Inspection on 11/05/07 for Rosewood

This inspection was carried out on 11th May 2007.

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

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

Other inspections for this house

Rosewood 10/08/05

Rosewood 12/05/05

Rosewood 16/11/04

Rosewood 20/05/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Sutton Lodge Nursing Home

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 Rosewood Farmfield Drive Charlwood Surrey RH6 0BG Lead Inspector Pat Collins Unannounced Inspection 11th May 2007 10:30 Rosewood DS0000033902.V336034.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 Rosewood DS0000033902.V336034.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. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosewood Address Farmfield Drive Charlwood Surrey RH6 0BG 01883 383838 01293 774907 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) Surrey and Borders Partnership NHS Trust Post Vacant Care Home 8 Category(ies) of Learning disability (8), Physical disability (8), registration, with number Sensory impairment (8) of places Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. There will be a registered nurse of level one or above and three health care assistants on the day shift. There will be one registered nurse of level one or above and one health care assistant on the night shift. The registered manager must be in addition to staff for at least two shifts per week, in order to carry out the responsibilities under the Care Standards Act 2000 10th August 2005 Date of last inspection Brief Description of the Service: Rosewood is a care home with nursing owned and managed by Surrey Borders Partnership NHS Trust. The home is registered to accommodate up to eight adults of mixed gender with learning disabilities, neurological conditions, multiple physical disabilities and/or sensory impairments. Referrals will be consideration for short-term accommodation post-operative or palliative care and convalescence following illnesses or accidents for adults meeting the full admission criteria. The age range of people currently living at the home is from 30 to 50 years. The home is situated in a peaceful, semi rural location within easy reach of local towns and all community facilities. The property is a large, detached, purpose built bungalow and wheelchair accessible throughout. Bedroom accommodation is all single occupancy. Bedrooms have overhead tracking for use of hoists also specialist toilet, bathroom and shower facilities. A call bell facility is available throughout the home. Communal areas comprise of a large lounge, separate sun lounge, a dining/therapy room and sensory room. There is a fitted kitchen, separate utility room and office facilities. The furnishings and décor are domestic in style and character. The front garden is open plan and parking facilities are available for eight cars also the home’s two specially adapted vehicles. The rear garden is secure and private with a furnished patio, sunshade and wide paths suitable for wheelchair use. Fee charges range from £51,936.03 to £129,758.76 per annum Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit formed part of the key inspection process using the new ‘Inspecting for Better Lives’ (IBL) methodology. This was the home’s first key inspection and incorporates observations made at the time of this visit to the home. Judgements are based also on the cumulative assessment, knowledge, and experience of service provision since the time of the last inspection in August 2005. The visit was carried out by Ms Pat Collins, Regulation Inspector, commencing at 10.30 hrs and finishing at 18.00 hrs. The home manager was present until 13.00hrs and the deputy manager was present throughout the visit. Consultation with managers and staff confirmed their preference to refer to people using this service as ‘residents’. This term is therefore used throughout this report. Most residents have a severe or profound learning disability and one resident has additional secondary conditions including dementia and a mental health disorder. None of the residents were able to communicate their views about the services to the inspector. Judgements about their wellbeing have been made taking into account direct observations of their mood, demeanour, behaviour, gestures and appearance. Also observation of care practice, interaction between staff and residents, from records, discussions with staff and feedback in comment cards received from three relatives and one professional. The inspection process also takes account information supplied by the home manager in a pre-inspection questionnaire and during telephone a telephone conversation with her after the inspection visit. Further information was received additionally during a telephone conversation between the inspector and a resident’s relative. All areas of the home were viewed and some records examined. There were seven residents accommodated and the inspector was introduced to all residents. Though one resident was out of the home throughout the visit, there was opportunity for the inspector to meet him prior to being transported by a staff member to spend the day with his relative. The inspector would like to thank the residents and staff for their hospitality and cooperation during the inspection visit and all who contributed information. What the service does well: The physical design and layout of the premises ensures provision of a safe, well-maintained, accessible and comfortable environment. