Inspection on 09/01/07 for Rowan Lodge

This inspection was carried out on 9th January 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rowan Lodge 09/08/07

Rowan Lodge 13/04/06

Rowan Lodge 10/11/05

Rowan Lodge 29/04/05

Rowan Lodge 15/10/04

Rowan Lodge 14/05/04

Rowan Lodge 14/10/03

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

CARE HOMES FOR OLDER PEOPLE Rowan Lodge 36 Keble Close Northolt Middlesex UB5 4QE Lead Inspector Jean Bovell Key Unannounced Inspection 9th January 2007 12:20 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 Lodge DS0000027762.V325669.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 Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rowan Lodge Address 36 Keble Close Northolt Middlesex UB5 4QE 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) 0208 423 9095 020 8423 9095 Mr Ramnarain Dyanan Sham Laima Bruzinskeine Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (0), Old age, not falling within any other category (0) Rowan Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Accommodation on ground and first floors only. Date of last inspection 13th April 2006 Brief Description of the Service: Rowan Lodge is a care home providing support for three older people, who are over sixty-five years of age, and have past or present mental health needs. All of the current service users are female. The home was first registered in 1991. The Registered Provider owns another larger home in Harrow. The home is situated in a quiet road in Northolt and there is easy access to local shops and to a bus route. The accommodation for the service users consists of a goodsized lounge/dining area, a kitchen and a small utility area on the ground floor. Two bedrooms are located on the first floor and one bedroom is located on the ground floor. There is a small paved area to the front of the home and a goodsized garden to the rear of the house. Rowan Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out between 12:20 pm and 4:30 pm on 9th January 2007. The Registered Manager and three service users were present. During the course of the inspection, the home’s policies, procedures, records and documents were viewed. A tour of the building was undertaken and observations were made. The Inspector spoke to three service users and one care support worker who covered duty on the afternoon/evening shift. The requirements that were made at the last inspection and all key Standards were examined. The Registered Manager was co-operative and provided appropriate assistance throughout the inspection. What the service does well: What has improved since the last inspection? Of the seven requirements that were made at the last inspection, two had been complied with. These related to washbasin and bath taps and management issues. Rowan Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rowan Lodge DS0000027762.V325669.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 Lodge DS0000027762.V325669.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): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate needs led assessments are carried out in relation to prospective service users prior to admission. EVIDENCE: The personal files relating to three service users were viewed and each contained copies of initial comprehensive needs led assessments that had been carried out by the home prior to admission. Rowan Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 9 Assessments that were submitted by placing Authorities at the point of referral were also evidenced. Appropriately signed contracts/statement of terms and conditions confirming that specific assessed needs would be met at the home were within all service users’ files. The home does not provide an intermediate care service. Rowan Lodge DS0000027762.V325669.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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are being adequately drawn up and the health care needs of the service users are being appropriately met. The home’s policy and procedures on medication are satisfactory and the privacy and dignity of the service users are being respected. EVIDENCE: The separate personal, health care and social needs of the service were clearly stated within care plans that were viewed and related risk assessments had Rowan Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 11 been carried out. All care plans and risk assessments were reviewed on a monthly basis or following specific incidents or accidents. The records indicated that service users received appropriate access to General Practitioners, District Nurses, Community Psychiatric Nurses and Physiotherapist. Regular dental, optical and chiropody checks were arranged and service users were escorted to medical appointments The Inspector was advised by the Registered Manager that none of the service users were able to administer their own medication. The home’s policy and procedures on medication were in place and the storage, disposal and administration of medicines were satisfactory. The records were reflective of medication training being delivered to all care support workers. The Registered Manager reported that personal care tasks were carried out in privacy within bathroom or bedrooms. Service users were able to make personal calls, receive confidential mail and meet with relatives and/or friends in their separate bedrooms. Service users wore their own clothes and were observed being treated sensitively and with respect by the Registered Manager and a care support worker at the time of the inspection. Three service users who spoke to the Inspector reported that their privacy and dignity were being upheld at the home. Rowan Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 