CARE HOME ADULTS 18-65
Rowandale Back Lane Clayton le Woods Chorley Lancashire PR6 7EU Lead Inspector
Val Turley Announced Inspection 5th October 2005 09:30 Rowandale DS0000045627.V255169.R01.S.doc Version 5.0 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.V255169.R01.S.doc Version 5.0 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.V255169.R01.S.doc Version 5.0 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.V255169.R01.S.doc Version 5.0 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. 4th March 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.V255169.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection that took place over one day in October 2005 by two regulation inspectors. The inspection involved observation of and discussion with the service users who lived at the home and also discussion with and observation of the staff working there, an examination of records, policies and procedures and a tour of the premises. As part of the inspection, the inspectors used “case tracking” as a means of assessing some of the National Minimum Standards. This process allowed the inspectors to focus on two of the service users living at the home. All records relating to those individual were inspected along with their room. Where possible the service users were invited to discuss their experiences of living at the home. What the service does well: What has improved since the last inspection? Rowandale DS0000045627.V255169.R01.S.doc Version 5.0 Page 6 Since the last inspection the homes procedure for the recruitment of staff had improved and staff were now only appointed to post when POVA checks and Criminal Record Bureau checks were in place. 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. Rowandale DS0000045627.V255169.R01.S.doc Version 5.0 Page 7 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.V255169.R01.S.doc Version 5.0 Page 8 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): 2 The home had a thorough pre-admission assessment procedure in place, which was used to determine whether appropriate support could be provided for potential service users. EVIDENCE: The file of one recently admitted service user was examined. An assessment had been provided by the care manager and the home had undertaken its own assessment. The information collected through this process had provided a comprehensive outline of the service users support needs. The service user had a care plan in place with information from the pre-admission procedure being used to provide a foundation for this. Rowandale DS0000045627.V255169.R01.S.doc Version 5.0 Page 9 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 care planning process was not thorough enough to ensure that individual service user needs were consistently met. EVIDENCE: The files of two service users were tracked. The care plans included the service users preferred routines at certain times of the day and moving and handling protocols. This information provided staff with useful guidance as to service users preferences. Not all detail had been carried over from the pre-admission assessment to the care plan. The additional detail should have been included to ensure that the service users received appropriate support in all situations. Both service users had communication difficulties and the home was in the process of developing small booklets that outlined the service users basic support needs, communication strategies used and their likes and dislikes. It was planned that this booklet would be readily available to support staff. There was no indication that the care plans had been drawn up with the involvement of family, friends or an advocate. It had been recommended by a care manager that an advocate be linked to one of the service users but this had not been acted upon. The use of advocates or involvement of relatives or friends was considered to be advisable because of the communication
Rowandale DS0000045627.V255169.R01.S.doc Version 5.0 Page 10 difficulties of the service users and the need to ensure that their support needs are correctly identified. Both care plans had been reviewed regularly to ensure that the identified support needs of the service users continued to be met. The care plans did not contain any risk assessments. These must be undertaken to ensure that risks to service users are minimised in all activities they undertake. This includes the use of bed rails. One of the care plans did not include the photograph of the service user concerned, allowing the possibility of support staff providing inappropriate support through mistaken identity. Information provided by a family involved in the service and by an involved social care professional indicated that they were both very pleased with the care provided. A service user living at the home expressed her pleasure by stating that it was the ‘best place’ she had lived in and that she looked upon all the service user and staff as her friends. Rowandale DS0000045627.V255169.R01.S.doc Version 5.0 Page 11 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 17 The home arranged a variety of activities for the service users although a record of each service users involvement should be made to enable staff to monitor the success of the different activities. The service users enjoyed a varied and healthy diet and were supported appropriately by staff at mealtimes. EVIDENCE: Both files examined included details of the service users interests and hobbies. Written evidence on one file indicated that the service user had enjoyed several outings within the local community and had been involved in activities arranged within the home. The service user was able to communicate with the inspectors telling them which activities she enjoyed and which she had been involved in. Discussion with staff also indicated that the service user had been involved in those activities. The second file outlined the service users interests and hobbies but there was little written evidence that the service user had been included in any trips out of the home. There was written evidence that the service user had been involved in a few activities organised within the home. Discussion with staff suggested that the service user had been involved in a variety of trips and activities. As the service user was unable to communicate easily it is important that activities and trips out are recorded to
Rowandale DS0000045627.V255169.R01.S.doc Version 5.0 Page 12 inform all staff of the success or otherwise of these events and to ensure that activities are not repeated unnecessarily. A record of the meals prepared at the home was kept as well as the meals taken by each of the service users. The menu included a reasonable range of foods for the benefit of the service users. A fluid intake chart was maintained for one of the service users to ensure that enough fluids were taken during the day. The care plan of one of the service users included guidance on the support to be provided at mealtimes. Service users were observed to be supported appropriately by staff at mealtimes. The cook was heard to invite service user into the kitchen to help/observe the meals being prepared. On the day of the inspection a family member was visiting the home and stated that she was given every assistance to visit the home and was always made to feel welcome. Discussion with staff indicated that the home enjoyed good links with families and discussion with one of the service users indicated that she had regular contact with her family. Rowandale DS0000045627.V255169.R01.S.doc Version 5.0 Page 13 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): 19 and 20 Some additional work needs to be undertaken by the home to ensure that the health and emotional needs of the service users are addressed and so helping to ensure that they enjoyed a good quality of life. EVIDENCE: National Minimum Standard 19 was not fully assessed at this inspection but it was recommended that health action plans be developed for each of the service users to ensure that they receive as far as possible that their health care is assessed holistically and any concerns addressed. Information provided by a GP and a visiting health professional indicated that the overall care provided for service users was satisfactory. Staff had received training in the administration of medication and appropriate records had been kept of all medications received into the home and those returned to the pharmacy. There were however a number of issues that should be addressed to ensure that the medication in the home is managed in line with the guidelines from the Royal Pharmaceutical Society of Great Britain. Not all of the medication records included a photograph of the service user allowing the possibility of the medication being administered in error. The service users consent to medication had not been sought and recorded in the individual care plans. The Medication Administration Record (MAR) had not been signed by staff to indicate that external preparations had been administered. This omission makes it difficult to determine whether medications are effective in their use. It
