Inspection on 06/04/09 for Roslin

This inspection was carried out on 6th April 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Roslin 28/07/09

Roslin 12/04/07

Roslin 14/02/06

Roslin 08/08/05

Roslin 16/12/04

Roslin 24/06/04

Roslin 04/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 20/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Roslin 1 The Chesters Low Fell Gateshead Tyne & Wear NE9 5PB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elizabeth Gaffney     Date: 0 6 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 39 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 39 Information about the care home Name of care home: Address: Roslin 1 The Chesters Low Fell Gateshead Tyne & Wear NE9 5PB 01914873191 01914873191 ntawnt.roslin@nhs.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Northumberland, Tyne & Wear NHS Trust care home 5 Number of places (if applicable): Under 65 Over 65 0 0 0 learning disability mental disorder, excluding learning disability or dementia physical disability Additional conditions: 5 2 1 The maximum number of service users who can be accommodated is 5 The registered peson may provide the following categories of service only: To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD, maximum number of places 5 Mental Disorder, excluding learning disability or dementia - Code MD, maximum number of places 2 Physical Disability - Code PD, maximum number of places 1 Date of last inspection Brief description of the care home Roslin is a detached house in a quiet area of Low Fell in Gateshead. It is close to local amenities including a shopping area, GP surgeries and local public transport. The local college is within walking distance of the home. Roslin provides personal care for five people with a learning disability. Nursing care is not provided. There are four bedrooms Care Homes for Adults (18-65 years) Page 4 of 39 Brief description of the care home on the first floor and one on the ground floor that is suitable for people with physical disabilities. The home comprises a large entrance hall, a sitting room, conservatory and a combined kitchen/breakfast room. Assisted bathing facilities are also provided. There are gardens to all sides of the house. Roslin has its own transport. Charges range from 400 to 500 pounds and an extra charge is made for personal toiletries. Copies of the homes inspection reports are available on request from the office. Care Homes for Adults (18-65 years) Page 5 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. How the inspection was carried out: Before the visit, we looked at: - Information we have received since the last key inspection visit on the 12 April 2007; - How the service dealt with any complaints and concerns since the last visit; - Any changes to how the home is run; - Tthe managers view of how well they care for people; - The views of relatives, other professionals and staff. Care Homes for Adults (18-65 years) Page 6 of 39 An unannounced visit was made on the 06 April 2009. During the inspection we talked with the new manager. We looked at information about the people who use the service and how well their needs are met. We also looked at other records which must be kept and checked that staff have the knowledge, skills and training to meet the needs of the people they care for. We looked around the building to make sure it was clean, safe and comfortable and checked what improvements have been made since the last inspection. We told the manager what we found. What the care home does well: What has improved since the last inspection? What they could do better: Ensure that peoples assessments are updated every 12 months. The format used to record peoples assessment information is available in an easy to read format. Review and update each persons communication dictionary. This should be done collaboratively with the person themselves, their family, staff from the home and other relevant professionals. Ensure that a system is put in place to monitor the quality and content of peoples care records. Ensure that peoples care plans cover each of the areas referred to in the National Minimum Standards. Ensure that the homes care records contain evidence staff have explored all appropriate ways to enable people to make everyday as well as more important decisions. Ensure that all staff receive training in preparing and implementing Person Centred Plans. Ensure that the premises are kept in a good condition, well maintained and suitably Care Homes for Adults (18-65 years) Page 8 of 39 decorated. Complete the Department of Health self-assessment infection control checklist. Ensure that a recognised nutritional screening tool is used where staff identify that a person may be at risk of under or over nutrition. Carry out an appropriate risk assessment where people are identified as being at risk of choking. The assessment should be shared with relevant professionals. Review the homes menus to ensure that they are nutritionally balanced and contain all of the information recommended by the Commission. Complete a pressure sore risk assessment where people have significant mobility needs and are at risk of under nutrition. Review and update peoples Health Action Plans yearly. Make arrangements for staff to receive training in managing epilepsy. Ensure that a support plan is devised which provides staff with clear guidance on how to manage peoples need for support with