Inspection on 19/12/07 for Rowan House

This inspection was carried out on 19th December 2007.

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

Other inspections for this house

Rowan House 04/07/07

Rowan House 26/09/06

Rowan House 24/10/05

Rowan House 18/07/05

Rowan House 30/11/04

Rowan House 17/08/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Rowan House 9 Darwin Road Shirley Southampton Hampshire SO15 5BS Lead Inspector Craig Willis Key Unannounced Inspection 19th December 2007 09:30 X10015.doc Version 1.40 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 DS0000011873.V356449.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 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 DS0000011873.V356449.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rowan House Address 9 Darwin Road Shirley Southampton Hampshire SO15 5BS 023 8022 5238 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) Mrs A Hurley Mr R 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 DS0000011873.V356449.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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. 11th October 2007 Date of last inspection Brief Description of the Service: Rowan House is a large three-storey older style house situated in a residential area of Southampton. The service is registered to provide personal care to 16 people in the older person, dementia and mental disorder categories. Up to three people can be accommodated from 55 years of age with mental health problems. Accommodation is provided on the ground and first floor of the property with a shaft lift that allows access to the first floor. Mrs Hurley is the registered manager. The home has seven shared rooms and two single rooms, none of the rooms have en suite facilities. They are all fitted with wash hand basins. The home has a kitchen, dining room/lounge on the ground floor and all of these rooms are accessible to people. There is a small garden at the rear of the service. The current fee charged is £335-£430 per week. Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The evidence used to write this report was gained from a review of the information the provider sent to us since the last visit, the previous key inspection report and the report of a random inspection that took place on 11 October 2007. This information included incident reports, an improvement plan completed by the provider and an annual quality assurance assessment. A site visit to the home was made on 19 December 2007. During the visit we spoke with people who live in the home, the manager and staff on duty. The communal areas of the building were viewed and documents relating to the running of the home were inspected during the visit. What the service does well: What has improved since the last inspection? There have been significant improvements to the way people’s medication is stored, recorded and administered. This means people are now supported to take their medication more safely. Complaints are now clearly recorded and people are confident any complaints they make will be taken seriously and investigated. The home has been greatly improved and now provides a clean, comfortable and safe environment for people. Staffing levels have been reviewed and there are now more staff on each shift. Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 Page 6 Some additional training has been provided to staff and more is planned. This will help to ensure staff have the right skills to meet people’s needs. Personal records are now being securely stored in locked cabinets. 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 DS0000011873.V356449.R01.S.doc Version 5.2 Page 7 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 Outcomes Statutory Requirements Identified During the Inspection Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems to assess people’s needs before they move into the home. This helps to assure people that the home will be able to meet their needs. EVIDENCE: One person has moved into the home since the last inspection. We looked at the records of this person during the visit. Before they moved into the home the manager assessed the person’s needs. There was also a copy of the person’s care management assessment and discharge notes from hospital. People are able to visit the home before they move in, to decide whether it is the right place for them. Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 Page 9 The home does not provide intermediate care and therefore standard 6 is not applicable. Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are treated well and their needs are set out in clear care plans, which help staff provide the right care and support. The medication systems have been greatly improved to make them safer, however, they would be further improved by the development of clear policies and procedures and more secure storage. EVIDENCE: We looked at the personal records of three people who live in the home during the visit. Each person had a set of care plans that set out how their assessed needs should be met. These care plans are reviewed every month and have been amended where people’s needs have changed. Since the last inspection risk assessments have been completed for specific risks people face, for example a moving and handling assessment or assessments for the use of bed Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 Page 11 rails. These risk assessments contain actions that should be taken to minimise the identified risks and are also reviewed monthly. People’s records demonstrated that they were supported to attend the health services they need, for example GP, nurse, chiropodist and psychiatrist. These records include any advice that is given by the practitioner. People spoken with during the visit said they were able to see their GP when they need to. We conducted a random inspection by a pharmacist on 11 October 2007 following concerns raised in the last key inspection about the safety of the medication administration systems. Following the random inspection we made additional requirements about hand written changes to medicine records, use of sticky labels on medicine records, the need for clear medication policies procedures, the need for a controlled drugs cupboard and controlled drugs register and the need for clear guidelines about when to give medicine that is prescribed to be taken ‘as required’. We inspected the medication storage and records again during this visit. The manager now completes a weekly audit of the medication records and storage to ensure the correct systems are being followed. All seven staff that administer medication have completed a basic medication administration training course provided by the home’s supplying pharmacist. The manager reported that she has booked all staff to complete a more