who are able are given a key to their room. Some residents had chosen to stay in their own rooms. The registered nurse advised that the residents are encouraged to join in with other residents but they can choose to stay in their own rooms if they wish. The home has an adapted kitchen where the residents who are able can prepare meals and do their own cooking. The inspector was advised that the Rosehill Rehabilitation Unit DS0000028792.V306809.R01.S.doc Version 5.2 Page 14 Occupational therapist assesses the residents ability and reviews the equipment they need to progress. The chef advised that the main meal of the day had been moved to the evening after discussion with the residents and staff. This change of time had just started. Menus were provided, which showed the residents have a varied diet. During the inspection the residents were given a light meal at lunchtime. One relatives comment card indicated that they would like staff to ensure their relative had assistance to cut up their food to enable them to eat it. Staff were seen assisting the residents during the lunchtime meal. All the residents were eating their meals at their own pace. One resident told the inspector they enjoyed the meals provided. Another commented that since the dining room had been separated out from the lounge and smoking had been band it had made meals times a better experience. The inspector saw new tablecloths had been provided for the tables in the dining room and the doors between the lounge and dining room closed. A new hot cabinet had been provided since the last inspection. However this was not used during the time the inspector was in the home. Nutritional risk assessments are an integral part of the care planning process in place. The residents care plans viewed had a record of their personal preferences and choices and any specialist dietary requirements. The chef advised that the food is prepared for individual residents who require specialist diets after discussion with the registered nurse responsible for their care. The inspector was advised that the assistant cook was in the process of completing the environmental health course for safer food better business. The course pack was available in the kitchen for reference. Some kitchen appliances had been renewed since the last inspection. Rosehill Rehabilitation Unit DS0000028792.V306809.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. The residents continue to receive care from the staff team who try to meet their physical, emotional and health care needs in a way they prefer. EVIDENCE: The acting manager advised that she was reviewing the way the resident’s care is recorded and planned. She commented that the company was moving towards a rehabilitation centre that concentrated on intensive rehabilitation for the residents over a set period of time. This she felt would enable the residents who were able to achieve their maximum potential before moving on to a more independent lifestyle. Both the residents whose care was followed had comprehensive care planning in place to address their care needs. One had the new style records being introduced by the acting manager the other had the pervious style care planning records in place. The registered nurse advised that the nursing team were in the process of completing new care plans for each resident. They commented that providing a multidisciplinary record that all the professional disciplines in the home used to record assessments and goals for the residents was working well. The plans of care viewed by the inspector identified the Rosehill Rehabilitation Unit DS0000028792.V306809.R01.S.doc Version 5.2 Page 16 residents self care abilities and the goals they were working towards. The home employs full and part time Physiotherapists, Occupational therapists and Psychology staff as well as Registered Nurses from different disciplines and rehabilitation care staff. This multidisciplinary team enables the resident’s care and rehabilitation needs to be holistically assessed by staff who are competent and capable. A key worker system was in use. One relative who returned a comment card indicated that staff had worked well with their relative enabling them to improve their mobility since their admission. The inspector was shown the specialist equipment used for individual residents in their own rooms as well as the equipment provided in the homes gym. The acting manager advised that she continues to use the specialist head injury team for advise and support as well as other hospital and community based specialists such as dieticians, speech therapists and specialist nurses. During the inspection two residents who had improved were moving out into a different setting, which would allow them to develop their life skills further. One of these residents told the inspector the staff at the home had helped them to prepare for the next step. A record of other health care professionals who had assessed the residents was available in their care plan. A record of speech therapy, chiropody and optician assessments were seen in residents care plans. Registered nurses take responsibility for the resident’s medication who are unable to manage this for them selves. A risk assessment process was seen in place to assess the resident’s ability to manage their own medication. The resident’s medication continues to be stored in a locked treatment room and the medication in use stored in a locked medicine trolley. A lockable drug fridge is provided for medication, which needs to be kept cold. The temperature of this had been recorded regularly to ensure it maintained an acceptable temperature for the medication being stored. The medication records for the two residents whose care was followed were viewed. These had been recorded and signed as expected. The controlled drug record and records of disposed medication was checked. Two members of staff had signed both records. The registered nurse explained how the medication stock and ordering is managed using the residents prescription from the GP. A record of GP visits is made in individual residents care plans and where treatment had changed this had been incorporated in to the residents care plan. The registered nurse advised that the resident see health care professionals including their GP in the privacy of their own rooms. An audit system is in place to assess the medication practices. The inspector was shown a completed medication audit from July 06. Reference books were available for staff use regarding medication. Rosehill Rehabilitation Unit DS0000028792.V306809.R01.S.doc Version 5.2 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. 