their epilepsy. Re-locate the medication cupboard. Ensure that staffs competency to administer medication is assessed and a written record kept. Arrange for the homes medication practices, policies and procedures to be checked on a regular basis by an experienced pharmacist. Ensure that all staff receive safeguarding, physical intervention and equality and diversity training. Ensure that the personnel records for staff appointed after April 2002 contain evidence of proof of identity including a recent photograph. Ensure that the required fire safety checks are carried out. Prepare a Personal Emergency Evacuation Plan for each person living at Roslin. Review the homes fire risk assessment every 12 months. Ensure that the temperature of the hot water supplied to areas of the home used by service users is checked each week. Review and where necessary update the homes work place and COSHH risk assessments every 12 months. Ensure that a robust system is put in place to review the quality of services and care provided at the home. This will help to ensure that the home is run in the best interests of the people using the service. Ensure that the homes Annual Quality Assurance Assessment contains appropriate evidence showing how Roslin is complying with the National Minimum Standards. Ensure that people using the service, their relatives, staff and professionals who have contact with Roslin, are issued satisfaction surveys which enable them to comment on the quality of care and services provided. If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 9 of 39 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 39 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before they move into Roslin. This helps the home to reach an informed decision about whether they are able to offer a suitable placement. It also means that people will be able to benefit from living in a service where they know that their needs will be met. Evidence: No one has moved into Roslion since the last inspection. It has therefore not been possible to assess the homes performance against Key Standard 2. The Outcome Area rating therefore remains good. However, it was confirmed that peoples care records contain copies of their social services assessment. Care Homes for Adults (18-65 years) Page 12 of 39 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place for ensuring that peoples care records and assessments are kept up to date are not fully satisfactory. This could lead to staff being unclear about peoples current needs and how they should be met. Evidence: Peoples care records include a personal profile. This provides staff with important information about peoples lives before they came to live at Roslin. Although assessments have been carried out, some of those checked have not been updated during the previous 12 months. Up to date assessment information will help staff to ensure that Roslin is able to meet peoples needs. A range of support plans has been put in place for each person. These focus on what each person is able to do at present, what staff hope to achieve by their intervention and how each persons assessed needs will be met at Roslin. However, care plans addressing peoples needs in the following areas are not in place for each person Care Homes for Adults (18-65 years) Page 13 of 39 Evidence: culture and faith; maintaining family contacts; specific condition related needs and financial management. Also, some peoples care plans have not been reviewed on a regular basis. Up to date care plans addressing peoples needs in the areas recommended by the National Minimum Standards will help staff to be clear about how they should care for and support each individual. None of the people living at the home have had their needs reviewed by social services during the previous 12 months. The manager is taking action to ensure that all care plans and risk assessments are updated. Up-to-date, well maintained care records will help the manager to audit the care being provided and make sure that staff are meeting peoples needs in a satisfactory manner. A checklist is being introduced to help keyworkers keep peoples care records up to date. The manager has made arrangements for out of date and duplicated information in peoples care records to be archived. People living at the home communicate in a variety of ways using body movements, facial expressions, gestures, signing and speech. Although each persons care record includes a communication dictionary, those looked at contain limited information. An appropriately completed communication dictionary will contain a detailed description of how the person communicates and how staff can best communicate with the person. This will help staff to be clearer about the range of strategies that can be used to communicate with the people in their care. Staff have assessed the risks that people using the service experience as they go about their daily lives. Staff have used a standardised format which prompts them to consider what risks are present, what can be done to minimise them and how will this benefit the person concerned. However, the format is not available in an easy to read version and neither is the information included within it. Also, some of the risk assessments looked at have not been reviewed within the last 12 months. Some have not been updated since 2006. Peoples support plans and assessments contain information about their likes, dislikes