CARE HOMES FOR OLDER PEOPLE
Rowan House 9 Darwin Road Shirley Southampton Hampshire SO15 5BS Lead Inspector
Christine Walsh Unannounced Inspection 26th September 2006 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.V305815.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.V305815.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.V305815.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. 24th October 2005 Date of last inspection 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 owned by Mr and Mrs Hurley, Mrs Hurley is also the registered manager. 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 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 accessible to service users. To the front of the property is a small garden and car park and to the rear is a 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 DS0000011873.V305815.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The visit to Rowan House was undertaken by one inspector over two days. Mrs Hurley, the owner and registered manager assisted the inspector and was available on both days. As part of the inspection process the inspector met residents, staff and spoke with relatives, care managers and a general practitioner who regularly visits the home. In addition the inspector received comment cards from residents. What the service does well:
The service does well to provide a warm, friendly, welcoming and clean environment to live. Mrs Hurley’s philosophy is to treat people as if they are your family and to provide a family orientated lifestyle for the residents to live. This was reflected through discussion with and observation of staff who appeared to share Mrs Hurley’s philosophy. The home does well to ensure residents receive the medical and psychological assistance they need. The inspector received very positive comments about the home and the standard of care provided including the resident’s physical and health care needs and treatment from a local general practitioner and community psychiatric nurse (CPN). Both informed the inspector that they did not have` any concerns about the level and standard of care provided to their patients. A GP commented: “It’s one of the best homes in the area” A CPN commented: “The home always keeps us informed of any concerns they might have about a resident”. The home does well to ensure that residents are provided with choices about how they wish to spend their day, what they would like to eat and what activities they would like to engage in. One resident informed the inspector that he could get up and go to bed when he wished and staff supported him to do this. Residents were observed engaged in various activities from individual to arranged activity by staff. Residents were observed assisting with daily chores such as washing up and laying tables for lunch. Staff were observed to engage positively with the residents from making eye contact and smiling to assisting when required. However some residents were observed sitting for long periods of time without stimulation or engagement, this will be addressed in what the home could do better.
Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 6 The home does well to make its visitors feel welcome. The home was observed to receive a stream of visitors during the inspection, each was warmly received by staff and offered a drink and provided with information about the wellbeing of their relative or friend. The home does well to provide nutritious and well-balanced meals. The inspector received numerous positive comments about the high standard of food in the home and residents were observed to be enjoying their meals. Visitors to the home were overheard remarking on the smell of the food, one visitor said: “Dinner smells very good I am tempted to stay” A resident said: “The meals are very good here” The home does well to engage residents in structured activites and entertainment, encourage visitors and community participation and consider the residents rights, The home does well to provide a clean, bright and airy environment to live. The home is well maintained and regular improvements are made, recently the home has installed new kitchen work surfaces, which have a hygienic coating and installed solar panel for heating the water and the home. Bedrooms are predominately shared rooms, however the rooms are personalised and privacy screens provided. The bedrooms were viewed to be very clean with matching bed linen and clean soft towels which are replaced daily. The home does well to accommodate residents with mobility difficulties with equipment to support them to move around safely and a lift to access the first floor, however limited storage space compromises the resident’s safety and will be addressed in what the home could do better. During the two-day visit the inspector observed residents making use of the pretty private and safe garden. A children’s nursery is located nearby and the children could be heard playing in the garden. A resident who informed the inspector she loves nature, all animals and loves to see the birds in the garden was observed filling the birdbath. The home does well to appoint a dedicated staff team who are willing to undertake extra duties and ensure resident’s needs are met such as providing structured activity and supporting residents to attend planned hospital appointments. The staff were observed to work well together, organised, very busy but not harassed and importantly polite and respectful to residents, each other and visitors. Positive engagement and camaraderie and a relaxed atmosphere was observed throughout the visit. Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
