Inspection on 08/05/06 for Rosewood

This inspection was carried out on 8th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosewood 24/04/07

Rosewood 11/01/06

Rosewood 15/08/05

Rosewood 03/11/04

Rosewood 06/05/04

Rosewood 17/12/03

Rosewood 29/05/03

Rosewood 25/07/02

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

CARE HOME ADULTS 18-65 Rosewood Church Lane Grangetown Middlesbrough TS6 6TP Lead Inspector Jane Bassett Key Unannounced Inspection 8th May 2006 09:30 Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Rosewood Address Church Lane Grangetown Middlesbrough TS6 6TP 01642 463306 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) The Bridgings Limited Miss Theresa Paula Massey Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 8 residents with Learning Disability and Physical Disability Date of last inspection 11th January 2006 Brief Description of the Service: Rosewood, Bridgings Limited, is a care home for 8 service users with a learning disability, some of who have associated physical disabilities. The home is a detached bungalow, set in its own grounds and is on one level, which is suited to the needs of highly physically dependent people. Each service user has their own room, which is personalised according to taste and preference and which is equipped to meet the needs of each individual. There is land surrounding the property, which can be used for outdoor activity when weather permits. The home has its own transport which has been adapted for the use of service users with a physical disability. Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection report includes information obtained from a pre inspection questionnaire, two relative / visitor and four service user comment cards were received. An unannounced visit to the home was carried out. During the visit, which lasted six hours the inspector carried out a tour of the environment, an audit of documentation including staff records and residents files, and spoke to two residents, one family member, one staff member, the deputy manager and the manager. Whilst it was difficult for the inspector to obtain the views of the residents all appeared settled and comfortable in their surroundings. What the service does well: What has improved since the last inspection? What they could do better: The recording of personal monies must be made more robust to promote the protection of the vulnerable residents. Risk assessment recording would benefit from further development to include evidence of review, discussion and agreement. Risk assessment must be carried out in relation to the use of bed rails and lap straps. Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 6 Whilst the home has a policy and procedure on handling complaints, that is accessible to all, this would benefit from the inclusion of details of the complaints procedures of the local authorities funding the care provided. Documentation must be available within the home to record any complaints should they be received. Documentation must be improved to ensure continuous assessment of the quality of the service provided. Further work must be carried out in relation to the storage provided in one of the bathrooms. 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. Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 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 Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The assessment procedure ensured that resident’s needs could be met. EVIDENCE: The manager told the inspector that the home has not had any admissions since the last inspection when this standard was assessed and met. Three plans of care examined contained evidence of care management assessment plans and reviews. Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Staff support residents to make decisions about their lives. Where possible there is consultation on all aspects of life in the home. EVIDENCE: The manager said, and staff confirmed, that all residents who are able, are given choice as to how they spend their day, for example residents choose when they get up, go to bed and what they would like to do during the day. Residents are supported in all aspects of daily living including visiting friends and relatives, social activities and holidays. Informal consultation with residents takes place on a daily basis. Staff were able to demonstrate through their actions and responses to questions a good knowledge of the likes and dislikes of individual residents. Whilst it was difficult to obtain residents views the inspector observed a friendly and respectful rapport between residents and staff. Staff were seen to offer residents choice and support independence. Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 10 Three care plans were examined. These were found to be well organised and contained a detailed picture of residents of residents needs and how a resident would wish these to be met. In addition the home has individual health action plans that reflect the health care needs of the residents. Risk assessment documentation continues to require evidence of consultation and agreement. There was no evidence that risk assessments had been carried out in relation to the use of bed rails and lap straps. Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Residents are enabled to participate in varied activities, and are supported by the staff to integrate within the local community. Staff encourage contact between family and friends. Residents are offered a varied diet. EVIDENCE: Discussion with both the manager and staff confirmed that as far as possible the residents have opportunities for personal development, for example one resident attends college, others are on work placements within the local community. Activities at the home are varied and include meals out, trips to the local fair, outings to Redcar etc. A number of residents have been on holidays supported by the staff. Contact between residents and their family and friends is supported and encouraged by the staff. The inspector was told that residents are encouraged to have an input into the life within the home, for example assisting in the kitchen if they wish. Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 12 The manager told the inspector that the menus were varied and the home provides a healthy diet. Resident’s likes and dislikes are discussed and recorded. Fresh fruit and vegetables are used within the meals. In addition, residents enjoy the occasional takeaway or meal out. Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Care staff provide personal care in the way preferred by the resident, and work alongside other professional to ensure care needs are met, promoting wellbeing. Medication is administered as required promoting the safety and wellbeing of the residents EVIDENCE: Care staff were able to demonstrate a good knowledge of the personal care needs and preferences of individual residents. Care was seen to be delivered in a discreet manner ensuring privacy and dignity. Both the manager and staff told the inspector that support is sought from other professionals as required, for example the challenging behaviour team, district nurses and dietician. Plans of care seen were found to contain evidence of assessment by the community physiotherapist for each resident, which included a regime for either exercise or passive movement as appropriate. The manager told the inspector that staff have received instruction in relation to these. Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 14 An audit of medication found no concerns with the ordering, storage and administration of medication. The manager told the inspector that all staff who administer medication have received the appropriate training. Information received in the pre inspection questionnaire indicated that the home has a policy and procedure in relation to medication. A family member who spoke to the inspector said they were very happy with the care their relative receives. A comment received by the inspector stated ‘ the staff at Rosewood are very good and look after the residents very well’. Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The home has policies and procedures in relation to complaints and protection to promote the safety and wellbeing of the residents. Procedures in relation to personal allowances must be made more robust. EVIDENCE: Residents who spoke to the inspector told her they had ‘ no worries’ and were happy at the home. Staff who spoke to the inspector were able to demonstrate through response to questions the course of action they would take if they had any concerns. All said that they have received training in protection from abuse and ‘no secrets’. Information received from the manager and in the pre inspection questionnaire indicated the home has not received any complaints in the previous year. The home has a policy and procedure in relation to complaints and concerns. This was seen to be accessible to all. Responses received from families indicated that they were aware of the homes complaints procedure, however had not had any need to use it. The manager said that the home had not received any complaints. However the home does not have any documentation to record any complaints or concerns should these be raised. The information contained within the procedure should be developed to include details of authorities funding the care of residents. The home maintains records of personal monies held on behalf of individual residents. However these did not always contain two signatures, receipts or details of monies withdrawn from individual’s bank accounts. A random sample of personal allowances found there were no discrepancies with the balance stated on the record sheet and the actual amount in the individual money envelope. Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 The home was found to be clean and hygienic. Improvements continue to be made in relation to the environment. EVIDENCE: The inspector toured the home and noted that improvements have continued since the previous inspection. New carpets have been laid in the dining room and lounge. The trip hazard in the kitchen has been addressed and the office chair replaced. However the appearance of the bathroom continues to be marred by the open storage shelves. It was also found that a supply of enteral feed was being stored on these shelves, raising concerns of cross infection. This must be moved to a more appropriate environment. Residents bedrooms were seen to be comfortable and individual to taste and lifestyle. Staff told the inspector that residents are supported to choose colour schemes and furniture. On the day of the inspection the home was seen to be clean and hygienic. Staff told the inspector that there are sufficient supplies and appropriate equipment to meet the needs of the residents. Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35. Staff at the home work as an effective and committed team and are well supported by the manager. Training is accessed to ensure staff have the appropriate knowledge to meet the residents needs. EVIDENCE: Three staff files were examined these were found to contain the appropriate documentation in relation to recruitment. The recording of Criminal Record Bureau checks should be made more robust and include the reference number and level of check obtained. Records and pre inspection questionnaire included evidence of staff training for example Administration of medication, Fire safety, Food hygiene, First aid and ‘no secrets’. Further training in the approach to challenging behaviour is planned. A total of 10 staff ( 85 ) have completed NVQ at level 2 or 3. Staff confirmed that training was available and encouraged. The manager told the inspector that her style was to work alongside her staff. Staff who spoke to the inspector confirmed this indicating that there was an ‘open door’ policy where they were listened to and supported. Staff supervision is undertaken by the manager and is viewed as a useful and positive tool. Staff were able to demonstrate strong commitment and loyalty to their residents. One resident told the inspector the ‘staff were all nice’, another said they ‘ like all the staff’. Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Rosewood is a well run home, with an ethos that places residents at the centre of the care delivery. EVIDENCE: The manager and staff were all able to demonstrate a commitment to the residents who are valued as individuals. Discussion with staff, a visitor and comment cards received confirmed that the home is well run and place the residents at the centre of all the care provided. One comment received from a family member stated ‘ Rosewood is an extremely well run care home with excellent staff’. A resident told the inspector that they were ‘happy’ at the home and ‘has no worries’. The home carries out an annual quality audit, however this would benefit from development to include the date it was carried out, an analysis of the responses and action plan to address any issues raised. The manager told the inspector that the registered provider visits the home regularly, however there were no records to confirm Regulation 26 visits take place. Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 19 The pre inspection questionnaire indicated that routine maintenance and required checks, including hot water temperatures are carried out. It was seen on the day of inspection that fire training had been carried out as required. Records seen indicated fire tests and drills take place as required, accidents are documented, and hoists are serviced as required. Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 20 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 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 2 X X X 3 Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 21 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. 2. 3. 4. Standard YA9 YA22 YA23 YA24 Regulation 13(4)(c) 17(11) 17(2) 23(2)(b) Requirement Timescale for action 01/06/06 Risk assessments in relation to the use of bedrails and lap straps must be carried out. Provision must be made to 01/08/06 record any complaints received by the home. The recording of resident’s 01/06/06 personal allowances must be made more robust. The appearance of the bathroom 01/08/06 must be improved by boxing-in of the open-shelved storage area. This requirement is outstanding from the previous inspections held on the 18/08/05 and 28/02/06. Enteral feed products must not be stored in the bathroom. The quality assurance tool should be developed further to include analysis of audit, any subsequent action plan and outcomes of Regulation 26 visits. 01/06/06 01/09/06 5. 6 YA24 YA39 23(l) 35 Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 22 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 Refer to Standard YA9 YA22 YA34 Good Practice Recommendations Risk assessments should include evidence of discussion and agreement with resident and or family. The Complaints policy and procedure should be developed to include details of all funding authorities. Records of Criminal Record Bureau checks should be developed to include reference number and level of check. Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rosewood DS0000000112.V293314.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!