and personal preferences. However, they contain limited information about the decisions that each person is able to make. For example, in the care records checked, there is no information about what action staff should take if individuals are unable to make particular decisions. Care Homes for Adults (18-65 years) Page 14 of 39 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for meeting peoples lifestyle needs are not fully satisfactory. This may mean that people are not able to benefit from leading a lifestyle which promotes active involvement in the community and continuing personal development. Evidence: Social care and leisure support plans have been devised for each person. However, some of the guidance given to staff about how to meet peoples needs in this area is too vague. It is difficult to assess how effective they have been in helping people to develop a community presence and benefit from community participation. Staff are currently drawing up timetables of opportunities for each person with a view to enabling them to benefit from a wider range of social and leisure based activities. One person said: ...we are running short staffed at the time being. We could always do with extra staff to enable people to have more freedom and choice of outings. Care Homes for Adults (18-65 years) Page 15 of 39 Evidence: Each person has a Care Plan Day where they have one to one time with their keyworker to do such things as personal shopping or going out for a meal. However, the manager said that additional one to one activities cannot be provided as two staff must always be available in the building. A member of staff said that it is very difficult to find the time to carry out one to one activities given the needs of people currently using the service. The provider has failed to meet a previous deadline regarding a requirement to deploy staff within the home to ensure that service users social interests and programme of activities are supported. However, staff try to ensure that people access as many community based activities as possible. On the day of the inspection, a member of staff transported a service user to their day care centre. This helps the person to benefit from being involved in structured day time activities where there are opportunities to socialise with friends. Staff also support people to manage their own finances by helping them to visit their local bank. One person is encouraged to maintain contact with their local church. Another person is supported to go to the local pub and watch the football. Staff also help people to pursue their hobbies and attend a local disco. Where appropriate, staff support people to keep in regular contact with family members. People are supported to participate in the running of the home. For example, staff encourage and prompt people to lay the table ready for the evening meal and clear up afterwards. One service user filled the dishwasher with staff oversight. People are encouraged to take responsibility for keeping their bedrooms clean and tidy. However, one persons bedrooms was not clean. A number of potential hazards were also identified in this bedroom. For example, a large multi-socket extension lead has been placed adjacent to the washbasin. This has the potential to result in water being splashed onto the extension socket. The manager has identified a number of concerns in this bedroom and is taking action to address them. During the inspection, the keyworker supported the service user concerned to clean their bedroom and remove potential trip hazards. The home has a written menu which is prepared each week. Copies of the menus are placed on a notice board in the kitchen. Although each person is able to choose one evening meal per week, people can choose an alternative if they do not like the choice on offer. The menu covers all main meal times and states that a choice of beverages and snacks are available between meals. However, although the menus are informed by service user choice, it is difficult to tell from the records looked at whether people are receiving a nutritionally balanced diet. For example, the types of vegetables served are not specified. No detail is given of the range of foods available on the Sunday buffet meal. Also, according to the menus examined, the recommended three portions Care Homes for Adults (18-65 years) Page 16 of 39 Evidence: of vegetables and two of fruit are not being provided. On the day of the inspection, the evening meal consisted of scampi and chips. One of the people living at the home has been identified as being at risk of poor nutrition and choking. The home has been given guidelines to help them meet the persons nutritional care needs. However, an examination of this persons care records indicates that the home has not carried out its own nutritional screening using a recognised tool. Also, an assessment of the risks posed by choking has not been carried out. The use of a nutritional screening tool will help staff to identify whether people are at risk of poor nutrition or eating problems. A robust risk assessment will help ensure that the person receives the support they need to eat safely. Staff have not received training in how to manage under and over nutrition. Care Homes for Adults (18-65 years) Page 17 of 39 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for meeting peoples physical and personal healthcare needs are not fully satisfactory. Because