The home has worked on the four requirements issued following the last visit to the home. However only two have been fully met and the other two require further work on them to complete the process. These requirements have not been re issued as repeated requirements but a further requirement identifying what further action is required. Staff confirmed that they now receive regular training and support and supervisions, however records show that these do not fully cover all areas of the support staff require. The outcomes for the residents living at Rowan House are generally very good and positive comments have been received from residents, relatives and other professionals, however following the inspection process it was identified that the home has failed to fully achieve in eighteen areas and has been issued with eighteen requirements and four recommendations. This, on reflection is down to the management of the home and its administration processes. Mrs Hurley must ensure as the registered manager that if she is to delegate administration tasks to staff who appear loyal and committed that she knows what they are doing by regularly reviewing practices and the homes documentation, such as the assessment process, developing and reviewing care plan documentation and medication administration. In these areas an inconsistent approach was found such as the standard of information held and the documentation used. Poor practices were observed in the administration of medication. A failure to ensure the residents’ needs are fully assessed and these identified needs or risks are developed into specific care plans the home could potentially place residents at risk of not having their needs met. Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 8 The placement of an inappropriate office in the kitchen compromises the resident’s confidentiality. Personal plans and other personal information had not been securely locked away and was easily accessible to all, including residents and visitors. Mrs Hurley must consider an alternative place to hold handovers and staff meetings to ensure discussions regarding residents are not easily overheard and ensure all information pertaining to residents are securely locked away. Mrs Hurley must ensure when obtaining information from the residents or relative that she considers the residents interests, hobbies, history and their cognitive and sensory needs in order that a person centered approach is adopted when planning activities and when supporting specific interests. The home must consider the residents and visiting relatives/friends privacy, the home currently does not have a private area other than residents’ bedrooms to entertain guests, (the majority of these are shared rooms). The home does well to provide residents with day to day choices and staff demonstrate that they respect and understand the rights of the residents, however further work is required to ensure that those residents with cognitive and sensory needs are supported appropriately to make informed choices. The residents and relatives are comfortable in approaching Mrs Hurley and the staff if they are unhappy or wish to make a complaint, however complaints must be appropriately documented identifying the nature of the complaint, action taken and the outcome. Mrs Hurley must ensure a professional approach is taken when receiving a complaint, deal with the issues and extract any learning. The home provides a warm and welcoming place to live, however its cluttered lounge, and warren of corridors and rooms places the residents at risk from falls and becoming easily disorientated. Therefore Mrs Hurley must consider how she can safeguard the residents from potential harm and assist residents to maintain their independence. The home does well to recruit dedicated and hard working staff, however Mrs Hurley must ensure that she has adequate numbers of competent skilled staff to meet and support the assessed needs of the residents at times when required. A full review of the residents assessed needs will assist in this process. Staff require support through training to meet the needs of the residents who present with specific health care or mental health needs such as diabetes and challenging behaviour. Mrs Hurley fails to fully protect the residents from the potential risk of harm by not undertaking a thorough recruitment process. Two newly appointed staff member’s documentation provided no evidence that required checks such as obtaining references, criminal record bureau (CRB) and protection of vulnerable (POVA) checks had been undertaken, an immediate requirement was issued in respect of this.
Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 9 Mrs Hurley demonstrates that she is a very generous and caring owner/registered manager, however Mrs Hurley must maintain a professional approach to the operation of the home. As identified in many of the paragraphs above Mrs Hurley must make herself aware of the day-to-day operation of the home and ensure staff are fully undertaking their roles and responsibilities, such as reviewing personal plans, auditing staff’s notes and practices and ensuring the views of the residents, relatives and professionals are acted upon. Mrs Hurley does well to ensure as far as feasibly possible the home is free from potential risks to the residents and staff, however Mrs Hurley must ensure all areas of the home are made safe such as removing wheels from storage boxes stored on wardrobes, safe access through the kitchen to the garden and safe access down into the garden. 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 DS0000011873.V305815.R01.S.doc Version 5.2 Page 10 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.V305815.R01.S.doc Version 5.2 Page 11 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 the following standard(s): 2 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home does well to undertake an assessment on prospective residents, however the home is advised to undertake a uniformed approach to documenting assessed needs. EVIDENCE: In order to establish the home’s assessment process the inspector tracked four residents’ personal plans, met with MH, spoke with a number of social workers and met with staff. The social workers with whom the inspector spoke with were very complimentary of the service and their approach to the assessment process. The home always asks for a local authority assessment and regularly attends reviews. Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 12 Mrs Hurley informed the inspector that she or a senior member of her staff will always meet with prospective residents and family members to assess their needs and establish the home can meet them. The resident will then visit for a day where staff will observe them and find out further information about them. However Mrs Hurley’s use of several types of assessment documentation does not allow a consistent approach to assessing prospective residents needs and could potentially place residents at risk from not having all their needs fully identified and appropriately assessed. The home must also ensure that the residents’ assessed needs in both the homes assessment process and local authorities assessment inform the residents personal plans i.e. continence needs. Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 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. The home does well to ensure residents receive the appropriate care and support with the personal and health care needs, however better administration and auditing of care records is required. The home’s medication administration procedures require reviewing to ensure residents are receiving the correct amount of medication at the correct time using the correct procedures. EVIDENCE: The inspector tracked four residents’ personal plans and met with staff to establish their understanding and knowledge of them. There was good evidence that care plans had been completed identifying some of the resident’s strengths and needs. However on viewing the plans the inspector observed that not all areas of need had a care plan informing the staff how to support them such as when a resident requires his inhaler, how to apply eye ointment or staff’s approach when a resident presents with challenging behaviours such
Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 14 as spitting tablets out. Although three of the four plans seen had moving and handling risk assessments one didn’t. Not all residents had risk assessments despite the inspector being informed of some residents who like to wander and evidence seen in daily notes that a resident had left the service without the knowledge of the staff and was brought back by the police when found on the other side of the city. A newly admitted resident did not have any plan in place, another resident whose needs had significantly changed had not had her plans reviewed to reflect her current level of need and care required. The inspector met with three staff who had mixed views on the use of and the current quality of the plans. One member of staff said she wasn’t involved in developing plans but did read them from time to time. In view of the inconsistent approach to developing and reviewing plans the residents are at risk of not having their needs fully and consistently met, therefore Mrs Hurley must review all care plans and is advised to ensure the documentation used is uniform and ordered so that staff can easily access information. As the registered manager Mrs Hurley must ensure she is fully aware of residents’ personal plans. The home does well to ensure residents physical and mental health needs are met. The inspector spoke with a general practitioner and a community psychiatric nurse (CPN), who were both complimentary of the service. “The residents are well looked after and the staff are very attentive” “The staff know what the concerns are and the residents are always ready for our visits” “If they have a concern about a resident they call us without delay” “Rowan House is one of the better homes I visit” It’s apparent the home has established good working relationships with visiting professionals, including chiropodists, opticians and dentists. If relatives are unavailable to support a resident to a planned hospital appointment then the home will make arrangements to support the resident, however this is not always possible for emergencies. This was the subject of a recent complaint, which Mrs Hurley has responded to. However Mrs Hurley is advised to develop a clear emergency procedure for staff and review the homes Statement of Purpose to include hospital visits and emergencies. The home must also ensure that it keeps clear and accurate records following the outcome of visits from visiting professionals.
Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 15 On the both days of the inspection the inspector observed medication being administered and viewed medication administration records. Poor practice was observed in the practice of administration to record keeping. Staff were observed administering medication without referring to the medication administration record and leaving medication unsupervised. This was brought to the member of staff’s attention who was observed the next day following correct procedures. The manager uses a blister pack system that is provided by a well known high street pharmacy, medication from blister packs must be consistent with the information on the records and be administered in date order. However there was evidence to suggest this had not been done for a small number of residents. Other concerns noted by the inspector were the failure to record fully the details of a homely remedy being administered to a resident on the administration chart and in the resident’s notes. There was no record as to why the resident required an analgesic and there was failure to provide written documentation of an alteration to a medication. On the second day of the inspection all areas of concern were identified and had been addressed, however Mrs Hurley is responsible for ensuring residents receive their medication as prescribed, therefore she must ensure staff are following correct procedures when administering medication. Mrs Hurley must provide further training for staff, request the pharmacist to audit the medication and carry out regular checks on medication to ensure there are no discrepancies. The home does well to respect the dignity and privacy of the residents, staff with whom the inspector met and observed showed kindness and respect to the residents and when asked knew the importance of privacy, dignity, offering choices and maintaining independence. However residents’ confidentiality is compromised by the office being located in the kitchen, residents’ personal plans are easily accessible and not locked away and discussions about residents are held in the kitchen. Mrs Hurley must lock all personal information away and consider an alternative place to hold discussions about residents in private. Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 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 does well to encourage the residents to participate in activities, access their local community, exercise choice and control over their lives and receive wholesome and well-balanced meals. However the home must consider the cognitive and sensory disabilities of the residents when providing activities and choices. EVIDENCE: Following the last visit to the home Mrs Hurley was required to improve activities. Over the two-day visit to the home the inspector observed residents engaged in a number of activities, including group and individual activities. Mrs Hurley has nominated a member of staff to undertake group activities several times a week these include board games. Another member of staff visits the home weekly to undertake armchair exercises and another regularly manicures and paints the ladies’ nails. Outside entertainers visit the home, as do the local clergy. When staffing permits residents are supported to go out to the local shops to purchase required items.
Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 17 Some residents were observed participating in their own activity such as colouring, reading the paper and watching TV. One resident was observed assisting in the kitchen and another bringing in the post. However when a residents was asked if they had plenty to do the resident replied, “I sometimes get bored” and comment cards identified some concerns from relatives who requested more activity. This was identified in quality questionnaire Mrs Hurley undertook earlier in the year. Mrs Hurley is advised to consider the interests, hobbies and previous occupations of the residents and consider tailoring activities around these. Over the two-day inspection the inspector observed regular visitors being made welcome in the home, offered refreshments, informed where their relative was and how they are. Comments received from relatives and friends stated that they are always made to feel welcome; “I never tell them when I am coming, I am always made welcome with a drink and home made cakes and mum always looks clean and tidy” However as identified above in section 19-26 environment some visitors have raised concerns regarding privacy and lack of space to have quality time with their friend or relative. A requirement has been issued in respect of this concern. Through the course of the visit, speaking with residents and staff the inspector established that the residents are supported to make day-to-day choices, however this appeared to be for those whose cognitive and sensory ability was not so impaired. The residents with whom the inspector met said they could choose when to go to bed, when and where to have their meals and what to where. “I go to bed very early because I like to get up early, the staff support me and bring me a nice cup of tea” The inspector viewed in a day care resident’s records a document requesting their likes and dislikes, how they like their beverages made, when they like to go to bed and get up? This is a valuable document and although has some relevance for day care residents it would be more beneficial for long term residents, however of the four files the inspector viewed not one had this document. Good practice would be to include this in the assessment process and have on file for long-term residents. The inspector observed staff informing residents that they will be having a bath and the residents did not appear to mind, however when staff were asked about daily routines and personal care the inspector was informed that the home carries out two to three baths a day or as required but no one could clearly answer if the choice of what day and when to have a bath was made by the resident. Mrs Hurley must ensure residents are consulted as to when and
Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 18 how often they would like a bath and accommodate their wishes as far as feasibly possible. Residents are provided with wholesome home made meals made with fresh foods. The home is well known for the good wholesome food it provides, the inspector received many comment cards and had discussions with residents and staff as to how good the food is. Even the GP the inspector spoke with said the food was very good. The daily menu is displayed in the dining room and anyone wishing to have and alternative can do so. Breakfasts are provided at the time of the residents choosing and the residents can choose from a range of savoury hot and cold snacks in the evening. The home caters for special diets and residents are supported to eat where required, however the home must consider good practice in providing staff with an awareness of healthy eating for those residents with diabetes. The home must also consider how they empower residents with limited cognitive and sensory ability to make choices. Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 19 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 the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an adequate complaints procedure and residents appear to know who to speak to, however the owner must takes steps to improve practices to avoid unnecessary complaints. The home must ensure residents in their care are fully protected from potential risk of abuse. EVIDENCE: On viewing evidence in records, comment cards, speaking with residents, relatives, staff and Mrs Hurley the inspector was able to establish that on the whole people knew who to speak with if they were unhappy about the standard of care. The inspector has received some very positive comments about the home such as: “ I have no complaints” “The staff are very kind and helpful” “The food is excellent” Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 20 The home has a complaints procedure that is clearly displayed in the entrance hall of the home. Staff with whom the inspector met were clear of their role when receiving a complaint from residents or relatives. Mrs Hurley informed the inspector that she is accessible the majority of the times if anyone wishes to discuss any concerns with her and staff can get hold of her in an emergency. The inspector was informed that a complaints logbook is situated in the entrance hall if anyone wishes to make a complaint and she views this from time to time. On viewing the complaints log it was found to be empty despite the home receiving a small number of complaints of which the Commission for Social Care Inspection had been made aware. Mrs Hurley is advised that it is not good practice to leave the complaints logbook in a public area as confidential information may be held. Mrs Hurley was informed that she is required to keep a log of all complaints, including the name of the complainant the nature of the complaint and how it was resolved. The home has been subject to two serious complaints in the last six months, which has brought into question how accessible and approachable Mrs Hurley is when receiving complaints. Mrs Hurley is advised to adopt a professional approach when receiving and dealing with complaints and take time to reflect what the home could do better to avoid similar complaints being received again. In addition to receiving two complaints one of these led to an adult protection referral being made to Social Services to investigate. Mrs Hurley demonstrated that she has undertaken the actions as agreed at the strategy meeting to ensure a similar situation does not occur again. The home has adult protection and whistle blowing policies and procedures and there was evidence of the local authorities adult protection procedures clearly displayed for staff, however Mrs Hurley is advised to change the details of the regulatory body from the National Care Standards Commission (NCSC) to the Commission for Social Care Inspection (CSCI) to avoid potential confusion. The staff with which the inspector met gave clear and decisive answers to what they would do if they suspected or witnessed abuse however very few staff have undertaken abuse awareness training led by the home other than in their National Vocational Qualification (NVQ) whilst at college. It is the responsibility of Mrs Hurley to ensure all her staff receives abuse awareness training. Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 21 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 the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service does well to provide a homely, well-maintained and clean environment for residents to live. However restricted space presents with problems for storage and places for residents to meet with relatives in private. EVIDENCE: Mrs Hurley provides a warm, welcoming and friendly environment for the residents to live. The residents with whom the inspector met said they were comfortable and were happy with the cleanliness and appearance of the home. The home has predominately shared rooms with two single rooms situated on the first floor, three double rooms are situated on the ground floor for those residents who have mobility difficulties or who could potentially place themselves at risk through wandering. A fully serviceable lift is available for residents situated on the first floor.
Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 22 The lounge is separated into four areas, one for dining and the others a seating area with a TV in each. The rooms are comfortably furnished with quality furnishings and the dining tables are dressed with clean linen tablecloths. Bedrooms are pleasantly decorated and beds are dressed with matching linen, which are changed daily if required. The bedrooms are individualised with personal effects and shared rooms are screened to preserve residents’ privacy. Mrs Hurley has a regular handy man who deals with day-to-day maintenance and repairs. He was observed to be busy on one of the days of the inspection repairing a lock and maintaining the garden. However contactors and Mrs Hurley carry out large pieces of work has recently had solar heating installed and new kitchen surfaces. In the very near future Mrs Hurley has plans to refurbish and decorate the downstairs bathroom. It cannot be denied that the home offers a very warm and welcoming environment for the residents to live, home from home, however its lack of storage facilities, places for residents to meet with relatives in private and office space compromises residents safety, choice, privacy and confidentiality. Mrs Hurley was required to remove unwanted and unused walking frames and wheelchairs from the lounge to minimise the risk of residents falling. This was done at the time of the visit, however Mrs Hurley must consider alternative places other than the lounge and residents bedrooms, (which are mostly shared) for the residents to entertain their visitors in private. Concerns regarding resident’s behaviours have been brought to the attention of the inspector and how this at times causes distress. Mrs Hurley must also consider the position of the office, which is currently situated in the kitchen as this compromises residents’ confidentiality. Mrs Hurley prides herself on the cleanliness of the home. The home has a designated cleaner three times a week who carries out general cleaning duties, however staff care are responsible for keeping the home generally clean and tidy. The home has adopted good infection control procedures and the staff are to undertake infection control training shortly. The home has good systems in place for laundering clothes, good quality products are used to launder clothes, clothes requiring hand washing are done so and when the weather permits all washing is hung on the line to dry and air through. Concerns regarding the unpleasant odour of one room and the upkeep of a toilet were brought to Mrs Hurley’s attention and dealt with immediately. Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home dose well to promote staff competencies through training, however the home must consider if it has suffient numbers of staff to meet the needs of the residents and undertake robust recruitment procedures to protect residents from potential risk of harm. An immediate requirement was issued in respect of the home’s poor recruitment procedures. EVIDENCE: Through observation and speaking with residents and staff the inspector observed residents having their needs and requests met to by dedicated staff. The inspector observed for forty-five minutes in the morning of the second day staff busily attending to the needs of the residents, although busy residents were attended to in a calm and relaxed way and staff did not appear rushed or hassled. The staff were observed to engage eye contact, smiling and talking with residents when they entered the lounge. Requests from residents were immediately tended to or the residents advised when the staff member could assist. The residents were not left alone for more than five minutes in any one period. Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 24 Residents were observed to be smartly dressed and well groomed, one resident was having her hair set by a member of staff and another member of staff came in on her off duty to undertake a half hour session on armchair exercises. This demonstrates the staff are dedicated and committed to ensuring the resident receive good care. However a recent complaint and several comments cards have identified concerns regarding staffing levels. The manager is therefore required to undertake an assessment of the residents needs, verses times of day and staff activity and adjust staffing levels accordingly. The home does well to promote, encourage and support staff to undertake a national vocational qualification. Mrs Hurley currently has five staff trained in NVQ 2 and four going to start this year and the deputy manager is hoping to commence NVQ4 soon. As part of the inspection process the inspector met with and viewed staff records. Three staff, with which the inspector met confirmed that they had completed an application, were interviewed and provided Mrs Hurley with reference details and identification in order that appropriate checks could be carried out. However when viewing the records of the two most recent members of staff the inspector established that Mrs Hurley had not undertaken robust procedures to minimise the risk of harm to the residents. Evidence showed staff commencing before references protection of vulnerable adults (POVA) and criminal records bureau (CRB) checks had been received. An immediate requirement was issued in respect of this and Mrs Hurley was required to ensure the residents were protected by taking appropriate action with the staff member