CARE HOME ADULTS 18-65
Rowandale Back Lane Clayton le Woods Chorley Lancashire PR6 7EU Lead Inspector
Val Turley Unannounced Inspection 15th March 2006 09:30 Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 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 Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 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 Adults 18-65. 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. Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Rowandale Address Back Lane Clayton le Woods Chorley Lancashire PR6 7EU 01772 620739 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) rowendale@tiscali.co.uk Dalesview Partnership Mrs Tina Diane Roberts Care Home 10 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (1) of places Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 10 service users to include: Up to 9 service users in the category of LD (Learning Disability not falling within any other category) needing personal care only. 1 Male service user in the category LD(E) (Learning Disability over the age of 65) needing personal care only. The registered provider should, at all times, employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the National Care Standards Commission regarding staffing levels in care homes. 5th October 2005 2. 3. Date of last inspection Brief Description of the Service: Rowandale stands in its own grounds and has open views to two sides. The building is a single storey purpose built establishment, with wide doorways and easy access throughout. The premises incorporate two homes, Rowandale and Hollydale, which share a common entrance, laundry and gardens. Rowandale accommodates ten service users with a Learning Disability. The home provides ten single bedrooms, two of which have en-suite facilities. The rooms have been decorated and furnished with specific service users in mind and are all individually furnished. The bathrooms and shower room have been specifically designed to provide a suitable environment for assisting clients with physical disabilities. There is a large spacious lounge/dining room and kitchen that clients may access with relevant supervision. In addition there is a laundry and office. The gardens have been landscaped to the front and side and offer a sensory area. There is also large patio to the rear. The home is situated in Clayton-le-Woods on the perimeter of a housing estate. There is a range of facilities including a supermarket, library, leisure centre, public houses and park. These are within walking distance and service users from the home access them. Clayton-le-Woods is situated on the A6 which is the main road linking the city of Preston and the market town of Chorley. This means the service users also have access to the facilities offered in these towns. Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day in March 2006 by one regulation inspector. The inspection took 4 hours. The inspection involved observation of the young adults who lived at the home and also communication with them, observation of the staff working there, an examination of records, policies and procedures and a tour of the premises. What the service does well: What has improved since the last inspection?
The care plans had been extended to reflect in more detail of the support needs of the service users enabling staff to provide effective and appropriate support. There was also a record of those individuals who had been included in the development of the care plans, including family members. Small booklets had been developed for each of the service users that provided staff with brief and accessible information regarding the support needs of the service users. Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 6 A more detailed record was being kept of community-based activities that the service users were involved in and this indicated that there was a range of activities provided that met the needs of the service users. The management of medication within the home was much better, with record keeping having improved and guidelines for the administration of ‘as required’ (PRN) medication having been drawn up for staff to follow. Health action plans had been developed for the service users enabling their health needs to be systematically addressed and routine checks to be undertaken. The complaints procedure had been reviewed and updated so that all documents providing information about the homes complaints procedure gave consistent advice and information. The homes policy that dealt with the protection of vulnerable adults had been recently reviewed and updated. It contained good clear guidance as to the action staff must take if they are made aware of any concerns regarding the safety and well being of any of the service users or of any allegations of abuse. Risk assessments had been developed in respect of the electric sockets situated next to the service users beds and socket guards had been fitted where necessary to safeguard the service users. The storage of incontinence aids in the bathroom areas had been improved to preserve the dignity of the service users. Training in epilepsy and PEG feeding had been arranged for the staff team. A review of the security of the home had been undertaken and risk assessments indicated that bedroom windows should be kept locked when rooms were not occupied to protect both the service user and their possessions. What they could do better:
Risk assessments had not been undertaken for all of the activities the service users were involved in, in particular those activities undertaken in the community. This omission left service users at risk when involved in these activities. The homes policy on personal relationships needed to be reviewed to and information regarding issues of consent and the need to consult at a multi disciplinary level should be included within the policy. This guidance would be helpful to staff when supporting service users in their personal relationships. Some additional work needed to be undertaken regarding the service users ability or methods of indicating consent to medication and any routines or strategies that staff may need to adopt when administering medication. This guidance should be recorded for staff to refer to when administering medication. The homes policy and procedure in respect of the management of challenging behaviour and the use of restraint needed to be reviewed to ensure it protected the rights and best interests of the service users. Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 7 The home recruitment procedure was not always followed rigorously and one member of staff employed at the home had not had the necessary checks undertaken leaving service users possibly unprotected. The homes quality assurance processes could be extended to include the views of health and social care professionals involved in the home. Staff should be reminded of their duty to keep the home secure to protect the service users and their possessions. 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. Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed at this inspection. EVIDENCE: Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 The home had improved the detail and guidance included within the care plans enabling support staff to provide more appropriate care for the service users. Not all activities that the service users were involved in been risk assessed leaving service users at risk. EVIDENCE: Standard 6 was partly assessed at this inspection. The requirements and recommendation made at the previous inspection were found to have been acted upon. The care plans had been further extended to reflect in more detail of the support needs of the service users enabling staff to provide effective and appropriate support. The care plans also contained a photograph of the service user. Standard 7 was also partly assessed at this inspection. Where possible the service user had been consulted as the care plan had been developed and revised, but the manager had also listed all of those individuals who had been consulted and contributed to the care plan. This included the families of the service users. Since the last inspection small booklets had been developed for each of the service users that provided staff with brief and accessible information regarding the support needs of the service users. These booklets were kept by the service users.
Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 11 A requirement made at the previous inspection in respect of standard 9 had not been acted upon. Risk assessments had not been undertaken for all of the activities the service users were involved in, in particular those activities undertaken in the community. This omission left service users at risk when involved in these activities. Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15 and 16 Staff supported service users to participate in a range of appropriate community-based activities that service users had indicated a preference for. The homes policy dealing with personal relationships did not provide staff with enough information and guidance in respect of the support they should provide to service users. EVIDENCE: The homes policy on personal and sexual relationships was examined. This was in the process of being reviewed by the organisation. Some additional work needs to be undertaken and information regarding issues of consent and the need to consult at a multi disciplinary level should be included within the policy. This guidance would be helpful to staff when supporting service users in their personal relationships. The daily routines within the home promoted the independence and dignity of the service users. Support staff were observed to knock on the doors of service users rooms before entering and also to interact with service users including them in activities around the home. Service users were also able to spend time in their rooms if they wished.
Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 13 Standards 12 and 13 were partly assessed at this inspection. Requirements made at the last inspection had been acted upon. A more detailed record was being kept of community-based activities that the service users were involved in and this indicated that there was a range of activities provided that met the needs of the service users. Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The home provided flexible and sensitive support to service users promoting their independence as far as possible. EVIDENCE: The staff were observed to provide sensitive and flexible support to the service users. They were given options and choices during the course of the day as to their individual preferences. The care plans included protocols that were based on the service users preferred routines in relation to personal care and early morning and bedtime routines. The home had a range of equipment and aids to enable the service users to be as independent as possible. There was a key worker system in place, which provided continuity of care. The service users received input from a number of health and social care professionals including a physiotherapist and a speech and language therapist. The home enjoyed good relationships with families and had links with the local advocacy service. The home had developed health action plans for each of the service users and these enabled the health needs of the service users to be systematically addressed and routine checks for each of the service users to be undertaken. On the day of the inspection one of the service users was feeling unwell and the staff took appropriate action to ensure the well being of the service user. The home had a good relationship with the GP who visited the service users at the home.
Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 15 The requirement and recommendations made at the previous inspection in respect of the management of medication in the home had been acted upon. A photograph of each of the service users was kept with the Medication Administration Record (MAR sheet) to help ensure that medication was administered to the correct service user. The administration of external preparations was being recorded on the MAR sheet, as was the administration of medication through a percutaneous endoscopic gastrostomy tube (PEG). Written guidance was in place regarding the use of rectal diazepam and other as required (PRN) medications. Some additional work needed to be undertaken regarding the service users ability or methods of indicating consent to medication and any routines or strategies that staff may need to adopt when administering medication. This guidance should be recorded for staff to refer to when administering medication. Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The home had generally good policies and procedures in place in order to protect service users. Where policies needed to be reviewed the senior staff were fully aware of the amendments that needed to be made and ensured that best practice was followed in the home. EVIDENCE: Standard 22 was partly assessed at this inspection. The complaints procedure had been reviewed and updated so that all documents providing information about the homes complaints procedure gave consistent advice and information. This standard has now been fully met. The homes policy that dealt with the protection of vulnerable adults had been recently reviewed and updated. It contained good clear guidance as to the action staff must take if they are made aware of any concerns regarding the safety and well being of any of the service users or of any allegations of abuse. The homes policy and procedure in respect of the management of challenging behaviour and the use of restraint was in the process of being reviewed to ensure it protected the rights and best interests of the service users. Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 EVIDENCE: Standard 24 was partly assessed at this inspection. A requirement made at the previous inspection had been acted upon. Risk assessments were seen to be in place in respect of electric sockets situated next to service users beds and were necessary socket guards had been fitted to protect the service users. Storage of incontinence pads in the bathrooms and toilet areas had been reviewed and these were less in evidence preserving the dignity of the service users. Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Staff were well supported and received a variety of training opportunities enabling them to provide appropriate for the service users. The home recruitment procedure was not always thorough enough leaving service users possibly unprotected. EVIDENCE: The staff team were well supported by the senior support staff working at the home. Team meetings had been recently held for all staff to inform them of recent developments and proposals. The induction training provided by the organisation gave the staff the necessary basic skills to support the service users appropriately. Information was included within care plans, which gave staff guidance as to how any challenging behaviour should be dealt with. Training and guidance provided by involved health professionals gave staff additional skills and knowledge to help them work effectively. The home was committed to the provision of training for staff and was continuing to work towards 50 of its staff achieve a relevant qualification in care. A recommendation made at the previous inspection had been acted upon and training in epilepsy and PEG feeding had been arranged for the staff team. The files of three recently appointed members of staff were examined. The documentation in place showed that there was an awareness of the checks that needed to be undertaken prior to a member of staff being appointed. However the application form from one of the members of staff had not been fully completed with the applicants work history having been omitted. A
Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 19 reference from the previous employer had not been obtained and one of the references returned stated that they were unable to make any comments regarding the application. The appointment of this member of staff left the service users in a position of risk as all of the necessary checks had not been undertaken. The other staff files had all the necessary documentation in place and the appropriate checks had been undertaken to protect the service users as far as possible. Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The home was generally well managed with the rights and best interests of the service users being safeguarded. EVIDENCE: The registered manager of the home had the appropriate qualifications and experience to run the home effectively. She had undertaken recent additional training to update her skills and knowledge. The manager was fully aware of her responsibilities to both the service users and the staff team and was keen to improve the support provided to the staff. The home had a number of quality assurance processes in place. It had achieved the Investors in People Award which is a quality assurance award accredited by an external body. The senior staff had the responsibility for undertaking a number of monthly audits to ensure the smooth running of the home this included a medication audit. Annual reviews were undertaken for each of the service users when the achievements of the service users were recognised and goals were set for the following year. The manager had undertaken a survey of the views of families over the summer of 2005. These results had been collated and published. The manager stated that the intention
Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 21 was for the organisation to produce a newsletter that would in future include the results of any surveys undertaken. It was recommended that the home survey the views of any involved stakeholders including health and social care professionals. Service users were encouraged and supported to become involved in the inspection process as far as they were able. The organisation reviewed any policies and procedures as necessary with senior members of staff becoming involved in this, increasing their own knowledge and expertise in the process. Standard 42 was partly assessed at this inspection. A recommendation made at the previous inspection had been acted upon. The security of the home had been reviewed and risk assessments had been undertaken in respect of the bedroom windows. Concern had been expressed as these windows opened wide onto a public footpath placing both the service users and their possessions in a vulnerable position. The manager stated that the larger windows in the bedrooms were now kept locked unless the room was occupied, with the key being kept readily available for use in case of an emergency. On the day of the inspection the windows were found to be closed although not all were locked. It was recommended that the staff be reminded of the need to maintain the safety and security of the home. Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X 1 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 2 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 2 X Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 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 YA9 Regulation 13(4)(c) Requirement The registered person must make arrangements to ensure that all unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. (Previous timescale of 30/11/05 not met) Timescale for action 31/05/06 2. YA15 3. 4. YA23 YA34 The homes policy regarding service users personal, family and sexual relationships must be reviewed. 13(6)(7)(8) The homes policy regarding the restraint of service users must be reviewed. 19(1)(4)(5) The registered person must not Sch 2 allow any persons to work at the care home unless full and satisfactory information has been received in respect of them. 12(4) 31/05/06 31/05/06 30/04/06 Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 24 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. 2. Refer to Standard YA20 YA42 Good Practice Recommendations Service users consent to medication should be recorded in the care plan. Staff should be reminded of the need to maintain the safety and security of the home. Rowandale DS0000045627.V264894.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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