Inspection on 10/01/08 for Rowan House Care Home

This inspection was carried out on 10th January 2008.

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

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 Care Home 06/01/09

Rowan House Care Home 20/03/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Rowan House Care Home 4 Lower Port View Saltash Cornwall PL12 4BY Lead Inspector Megan Walker Unannounced Inspection 10:00 10 January 2008 th 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 Care Home DS0000069072.V352700.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 Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rowan House Care Home Address 4 Lower Port View Saltash Cornwall PL12 4BY 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) 01752 843843 01752 843843 rowan.house@virgin.net M & C Care Limited Pearl Corden Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is 20. 20th March 2007 Date of last inspection Brief Description of the Service: Rowan House is a care home registered to provide care and accommodation for up to twenty people who have care needs within the categories of Old Age, not falling within any other category (OP). The home does not have the specialist categories to provide care for people with significant dementia or mental frailty needs. The home does not provide intermediate care and it is not registered to provide nursing care. The home is located near the centre of Saltash overlooking the River Tamar. Some of the bedrooms have views over the river. Accommodation to include communal areas and bedrooms is on the ground floor with bedrooms also available on a lower ground floor and second floor. Access to the lower ground floor bedrooms and second floor bedrooms is by the use of a stair lift if required, although there are two steps to negotiate without this facility. Sixteen of the home’s bedrooms are single and two of the bedrooms are registered as double rooms. The home has a garden with seating available and car parking is available in the grounds of the home. The current scale of charges ranging from £350.00 to £400.00 according to individual assessment of care needs. Additional charges include hairdressing, chiropody, toiletries, newspapers, magazines, journals etc, all charged at commercial rates. All charges’ information was provided to the CSCI in January 2008. Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a Key Inspection. The fieldwork part of this inspection was unannounced and took place on Thursday 10th January 2008 between 10h30 and 16H30. This visit included talking to six people who live at the home and three staff. We observed interactions between the staff and the people using this service. There was also a tour of the premises, and inspection of care plans, staff files, medication and other records and documentation. The Registered Manager was present at the time of this visit. She was able to provide relevant information such as the day-to-day routines as well as the management of the home. In addition other information used to inform this inspection: • The Commission for Social Care Inspection (CSCI) has introduced a legal document called an Annual Quality Assurance Assessment (AQAA). This is sent to all service providers for them to provide us with information about the provision and quality of their service, as well as how people using the service are involved in deciding what and how the service is offered and provided. This was returned to us completed by the Registered Manager. • The previous inspection report • All other information relating to Rowan House received by the CSCI since the last inspection. • “Have Your Say About Rowan House” Care Home Surveys were sent out and the CSCI received feedback and comments from – • 0 people using this service • 8 Relatives • 0 Staff • 0 Care Managers • 0 Health/Social Care Professionals in contact with the home Seven requirements and six “Good Practice” recommendations were made as a consequence of this inspection. What the service does well: Rowan House provides a comfortable environment for people who are mobile, mentally well and require twenty-four hour residential care for reasons of old age, and no other reason. Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? Since the last inspection there has been extensive refurbishment and redecoration both inside and outside the building, improving the living environment of the care home for the people who use this service. (See An additional medication storage cabinet has been installed so staff no longer “pot up” morning medication. Environment) What they could do better: Care plans could be more person-centred and include risk assessments relevant to individuals rather than a general risk assessment. (See Health and Personal Care) The CSCI believes that more could be done to improve older people’s lifestyle when they move into a care home. There was little evidence of the staff actively promoting people’s interests and hobbies or enabling people to take up new interests. Working practices were very task-orientated caring for a group of people rather than for individuals. (See Daily Life and Social Activities) Staffing levels are poor and put the people using this service and the staff caring for them at risk. (See Staffing) Robust measures must be put in place to ensure that all staff employed to work at the home understand that they have a duty of care to the people using this service. They should ensure their work practices protect the people using this service from harm by health and safety practices and hazards including fire safety risks that at the time of this visit were putting them at risk. (See Environment and Management and Administration) Only one accident has been reported to the CSCI since the home has been under new ownership (January 2007). This was also recorded in the home’s Accident Book. This is a matter of concern as it indicates that staff may not be recording accidents either by people using this service or staff members themselves. (See Management and Administration)) 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 Care Home DS0000069072.V352700.