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 6 The home has a clear criteria for admission criteria and decisions regarding admissions are based on holistic, comprehensive needs assessments to ensure needs can be met. Assessed needs and risks are addressed in care plans and effort made to establish residents’ wishes, affording choices in their daily lives, wherever possible and however small. Examples of good care practice were observed during the inspection visit. It was positive to see a resident with multiple disabilities sat in a specialist, oversized wheelchair in the kitchen showing an interest in staff preparing the evening meal. Staff included her in their conversations and noted to understand gestures used by this resident as a means of communication. Staff were observed during the visit to work closely with other residents interpreting facial expressions, gestures, sounds and body language in order to understand their wishes. There was a lovely, happy atmosphere in the home and frequent interaction between staff and residents. Staff were attentive and managing the needs of a resident who has mental health problems who was at times agitated and anxious. Healthy, varied diets are offered and residents’ dietary needs are met. A professional commented positively on staff promptly identifying problems and taking advice to ensure needs are met. A relative expressed satisfaction with staff discussing important issues with her. What has improved since the last inspection? What they could do better: The home manager is planning to update the statement of purpose to ensure accuracy. Also to update the service users guide including additional information and producing this in a more accessible format using pictures and symbols Comments received from a relative identified the need to develop opportunities for social stimulation and experiences outside the home. The home manager has herself recognised this shortfall and demonstrated a positive response to secure improvement. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 7 A review is necessary of physiotherapy needs to be satisfied that residents no longer require the same. The home manager has agreed to consult the physiotherapist and general practitioner regarding reassessing needs. Whilst medication practices are overall satisfactory some recommendations have been made for improvement. The is a need for the home manager to satisfy herself that self employed therapists working unsupervised with residents have CRB and POVA checks and for a record evidencing this to be maintained in the home. Evidence should also be available in the home that educational establishments supplying students to the home have carried out relevant CRB and POVA checks. Whilst minimum staffing levels are consistently maintained however based on available information, the practice of support workers undertaking catering duties, particularly at weekends, adversely impacts on social care opportunities. It was positive to note that the manager had identified this issue and interim arrangements made for staffing levels to be enhanced some day to enable residents to get out pending a review of staff activity. Further progress is needed in meeting national minimum targets for certificated training for support workers. A risk assessment is to be undertaken in respect of residents’ access to excessively hot water in the utility room and action taken where necessary to minimise this risk Quality assurance systems could be developed further to enable residents’ relatives’ views to be obtained where they advocate for residents. The employer’s liability certificate displayed is out of date. 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. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 8 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 Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: YA 1, 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home manager is planning to update the statement of purpose to ensure accuracy. Also to update the service users guide including additional information and producing this in a more accessible format using pictures and symbols. Decisions relating to admissions are based on holistic, comprehensive needs assessments to ensure needs can be met. EVIDENCE: The home’s statement of purpose was displayed in the office and noted to need revision and updating. Specifically to include details of the manager who is new in post. Recommendations include the need to ensure the accuracy of information in this document to avoid misleading prospective purchasers of services. The statement of purpose refers to available provision of physiotherapy and hydrotherapy, which is understood to no longer be provided. A copy of the service users guide which includes a summary of the statement of purpose and other information about the home for residents’ and their representatives’ use, was available in each bedroom. It was positive to note the intention to reproduce this document in a more accessible format for residents including photographs, pictures and widget and other symbols. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 10 Discussed was the statutory obligation to include details of fee charges and a statement of whether the placement is funded in whole or in part by different agencies/persons in this document. Also for details to include any additional charges not included in the fee. It was noted that residents’ are required to fund their own specialist hoist slings and this should be clearly stated in this document. The home has clear admission criteria and records confirmed comprehensive and holistic pre-admission assessments were carried out. All of the residents had lived at the home many years, some since it first opened ten years ago. They had been discharged from the Royal Earlswood Hospital during the community resettlement programme. Records confirmed multi-disciplinary preadmission assessments were obtained to consider the suitability of placements and ensure needs can be met. The home had one vacancy at the time of the inspection visit. There had been one admission in 2006 of an individual who had specific health care needs. Once these had been met he was discharged to a more appropriate placement suitable to fully meet his intellectual and social needs. Pre-admission procedures for this individual had included obtaining a summary of his care management