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. The residents can have confidence that they concerns will be listened to by a caring staff team. EVIDENCE: Four of the nine comment cards completed with staff on the residents behalf indicated that staff always listen and act on what they say. Three of the nine indicated that staff usually listen and act on what they say. The homes complaints policy is easily available for residents and visitors to the home. Seven of the nine comment cards received indicated that they knew who to speak to if they were not happy. The Commission has received one complaint about the service since the last inspection. This complaint was substantiated and changes put in place to reduce a reoccurrence of the same incident. The acting manager provided the record of complaints and concerns received for inspection. These showed that the home staff followed the organisation policy for handling of complaints. The inspector was shown the training material used to guide staff managing challenging behaviour. The home employs staff who assess and provide planed interventions to assist in the management of residents challenging behaviour. However two of the staff comments cards received indicated that they would like more training on how to manage challenging behaviour. Six of the seven staff that responded to the questionnaire indicated that they were aware of adult and child protection procedures. Rosehill Rehabilitation Unit DS0000028792.V306809.R01.S.doc Version 5.2 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. 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 lack of hot water and designated cleaning facilities for used commode pots and bedpans could put residents at risk from infection. This detracts from an otherwise pleasantly decorated and well maintained environment for the residents live in. EVIDENCE: The redecoration of individual residents rooms has continued since the last inspection. The communal lounge and dining room have also been refreshed. One resident told the inspector since the lounge and dining room have been separated by the dividing doors. The dining room is a much pleasanter place to eat meals. Tablecloth had been placed on the dining tables, which made them look attractive. One resident told the inspector they appreciated being able to eat their meals without someone smoking. The registered nurse told the inspector that they had changed where smoking is allowed in the home. Rosehill Rehabilitation Unit DS0000028792.V306809.R01.S.doc Version 5.2 Page 19 New furniture had been provided in some of the residents rooms seen during the inspection. The acting manager confirmed that this would continue until all the resident’s rooms had been redone. A patio area had been created from the lounge/dining room of the home. This provided an area where residents could sit. Ramps from the patio into the garden enabled wheelchair users to access the garden. Manual handling equipment including hoists, stand aids and specialist bathroom equipment were easily available. Since the last inspection the disabled access bathrooms the residents have access to have been upgraded. These include a new therapy bath in the annex, a new shower room, and hydrotherapy room. However there had been problems with the hot water supply since the fitting of the new bath and shower room. The registered nurse advised that when some of these are used there is not enough hot water available in individual residents rooms. For this reason the new bath and shower rooms were not being used at the time of the inspection. The residents have been disadvantaged by the lack of hot water to have showers and baths. The inspector was told of an engineer would be looking at the boiler and hot water systems that week. The home has disinfecting sluices on each floor where the residents are housed. However no facilities were provided to empty commode pots or bedpans prior to them being disinfected. The registered nurse advised that these are 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 cleaning liquid had been provided for staff use. This could pose an infection control risk for the residents and staff. The acting manager and deputy manager advised that they had requested a different type of sluice that was capable of cleaning as well as disinfecting. However no record of this being ordered was provided. The inspector had recommended at the last inspection the sluices provided in the home should have the facility to clean as well as disinfect. The acting manager confirmed that the flooring in the laundry had been completed and this was easily cleanable. All the areas in the home that the residents have access to were fresh and clean. The comment cards received from the residents indicated that the home is always fresh and clean. Cleaning staff were cleaning individual residents bedrooms and the communal areas during the inspection. Spillages were being cleaned as they occurred by staff. The home has infection control policies in place, which are easily available for staff. Gloves and aprons were available for staff providing personal care for residents. A clinical waste disposal system is in place. Rosehill Rehabilitation Unit DS0000028792.V306809.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Robust recruitment policy ensures residents are protected from unsuitable staff. The staff are friendly and supportive towards the residents. However with out the right level of supervision, training and support they may not always understand how to provide the best care for residents. EVIDENCE: The revised induction programme was in use at this inspection. The acting manager advised that this was given to all new staff; as it covered basic organisational information new staff needed to know. The manager confirmed that all new staff were given this induction workbook to work though. Copies of certificates for completion of induction were seen in staff files. The training co-ordinator had left since the last inspection. The deputy manager advised that she had taken on this role and was in the process of up dating staff training records. However none of the staff files viewed had an up to date training and development plan. The acting manager advised that she had started to address this. Copies of staff supervision and appraisals were Rosehill Rehabilitation Unit DS0000028792.V306809.R01.S.doc Version 5.2 Page 21 available in the staff files viewed. However none of these had been up dated recently. The pre-inspection questionnaire stated that one of the eleven care staff employed had an NVQ in care. This does not meet the standard of 50 of care staff having an NVQ 2 or above by 2005. However the home does employ eleven therapy staff, which includes three registered Occupational therapists and two registered Physiotherapists. Eight registered nurses from different health backgrounds are also employed. The duty rota shows in what capacity staff work and