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 Care Home DS0000069072.V352700.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): 1, 2, 3, 4, 5 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People choosing to use this service and their families can feel confident that their needs will be assessed before moving into the home and that they can have the information they need to make an informed choice about where to live. EVIDENCE: Anyone considering moving in to Rowan House is offered an informal tour of the home and an opportunity to talk to people using the service. This may include a visit to the home for the day. Rowan House also provides a domiciliary care service and day-care for people living in the local community. This has been advantageous for people seeking residential care as they already know of the care home. Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 9 A copy of the home’s Statement of Purpose (also called a brochure) and scale of care fees are sent to all prospective residents. The Service User’s Guide (a booklet/brochure explaining the terms and conditions of living in the care home including how to make a complaint), is also given to prospective residents. We looked at a copy during our visit. A few things needed updating since the change of ownership of the care home and The Registered Manager agreed to do this. We looked at a sample of care files and found the Registered Manager or a senior staff member had completed assessments of care needs. This was a tick box style list rather than a person-centred individual care assessment. In some cases there was also an assessment by a social worker on behalf of the local authority that was funding the placement. Everyone living at the home received a Licence Agreement stating the terms and conditions of residence at the home. This was renewed annually and included any fee increase. After the pre-assessment and visit(s) to the home, the Registered Manager said that she would confirm an offer of a place at the home verbally. We suggested that it could be helpful to prospective residents and their families if they were sent a letter offering a place at the home confirming the care home is able to meet her/his needs with regard to the assessment of her/his care needs, as well as the bedroom number, the fee and a moving in date. On the day of this visit there was an emergency admission however the Registered Manager confirmed that this was not usual practice. Rowan House Care Home DS0000069072.V352700.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): 7, 8, 9, 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The personal care that people receive meets their individual needs if they are mentally well and able to communicate their preferences. The principles of respect, dignity and privacy are generally put into practice. EVIDENCE: We chose five people, both men and women, to look at their care files and care generally because they were, for example, people with more complex needs (such as health care needs), and/or people with changing needs. Each care file seen had a photograph of the person whose file it was, an assessment of care needs, and a care plan that was reviewed monthly by the Registered Manager. There was a generic risk assessment on each file however there was little evidence of person-centred care planning. People had signed their care plans. Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 11 The daily records were brief and mainly reported about bodily functions, including blood sugar levels to monitor diabetes. There were no personal support plans to inform staff what action to take in the event bood sugars were too high/low. Records of people’s weight were seen. In one instance there was guidance for staff about monitoring a person’s weight because this was identified in the pre-assessment, as a care need. However on the other files although weight was recorded, there was no evidence that weight changes were being monitored. No social histories were seen on the care files provided to us. There was little information about people’s preffered activites or their interests. Feedback we received from some families spoke highly of the support their relative had received from the staff and felt they were well cared for at Rowan House. Others said that it could be difficult to find out information about the care and welfare of their relative. They said they were not included in care plans reviews or told about any changes to their relative’s care plan. Some relatives were unclear about arrangements for hospital appointments. There was nothing in the Service Users’ Guide or contract explaining this practice. The Registered Manager explained that usually the family would be asked to take their relative. If this was not possible then a staff member would be called in to escort the person to the appointment if they were unable to go alone or preferred to have someone with them. We looked at the recent staff rota and this showed extra hours staff had escorted people to appointments. Medication was seen kept in a lockable trolley tethered in the dining room. Controlled medication (when there was a need although there was none at the time of this visit) was also kept in a separate lockable box in this cupboard. An additional medication cabinet had been fitted to a wall on the lower ground floor to store morning medication. This meant that staff could administer these medications to the people in bedrooms on this level