assessment and care plan. Records demonstrate effort made to ascertain prospective residents’ wishes and aspirations, where possible, during pre-admission assessments and carers’ views were obtained. Life story information was obtained from relevant sources to ensure a person centred approach to assessments and care planning Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 6, 7, 9 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Assessed needs and risks were addressed in care plans and effort made to illicit residents wishes to afford choices where possible in their daily lives. EVIDENCE: All residents had a learning disability, some having severe and profound learning disabilities as their primary condition at the time of admission. Six residents’ had multiple physical and some also had sensory impairments. One resident had a mental health disorder and dementia. Residents had other associated health conditions and only one resident was ambulant. Some residents had no verbal communication and individuals’ who were able to speak with the inspector were very limited in their use of language. Staff were observed to have a very good knowledge and understanding of residents needs. Examples of good care practice were observed during the inspection visit. It was positive to see a resident with multiple disabilities and uses a specialist, oversized wheelchair, sat in the kitchen showing an interest in staff preparing the evening meal. Staff included her in their conversations and noted to understand gestures used by this resident as a means of communication. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 12 There was a lovely, happy atmosphere in the home and frequent interaction between staff and residents. Staff informed the inspector that all residents had a named nurse and key worker who were responsible, together with the residents and/or their representative, for developing individual care plans. Three care plans (Essential Life Plans) were examined. The manager confirmed her intention to review formats of care plans and other relevant documents and develop these in a more accessible format. The use of pictures and symbols will benefit individual residents’ by enabling understanding and participation in planning their care. There was noted to be further training being organised for staff on person centred planning. Behaviour management plans were viewed also risk assessments. Risk management strategies were incorporated into care plans and subject to ongoing review. Any limitations on freedom, choice or facilities was recorded and intended to be in residents’ best interest. These were agreed involving the multi disciplinary team, relatives/advocates, and residents where possible within individual levels of intellectual capability and understanding. A door alarm had been fitted to the front door to ensure the safety of one resident. The home was observed to provide a positive environment for a resident who was stated to have dementia in addition to other conditions. The home manager has a mental health nursing qualification in addition to a nursing qualification for learning disabilities. A staff member had also recently attended a dementia care workshop. There was evidently a good understanding of dementia within the team and no barriers to meeting the changing needs of this individual. Discussions with the home manager confirmed her intention to propose regular group meetings with relatives to enhance communication and enable them to influence decision – making. The home manager confirmed relatives were invited to attend review meetings where care plans were discussed. Currently there was not formal arrangement for engaging relatives in the ongoing evaluation and decisions to revise care plans between review meetings. The manager was amenable to the recommendation for this opportunity to be offered to relatives who wish to be more involved. It was suggested that relatives be requested to countersign care plans. Records and observations confirmed staff commitment to identifying residents’ diverse needs and to meeting the same wherever possible. Good attention was given to residents’ personal appearance and clothing on the day of the inspection visit. Care delivery and the home’s operation and management was observed to respect residents’ individuality, dignity and privacy. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: YA 12, 13, 15, 16, 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents have complex needs and staff try to provide appropriate stimulation in house and outside of the home within existing available resources. The home manager recognised this is an area for improvement and demonstrated action being taken in the area. Healthy, varied diets are offered and residents’ dietary needs are met. EVIDENCE: The statement of purpose sets out the home’s philosophy of care, acknowledging the individuality of each person living at the home. The aim is to provide a safe, stimulating and therapeutic environment promoting as much independence for each resident as is possible. Also to support residents in maintaining relationships with family and friends, in practicing religious beliefs and in having a community presence. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 14 The current residents have complex needs and are reliant on staff, family members/other representatives making decisions on their behalf. Staff were observed during the visit to work closely with residents interpreting facial expressions, gestures, sounds and body language in order to understand their wishes and afford opportunities for choice, however small. Staff were observed talking to residents in a respectful and friendly manner. Residents’ had individualised daily activity programmes, which included two hours activities provided by the Trust’s Day Services staff per week for each resident. Activities were group and one to one sessions appropriate to meet individual needs and interests. They include carriage driving, snoezelen sessions using the home’s sensory equipment, one resident enjoyed going to watch line dancing, art therapy and going out to local shops and garden centres and other places of interest. There was weekly input from a trained aroma/reflexology therapist; also a group weekly music therapy session provided by a music therapist. The latter was in progress at the time of the visit and residents’ stated to benefit immensely from this type of interactive activity. It was positive to note additional funding had been approved to enable two sessions of music therapy to be provided weekly, in future. A support worker on duty at the time of the visit was noted to be highly motivated to engage residents’ interest in their garden and should be commended for her hard work and creativity. It is acknowledged the home manager and some staff also make a contribution to this activity. The inspector was informed that individual residents enjoyed sitting out in the garden in their wheelchairs watching her tending plants in the greenhouse and potting and watering patio plants and hanging baskets. The manager and this staff member had planted shrubs in raised flowerbeds and were developing a sensory garden. Feedback from one resident’s relative highlighted some dissatisfaction with provision for social stimulation at the home and for accessing community resources. Observations of the care plan for this individual confirmed one of the care objectives was to introduce this person to a variety of new experiences in the wider community. Also for staff to encourage this individual in use and expansion of communication skills e.g. vocalising and body language. Discussion with the home manager confirmed she had identified this area of the home’s operation was in need of development and had been in discussions with her line manager in this matter. The home’s deputy manager was responsible for planning the rota and the home manager had requested she plan an approved driver on all day shifts for driving the home’s two specialist vehicles. All but one of the residents has specialist, exceptionally oversized chairs and wheelchairs. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 15 One constraint to the frequency of outings for individuals was noted to be limitations on the number of chairs that fit into vehicles, in the case of some, the vehicle used only accommodates one wheelchair. The home manager also has to achieve a balance of staff numbers remaining in the home and deployed on outings to ensure safe practice in both areas. Some times two staff will go out with residents using two wheelchairs. The home manager is aware of the need to review moving and handling risk assessments to ensure two staff can safely load and unload wheelchair on and off vehicles. If three staff is necessary the home’s set staffing levels will limit outings to one wheelchair user, which decreases opportunities for residents to go out. It is acknowledged that staff do take residents out locally without using transport. On the day of the inspection visit a nurse went out with a resident in a wheelchair to feed the ducks in a nearby pond. The home’s staffing levels during the day total four which may include the home manager. The manager works two shifts supernumerary to staffing levels and it is essential that this time be used for management and administration tasks. An additional factor which inhibits social activities particularly outings is the deployment of support workers on catering duties to prepare and cook the evening meal and all meals at weekends and when the cook is on leave. This depletes available care hours. It was noted that the home manager has consulted her line manager regarding these issues to explore whether a permanent increase in staffing levels at peak times can be achieved in order to enhance opportunities for residents to access community facilities. Whilst acknowledging action taken by the home manager for additional support staff to be on duty some days for this purpose this can be only a short term solution without an increase in the staff budget. Despite these difficulties it was positive to note that residents had experienced small group holidays accompanied by staff. It was noted that no arrangements had yet been made to book holidays due to recent management instability since the registered manager’s retirement last year. Discussion is taking place for long weekends away to be booked in favour of whole weeks. Two residents were noted to have ability to follow and enjoy some television programmes. At the time of the visit staff described accompanying residents to theatre performances from time to time. Staff engaged individual residents who had gone to see these shows in the past or booked to see another show in the conversation with the inspector about this activity. These residents were able to communicate through limited speech or gestures and smiles that they had enjoyed the same. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 16 Social events occasionally took place in the garden, inviting residents’ relatives and friends living in other care homes. A relative commented that the home is very good at ensuring special events e.g. birthdays are celebrated. Photographs of social events, outings and holidays were displayed in bedrooms. A particularly enjoyable activity was a visit from a small animal farm and photos seen of residents’ handling guinea pigs and other animals. It was noted that none of the residents had opportunity to practice religious beliefs and not clear in the care plans sampled whether their wishes had been ascertained in this matter. All residents have relatives and some visit very regularly. One relative commented, “ staff have created a homely, happy environment with a family atmosphere” Another “ They keep residents clean and pleasant, there are plenty of celebrations and I am happy about the way staff cooperate and discuss issues”. A staff member was observed