12 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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are able to maintain contact with relatives and/or friends and receive choices in relation to their daily routines. Wholesome and varied meals are being provided. Requirements under Standard 12 relating to activities that were made at the last inspection have not been complied with. EVIDENCE: Although various daily activities were listed on an Activities Programme, three service users that were spoken with reported that organised activities occurred on only two separate days each week. There were regular weekly visits from an organ player and two service users attended a day centre each Thursday. Rowan Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 13 One service user was on occasions accompanied by a care support worker during short shopping trips but no activities occurred on weekends. Two service users expressed feelings of boredom and isolation from the local community. One service user said that he/she would welcome the opportunity to attend a Sunday Church Service but was particularly saddened about being prevented from attending the day centre due to mobility difficulties. This matter was discussed with the Registered Manager and the Inspector was advised that the service user had chosen not to attend the day centre. However, the Registered Manager confirmed that he/she would in future be included in day centre activities. This information was subsequently communicated to the service user. The records indicated that the service users joined others for lunch at a larger home also owned by the Registered Provider on Christmas day and the Registered Manager confirmed that the service users were taken on a day trip last summer. On the day of the inspection service users were observed sitting in the lounge and listening to music being played from a radio. One service walked around the garden and another watched television in his/her bedroom. An organ player called on the afternoon of the inspection but the performance did not appear to inspire noticeable enjoyment or sing-along participation and one service user chose to retire to his/her bedroom. The home’s visiting policy was in place and two service users confirmed that they received regular visits and telephone calls for their respective relatives. The Inspector was informed by the Registered Manager that service users received choice in relation to activities, meals, personal purchases, what they wore and when they awoke on mornings or retired. Personal choices were reflected in separate bedrooms and service users were observed moving freely around the house and garden. Varied and nutritional meals were listed on the menus and drinks and snacks were readily available. The service users reported being satisfied with the quantity and variety of meals they received. Rowan Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 14 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 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints are being investigated as required and the home’s policies and procedures on Adult Abuse are satisfactory. The home’s recording systems are not satisfactorily robust to ensure that service users are protected from abuse. EVIDENCE: The home’s policy and procedures relating to complaints were clearly written and accessible the service users and their relatives. One complaint of abuse was made by a service user following the last inspection and was appropriately investigated by the London Borough of Ealing Safeguarding Adults Team and the London Borough of Hounslow Review team. However, the required Regulation 37 relating to the incident was not immediately sent to the CSCI. Rowan Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 15 The London Borough of Ealing Manual on Safeguarding Vulnerable Adults and the home’s policy on Adult Protection were in place. The records indicated that training on the Protection of Vulnerable Adults had been delivered to the care support workers. One service user reported that he/she had suffered severe bruises and chronic back pain after falling down a flight of stairs from first floor to ground floor at the home. This occurred many months ago but the service user was of the view the accident resulted in a fractured hip that was only discovered when he/she fell on route to an unrelated hospital appointment. The Registered Manager confirmed the occurrence of the accident and reported that a service user was, as a consequence, transferred to a bedroom on the ground floor. However, there was no recorded evidence of the incident nor was Regulation 37 form completed and submitted to the CSCI. The Registered Manager confirmed that relatives or placing Authorities were responsible for the financial affairs of the service users but personal allowances were held in safekeeping at the home. The financial records relating to three service users were examined and were not satisfactorily recorded. Essentially, outgoings were not itemised in relation to receipts and the credit cards of care workers were being used for small purchases. This is not good practice. Rowan Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 16 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is safe and well maintained but the garden must be cleared of discarded items. EVIDENCE: The communal areas within the home are attractively decorated, comfortably furnished and suitable for shared or individual activity. Rowan Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 17 The kitchen was in the process of being decorated at the time of the inspection. The garden is accessible to the service users and reasonably maintained