of this peopole may not be able to benefit from living a healthy lifestyle which promotes their physical and emotional well being. Evidence: Arrangements have been made to meet peoples health care needs. For example, each person has seen their GP, community nurse and dentist within the last six months. People have also received optical care within the last two years. Other healthcare services are arranged on an as and when required basis. Staff are currently in the process of completing each persons Health Action Plan. They are working with service users to ensure that all their health care checks are up to date. Peoples care records contain important information about their healthcare needs. Staff have obtained information about peoples health conditions and the medications they take. One member of staff said that this helps them to understand what support people need and how their medications affect them. Care Homes for Adults (18-65 years) Page 18 of 39 Evidence: One of the people living at the home has epilepsy. However, a care plan covering their needs in this area has not been devised. Also, there is no evidence that staff have received training in caring for people with epilepsy. The manager and keyworker are in the process of looking at what arrangements will need to be put in place should a change be made to the persons medication regime. Most of the people living at the home are mobile and therefore not at risk of developing pressure sores. However, one person has significant mobility needs and requires the use of a wheelchair when outside of the home. A pressure sore risk assessment has not been completed for this individual. This person is also at risk of under nutrition. The service operates a keyworker system. Keyworkers act as a point of contact for families, friends and other professionals. They are responsible for developing peoples support plans and risk assessments. Staff said that they are clear about how to meet peoples personal care needs. However, some peoples support plans do not clearly identify their personal care needs, how these will be met and what staff hope to achieve by their involvement. Moving and handling risk assessments have been completed for each person. Although two assessments have been recently updated, one had not been reviewed during the last 12 months. In addition, the assessment for one person does not clearly describe the actions to be taken by staff when assisting them to mobilise and transfer. All medication is kept in a secure cupboard. This means that service users are not able to access dangerous medication that could place them at risk. The medication cupboard is kept tidy and well ordered. Medication stock levels are kept to a minimum. There are records confirming that people receive their medication. A record is kept of medicines received into the building. A receipt book is used to record medicines disposed to the homes supplying pharmacist. Photos to identify each person have been placed with their medication records. However, a number of concerns were identified. Hand wash facilities are not readily available in the area from which medicines are administered. Whilst staff prepare to administer medication, the medication cupboard door is left open making it difficult for service users to access their bedrooms or use the stairs to access the communal areas. The new manager is looking into the possibility of re-locating the area in which medicines are kept as part of the refurbishment of the kitchen. Because the medication cupboard is fitted with wooden slats that have small spaces between them, staff do not have an appropriate surface on which to prepare and record that medication has been given. There is no written evidence that one staff members competency to administer medication has Care Homes for Adults (18-65 years) Page 19 of 39 Evidence: been assessed. The competency of two other staff has not been re-assessed within the last 12 months. In one persons medication administration record, staff have not always completed the record to confirm that medication had been given. The home is using an out of date medication reference source. The service has not been inspected by a pharmacist within the last 12 months. Care Homes for Adults (18-65 years) Page 20 of 39 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff take action to keep people safe and they ensure that complaints are responded to appropriately. This means that people living at Roslin can be confident that staff will try to protect them from harm and listen to and act upon their concerns. Evidence: Details of the homes complaints procedure are included in the service user guide. Both the home and the Commission have been notified of one complaint since the last inspection. The concerns raised by the complainant about the inappropriateness of their relatives bathing facilities have been rectified. A second complaint received by the provider has also been resolved. All staff said that they have been told how to handle complaints. One member of staff said that staff are very aware of the homes complaints procedure. The manager has obtained a copy of the Trusts recently updated safeguarding policy. A copy of the local authoritys safeguarding procedures is available within the home. The Commission has been notified of two safeguarding concerns since the last inspection. Both occurred as a result of issues that took place outside of