to transport a resident to spend the day with his relative who lives local to the home. The relatives of another resident who live a long distance from the home but visit weekly, were pleased that staff had taken her to visit them during a holiday arranged last year for a group near their home. They would like the home to facilitate further home visits for this resident from time to time. The home manager stated it was her understanding that this was already planned to take place every couple of months. This information had not been communicated to the relatives of this resident. The home employs a dedicated worker who undertakes catering and some cleaning duties and purchases provisions. He works part time, Monday to Fridays He was noted to undertake deep cleaning duties and support workers including night staff shared cleaning and laundry tasks. The cook and all staff had basic food hygiene training certificates. The fitted kitchen was domestic in scale, clean and tidy. Food storage was mostly satisfactory, it was suggested to the cook that he record dates of opening jars stored in the refrigerator. The home had a four weekly rotating menu produced in collaboration with the cook by the home’s former manager. It was stated that a dietician had approved the menu. The cook stated that a new summer menu was being planned. Fresh vegetables and delicious soft fruits were available. Two residents were noted to be on peg feeds and a dietician involved in monitoring their needs. The dietician brought specialist-weighing scales with her to monitor the weights of all residents. Comments from this professional confirmed staff to be generally very good at recognising problems and seeking advice promptly. Only one resident was able to eat an ordinary diet, the remaining residents had their food liquidised. Presentation of liquidised food was good separating colours and textures on plates. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 17 Residents including those on peg feeds came together in the dining room even though they were unable to use the dining table. Staff were observed taking their time feeding residents without rushing them and interacting with residents, recognising the social importance of mealtimes. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 18, 19, 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Health and personal care delivery is in accordance with care plans and based on assessed needs. A review is necessary however of physiotherapy needs. Medication practices are overall satisfactory however additional safeguards necessary if the home continues the practice of secondary dispensing. EVIDENCE: Residents were registered with a local general practitioner and received all appropriate and specialist health care input to ensure their needs were met. A first level nurse leads each shift and constantly assesses residents’ healthcare needs, administering any treatment prescribed by the general practitioner or hospital consultants. Care plans detailed personal and healthcare needs and how these will be met including pressure sore prevention strategies. A resident had developed a small pressure sore that was responding well to treatment by district nurses. Moving and handling risk assessments were carried out and necessary equipment for moving and handling documented in care plans. Staff demonstrated awareness of residents’ preferences and accounts of how residents’ might respond if their needs were not met in the manner of their choice. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 19 Evidence of staff training in moving and handling, health and safety and other health related staff training was seen to ensure staff competencies in meeting healthcare needs. Health care plans examined for one resident included behaviour management plans and risk assessments. Staff were observed to competently and reassuringly manage behaviour of a resident who was pacing up and down corridors for most of the inspection and at times agitated and distressed. They were following care plans and used distracting techniques to discourage disinhibited behaviour. Staff were trying hard to encourage this person to eat and take fluids throughout the visit. Records demonstrated this individual was under the care of specialists which multi-disciplinary management of mental health problems, refusal of food and medication. The general practitioner and dietician were monitored nutrition and weight loss for this individual and risk assessments and care plans were in place to address these problems. Also risk assessments for managing behaviour outside of the home and for ensuring safety in the home’s vehicle. A 2:1 staffing ratio was in place for this individual when in the home’s vehicle. Staff reviewed the mobility needs of residents and individuals’ requiring specialist, fitted seating referred to a physiotherapist and NHS wheelchair service or the Special Seating Service. Residents had oversized or unusually shaped chairs and wheelchairs. Records and observations confirmed the standard practice of individual residents’ who needed specialist slings being required to self - fund the same. To ensure that prospective residents’ and purchasers of services can make an informed choice in the matter it is recommended that this additional charge be explicitly stated in the statement of purpose and service users guide. If this is not an option then preadmission assessments need to address whether needs can be fully met without specialist hoists and if not admissions not agreed. Areas of discussion after the visit with the home manager included observations that physiotherapy was discontinued for residents coinciding with the retirement of a physiotherapist. The records examined did not demonstrate that individuals no longer required physiotherapy however. The manager agreed to arrange for physiotherapy assessments to be carried out to be satisfied this was no longer needed. In the event that residents’ still require physiotherapy then suitable arrangements must be made to meet their needs. . Management of medication was inspected and noted from previous inspection reports that the home has a sustained record of full compliance with the administration, safekeeping and disposal of all medication. Nurses hold medication keys and administer medication. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 20 The storage and administration of medication is satisfactory and medication records are maintained up to date. A record of medication disposal back to the pharmacy was seen. It was recommended to the home manager that she satisfies herself that disposal of medication is to a pharmacy that has a Waste Management Licence as this was not evidenced at the time of the inspection. None of the residents had capacity to self-administer their medication. Cold storage of medication was in a lockable container in the domestic fridge. Discussion took place with the home manager after the inspection visit regarding observations of routine secondary dispensing at the home. It was recommended this be avoided to minimise and reduce the potential for error. Where this cannot be avoided there is a need to develop the written procedure underpinning this practice to ensure this details staff authorised to do this, what containers to use, information to be provided on labels and a clear record maintained of staff involved in each stage of the procedure. Other areas discussed was the oxygen cylinders stored in the clinical room stated to be no longer needed or prescribed for a named resident. If the purpose of retaining these in the home is for general use then appropriate checks must be carried out and recorded. The clinical room had signage on the door alerting staff to storage of oxygen. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 22, 23 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Effective complaint procedures were in place and accessible to resident’ advocates. Procedures for safeguarding adults were robust enabling appropriate response to allegations or suspicions of abuse. EVIDENCE: Residents all have family members who are in contact and visit and can advocate for them and raise any concerns. Comments from relatives confirmed they were aware of the complaint procedure and stated staff usually responded appropriately to past concerns. Procedures for responding to complaints and concerns were in place. The home manager was aware that the procedure required updating to include change of contact details for the Commission of Social Care Inspection (CSCI). There had been no complaints investigated under the homes complaint procedure in the last twelve months. The CSCI had not received any complaint about the home since the last inspection. Staff confirmed receiving safeguarding adults training. One safeguarding incident had been investigated under local multi-agency safeguarding adults procedures in the last twelve months. Referral procedures and outcome had been appropriately managed. Records sampled confirmed systems were robust for safeguard residents’ personal money. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 24, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the premises enables people who use this service to live in a safe, well-maintained, accessible and comfortable environment. EVIDENCE: The accommodation is purpose built and on one level with specialist design and facilities suitable to meet the complex physical needs of the people using services. All areas were clean, hygienic and overall safe. Odour control throughout the home was well-managed Open sluice facilities in shower/bathrooms were noted and discussion took place with the deputy manager regarding infection control procedures and practice in this area. Staff were stated to have had mandatory training in infection control training. The home does not have a closed bedpan washer. An open sluice in the utility room was stated not to be used for disposal of body fluids. Bathrooms and toilet facilities had yellow bags and containers with had lids and external storage for collection satisfactory. All bathrooms and toilets had soap dispensers and paper towels. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 23 Also discussed with the deputy manager was the need for a risk assessment to be carried out for a named person who is ambulant and could therefore access the utility room where hot water temperature were excessively high. The deputy manager confirmed this would be done and appropriate action taken to minimise risk. Corridor widths and bedrooms are spacious to accommodate oversized wheelchairs and chairs and safe movement of equipment. All bedrooms and shower rooms have overhead tracking for use of hoists. Bedrooms were all well personalised and nicely decorated and furnished. Bedrooms had personal televisions, music systems and DVD players. Beds are height adjustable and specialist fitted commodes available also pressurerelieving equipment. The kitchen was clean and hygienic though attention will be necessary in the future for replacement of kitchen cupboard doors showing signs of wear and tear. Kitchen equipment was clean and in working order. The home manager informed the inspector of plans to brighten up the lounge and dining room and rearrange furniture; also for replacing curtains and the dining table with a larger one. This action was intended to define the purpose of these rooms for residents’. Whilst residents’ sat in specialist chairs on wheels in these areas the home manager emphasised the importance of making these rooms fit for purpose and as comfortable as possible. The sun lounge was an attractive, light area affording opportunity for visitors to meet residents in private. The home’s large garden was tidy and safe. Colourful shrubs and potted plants created a pleasant environment for the enjoyment of residents and their visitors. There is a large patio with table and chairs and large awning from the patio doors for sunshade. Pathways are wide for wheelchair access and lit up at night with underground lights. The home has a water feature, green house and raised flowerbeds. The home manager had tried unsuccessfully to obtain some topsoil for these flowerbeds for which there is no budget. External garden maintenance includes grass cutting and the staff are required to do the rest. One support worker was highly motivated to developing the garden for residents’ enjoyment and was doing an excellent job. . Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 32, 33, 34, 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst staff recruitment procedures safeguard residents, there is need to evidence that self employed therapists working unsupervised with residents have CRB and POVA checks. Minimum staffing levels are consistently maintained however based on available information the practice of support workers undertaking catering duties, particularly at weekends, adversely impacts on social care opportunities. There is a staff training and development programme. Further progress is needed in meeting national minimum targets for certificated training for support workers. EVIDENCE: The staff group is well established. With the exception of the manager they have all worked at the home for many years, many transfering from The Royal Earlswood hospital when the home was first registered. Staff turnover is low . Student nurses are regularily placed at the home as part of their course. Three nurses have attained the NEB 998 Assessors qualification and act as their mentors. Students were stated to be always be supernumerary to staffing levels and directly supervised in the delivery of personal and nursing care. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 25 Discussed with the home manager was the recommendation for the care provider to obtain written confirmation from the educational establishments supplying students to the home that relevant checks have been undertaken. If this is held by the human resources a copy should be available for inspection purposes, in the home. A separate check is required for each placement as POVA checks are not portable (with the exception of employment agencies). Rotas sampled confirmed that staffing levels are consistently in accordance with those specified on the certificate, one nurse on duty every shift during the day and 3 support workers and at night there was one waking member of staff and one sleeping in, one of whom must be a nurse. Discussions with staff confirmed they considered they were able to practice safely when working alone during the night describing how this was achieved. The home manager works two shifts supernumarary to staffing levels and currently works one other shift as part of the home’s skill mix and numbers. She is required to work in another home two shifts a week which is a temporary arrangement. It was noted that two staff vacancies were frozen and one staff member was on long-term sick leave. Staffing levels were maintained by the team working additional hours and use of agency support workers. The manager reported a recent change of the agency used having identified concerns about the competence of agency workers previously supplied. It was noted that the organisation had an approved list of agencies she could use. Discussed with the home manager was the importance of satisfying herself of the training received by agency staff. It was assumed that human resources staff had obtained this information and agreed that the home manager would obtain a copy of this information to be held in the home. The home manager advised that staff supplied by the new agency appeared competent. The home manager was made aware that the inspector had received some comments from third parties criticising agency staff. The home manager was confident these related to staff supplied by the former agency. Discussions with the home manager confirmed a review in progress to increase opportunities for residents to go out in the community. Currently staff are on the rota on set days working supernumary to staffing levels for this purpose. The manager is aware that the budget cannot sustain this long term without an increase in establishment budget/staffing levels. She was in discussion with her line manager and currently tracking staff activity to support the case for increased staffing hours. Further comment is made in this report in the section including Standards 11 – 17. Personnel records were securely stored at the home. The staff recruitment and vetting procedures ensured CRB and POVA checks, checking previous employment history, obtaining references and evidencing qualifications and nurses pin numbers. Staff confirmed that they received appropriate mandatory and service specific training and records sampled evidenced the same. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 26 Consultation with staff indicated they had received all mandatory and some service specific training. The manager has discussed with the nurse designated responsibility for coordinating training records the need to maintain a master record of all staff training. At the time of the inspection one support worker had completed NVQ 2 training and a further two enrolled at college to obtain this certificate. It was noted that some support workers were reluctant to undertake NVQ 2 training as they were nearing retirement. . Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home manager has relevant qualifications and experience and is new in post. She is preparing to make application for registration. The home has a consistent record of compliance with relevant health and safety requirements. The deputy manager agreed to risk assess a hazard in the environment specific to a named resident to ensure her safety. Quality assurance systems could be developed further to enable residents’ relatives’ views to be obtained where they advocate for residents. EVIDENCE: The home’s registered manager retired on 31st August 2006 and interim ‘acting’ management arrangements were in place until the appointment of a new home manager on 01/04/07. The home manager had worked alongside the ‘acting’ manager for some months prior to this. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 28 The new manager has suitable professional qualifications and a management qualification also extensive management experience in other positions within the Trust. She does not have the registered managers award qualification. Observations confirmed the home manager is committed to the delivery of person centred quality care and ensuring effective outcomes for residents. Areas of discussion included clarification of the home’s future in relation to the Trust’s three-year strategy to concentrate resources and services on health services. It was stated that meetings had taken place between senior managers of the Trust and families of residents and with staff. The home manager did not have information about the home’s future. Residents’ needs had been all reassessed recently and these assessments sent to Surrey County Council. Without exception staff spoke in positive terms about the new home manager’s style of management. It was described as open and inclusive and stated she had achieved the position of being respected and liked by staff. Another comment from a staff member was “she is a breathe of fresh air”, qualifying that the manager was good at sharing information which created an enabling and empowering environment. Staff spoke positively about small but positive changes the home manager had made in consultation with them. Quality Assurance systems included health and safety audits and other audits and monitoring arrangements. External managers on behalf of the Responsible Individual conducted monthly unannounced visits. During these all aspects of the home’s management and care were sampled and reviewed. Records examined by the inspector included the registration certificate, which was displayed, fire safety records and hot water temperature monitoring. Records. Noting high water temperature readings in the kitchen and utility room clarification was sought of arrangements for maintaining the safety of residents in these areas. There was only one resident ambulant who was monitored at all when in the kitchen. A lock was fitted on the kitchen door for use when this area was unoccupied. The utility room does not have a lock and the deputy manager confirmed a risk assessment would be carried out for this area. Other areas of discussion with the home manager included arrangements for ensuring staff are competent at clamping wheelchairs in vehicles. Currently there is no training provided however a support worker was stated to be skilled in this practice and demonstrates how to do this to colleagues. The home manager intends to explore availability of any training. The need to ensure robust systems for monitoring driving licenses at regular intervals for staff approved to drive the home’s vehicles was discussed. Also for the home to develop a checklist style of risk assessment for environments for use by staff on arrival at holiday destinations. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 29 Observations confirmed the need to obtain an up to date employers liability certificate. This was identified at the time of the last inspection and action taken at the time but the expiry date was again exceeded. Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations Recommendation made to update the statement of purpose and service users guide ensuring accuracy of information, details of home manager, remove misleading statements about services on offer, for example physiotherapy and hydrotherapy. Also to include any additional charges including self-funding specialist slings. If this is not an option then assessment procedures for new referrals need to consider whether needs can be met without this equipment in determining whether admission can proceed on the basis of being confident that needs can be met. Recommendation is made for relatives to be offered opportunities to be involved in revising care plans on a more formal basis in between care reviews. It was suggested that relatives be requested to countersign care plans. 2 YA6 Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 32 3 YA20 Recommendation is made for the home manager to satisfy herself that disposal of medication is to a pharmacy that has a Waste Management Licence. It was recommended that secondary dispensing be avoided to minimise and reduce the potential for error. Where this cannot be avoided there is a need to develop the written procedure underpinning this practice to ensure this details staff authorised to do this, what containers to use, information to be provided on labels and a clear record maintained of staff involved in each stage of the procedure. It is recommended that oxygen cylinders stored in the clinical room stated to be no longer needed or prescribed for a named resident be returned to the supplier. If the home wishes to retain these for use in emergencies then appropriate checks should be reinstated. It is recommended that evidence is maintained in the home for inspection of management checks on CRB and POVA records for self employed therapists who have unsupervised access to residents. It is recommended for the home manager to ensure written confirmation is in place from the educational establishments supplying students to the home that relevant checks have been undertaken. If this is held by the human resources a copy should be available for inspection purposes in the home. A separate check is required for each placement as POVA checks are not portable (with the exception of employment agencies). 4 YA20 5 YA20 6 YA34 7 YA34 Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 Rosewood DS0000033902.V336034.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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