in depth course through a local college from January 2007. This is a distance learning course and all staff completing it will submit their work for assessment. During the visit all medication was stored in a locked cupboard in the kitchen. No medications were left in bathrooms and all creams / ointments were labelled with the persons name and the GPs instructions. Everybody had a sufficient supply of medication they had been prescribed. The medication administration record for the current month was inspected and had been fully completed. This gave a record of medication that had been received into the home and administered to people. Handwritten changes to the medication administration charts are no longer made. The manager obtains letters from the GP where people’s medication or dosage changes. This is particularly important for the people who take bloodthinning medication as the dosage changes regularly. Sticky labels are no longer used on the medication administration charts to remind staff of the current dose of a medication that is required. The letter that is received from the GP in kept in the file with the medication administration charts so it is easy for staff to refer to. Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 Page 12 The manager has started recording controlled drugs in a bound book with numbered pages, with two staff signing when a controlled drug is administered and a running balance of the remaining medication recorded. Following discussions during the visit the manager will look at buying a purpose printed controlled drug register. There are now clear, individual guidelines in place for people who are prescribed medication to be taken on a ‘when required’ basis. Two requirements were made following the random inspection that have not yet been complied with as the time-scale for compliance has not yet expired. These are about the need for a controlled drugs cupboard and the need for clear, comprehensive policies and procedures for medication. The manager reported that a controlled drugs cupboard has been ordered and that she plans to develop new medication policies and procedures within the time-scale of 17 January 2008. These requirements are carried forward into this report. The manager also reported that she has not yet taken temperature readings of the medication storage cupboard, as was recommended following the random inspection, but will do so. This recommendation from the random inspection is also carried forward in this report. People spoken with said staff treated them well and respected them. During the visit staff were observed interacting with people who live in the home in a friendly and respectful manner. Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides good support to meet people’s social and cultural needs. Visitors are made welcome and people receive good food that they enjoy. EVIDENCE: Details of people’s social, cultural and religious needs were seen in the personal records we looked at. Most people spoken with during the visit said they liked the activities that are organised. One person said he didn’t like group activities, but preferred to spend time alone reading or talking to a friend. Activities organised include music and movement, games and visiting entertainers and singers. During the visit staff were observed spending time one to one with people who live in the home, chatting and providing emotional support. People are supported to practise their religion. The home has an open visiting policy and people spoken with said their visitors were made to feel welcome. During this inspection two relatives came to visit people. Comment cards were not sent out to relatives before this inspection; however, positive comments were received from relatives before the last Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 Page 14 inspection in July 2007. During this visit a number of Christmas cards relatives had sent to the manager and staff were viewed, many with positive comments about the care provided in the home. The home has a planned menu that provides a varied and nutritious diet. People’s specific dietary needs, for example due to diabetes, and likes and dislikes are recorded. The staff member who was working in the kitchen on the day of the visit demonstrated a good understanding of people’s dietary needs. People spoken with said they thought the food is good and confirmed they could have an alternative meal if they wanted to. Food was well presented and the mealtime was a relaxed, social occasion. Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems to respond to complaints and keep people safe from abuse. This gives people confidence that any complaints they make will be taken seriously and investigated. EVIDENCE: A requirement was made at the last key inspection that the manager must keep a record of all complaints and details of any investigation and actions taken. Three complaints have been received since the last key inspection, concerning staff conduct, care of a person who lives in the home and cleanliness of a bedroom. The manager had recorded all of the details of the complaints and the actions that had been taken. The issue regarding staff conduct had also been raised with adult services, who contacted the manager to discuss the concerns. The concern has been investigated by the manager and was not substantiated. The requirement made at the last inspection has been complied with. People spoken with said they were confident any complaint they made would be taken seriously and investigated. Staff spoken with said they had received training in protecting people from abuse and said they were aware of the home’s safeguarding procedures. Staff spoken with demonstrated a good understanding of different types of abuse, signs that someone may be being abused and how to report any allegations of Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 Page 16 abuse. The manager reported that further safeguarding training is planned for staff, although this has not yet been booked. Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has been greatly improved and provides a clean, comfortable and safe environment for people. EVIDENCE: Two requirements were made following the last key inspection, regarding the storage of equipment and unused furniture and repairs to the laundry room. Since the last inspection the manager has refurbished the laundry room, with new flooring and a new boiler. This means that there is no longer a washing machine in a storage area beside the kitchen that required soiled laundry to be taken through the kitchen. Problems with the supply of hot water to some of the bedrooms have been remedied. The manager has also removed unused furniture from the home, which was being stored in people’s bedrooms. At the time of the visit some hairdressing equipment was being stored in boxes in one Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 Page 18 of the bedrooms. The manager reported that she was in the process of clearing some additional space in the storage areas so this equipment could be moved. The requirements made in the last inspection report concerning the environment have been complied with. Since the last inspection new carpets have been laid throughout the home and all communal areas and most of the bedrooms have been re-decorated. New windows have been fitted on the south side of the building and the manager reported she plans to have new windows on the north side in the next year. The manager is also planning to build a conservatory and additional storage areas. People spoken with said they thought the works had made a big improvement to the home and had been done very well so there was minimal disruption. The home was clean throughout and there were suitable hand washing facilities in bathrooms, toilets, kitchen and the laundry room. Staff were provided with protective clothing, for example gloves and aprons, as part of the home’s infection control measures. Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 Page 19 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are good systems to check staff before they start work in the home and ensure there are enough staff working at any one time. This helps to keep people safe and ensure their needs are met. Planned improvements in the training programme will help to ensure staff have the skills to meet people’s needs. EVIDENCE: A requirement was made following the last key inspection that staffing levels must be reviewed to ensure there are sufficient staff to meet people’s needs. The manager reported that an additional 60 staffing hours per week have been provided following a review. This has provided dedicated staff in the kitchen and for domestic duties, leaving care staff to concentrate on providing care to people. Staff spoken with said they felt these additional staff had made a big difference to how the home operates. People who live in the home said they felt there are sufficient staff to meet their needs. This requirement has been complied with. Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 Page 20 At the time of the visit four staff held the National Vocational Qualification (NVQ) at level 2 or 3, one has nearly completed the award and four are due to start in January 2008. Three new staff members have been recruited since the last key inspection. The records of these staff were inspected and contained evidence of a Criminal Records Bureau (CRB) disclosure or protection of vulnerable adults list check and written references. Where a staff member had started work without a full CRB disclosure they were working under supervision and not providing any one-to-one care. Following the last key inspection the manager has bought an additional training package through a local college. This will involve distance-learning courses that are assessed. Staff have completed an infection control course and courses in medication, dementia and adult protection are planned. Previous training that staff have completed includes moving and handling, fire safety and dementia care. The manager has used a training company to map the skills of all staff and identify areas of learning needs that staff have. This is being used to plan future training. Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 Page 21 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is now being well managed and there are good systems to keep people safe and ensure personal information is kept confidential. EVIDENCE: The home has a registered manager who is also the provider. People who live in the home and staff spoken with during the visit were positive about the manager and the support they receive from her. The manager does not have the NVQ in care at level 4 or the registered manager’s award. The manager reported that she had intended to employ a deputy manager who would complete these qualifications, but this has not yet happened. Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 Page 22 The manager has ensured that all of the requirements from the last key inspection in July 2007 have been met and all of the requirements from the random inspection of October 2007 where the time-scale has elapsed have been met. There are two requirements from the random visit with a timescale of 17/1/08, which have not yet been completed. These requirements are carried forward into this report. The manager said she was determined to ensure that the improvements she has made since the last inspection are maintained. The manager has a plan of further improvements she needs to make and should continue to assess the performance of the home to ensure these are achieved. We looked at the personal financial records for two people who live in the home during the visit. The manager reported that she was an appointee for one person, with families and advocates acting on behalf of others. Records of all transactions are maintained and receipts are obtained for purchases. The money held for the two people checked matched the record. Money was individually stored in a locked cupboard. A requirement was made at the last inspection that all personal records of people who live in the home and staff must be securely stored to maintain confidentiality. During this visit all personal information was stored in locked filing cabinets. This requirement has been complied with. The manager reported that there is an on-going programme for servicing and maintenance of equipment. The records relating to the fire alarm, fire-fighting equipment, hoists and lift were sampled and confirmed the manager’s report. Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 3 3 Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Timescale for action Clear and comprehensive policies 17/01/08 and procedures for the receipt, recording, storage, safe handling, administration, selfadministration and disposal of medicines, specific to the home, must be produced. The advice of the supplying pharmacist could be sought to assist in this task. To have a Controlled Drugs cupboard, which complies with the Misuse of Drugs (Safe Custody) Regulations 1973, provided for the secure storage of any Controlled Drugs, including Temazepam. 17/01/08 Requirement 2. OP9 13(2) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000011873.V356449.R01.S.doc Version 5.2 Page 25 Rowan House 1 Standard OP9 All medicine to be stored at the temperature recommended by the manufacturer. To keep a record of the medicine storage area to confirm this. Rowan House DS0000011873.V356449.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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. 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