the home. The most recent safeguarding concern is currently being dealt with under the local authoritys safeguarding procedures. No referrals regarding unacceptable staff conduct have been made to the Independent Safeguarding Authority. Care Homes for Adults (18-65 years) Page 21 of 39 Evidence: An examination of the homes training files shows that not all staff have received safeguarding training. A requirement regarding this matter was set following the last inspection of the service. The timescale has since expired. Most staff have not received training in how to manage situations where physical intervention may be required. Care Homes for Adults (18-65 years) Page 22 of 39 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for maintaining the building and replacing its furniture and fittings are not satisfactory. This means that people are not able to benefit from living in an environment that is safe, well maintained and which meets their needs. Evidence: The home is a large, detached family house in a quiet cul-de-sac in Low Fell. It has been adapted to meet the needs of the people using the service. The home has a large reception room, a separate kitchen and a conservatory. An adapted shower has recently been installed on the ground floor. This means that people are able to shower in a safe setting that meets their needs and promotes their independence. There is a communal bathroom on the first floor. The bathroom is fitted with various mobility aids. Each person has their own bedroom and some have en-suite facilities. All bedrooms have been personalised to reflect the preferences of the occupant. The house has a front driveway and a good-sized back garden. The house is warm, well lit and comfortable. The provider has an established system for renewing the fabric of the building, its furnishings and fittings, and for dealing with any repairs or maintenance. Whilst there is evidence that most requests for repairs have been actioned, it is clear from the Care Homes for Adults (18-65 years) Page 23 of 39 Evidence: providers most recent monitoring visit report that required improvements to the service have not been carried out. During this inspection, the following concerns were identified. The kitchen is in a poor condition. For example, the carpet is very stained. There are a number of broken cupboard and draw fronts. The carcases of some kitchen units are in a poor state. The standard of decoration is unsatisfactory. One of the microwaves does not work. The wall adjacent to the unit housing the cooker is damaged as a result of there not being sufficient clearance to open and close the door. The home does not have a complete set of crockery. Some crockery is chipped. The provider has failed to meet three previous deadlines regarding a requirement to refurbish the kitchen. It was also identified that the vanity sink unit in one service users bedroom is in a poor condition. A knob is missing off their set of drawers. The blinds are in a poor condition. The privacy lock to the en-suite facility in another service users bedroom does not work satisfactorily. There is no cover to the light fitting. The cubicle shower does not work. It looks unclean and is being used to store old bathroom fittings. Sellotape has been placed over the bedroom door catch. This prevents the rooms occupant using the privacy lock. An explanation for this could not be provided. The carpet is stained in places. The wardrobe doors have been condemned. The window blinds, carpet and bedside cabinet in a third bedroom are in a poor condition. The wardrobe handles are broken making it difficult for the occupant to open and close their wardrobe. Some of the bedrooms are not clean. The Department of Health checklist for assessing infection control measures in residential care homes has not been completed. The paintwork in some areas of the building is in a poor condition. Radiators throughout the building are unguarded and window restrictors have not been fitted to any of the first floor windows. The shower fitting in the first floor bathroom is not working. The plastic shelving adjacent to the bath is cracked in places. The toilet roll holder is broken. The light pull chord is broken. The stair carpet is threadbare in one place. There is no level access to the garden area from either the rear door or conservatory. This will make it difficult for people using the service to access and enjoy the homes garden. One of the paving slabs to the rear of the home is cracked and some are uneven. This could cause people to trip and fall. There is no level access to the front of the house. At least one of the people using the Care Homes for Adults (18-65 years) Page 24 of 39 Evidence: service has mobility needs and uses a wheelchair outside of the home. The inspector observed a member of staff supporting one person to leave the building in their wheelchair. The member of staff tipped the person and their wheelchair backwards in order to manoeuvre them over the small step. This is considered to be a dangerous practice that places both the person and staff member at risk of injury. The provider has failed to meet a previous deadline regarding a requirement to ensure that there are adequate adaptations to enable safe access to and from the home for service users with a disability. Care Homes for Adults (18-65 years) Page 25 of 39 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can feel confident that