concerned. Following the last visit to the home Mrs Hurley was issued with a requirement to ensure staff are suitably qualified to meet the needs of the residents. Mrs Hurley promotes and supports her staff to undertake regular training funded by the home. Staff confirmed that they receive regular training including mandatory training such as food hygiene, moving and handling and fire. There was evidence of staff receiving a full one-day course in dementia care and a working in care induction course distant learning run by Southampton City Council. Staff are to receive in the near future infection control and abuse training. However Mrs Hurley must consider training or providing information for staff on meeting the individual needs of residents who present with specific medical or mental health problems such as diabetes and depression. Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered manager demonstrates a caring and generous approach to the needs of the residents and staff, however must ensure she is fully aware of her legal responsibilities. The service undertakes to seek the views of the residents, staff and relatives however must ensure appropriate action is taken to ensure this is done in their best interest. The service does well to safeguard residents’ financial interests. The registered manager does well to provide staff with support, however further consideration must be given as to how effective the current approach is fully supporting the staff. Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 26 The service is taking steps to protect the health, safety and welfare of the residents and staff, however further work is required in this area. EVIDENCE: Mrs Hurley the registered manager demonstrates a very caring, trusting and generous approach to the care and support of the residents and her staff. Many examples of Mrs Hurley’s generosity and family orientated approach to care were observed through visiting the home and through seeking the views of the residents, staff and relatives. “Mrs Hurley really cares about the residents and the residents appear happy” Mrs Hurley has a loyal staff team who respect her as a person and the owner of the home, however through observation and discussion it was established that Mrs Hurley needs to improve her management skills and take time to reflect why things go wrong and how she can make improvements rather than dwelling than dwelling on her own feelings. Mrs Hurley does not currently hold a (NVQ) national vocation qualification 4, or registered managers award and is hoping to train up a senior carer to manage the home in the future, however in the interim Mrs Hurley must ensure senior staff are aware of their roles and responsibilities are given clear direction to do so. When asked what the home could do better the inspector was informed “One person in charge so things don’t get missed like care plans and medication”. Mrs Hurley would benefit from some form of management training, as the outcome for residents is the home is at potential risk of failing to deliver a consistent standard of care. Through discussion with residents, staff and seeking the views of relatives and visiting professionals the inspector established that the home delivers a good standard of care that meets the needs and wishes of the residents and those involved in the service. “The carers are very good” “It’s one of the best homes I visit” “They have done wonders with my friend” Following the previous visit to the home Mrs Hurley was required to undertake a quality review of the home, seeking the views of those involved in the home. Mrs Hurley has developed a questionnaire for residents, relatives and visiting professionals. The inspector viewed samples of these and positive comments Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 27 were seen. However there were a small number of comments made in respect of complaints and activity that require action by the home. Mrs Hurley was unaware that following the questionnaire that she is required to analyse the information and a develop an action plan and a report for interested parties including the Commission for Social Care Inspection detailing how she intends to improve standards and areas of concern. Therefore Mrs Hurley has been issued with a requirement to review the information, take action and provide a report to residents, staff, and relatives, visiting professionals and the Commission for Social Care Inspection. The home does not currently hold staff meetings as Mrs Hurley is easily accessible day and night, however a recent complaint and the outcome of Mrs Hurley’s investigation identified that not all staff are fully aware of the home’s polices and procedures. In order to avoid such complaints and to ensure staff are knowledgeable of the homes policies and procedures Mrs Hurley is advised to hold regular staff meetings and make herself aware of the National Minimal Standards for Older Persons and the Registered Care Homes Act 2000. Mrs Hurley does well to have good administration systems in place for supporting residents with their personal monies. Residents who are able to manage their own money are enable to do so and lockable storage is provided to safeguard their money and valuables. Money held on behalf of the residents is well accounted for. The inspector viewed the records and balances held for four residents and observed that all transactions had been clearly recorded, receipted