number of hours worked each week to cover shifts. The acting manager advised that the organisation has a department for training, which provides in house training for staff. Examples of training staff had received for positive behaviour management were shown. The deputy manager advised that some staff had completed this recently and others would be completing this by the end of the month. She further stated that managing challenging behaviour and positive behaviour management are core-training elements for the organisation. This training has been completed since the staff comment cards were received in December 06. The seven comment cards received form staff contained the following written comments, when asked, “What does the home do well”. “ Staff go an extra mile to meet the client’s needs”. “It’s an excellent homely atmosphere in which the service users seem to be happy and relaxed“. We work as a team to get results” Three of the seven comments cards received indicated that they had received formal one-one planned supervision. Four indicated that they had not had one-one planned supervision. Five of the staff comment cards indicated that they felt they had enough supported from the care home to do their job well. One did not respond and one indicated they did not. The inspector was shown the new supervision record to be used for staff supervision. The acting manager advised that she was in the process of starting these for staff. Although none had been completed at the time of the inspection When asked for one thing to improve the way the care home works four of the seven staff comment cards contained comments. These included; ”More trips out for clients”, Allowing more time for one-one activities for clients”, More training for behavioural problems for clients” and “Include induction packs on brain injury for new members of staff,” The relatives and health and social care professional comment cards received contained the following comments about the staff team. “One of the few homes/agencies that have a good staffing level”, “service users, rely on and enjoy the support given by the staff of Rosehill”. “They are marvellous” One comment indicated that “very seldom are we given light refreshments i.e. tea or coffee. It would be so welcome when travelling a fair distance”. Rosehill Rehabilitation Unit DS0000028792.V306809.R01.S.doc Version 5.2 Page 22 The organisation has a clear recruitment policy. The three staff files viewed during the inspection followed this process and contained the information needed to confirm a staff member was suitable. This included an application form references, police check and proof of identity. Work permits had been obtained for staff who needed them. The administrator advised that head offices deals with co-ordination of staff recruitment files and copies are kept at the home. New staff members are offered an induction, which can be tailored to their skills and abilities. Copies of signed contracts of employment were provided. Rosehill Rehabilitation Unit DS0000028792.V306809.R01.S.doc Version 5.2 Page 23 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 is a positive open atmosphere in the home where the staff team encourage the residents to maintain their individuality. EVIDENCE: The registered manager has left to take up a senior position with in the organisation. An acting manager has been appointed while recruitment of a new manager takes place. The Commission has been kept informed of the progress. The Organisation has a quality audit system in place. The results of internal audits completed were available for inspection. The acting manager advised that each quarter a different area is quality assured to ensure they are meeting the high standards the company expects. Rosehill Rehabilitation Unit DS0000028792.V306809.R01.S.doc Version 5.2 Page 24 Individual residents care reviews demonstrate their improvement and goals achieved. Since the last inspection two of the residents have moved in to different accommodation in preparation for independent living. The training information provided indicated that staff had received manual handling and fire training. The pre inspection information indicated that 20 staff holds a current First Aid certificate. The home has a full time maintenance man and gardener. Chemicals used in the home were stored securely. Health and safety policies and procedures were provided for staff. A system for reporting accidents and untoward incidents is in place. The Commission is kept informed of incidents in the home, which affect the well being of the residents. The acting manager had notified the Commission of the current problems with the hot water system. There is a clear induction process, which follows Skills For Care guidelines. The inspector was told 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 acting manager has confirmed that these are in the process of being completed for all staff. Rosehill Rehabilitation Unit DS0000028792.V306809.R01.S.doc Version 5.2 Page 25 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 2 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 3 3 X 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.V306809.R01.S.doc Version 5.2 Page 26 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. 1 Standard YA30 Regulation 23 (2)(j) Requirement There are provided at appropriate places in the premises sufficient numbers of lavatories and wash-hand basins, baths and showers fitted with a hot and cold water supply Hot water must be available in sufficient quantity for resident’s disabled access bathrooms and individual rooms to meet the residents personal hygiene needs. 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. Timescale for action 30/03/07 2 YA30 23(2)(k) 01/06/07 Rosehill Rehabilitation Unit DS0000028792.V306809.R01.S.doc Version 5.2 Page 27 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 2 3 4 5 Refer to Standard YA27 YA32 YA35 YA36 YA37 Good Practice Recommendations The available toilets and disabled access bathrooms should have sufficient hot water available to allow them to be used at suitable times to meet the residents care needs. Care staff should complete training that increases their skills and knowledge of the residents care needs. All staff should have an up to date training and development plan that reflects their learning needs and is linked to the needs of the residents. Staff should receive the support and supervision they need to carry out their jobs. The home should have a registered manager in post Rosehill Rehabilitation Unit DS0000028792.V306809.R01.S.doc Version 5.2 Page 28 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.V306809.R01.S.doc Version 5.2 Page 29 - 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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