they are being cared for by professionally qualified and well supervised staff. However, the arrangements for providing staff with more specialist training and ensuring that all of the required preemployment checks are carried out, are not fully satisfactory. Because of this, people may not be able to benefit from being cared for by staff who are suitbably and appropriately trained. Evidence: There are rotas that show which staff are on duty and at what times. However, the rotas do not include staffs full names. The staff team consists of a manager, an assistant manager and five support workers. The rotas show that for five service users there are always a minimum of two staff on duty between 8 am and 8 pm. A member of staff sleeps over in the building between 8 pm and 8 am. Staff turnover is low with only one member of staff having left their employment since the last inspection. Over 90 per cent of the staff team have obtained a National Vocational Qualification at Levels 2 and 3. One member of staff is in the process of completing such a qualification. Care Homes for Adults (18-65 years) Page 26 of 39 Evidence: Staff receive supervision at the frequency stipulated in the National Minimum Standards. However, some of the records looked at contain very little information about the content of the sessions held. A personal development review has been completed for each member of staff during the previous 12 months. A range of pre-employment checks are carried out before staff can commence work at the service. For example, all staff are subject to a Criminal Records Bureau disclosure check. Staff are required to provide a statement about whether they have any convictions and undergo medical clearance to ensure that they are fit for the job for which they are being employed. However, there is no evidence that one persons identity has been verified. Also, some peoples files do not contain a recent photograph. Another persons personnel file contained only one written reference. Staff are supported to complete an in-house induction and a written record is kept. There are opportunities for staff to complete mandatory training. For example, all staff have completed training in first aid, fire safety, health and safety and moving and handling. However, there is no documentary evidence confirming that some staff have completed infection control or food hygiene training. Ensuring that staff complete the required mandatory training will help them to keep people using the service safe. Some staff have completed training that is more relevant to the needs of the people they care for such as conflict resolution training. However, some staff have not completed physical intervention, learning disability or mental health awareness training or training in equality and diversity. The provider has failed to meet a previous deadline regarding a requirement to provide staff with training relevant to the needs of the service users and purpose of the home, including mental health awareness training. Care Homes for Adults (18-65 years) Page 27 of 39 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for overseeing the conduct and management of the home are not fully satisfactory. This could mean that people are not able to benefit from living in a home which is well run and meets their needs. Evidence: The home does not currently have a registered manager. However, the provider has appointed a temporary manager to oversee the day to day running of the service. Mr Foster has considerable experience of working with adults who have learning disabilities within a residential setting. He has obtained a National Vocational Qualification in Care at Level 4 as well as the Registered Managers Award. Mr Foster updates his mandatory training on a regular basis. Throughout the inspection he demonstrated good leadership skills and has a clear vision of what improvements he wants to make at the home. Arrangements are in place to monitor the service. For example, the provider ensures that unannounced visits are carried out to monitor the quality of services and care Care Homes for Adults (18-65 years) Page 28 of 39 Evidence: provided at the home. A development plan is also completed each year. However, the following concerns were identified. Provider monitoring visits have not been carried out each month and this could could result in the provider not having an appropriate overview of how the service is operating. Although there is an annual development plan, it is evident that some of the previous developmental goals have not been achieved. Also, the plan does not state what action needs to be taken to comply with requirements stipulated in the homes previous inspection report. There is no evidence that a review of the homes performance against the National Minimum Standards and Care Home Regulations has taken place. People using the service, their relatives, staff and professionals who have contact with Roslin, have not been given the opportunity to complete satisfaction surveys during the last 12 months. The Commission is satisfied that the new manager completed the AQAA as well as he could given the short amount of time that he has worked at the home. However, the AQAA does not provide sufficiently robust evidence of how well the home is complying with the National Minimum Standards and Care Homes Regulation. Although a range of policies and procedures are in place, some have not been updated since 