directly each morning. Medication was dispensed in colour-coded blister packs. Any medication that was dispensed separately was clearly marked with the person’s name. The medication records and blister packs did not have a photograph of the person for whom the medication was intended. At the time of this visit the kitchen ‘fridge’ was used to store eye drops. The Registered Manager was advised that all medication requiring a controlled temperature, in compliance with pharmaceutical guidelines for medication, should be kept in a separate lockable ‘fridge’. Locks were provided so those people who wished to lock their room could do so. There were agreements for keys on people’s care files. There was no evidence about the type and use of door locks for bedrooms to form part of individual care plans. When we toured the building we found that all the bedroom doors were unlocked and several were propped open with a door wedge. The door locks were ‘Yale’ type locks so required a ’master’ key to open them in the event of an emergency. Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 12 During this visit we observed that staff were respectful towards the people using this service. Feedback we received from some relatives indicated that some staff were disrespectful and their attitudes towards the people using this service could be improved. Rowan House Care Home DS0000069072.V352700.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): 12, 13, 14, 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who are independent find the lifestyle offered in the home matches their expectations and preferences and satisfies their interests and needs. People are supported to continue to enjoy familiar supportive relationships with family and friends. There is no choice only a selection of alternatives offered at mealtimes. EVIDENCE: Throughout this visit people using this service were seen either in one of the two lounge areas or in their bedrooms. They told us they could come and go as they wished. We also saw families coming into visit people in the home. Everyone we spoke to was complimentary about her or his room. They told us that they were comfortable and bedrooms we saw were personalised with the occupant’s own possessions arranged as each individual preferred. Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 14 The feedback we received from relatives about improvements in the care home was varied however the main theme was about low staffing levels and staff attitudes towards the people using this service that contributed to the lack of activities: “Offer the residents more stimulation with activities, visits out.” “Mental stimulation for residents would be a benefit. Also some form of physical exercise i.e. massage of hands and gentle joint movements.” “Employ more staff and staff who actually want to be there…” During this visit observation of interaction between the staff and the people living at the home saw the staff mainly assisting with daily living activities such as assisting to and from the dining room. There was very little engagement in ‘chit-chat’ with the residents or encouragement for peer interaction either. There was no evidence of people being actively encouraged in their personal interests or hobbies and there was little information about this recorded on individual care plans. On the day of our visit the televisions were on all day in both lounges. In the smaller lounge it was loud and the people in this room were watching it. In the other room people were seated around the room and the television was on in the background. The picture was not in focus and the colour was too bright so images were unclear. The arrangement of the chairs in this lounge was prohibitive for some people to watch the television comfortably because the chairs were at a right angle to the television. The room is rectangular and long in shape so those people who chose to sit at the far end were also disadvantaged in being able to see the television because it had a small screen. On our arrival the Registered Manager was printing puzzles from an activities’ programme she has bought for the home. She explained that these were for an in-house activities’ session the following day and this was something she did weekly. One person told us that the previous day a choir had been in to sing. The Registered Manager confirmed that there was weekly midweek entertainment provided by external contractors. The Registered Manager sent out a quality assurance survey to everyone living in the home in May 2007. People had asked for trips out in the home’s minibus. The Registered Manager confirmed that there had been a few trips last summer and that as soon as the weather improved these would be restart for anyone interested in going out. Rowan House is not specifically a faith-based care home however it maintains connections with local churches. People who wish to may share in a short service of Holy Communion at the home once a month. The home celebrates the Christian festivals of Christmas and Easter. At the time of this inspection everyone living at Rowan House was reported in the AQAA as being White, British and Christian. Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 15 Generally the people living at Rowan House who we asked were complimentary about the food they were provided. All the meals are cooked on the premises. There is a four-week rota of menus. There is one main course at lunchtime, however there are several alternatives each day. Dietary needs are catered for, as are individual likes and dislikes. Local shops in Saltash supply all fruit, vegetables and meat. The cook said that she used seasonal fresh vegetables whenever possible, and she would supplement this with frozen vegetables when needed. People were able to choose if they ate in the dining room or in their rooms. The night staff were responsible for breakfasts. This means the people who choose to have breakfast in their bedrooms are taken it at 08H00, and the others could come down to the dining room for breakfast at 08H30. Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People using this service and their families/representatives need to feel confident that any complaints or concerns they raise will be taken seriously and acted upon by the staff and the management team. EVIDENCE: Since the last key inspection the CSCI has not received any complaints about Rowan House and the home has received one. The surveys that were returned from relatives were mixed opinions about making a complaint. In response to “Do you know how to make a complaint…?” two people ticked ‘No’, and one person ticked ‘Don’t know’ Four people ticked ‘Yes’ they knew how to make a complaint, however one person wrote that they felt unable to complain on behalf of their relative who lived in the care home. Two other people made similar inferences in their comments about the attitudes and behaviour of staff that, in their opinion, would be less tolerable to “a younger generation”. They did not feel confident that they were taken seriously on occasions they had raised concerns about the care of their relative. One person described their experience of making a complaint as “met with flippant disregard”. The Complaints Procedure is in the Service User’s Guide, a copy of which was seen during this visit on the notice board in the hallway. It is also included with Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 17 information given to people considering moving into Rowan House. The Registered Manager was advised that prominently displaying the home’s Complaints Procedure could improve people’s access to it. The Registered Manager told us that training was planned for herself and the staff so that they would feel confident to deal with concerns and complaints as they arose, and to identify poor practice for themselves. This was also stated in the AQAA – ‘How we have improved in the last 12 months’: “With continual training and reviewing our skill development in no secrets and POVA” [This refers to protecting vulnerable adults by being able to recognise physical, emotional and financial abuse, and institutional abuse.] ‘Our plans for improvement in the next 12 months’: “With continuing with training and awareness for all signs of abuse; and encourage whistle blowing if it is necessary.” Also in the AQAA it says that the service has improved in the past twelve months because the Registered Manager has changed her hours of work since the last key inspection “to make it easier for service users, advocates and staff to liaise with management”. Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 18 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): 19, 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Peoples’ private accommodation was personalised with their own possessions around them , however health and safety measures must also be attended to, to ensure that it is a safe home for people to live in. EVIDENCE: Since the last key inspection the Registered Provider has started an extensive programme of refurbishment throughout all the shared areas of the home. On the day of this visit redecoration had been finished in the lounges and the Registered Manager informed us that the pictures would be put back up on the walls in the near future. The Registered Provider has subsequently informed us that he has purchased new pictures and the people living in the home have been involved in deciding where pictures should be hung. The Registered Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 19 Provider has also told us in writing that a representative of a furniture company came to Rowan House so residents and staff choose from a selection of samples. He confirmed that decisions about the colour and design of all the new furniture took into account “appearance, practicality, safety, and ability to do the job”. The Registered Provider also told us that he discussed his plans for refurbishment with several of the people living at Rowan House, and generally he has tried to be as inclusive as is practicable with a large group of people. There were several matters of concern regarding health and safety and fire safety risks that we found on our tour of the premises – • Free standing portable radiators/fan heaters in bedrooms and corridors, one of which was also blocking a bedroom door. Freestanding portable heaters present a risk to the people using this service and to the staff. Heaters should be fixed to prevent injuries should they be accidentally knocked over. • Hot water taps were not regulated (water temperature went off the end of the thermometer in some rooms). There were no written risk assessments for individuals who may harm themselves with boiling water. • Fire doors wedged open. This puts people at risk. This would invalidate the home’s insurance policy in the event of a fire. • Bedroom doors wedged open. This puts people at risk. This would invalidate the home’s insurance policy in the event of a fire. • Bedroom doors did not have fire safety closures fitted so people would be at risk in the event of a fire in the home. • Some windows were locked so there was no means of natural ventilation. No key was evident near any of these locked windows and they did not look as though they had been opened recently. • No lockable cupboard was in use to store hazardous substances. There were no written risk assessments for individuals who may harm themselves because they do not recognise such products as dangerous or harmful. The Registered Manager informed us that the fan heaters had been an emergency provision Christmas Eve due to a central heating problem. She intended that all these heaters would be boxed up and put away in storage for emergency use only. The Registered Provider has subsequently confirmed that this has been done. The Registered Manager informed us that a new boiler was being fitted and the hot water taps would be regulated as part of this job. The registered provider has subsequently informed us in writing that it is not the homes policy to have bedroom wash hand basin hot taps regulated. He confirmed that each person living in the home would have a personalised risk assessment with a monthly update on the home risk assessment, including using a hot water tap. Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 20 The Registered Manager told us that the night staff wedged open the bedroom doors so they could hear people during the night if they needed assistance. This did not account for why the doors were wedged open at the time of this visit that was during the day has all the occupants for these rooms were upstairs in the lounges. The Fire Safety Plan for Rowan House states: “SELF CLOSING DOORS …Shall not be provided with any means of keeping them in an open position. AUTOMATIC RELEASES Self-closing doors fitted with automatic releases specified in the plan shall not be provided with any means of keeping them in an open position. THE DOORS TO BE CLOSED AT NIGHT AND WHENEVER THE PREMISES ARE UNOCCUPIED.” Wedging doors open is a matter of serious concern because it puts people using this service, visitors to the home, and staff at risk should there be a fire at the home. The Registered Provider has subsequently told us that automatic release devices were being fitted to these doors. The Registered Manager told us that the staff had keys for the windows and that people lock their windows in their rooms. We were unable to verify this with either the people whose windows were locked, and/or any staff members. The cleaning products and other hazardous substances were seen stored in the laundry room. The Registered Manager did not feel that it was necessary to lock these products away because only staff went into the laundry room. The laundry room is accessible from the courtyard at the back of the home or through an internal door near bedrooms. The Registered Provider has subsequently sent us a copy of the redecoration and maintenance programme for 2008. This confirmed that a new television aerial system had been fitted for the whole house, and hot water tap regulators would be fitted in residents’ bedrooms as required by individual risk assessments. The redecoration programme continues with upgrading of bathrooms and toilets, and bedrooms in consultation with residents and their preferences. The Registered Provider plans to provide en-suites and a conservatory as part of the long-term refurbishment plans, 2009-10. Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 21 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): 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. Staffing arrangements are not robust enough to assure people that suitable and competent staff that can meet their existing and changing needs will look them after. EVIDENCE: On the day of this visit on duty in the morning there was the Registered Manager and two care assistants. In the afternoon there was one care assistant. There were also a domestic assistant who worked part time (10h0016h00), and a cook, who also worked part time (09H00-14:00). The care assistant was reliant on the domestic assistant for help during the afternoon. In total the numbers of staff employed to work at Rowan House according to the staff rotas and the AQAA were eleven care staff, two cooks, two domestic assistants, a ‘handyman’, a Deputy Manager (nights) and the Registered Manager (days and on call). The majority of the staff worked part time, between fifteen to thirty-two hours per week. The Registered Manager showed on the rota as working forty-four hours over five shifts. The Deputy Manager was shown on the rota as working 55hrs over three shifts each week. This exceeds the European Working Time Directive of forty-eight hours, including overtime, in any seven day period. Staff may choose to opt out of this and Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 22 work more hours however there was nothing on any staff files or in staff contracts to show they had been offered and agreed to in writing this “opt out” agreement. The staff rota showed two senior carers worked alternate nights, having started work late afternoon (tea time) and finishing at 09:00 (after serving breakfast). These staff were therefore working, on average, sixteen hours each shift. It was unclear from the rota whether the senior care assistant or the deputy manager was the “sleeper” over night (only one carer is awake at night). The Registered Provider has subsequently informed us that he was reviewing staff hours of work generally, including cover at night. At the time of this visit there were in total eighteen residents and one person at the home for day care. Two other people came in one day a week for a bath and lunch. Three people living in the home chose to stay in their bedrooms during the day, and one person was in bed for health reasons. Two people were dependent on two staff to assist them with their care. There was an emergency admission during the afternoon of this visit, and the Registered Manager had a pre-arranged meeting also in the afternoon. This left one care assistant and the domestic assistant to look after the residents and their visitors in the two lounges, and the four people in their bedrooms, prepare and serve afternoon drinks, finish domestic tasks including the laundry, and prepare the bedroom for the emergency arrival. The domiciliary care agency supervisor, because at the time of this visit was