and accounted for. However Mrs Hurley may wish to consider when asking staff if they have any issues about the home that this focuses on the residential home and not their personal home life, although there is no reason why personal issues cannot be discussed if they are relevant and could have an impact on the delivery of care. Staff with whom the inspector met said they felt well supported by Mrs Hurley but were not always clear of what her expectations of them are. Mrs Hurley demonstrates that she has the health, safety and welfare of the residents and staff in mind day to day. Mrs Hurley was required following the previous visit to the home to undertake environmental risk assessments on residents and staff. The inspector viewed a comprehensive environmental risk assessment that includes slips, trips and falls and individual hazards such as smoking and choking. However Mrs Hurley must ensure all staff are aware of the risk assessments and address the hazards the inspector observed during the visit, such as residents using the kitchen as a thoroughfare to the garden when hot meals are being prepared and served, residents accessing the garden via a large step and the potential hazard of storage boxes on wheels on top of cupboards could prove to the residents. A comment received from a resident revealed that disabled access to the garden would be desired. The inspector observed the lounge to be cluttered with wheelchairs and unused Zimmer
Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 28 frames causing a potential risk to residents, this was brought to the attention of Mrs Hurley who promptly acted upon the inspectors concerns. Mrs Hurley is advised that she must consider the potential risks and take action to minimise them. Mrs Hurley is aware of the new fire regulations that come into force on the 1st October 2006 and has completed a comprehensive fire risk assessment, guidance posters for residents and staff and is in the process of putting an easy accessible fire information pack together in the case of an emergency. Staff confirmed they receive training and the handy man confirmed that he makes regular checks on call points, emergency lighting and door closures. Service certificates for utilities and moving and handling equipment were not viewed on this occasion as Mrs Hurley provided written information prior to the visit that all service checks are up together. Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 29 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 2 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15 Requirement The manager must ensure residents identified in the body of the report as not having personal plans in place have them by the stated date. The manager must audit and review all resident’s personal plans. Care plans must clearly describe how the care must be carried out and must be informed by individual assessed needs. The manager must undertake regular audits of medication records and practices and request the pharmacist to undertake an audit of the medication records and practices. The manager must ensure staff are fully competent and trained to administer medication. The manager all records pertaining to the residents must be securely locked away when
DS0000011873.V305815.R01.S.doc Timescale for action 31/10/06 2 OP7 15 30/11/06 3 OP30 OP9 13 31/10/06 4 OP9 13 30/11/06 5 OP10 OP19 17 31/10/06 Rowan House Version 5.2 Page 31 not in use. 7 OP27 18 The manager is required to review staffing levels against assessed needs of the residents, times of day and staff activity, and ensure levels are sufficient. The manager must ensure staff are competent and skilled to meet the assessed needs of the residents who present with specific medical and mental health difficulties such as diabetes and depression. The manager must review the information gathered through the quality audit and forward a report detailing the actions to all residents and stakeholders, including the Commission for Social Care Inspection. Storage boxes on top of residents’ cupboards must be safely secured. Unused furniture and equipment currently stored in the lounge must be safely stored away at all times. The manager must undertake to minimise the risk of residents using the kitchen as a thoroughfare to the garden and accessing the garden safely. 06/11/06 8 OP30 18(1) 31/10/06 9 OP33 24 01/12/06 10 OP19 OP38 13(4) 31/10/06 11 OP19 OP38 13(4) 31/10/06 12 OP38 13(4) 31/10/06 Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 32 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 OP2 OP7 2 3 4 OP31 OP12 Good Practice Recommendations Mrs Hurley is advised to use a uniform approach to documenting the assessed and identified care needs of the residents. The registered manager is advised to undertake a course in management/running a business. The manager must consider how the home can empower residents with impaired cognitive and sensory to make informed choices. The registered manager is advised to seek advice from services providing information and support to those caring for people with dementia. Mrs Hurley must consider an alternative place/room for the office. The manager must consider how residents may meet their visitors in private. OP30 OP3 5 6 OP19 OP19 Rowan House DS0000011873.V305815.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Hampshire Office 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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