CARE HOMES FOR OLDER PEOPLE
Rowan House 9 Darwin Road Southampton Hampshire SO15 5BS Lead Inspector
Lorraine Parton Unannounced 18 July 2005 9:00 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 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 Older People. 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 H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Rowan House Address 9 Darwin Road, Southampton SO15 5BS Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 023 8022 5238 Mr R and Mrs A Hurley Mrs A Hurley Care Home 16 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (16), Mental disorder, excluding learning of places disability or dementia (3), Mental Disorder, excluding learning disability or dementia - over 65 years of age (16), Old age, not falling within any other category (16) Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: A total of 3 service users in the categories (DE) and (MD) may be admitted at any one time between 55-64 years of age. Date of last inspection 30/11/04 Brief Description of the Service: Rowan House is a large three storey older style house situated in a quiet area of Southampton. Only the ground and first floor of the property accommodate service users and the top floor is the private residence of the owner. The home is registered for sixteen service users within the category of older persons, however, service users are also accommodated with varying levels of dementia. The home is owned by Mr and Mrs Hurley, Mrs Hurley is also the registered manager. The home provides seven double and two single room accommodation and none of the rooms have en suite facilities. The home has a kitchen, dining room and lounge on the ground floor and all of these rooms are accessable to service users. To the front of the property is a small garden and car park and to the rear is a large and pleasant garden that is used by many of the service users living in the home. The home is situated close to local shops and a short car journey away from the city of Southampton. Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over 5 hours and the inspector was assisted by the homes staff. The inspector audited fourteen of the thirty eight standards the remaining relevant standards will be audited at the next inspection. The inspector spoke with the homes staff who remained professional throughout the inspection and they displayed their knowledge and awareness of the service users living in the home. The inspection involved a walk around the home and audit of the homes documentation relevant to the care and service it was providing. The inspector spent the majority of the inspection speaking to service users who commented positively about the homes staff and the care they received. Some concerns were raised regarding menus and activities and these comments have been included in the report. The inspector also had the opportunity to speak to three visitors to the home who all stated they were happy with the care their relatives and friends were receiving in the home. Visitors advised the inspector that they are always made welcome and that the home keeps them fully involved in the care their relatives receive. What the service does well:
The home provides a homely and welcoming environment in which service users are able to participate in. Several of the service users participate within the home and these service users advised the inspector that they enjoy it. All service users living at the home spoke positively about the home staff and stated that the staff are ‘lovely’ ‘caring’ and ‘will do anything for you’. These comments were confirmed by visitors, who stated that their relatives were very happy living in the home. Many of the staff working at the home are trained to NVQ 2 level and staff spoken to displayed a commitment to providing a high standard of care and support to the service users living at the home. All staff displayed an understanding of service user needs and their willingness to improve their practices. Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
Many of the issues identified during the inspection are due to the home not formalising its methods of discussions with service users. The homes manager speaks to service users daily and concerns addressed, however, the home does not hold service user meetings etc and therefore cannot evidence service user views and involvement in the home. The home is required to consult with service users and their representatives about the service they receive and want as part of a quality monitoring system. This was required at the last inspection and has been carried forward into this inspection report. The home is required to ensure all service users and their representatives have access to the homes complaints procedure. Many of the service users and three visitors that the inspector spoke to were unaware of how to make a complaint and the procedure which the home should follow. The home has changed the care plans since the last inspection, however, these do not appear comprehensive and many identified needs are not included in the care plans. The home is required to review and develop all service user needs into the service user plans. This must include risk assessments, which are to be incorporated into the plans. Two concerns relating to activities and meals were raised during the inspection by service users. Through observation by the inspector and discussions with staff these concerns were found to be justified. The home is required to review its arrangements for meals and the provision of activities. At the time of the inspection only three staff were on duty and this included the preparing of meals. Service users stated they were unhappy about staff not being available for activities and staff advised the inspector they would like to do more but did not always have the time. The home is required to review its staffing levels especially during meal times and for activites/leisure. Whilst the home has a small staff team, the home is required to implement a programme of staff supervisions. Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 7 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. Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5 Service users are given information are made aware about the service the home will offer, however, service users are not always given a copy of the homes service user guide. Three new service users have not been given a contract and therefore they are also not aware of the terms and conditions of their tenancy. All other service users have a contract. All service users are assessed prior to admission, however, these were basic and did not cover all areas needed to fully assess if needs can be met. Prospective service users and or their representative are able to visit the home prior to agreeing to move in. EVIDENCE: The home has had five new admissions since the last inspection. Three of these admissions were in the last few weeks. The inspector had the opportunity to speak to the three new service users and one new service users family. All service users and the family member advised the inspector that the proprietor had informed them about the services in the home and had invited
Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 10 them to visit the home prior to moving in. All service users and their families had visited the home and had been made to feel welcome. Three of the newest service users had not been given a copy of the homes service user guide, a copy of the homes complaints procedure or had a contract of terms and conditions at the time of the inspection. The inspector was informed that this was to be completed on the return of the proprietor. Two other new service users had copies of these in their files. The home is required to ensure all service users have a contract , terms and conditions of tenancy, a copy or access to the complaints procedure and service user guide. All new service users files contained a copy of Southampton City Councils assessment of needs and a copy of the homes own assessment. The home assessment included basic information, likes and dislikes and choices in lifestyles etc, however, these were basic and not all areas of needs had been assessed. The home is required to develop its admission assessment to include all care areas and to obtain additional information in areas already assessing. Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10 All service user plans are in need of review and development. Service users health care needs are met, following assessment by relevant health care professionals. Service users are treated with respect and dignity. EVIDENCE: The inspector audited five service user plans of which three were new service users. Three of the service user plans were found to contain basic information and included dressing, bathing, personal needs, eating, mobility and leisure. Two of the new service users had not got a care plan, however, these home was keeping good records in preparation for these to be completed. One service user is experiencing an issue with falls, this had not been included in the care plan and following a recent fall this also had not instigated a care plan. The home has not completed a risk assessment and implemented suitable controls for example supervision/support when walking. Furthermore, one service user is experiencing depression and information and care advice/practices had not been incorporated into the care plan.
Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 12 Staff spoken to were fully aware of service user needs, however, this was not supported by clear documentation. The home is required to review and develop all service user plans. All service users are afforded access to relevant health care professionals and service users are registered with a general practitioner of their choice. The inspector had the opportunity to speak to a visiting health care professional who advised the inspector that the home provides a good level of care and support to service users who require assistance. Service users spoken to confirmed that the homes staff, respect their views and the need for their privacy and dignity to be up held. Staff were seen by the inspector to knock on doors before entering and interacting with service users in an equal and respectful manner. Service users confirmed that they receive personal care in private and are able to receive treatments and consultations in their bedrooms in private. Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 Service users are able to choose their lifestyles within the home. The home does not provide suitable activities. Service users are supported in whom they choose to have contact with. All service users are supported if necessary with access to the community. The meal provided at the time of the inspection were not adequate and do not suit service users choice. EVIDENCE: Service users advised the inspector that the home supports their choices in what time the go to bed and get up, participating in the home, and accessing the community. Service users spoken to advised the inspector that the home provides some activities occasionally, however, these are rare due to staff being busy. The home does have books and some games available, but service users stated that they keep themselves busy by helping out in the home and garden. Some service users participate in the home feeding the fish, gardening and one service users helps with the preparation of meals and washing up.
Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 14 Many of the service users stated they would like more activities and examples of this is a game of bingo, watching a film and a sing song. Service users also stated they would like some outside entertainers. The home does not have a video and therefore films etc cannot be watched unless they are on the television. The home does have visiting church groups. This was discussed with the homes staff who stated that activities and entertainment could be better, but due to numbers of staff this was not always possible especially if a service user is ill. The home is required to obtain the views of service users on the forms of entertainment they wish and implement a programme of activities into the home. Service users who wish have personalised their rooms and some rooms contain service users own furniture and belongings. The home has a visiting policy, which affords and encourages visitors at any reasonable time. Service users confirmed that they are able to see visitors in private in their own rooms and elsewhere in the home if not in use by other service users. Three visitors to the home confirmed that they were able to visit when they wished and that the homes staff always made them feel welcome. Service users spoken to stated that the home provides good food most of the time, however, occasionally the meal is not always what they like. One service user stated they didn’t like fish but ate it because alternatives weren’t offered. Other service users confirmed that the home will offer a alternative if they don’t like it but you need to ask and during lunch one service user had an alternative meal. Menus seen displayed a well balanced and nutritious variation, which, the staff stated are based on service users likes and dislikes. Previous inspection indicate this standard is fully met and no issues with regards to food provided by the home have been raised. The inspector was present for the lunch time meal and it was noted to be very small portions for all service users even those with a good appetite. The home also ran out of food during the serving up and had to cook more food leaving service users waiting for their meal. This is unacceptable. The home is required to ensure all service users are provided with a meal of suitable size appropriate to their needs and that meals are based on service user likes and dislikes. Meal times were noted to be relaxed for those service users who can manage themselves. The home provides support for four service users who require assistance to eat. The inspector noted that their meal was placed in front of them for approximate 3-5 minutes before a member of staff could assist them. Service users where trying to help themselves with their hands and the
Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 15 inspector had to fetch the member of staff, who was also attempting to serve meals to the other service users in the dining room. The member of staff then assisted all four service users with their meals at the same time. This was deemed by the inspector as unacceptable. This was fully discussed with the staff in the home and advice on good practice for assisting people with eating was given. The inspector noted that whilst four people where being assisted, the staff spoke to the service users throughout the meal and were observant to their needs for respect and dignity. Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Service users are aware of how to raise their concerns about the home or the care they receive, however, service users and visitors advised the inspector they were unaware of a complaints procedure. EVIDENCE: All service users spoken to confirmed that they would speak to the homes staff if they had any concerns and that they were happy that matters would be addressed. In discussions with both the service users and visitors it was evident that they were unaware of the homes complaints procedure The home has a complaints procedure, however, on speaking to the homes staff they were unsure if this is on display and whether service users are given a copy. The home is required to ensure all service users and their representative have access to the homes complaints procedure. The home has a copy of Hampshires adult protection policy and have a whistle blowing policy. Staff advised the inspector that the home has undertaken CRB checks for all staff, however, staff files were not available due to the absence of the registered provider/manager. This will be audited at the next inspection. Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) NONE EVIDENCE: Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 30 The home does not provide adequate numbers of staff at all times. Staff are well trained and competent to do their jobs, however, this is difficult at times due to shortage of staff at busy periods in the day. EVIDENCE: At the time of the inspection staff working included two care staff and the deputy manager. One of the care staff was also preparing and cooking lunch. Staff advised the inspector that generally this is adequate, however, if service users are ill or something occurs in the home then it can be difficult to maintain the support required by service users. The home is required to review staffing levels in accordance with service user needs this must include meal times and for activities. The home must ensure that a minimum of two carers, are available at all times. This must be solely for care. Cleaning and cooking must be additional. The inspector had the opportunity to speak to staff, who confirm that they had contracts. The home has not employed any new staff in the last year and many of the staff have worked at the home for many years. Staff advised the inspector of the range of training courses they have undertaken and this included NVQ 2, moving and handling, basic food hygiene, fire, and health and safety. Staff stated that the home has planned training for September for first aid and dementia care, the home is also planning refresher courses for moving and handling.
Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 19 Staff advised the inspector that the homes manager is in the home every day and therefore can discuss and raise concerns when necessary. The staff do not have supervision sessions and the home does not hold team meetings due to the size of the team. Staff confirmed that the manager keeps them fully informed and that they are involved in the running of the home. The home is required to formalise its arrangements for staff supervision and that these must be documented. Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) NONE EVIDENCE: Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 2 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 1
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x x x x x x x Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 22 Yes 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. 5. Standard 7 27 12 30 36 Regulation 15 18 16(2)(m)( n) 18(1) 18(2) Requirement Review and develop all service users plans. Review staffing levels in accordance with service user needs and especially meal times. Following consultation with service users review and provide activities in the home. Implement staff training appropriate to service user needs. Implement staff supervisions for a minimum of six sessions per year. These must be documented. Service users must be provided with meals that are adequate in amount and meet their choices in menus. Implement a suitable quality monitoring system that takes into account of the views of service users and other stakholders of the home. Undertake, document and implement service user risk assessments Ensure service users and or their representatives are aware of the homes complaints procedure. Timescale for action 31/10/05 31/9/05 31/9/05 31/10/05 31/9/05 6. 15 16(2)(i) 31/9/05 7. 33 24 31/10/05 8. 9. 38 16 13(4) 22 31/10/05 31/9/05 Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Rowan House H55-H03 S11873 Rowan House V218563 180705 stage4.doc Version 1.30 Page 24 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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