sharing the office with the Registered Manager hence working from the office at the time of this visit, assisted these staff as well dealing with her own domiciliary agency managerial tasks. Relatives commented in their surveys: “I would say everyone has a blanket approach dealt to them & no individual needs are met. “ “I reassure [my relative] that Rowan wont close but it would be far better if the staff were not under such pressure” “More money to pay higher calibre of staff but at present O.K. if not too many problems.” We requested to see a selection of personnel files including the most recently appointed staff as well as people who had worked at the home for some time. On each of the four files we looked at in detail three had an application form but only two had dates of employment. One file had no references. Only one file had a police check, and none of them had a POVA check (a check to ensure that people being employed to work in the care sector are not named on a list of people who are not allowed to work with vulnerable people). The registered provider has subsequently provided us with a list of each member of staff currently working at Rowan House with their police check reference number. There were records showing these staff members had regular fire safety training with a full training session due in January this year. The Registered Manager told us that training was arranged for care staff later in January on Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 23 the Mental Capacity Act, and on Dementia Care. There was, however, little evidence on the files we looked at to show that staff had any training specific to the needs or conditions of people living at the home (such as the aging process or conditions of old age, sensory impairment, diabetes, strokes, etc), to ensure they could meet peoples’ current or changing needs. The AQAA showed 50 of all staff were working towards a National Vocational Qualification (NVQ) in Care, Level 2 or above. Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 24 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): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health, safety and welfare needs to be pro-actively promoted by a competent and capable manager who is keen to raise standards and achieve positive outcomes for people using this service and the staff working here. EVIDENCE: The Registered Manager, Mrs Pearl Corden, has worked at Rowan House for twenty years. At the time of this visit she had three units left to complete on the Registered Manger’s Award. She hoped to complete this by February 2008. She had changed her working hours to meet the recommendations of her registration. The Registered Manager therefore works Monday to Thursday Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 25 08h30 to 17H030 and 08H30 to 16H30 on Fridays. A senior carer covers her previous night sleeping duties. Mrs Corden is also the named Registered Manager of the domiciliary agency. This is due to change in the near future as the agency has expanded rapidly so needs to be managed independently from the care home by its own Registered Manager. The Registered Manager confirmed that there was low staff turnover. This, in her opinion, was beneficial to the people using this service. Inspection of the staff rota showed low staffing levels that would make it difficult for any new staff to work in a supervised capacity until all checks were complete and good. Also, as care staff are expected to carry out domestic tasks that take them away from caring for people using this service, the staff rota and what we observed on the day of this visit, indicated that insufficient numbers of staff were on duty to guarantee residents’ safety and well-being. An assessment of potential risks in the environment such as water temperatures and trip hazards had not been completed. The risk assessment highlighting fire safety did not cover all areas of the home or the use of door guards. In the event of a fire, people using this service, staff and visitors to the home were at risk due to the use of door wedges. At the time of the last key inspection the Registered Provider was visiting the home weekly. Over recent months the CSCI has received “Regulation 26” reports (i.e. reports of visits by Registered Provider) that support and show evidence of at least monthly visits. A completed AQAA was received by the CSCI, completed by the Registered Manager. The AQAA was a general overview of the service provided at Rowan House. It did not provide adequate evidence to support the statements written about the service and plans for improvements over the next twelve months. People using this service are encouraged to make their own arrangements for the safekeeping of their money with the support of their friends/family/representatives. The monies held on the premises were secure. We did a random check and all were correct with records and receipts in respect of all financial transactions. Only one incident affecting the health, safety and/or well being of people using this service has been reported in the past year to the CSCI as required by Regulation 37 of the Care Homes Regulations 2001. The Registered Manager confirmed this was correct. We inspected the Accident Book and found it was empty. The Registered Manager said that the owners had taken the old book elsewhere. It was unclear from this discussion whether the staff and the Registered Manager were completing the Accident Book in accordance with the Health and Safety Executive guidance or if it was being completed at all. Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 26 Regular fire practices were recorded as being done at the home. There was a however a lacklustre approach by staff to fire safety in their use of door wedges and other objects to block open doors, and windows were locked without easy access to a key. The Registered Provider has subsequently informed us that he is reviewing the Fire Safety Risk Assessment for the care home. He plans to employ a Fire Safety Consultant who will be responsible for completing this. The Registered Provider has confirmed to us in writing that this work will commence on 8th May 2008. There was no identified lockable cupboard for storing hazardous substances. These were kept in the laundry or in the kitchen, both of which were accessible by anyone. Notices were stuck on cupboards around the kitchen and laundry about health and safety. There was little evidence to show if information was regularly reviewed and updated, and that staff were informed of these updates. Although the “Safer Food, Better Business” (Food Agency and Environmental Health regulations) diary was being used the ‘fridge’ and freezer temperatures were recorded elsewhere. These were found to be out of date and there was no daily record. The Registered Provider has subsequently met with us since this visit to consider a number of the areas of poor practice identified during this visit. He has been pro-active about putting in place measures to resolve areas of concern regarding the health and safety of the people using this service. Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 27 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 3 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 4 X X 2 Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 28 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 OP19 Regulation 23(4) Requirement The Registered Person must ensure the following: • Doors must not be wedged or held open with anything other than an automatic fire safety guard. All rooms must be assessed as part of the home’s fire risk assessment. If the risk assessment shows that the door of a room is preferred open, appropriate fire safety automatic door closures that comply with the home’s fire alarm system must be fitted. Action must be taken to minimise any other risks identified during the assessment of rooms for fire hazards. People must be able to open their bedroom windows to allow natural ventilation unless there is a risk assessment supporting that this option is unsafe. The Registered Person must review the current staffing ratios for any risks it presents to residents, and take any action to DS0000069072.V352700.R01.S.doc Timescale for action 29/03/08 2 OP19 23(2)(p) 29/02/08 3 OP27 18(1) 29/03/08 Rowan House Care Home Version 5.2 Page 29 4 OP27 18(1a) Sch4 (6e) 5 OP27 18(1)(A) 6 OP38 37 12 13 7 OP38 13(4a,c) minimise any identified risk for people using the service and for staff. The Registered Person must ensure that on duty at all times there is a sufficient and suitably qualified, competent and experienced skill mix of staff appropriate to meet the assessed needs of the residents at all times. The Registered Person must review the current staff deployment in the care home. Any identification of care staff undertaking too many different tasks during any one work period, and thereby compromising the care and safety of the people using the service, action must be taken to ensure this is minimised. The Registered Person must assess the current practice of having only one care worker awake when on duty in the care home overnight for any risk it presents to people using this service, and take action to minimise any identified risk. Accidents and incidents must be recorded and the Registered Person must inform the CSCI of any incident that affects the health, safety and welfare of the residents. Hazardous products must be stored in a locked cupboard when they are not in use to ensure unnecessary risks to people using this service are eliminated. 29/03/08 29/02/08 29/02/08 29/02/08 Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 30 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 OP4 Good Practice Recommendations In addition to giving a copy of the Service User’s Guide and Terms and Conditions of Residency, the Registered Person should confirm in writing to the prospective service user that the care home is able to meet her/his needs with regard to the assessment of her/his care needs. The Registered Person should ensure that all care plans are person-centred, identify individual care needs and methods of providing care and support for each person using this service. The Registered Person should ensure that care plans identify health care support plans e.g. diabetes – how to monitor and what to do if blood sugar levels are unstable. The Registered Person should provide a lockable ‘fridge’ to ensure that all medicines are stored securely in accordance with the current pharmaceutical storage regulations to prevent unauthorised access so potentially leading to non-availability of medicines for people in the home. This includes any medicines that require refrigeration. The Registered Person should provide a choice of main courses at lunchtime as well as alternatives. Peoples’ preferences, likes and dislikes should be regularly reviewed as part of the care plan review. The Registered Person should develop an effective quality assurance system to establish the level of satisfaction with the care services people receive in the home. This must be extended to all visitors to the home including health and social care professionals, to establish their level of satisfaction with the care services being provided in the home. The results of all the surveys undertaken must be published and available to prospective residents and the CSCI. 2 OP7 3 4 OP8 OP9 5 OP15 6 OP33 Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rowan House Care Home DS0000069072.V352700.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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