1993. This could mean that these policies and procedures do not reflect more recent guidance and developments that have taken place in caring for people with learning disabilities. Peoples health and safety is promoted. For example, the home has a current gas safety certificate. All electrical equipment has been safety checked and there is a current electrical safety certificate. Staff update their mandatory fire training each year. They participate in a minimum of two fire drills per year at which time they also receive in-house fire training. Following a requirement set in the last inspection report, the home has obtained important information about the hazardous materials in use within the home. However, the following concerns were identified. Fire alarm checks were not being carried out as one of the fire points could not be operated satisfactorily. An Immediate Requirement Notice (IRN) was issued at the time of the inspection. The provider took immediate action to address the concerns identified in the IRN. Also, staff are not carrying out monthly visual checks of the emergency lights, service users do not have their own Personal Emergency Evacuation Plans and the homes fire risk assessment has not been reviewed since November 2007. Although a range of work place risk assessments have been carried out, the majority Care Homes for Adults (18-65 years) Page 29 of 39 Evidence: of these have not been reviewed during the previous 12 months. For example, the Control of Substances Hazardous to Health (COSHH) risk assessment has not been updated since 2004. The homes in-house guidance for checking the temperature of hot water supplied to areas used by service users states that weekly checks should be carried out. The records show that this is not happening. Care Homes for Adults (18-65 years) Page 30 of 39 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 23 13(6) Ensure that all staff receive 25/08/2007 training on abuse awareness and local adult protection procedures. The kitchen must be refurbished and redecorated (Previous timescale of 01 Nov 2005 and 01 May 2006 for redecoration). 25/09/2007 2 24 23(2)(d) 3 29 23(2)(n) Ensure that there are adequate adaptations to enable safe access to and from the home for service users with a physical disability. Ensure that staff receive training relevant to the needs of service users and the purpose of the home, including mental health awareness training. 25/07/2007 4 35 18(1)(c)(i) 25/09/2007 Care Homes for Adults (18-65 years) Page 31 of 39 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 23 Repair or replace the privacy 06/04/2009 locks in all service users bedrooms and en-suites facilities. This will help to ensure that people are able to protect their privacy and control who has access to their bedroom and en-suite facility. (This requirement was addressed at the time of the inspection) 2 42 23 Ensure that the non06/04/2009 operational fire alarm point is repaired to enable the alarm system to be checked. This will help to ensure that people are able to benefit from living in a home where their health and safety is treated seriously. (This requirement was addressed at the time of the inspection) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 39 Ensure that the homes Annual Quality Assurance Assessment contains 01/06/2009 Care Homes for Adults (18-65 years) Page 32 of 39 sufficient evidence to show how Roslin is complying with the National Minimum Standards. This will help to show how well the service is performing and enable the Care Quality Commission to judge whether people are receiving good outcomes. 2 17 Ensure that: Each staff members file contains a recent photograph; Staffs identities have been verified and there is documentary evidence of this in their personnel records; Two written references are obtained for each member of staff. This will help to ensure that only suitable staff are employed at the service. 3 23 13 Ensure that all staff receive safeguarding training. This means that people using the service will be able to benefit from being cared for by staff who know how to keep them safe. 4 24 23 Refurbish and redecorate 21/08/2009 the kitchen. Previous timescales for complying with this requirement expired on 01 Nov 2005, 01 May 2006 and 25 September 2007. 03/08/2009 01/06/2009 Care Homes for Adults (18-65 years) Page 33 of 39 This will help to ensure that people are able to benefit from living in a wellmaintained environment that meets their needs. 5 24 23 Repair or replace the stair 21/08/2009 carpet and the plastic shelving, shower, toilet roll holder and light pull chord in the first floor bathroom. This will help to ensure that people are able to benefit from living in a wellmaintained environment that meets their needs. 6 24 23 Ensure that: 21/08/2009 The vanity unit in one service users bedroom is replaced, a new knob is fitted to the chest of drawers and the window blinds are either eplaced or repaired; The cubicle shower fitted in another persons bedroom is either replaced or repaired, the room is kept free of potential hazards and a light fitting is provided in the ensuite facility; The window blinds, bedside cabinet and carpet in a third bedroom are either replaced, repaired or cleaned and the wardrobe door knobs repaired. This will help to ensure that people are able to benefit from living in a well- Care Homes for Adults (18-65 years) Page 34 of 39 maintained environment that meets their needs. 