but contained various discarded items. There were no issues regarding the laundry. Overall, the home was clean, hygienic and well maintained. The atmosphere was calm and homely. Rowan Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care support workers are qualified and have received mandatory training for meeting the needs of the service users. The home’s recruitment policies and practices are satisfactory. A requirement under Standard 27 relating to appropriate staffing levels for ensuring activities within the community, has not been met. EVIDENCE: It was reflected on the staff rota that five care support workers including the Registered Manager were employed at the home. One care support worker was on duty during waking hours and there was one sleep in cover at night. Rowan Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 19 The Registered Manager confirmed that four care support workers had achieved level 2 National Vocational Qualification in health and social care. The recruitment files in relation to three service users were inspected at random and were found to contain all the required documents such CRB disclosure certificates, signed contracts/statement of terms and conditions, photo-identification, application forms and references. The records indicated that new care support workers received Induction Training and that subsequent staff training included Mental Health, Moving and Handling, Fire Awareness, Protection of Vulnerable Adults and Medication. Although the physical and health care needs of the service users were being met. No shared indoor activities were being organised and meaningful engagement was not observed between care staff and service users. Essentially, there were no indicators that the service users received appropriate stimulation at the home. Staff involvement in organising regular weekly indoor and outdoor activities was also not evident. However, increased staffing levels on specific days should ensure that service users are appropriately supported. Two service users that were spoken with expressed a desire to participate regularly in activities in the community – particularly on weekends. Rowan Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 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 is suitably experienced and qualified. Quality assurance exercises have not been completed and the financial records in relation personal allowances are not being satisfactorily completed to indicate that the home was not being satisfactorily being run in the best interests of the service users. The health and safety of service users and staff are not being satisfactorily promoted because not all health and safety checks are being updated. Rowan Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 21 EVIDENCE: The Registered Manager has been in post since November 2006. She had previously been a care support worker with the Company for three years and is currently receiving training for obtaining the Registered Managers Award. Although systems for quality assurance and quality monitoring were in place, there was no documented evidence that recent quality assurance exercises had been carried out. The financial allowances of the service users are being safeguarded at the home but outgoing expenditure was not appropriately noted on financial records that were examined at the time of the inspection. Records for gas maintenance and water temperature checks were up to date. Recordings of fire drills were not sufficiently detailed and weekly fire safety checks were not appropriately recorded. There was no documented evidence of portable appliances testing. Rowan Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 2 2 Rowan Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 23 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 OP12 Regulation 16(2)(m) (n) Timescale for action Service users must be enabled to 15/02/07 participate in activities in the local community. This is restated from the last two inspections, previous time scales 01/01/06 and 30/05/06. Service users must be enabled to 30/04/07 maintain their religious beliefs and attend local churches if they so wish. This is restated from the last two inspections previous timescales 01/01/06 and 30/06/06. The Registered Person must 15/02/07 ensure that financial records relating to the service users are accurate and up to date. The Registered Person that 15/02/07 records relating to accidents and incidents are being maintained. The Registered Person must 01/03/07 ensure that the garden is cleared of discarded items. The Registered person must 15/02/07 ensure that staffing levels are appropriate for supporting service user participation within the community. This is DS0000027762.V325669.R01.S.doc Version 5.2 Page 24 Requirement 2. OP12 16(3) 3. OP18 13(6) 4. 5. 6. OP18 OP19 OP27 17(1) (a) 23 (2) (o) 18(1)(a) Rowan Lodge restated from the last inspection. Previous timescale 30/06/06. 7. OP37 37 (1) (c) (g) The Registered Person must ensure that Regulation 37’s are submitted to the CSCI immediately following significant incidents and/or accidents. The Registered Person must ensure that fire safety checks are regularly carried out and appropriately recorded. This is restated from the last inspection. Previous timescale 30/05/06. The Registered Person must ensure that fire drills are appropriately carried out and accurately recorded. This is restated from the last inspection. Previous timescale 30/05/06. 07/02/07 8. OP38 23(4)(a) 15/02/07 9. OP38 23(4)(e) 15/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rowan Lodge DS0000027762.V325669.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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