Inspection on 14/12/06 for Rowan House

This inspection was carried out on 14th December 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rowan House 05/11/07

Rowan House 23/02/06

Rowan House 13/12/05

Rowan House 08/03/05

Rowan House 16/11/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Rowan House Church Lane Doddinghurst Brentwood Essex CM15 0NJ Lead Inspector Christine Bennett Unannounced Inspection 14th December 2006 10:00 Rowan House DS0000018115.V322963.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 Rowan House DS0000018115.V322963.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. Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rowan House Address Church Lane Doddinghurst Brentwood Essex CM15 0NJ 01277 823853 01277 822722 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) kingston@consensushealthcare.org Consensus Support Services Limited Mrs Trudy Jane Hunter Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23/02/06 Brief Description of the Service: Rowan House is owned and managed by Consensus Support Services Ltd. It provides care and accommodation for six service users who have a moderate to high level of learning disability. Rowan House is situated on the edge of a small village, with local shops and amenities nearby. Public transport does present some difficulty for staff and visitors. The home has its own transport to support service users to access community facilities. The building is a spacious mock Georgian family house. Residents’ bedrooms are provided on two floors in single accommodation. There is a separate lounge and dining room on the ground floor. Rowan House has developed two rooms, one as a music/art activity room and one as a sensory room. There is an enclosed garden at the rear of the property, which is mainly laid to patio and a gravel parking area at the front of the property. The Service User Guide and Statement of Purpose are up to date and available as required, in appropriate formats. A copy of the last inspection report is available in the manager’s office. This is discussed individually with relatives when it is published. Fees range between £1068.80 and £2030.00 per week. Extras not included in the fees include clothes, toiletries and haircuts. Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection. The site visit took place on 14th December 2006 over a four and a half hour period. Prior to this, a pre inspection questionnaire had been completed by the home and the views sought from placing Social Workers and the General Practitioner who visit the home. A tour of the building took place, random records and policies were inspected and time was spent with the residents and staff, observing care practice and seeking their views. Following the site visit a random selection of relatives were contacted to seek their views on the home. The manager was available at the site visit and feedback was given to her throughout the day. What the service does well: What has improved since the last inspection? Staffing levels have recently been improved which means the residents can go out more. A new trainer provider is starting in January 2007 to provide training for staff in line with the Learning Disability Award Framework. Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 Page 6 The manager said that general maintenance of the home has improved, so that residents’ daily lives are not disrupted. Changes have been made in medication procedures to promote safety. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The admission procedure includes a detailed assessment to ensure a resident’s needs can be met. The home provides a caring environment where visitors are welcome. EVIDENCE: The home has an up to date comprehensive Statement of Purpose and Service User Guide. These documents are supplied to residents and their relatives in a format suitable to their individual needs. There have been no new admissions to the home since the last inspection. The manager described a thorough assessment that is carried out before admission. This includes obtaining a detailed care plan and obtaining information from a range of sources including relevant professionals and family. This information will determine if the home can meet the needs of the prospective resident. They are then given the opportunity to spend time in the home before moving in. All residents have a contract, a copy of which was seen in care plans. Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Each resident has an individual plan, which supports them to take risks as part of an independent lifestyle. EVIDENCE: Care plans were seen to be generally comprehensive and person centred. Reviews are held on a regular basis. The care plan was viewed of a resident whose needs had changed recently. The manager was able to evidence the review that was held and the input from other professionals to address these changing needs. Staff spoken with confirmed that all the information they needed about a resident could be found easily in care plans. Risk assessments are contained in all residents’ files. These were seen to be detailed, giving staff the information needed to manage these risks. The home is committed to allowing the residents to make informed decisions. A keyworker system provides additional support, enabling one to one involvement. Advocacy services are encouraged to promote individual understanding of their rights. Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 Page 10 Meetings are held with the residents where their views are sought on the day to day running of the home. The manager was able to describe observations that might indicate a resident wanted a change in their daily activities. Relatives spoken with confirmed that the residents seemed happy and content in the home and were happy to return there. One mother said, “He has changed a lot since moving to Rowan House in a better way – his life is much much better”. The residents are encouraged to retain their independence. The manager confirmed that the residents assisted in the cleaning and tidying of their bedrooms. They are responsible for putting their laundry out for washing and one resident assists in making a sandwich for his lunch. Residents regularly accompany staff to do the weekly shopping for the home. Residents’ records are held securely in the manager’s office to protect confidentiality. Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Social activities take place and links with families are encouraged to enable residents to develop life skills. EVIDENCE: The manager confirmed that all the residents attend college, participating in various courses to suit their individual needs. The home is now fully staffed which enables the residents to participate in a wide range of activities in and out of the home. Each resident has a personal plan displayed in their bedroom, which identifies their weekly activities. The home has a sensory room and a craft/computer room. Two members of staff are the activities coordinators for the home and one told how they had recently bought a lot of equipment and games for the residents to enjoy. They explained that the residents had enjoyed making their own Christmas cards with craft material that had been purchased. Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 Page 12 Routines are flexible and resident focused. They are regularly reviewed and changed to suit individual needs. The home has it’s own transport which most staff are authorised to drive. A neighbour keeps the home informed of any activity in the local area that the residents might enjoy. Residents have an annual holiday. In the summer one resident was accompanied by the manager and his family to return to his homeland for 10 days. The mother confirmed that this would not previously have been possible and that it had been a success for everybody involved. It also allowed the resident to experience the culture of his native country and to be reacquainted with his extended family. The other residents were taken to Centreparcs where they were booked into individual chalets with two staff members. This enabled them to have the choice of mixing with the other residents or spending time alone. The home has an open visitors policy and residents can spend time with their visitors in the privacy of their own room or the sensory room. Two residents go to spend time with their family on a regular basis. One relative confirmed that staff accompany his son to enable him to spend time with his parents in his own home. The home has a 4 weekly rolling pictorial menu and a menu planner. Nutritional records are maintained for each resident. Staff shop weekly for the food and involve the residents to help with the shopping. Healthy eating is encouraged. Special consideration is given to residents’ cultural needs when planning the menu. The manager had obtained a cookery book of Greek recipes and had incorporated some of these into the menu. The menu is also adapted for a resident who has a weight problem. The manager confirmed that the residents are considered individually, observing religious preferences and a soft diet for a resident with problems swallowing. Residents were seen to be supervised at lunch with assistance given sensitively when needed. Drinks and snacks are available throughout the day with consideration given to any eating disorders. Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that the healthcare needs of the residents are met. EVIDENCE: Residents are allocated a keyworker, who is responsible for personal care and clothing. The staff know individual likes and dislikes and also their individual capabilities. These are recorded in the care plans. Any personal care is carried out in privacy and the dignity of the resident is respected. Generally relatives were happy with the care given at the home. One said they felt more attention could be paid to personal care with regard to teeth cleaning. The manager confirmed that the home has good communication with various health professionals. The GP surgery offers an immediate appointment when needed and the local learning disability team offer good support. The community nurse helps with walking, speech and language. A GP who responded in a survey confirmed that they had no concerns regarding the care provided by the home. A social worker said that the home is meeting the needs of the resident known to her adding, “the management works in partnership with the local community nurse”. Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 Page 14 A resident’s condition had recently deteriorated and the manager had sought advice from various healthcare professionals. A wheelchair had been provided to the resident to maximise independence. This resident is now unable to access the bath or shower and the company is planning to convert an existing bathroom into a wet room, which will accommodate a wheelchair. Medication is kept in the manager’s office. The temperature at which it is stored is taken daily, but records must be maintained to provide evidence. Medication records were found to be accurate although staff are advised to obtain two signatures for transcribed medication. Appropriate protocols were in place. Staff had received training in the administration of medication and medication assessments are carried out to evidence competency. No controlled medication is being stored in the home. Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an appropriate complaints policy in different formats to suit individual needs. Residents are protected by staff knowledge relating to POVA (Protection of vulnerable Adults). EVIDENCE: The home has an up to date complaints policy and procedure. It is clearly written and easy to understand. A copy of the complaint’s procedure is displayed around the home. An individual copy is given to residents and to relatives. It is available in pictorial format for residents. One complaint had been received since the last inspection. This has been recorded in the complaints book and is being investigated by the operations manager of the company. The outcome must be recorded when finalised. The home has an Adult Protection policy and the procedure for reporting abuse is evident on the wall of the manager’s office. There have been no allegations of abuse in the home. Staff have attended training in this area, which is updated annually. Staff spoken with at the site visit had a good knowledge of different forms of abuse and the reporting of abuse. Relatives feel that the home offers a safe environment for the residents and that they feel comfortable in bringing any concerns they have to the manager. One relative said, “they tell me everything, they never hide anything, I really trust them”. Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,27,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean with no unpleasant odours, offering a homely, comfortable environment for the residents. EVIDENCE: The home is well maintained and comfortable. The layout of the home gives the appearance of a personal home. Bedrooms have been decorated to suit individual tastes. Bedroom doors were lockable but only one resident has made use of this facility. The communal areas include a large lounge, a dining room, a sensory room and a craft/computer room. There are bathrooms and toilets on both floors. Equipment is provided in order to promote independence. The manager described a situation where a resident was assessed by the community health team and as a result the company purchased a wheelchair for him. This resident’s needs had recently changed which prevent him accessing a bath or shower. Adaptation is necessary to allow access to a wheelchair in order that his personal care needs can be met. The company have identified a Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 Page 17 bathroom that can be adapted to a wet room and also gain access to the laundry, without entering the kitchen. This work must be carried out urgently in order to fulfil this requirement. The home has a proactive infection control policy to ensure infections are minimised. The home was clean and tidy with no offensive odours. One member of staff said that she enjoyed working in the home as ”everything is in place here”. Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 Page 18 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): 31,32,33,34,35,36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment practice protects the residents. The home has an effective staff team who receive training to give them the skills to do their job. EVIDENCE: The staff records were examined for two new members of staff. Documentation was in place to protect the residents. This related to a completed application form, two references and a criminal records disclosure prior to commencing work. There was also evidence of a thorough induction programme, which is monitored by the manager. The home has increased its staff numbers and is currently fully staffed. Staff felt that there is a good staff team and that enough staff were now employed to enable them to fulfil their role. The manager confirmed that she monitors staff who are still working long shifts. Bank staff are available to cover sickness and annual leave. The home currently operates with four care staff on duty during the day and evening, and two waking night staff. Staff are responsible for cooking, laundry and cleaning. Additionally the manager works 9am-5pm on five days of the week. Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 Page 19 Staff training is being adapted from January 2007 in line with the Learning Disability Award Framework. Individualised training is recorded and any updates needed are addressed. There was evidence of varied training undertaken by staff, which included health and safety, food hygiene and managing conflict. Additionally many staff have achieved an NVQ qualification in care. Supervision of staff is carried out in a planned manner every month. Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home benefits from an experienced manager who provides guidance and direction to staff. EVIDENCE: The manager has been in position for five years and has completed her NVQ level 4. She has undertaken additional training on a regular basis to remain updated and is highly competent to run the home. She provides strong leadership, has good people skills and has a sound knowledge in a range of areas. A reviewing officer said, “I think the manager is very good. She has kept me informed of my client’s progress and seems to genuinely care for the welfare of the service users”. Three relatives confirmed that they were confident in her with comments, “I’ve got a lot of time for the manager” and “She is doing a very good job”. Staff meetings and residents meetings are held regularly to ensure they are listened to and valued. The manager does an annual quality review. She Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 Page 21 arranges for an independent advocate and the keyworkers to assist residents in giving their views. A copy of this review is made available to the Commission for Social Care Inspection and to the Registered Provider. She is in the process of putting the latest review into a picture format for the residents. The manager said that she met regularly with the company representatives and felt that she is well supported and her views respected. Supervision should be provided for the manager on a formal basis. Residents’ money is stored securely and any transactions recorded with receipts issued. Random checks were accurate. The manager is the appointee for three residents finances. The home has a range of policies and procedures to protect the residents. Updated policies and procedures are being introduced in February 2007 by the new company. Staff have received training in health and safety and are regularly updated. Regular fire drills and maintenance checks are carried out in the home to protect the residents and staff. Safe food/Better business is in operation in the home as recommended by Environment Health Agency. Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 Page 22 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 3 4 X 5 3 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 3 27 2 28 X 29 2 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 4 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 4 4 3 3 X 3 X Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard YA27 Regulation 23(2)(n) 23(2)(n) Requirement The registered provider provides bathroom/equipment suitable for individual assessed needs The registered provider provides bathroom/equipment suitable for individual assessed needs Timescale for action 31/03/07 31/03/07 YA29 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 YA30 YA36 YA20 Good Practice Recommendations The access to the laundry via the kitchen to be considered. Formal supervision should be arranged for the manager The temperature at which medication is stored is recorded and two signatures are obtained for transcribed medication. Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Rowan House DS0000018115.V322963.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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