7 24 23 Ensure that damaged woodwork and walls are repaired and redecorated. This will help to ensure that people are able to benefit from living in a wellmaintained environment that meets their needs. 8 39 26 The provider must ensure that it carries out monthly unannounced monitoring visits. This will help to provide the Trust with an overview of how well the service is operating. 9 42 23 Ensure that the homes: Fire alarms are tested each week; Emergency lights receive a visual check each month. This will help to ensure that people are protected in the event of a fire. 01/05/2009 01/06/2009 21/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 Ensure that the homes care records contain evidence that staff have explored what decisions people are able to make on a day to day basis. Where it is has been assessed that a person may be unable to make more important decisions, advice should be sought from social services about the need to complete an assessment under the Mental Capacity Act. Page 35 of 39 Care Homes for Adults (18-65 years) 2 6 Ensure that all staff receive training in preparing and implementing Person Centred Plans. Review and update each persons communication dictionary. This should be done collaboratively with the person, their family, staff from the home and other relevant professionals. Ensure that peoples support plans are reviewed and updated every six months. Contact social services to request that they carry out yearly reviews of peoples placements at the home. Ensure that peoples support plans cover each of the areas referred to in the National Minimum Standards. Ensure that: Peoples assessments are reviewed and where appropriate updated every 12 months; The format used to record peoples assessment information is available in an easy to read format. 3 6 4 6 5 6 6 6 7 9 Ensure that: - Risk assessments are reviewed and updated on an annual basis; - The risk assessment format used by the home is available in an easy read version. 8 17 Ensure that: A recognised nutritional screening tool is used where staff identify that a person may be at risk of under or over nutrition; Where people are identified as being at risk of choking, a recorded risk assessment is carried out. The assessment should be shared with relevant professionals. 9 17 Review the homes menus to ensure that they are nutritionally balanced and contain all of the information recommended by the Commission. Ensure that a support plan is devised which provides staff with clear guidance on how to manage peoples need for support with their epilepsy. Make arrangements for staff to receive training in managing epilepsy. Review and where appropriate update peoples Health Action Plans yearly. 10 19 11 12 19 19 Care Homes for Adults (18-65 years) Page 36 of 39 13 19 Complete a pressure sore risk assessment where people have significant mobility needs and are at risk of under nutrition. Ensure that: Staffs competency to administer medication is assessed at least once every 12 months and a written record kept; The homes medication practices, policies and procedures are checked on a regular basis by an experienced pharmacist; Staff are provided with appropriate access to handwash facilities when administering medication; Peoples medication records are signed following the administration of their medication. 14 20 15 16 17 18 19 20 20 23 24 24 24 24 Re-locate the medication cupboard. Ensure that all staff receive physical intervention training. Ensure that all privacy locks are kept in good working order. Ensure that the carpet in the kitchen is either cleaned or replaced. The homes crockery should be replaced. Fit window restrictors to all first floor bedroom windows. Provide level access into/out of the home and rear garden area. Replace the cracked paving slabs and ensure that they are evenly laid. Ensure that people receive the support they need to keep their bedrooms clean. Complete the Department of Health self-assessment infection control checklist. Ensure that all radiators are guarded to protect people at risk of falling and injuring themselves. Ensure that staff complete training in the following areas: infection control; food hygiene and Equality and Diversity. Ensure that the homes rotas include the full names of staff. Ensure that staff supervision records contain appropriate details about the content of supervision sessions. Submit an application to register a manager for the service. Ensure that the providers quality assurance system provides an overview of how well the home is meeting the 21 22 23 30 30 30 24 25 26 32 33 36 27 28 37 39 Care Homes for Adults (18-65 years) Page 37 of 39 National Minimum Standards and complying with the Care Homes Regulations. 29 39 Ensure that people using the service, their relatives, staff and professionals who have contact with Roslin, are issued satisfaction surveys which enable them to comment on the quality of care and services provided. Update and review the homes work place and COSHH risk assessments every 12 months. Prepare a Personal Emergency Evacuation Plan for each person living at Roslin. Ensure that the temperatire of the hot water supplied to areas of the home used by service users is checked each week as recommended by the provider. 30 31 42 42 32 42 Care Homes for Adults (18-65 years) Page 38 of 39 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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