Rowandale DS0000045627.V255169.R01.S.doc Version 5.0 Page 14 was recommended that guidance for the use of rectal diazepam be filed next to the appropriate MAR sheet to ensure that support staff are clear as to when it should be administered. Where a service user is fed through a percutaneous endoscopic gastrostomy (PEG) tube a record of the medication administered should be recorded on the MAR sheet. Rowandale DS0000045627.V255169.R01.S.doc Version 5.0 Page 15 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 Information about the homes complaints procedure was not consistent leaving service users and staff with different guidance as to the different ways in which a complaint could be made. EVIDENCE: The homes service users guide contained a clear complaints policy, using illustrations to help service users understand. It was also available on audiotape, ensuring as far as possible that most service users would find the information accessible. No complaints had been made to the service since the last inspection. The information within the complaints policy contained slightly different information and this should be reviewed to make it clear that complaints can be made to the Commission for Social Care Inspection at any stage. Rowandale DS0000045627.V255169.R01.S.doc Version 5.0 Page 16 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 and 30 The home was clean and comfortable and provided a pleasant and generally safe environment for both the young adults and support staff. EVIDENCE: The home was comfortable and well furnished providing a pleasant environment for both service users and support staff. The premises were accessible to all the service users, allowing them to make use of all the facilities. There was easy access to local facilities and service users were supported to make use of these. The manager stated that repairs and maintenance were attended to as the need arose ensuring that a comfortable environment was maintained. On the day of the inspection an immediate requirement notice was issued to ensure that a socket situated close to a service users bed was secured to the wall. The positioning of the sockets in the bedrooms gave some cause for concern as they were situated alongside the beds and within reach of the service users. A risk assessment must be undertaken to ensure that this arrangement is acceptable. It was recommended that storage in the bathrooms be reviewed to preserve the dignity of the service users. The home had a clean and well-equipped laundry, which was shared with the adjacent home. The laundry met the needs of the service users.
Rowandale DS0000045627.V255169.R01.S.doc Version 5.0 Page 17 Rowandale DS0000045627.V255169.R01.S.doc Version 5.0 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): 35 The support staff had received training enabling them to meet the changing needs of the service users. The professional development of staff was encouraged, but this could be further improved to the advantage of the both the service user and staff team. EVIDENCE: The home had induction and mandatory training in place ensuring that the staff could work safely within the home. The organisation provided a variety of training opportunities for staff and staff confirmed they received at least five days a year paid training. The home had a training matrix in place, which highlighted the training needs of the staff team and discussion with the manager suggested that she was committed to ensuring that the staff team received the training identified. It was recommended that the home access some training in epilepsy to help ensure that the health needs of the service users were met. The manager should also determine whether the staff team receive foundation training. Rowandale DS0000045627.V255169.R01.S.doc Version 5.0 Page 19 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): 42 The home was generally well maintained however some additional work needed to be undertaken to ensure the safety of the service users. EVIDENCE: The staff at the home undertook a range of training to ensure as far as possible the safety of the service users. The equipment and systems at the home were all serviced appropriately to maintain a safe environment. A review of the security of the home should be undertaken to ensure the safety of the service users, the staff and their possessions. Rowandale DS0000045627.V255169.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X
X Standard No 22 23 Score 2 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 X 1 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Rowandale Score X 2 2 X Standard No 37 38 39 40 41 42 43 Score X X X X X 2 X DS0000045627.V255169.R01.S.doc Version 5.0 Page 21 NO Are there any outstanding requirements from the last inspection? 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 YA6 Regulation 15(1) Requirement Care plans must reflect the service users needs in respect of their health and welfare and indicate how these needs are to be met. The service user and/or their representative should be consulted as the care plan is developed and revised. 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. A programme of activities must be provided to meet the needs of the service users Service users must be supported to engage in local, social and community activities. The registered person must make arrangements for the safe management of medication in the home. The registered person must establish a consistent complaints procedure. All parts of the home to which the service users have access to
DS0000045627.V255169.R01.S.doc Timescale for action 30/11/05 2 YA7 15(1)(2) 31/12/05 3 YA9 13(4)(c) 30/11/05 4 5 6 YA12 YA13 YA20 16(2)(n) 16(2)(m) 13(2) 30/11/05 30/11/05 30/11/05 7 8 YA22 YA24 22 13(4)(a) 30/11/05 30/11/05 Rowandale Version 5.0 Page 22 9 YA35 18(c)(i) must be free from hazards to their safety. The registered manager must ensure that staff receive appropriate training. 30/11/05 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 3 4 5 6 7 8 9 Refer to Standard YA19 YA20 YA20 YA20 YA20 YA20 YA24 YA35 YA42 Good Practice Recommendations Health action plans should be developed for each of the service users. A photograph of the service user should be kept with the Medication Administration Record. Service users consent to medication should be recorded in the care plan. The administration of external preparations should be included on the Medication Administration Record. Guidance regarding the administration of rectal diazepam should be kept with the Medication Administration Record. Medication administered through a PEG tube should be recorded on the Medication Administration Record. The storage arrangements for incontinence pads in the bathrooms and toilet areas should be reviewed. Training in epilepsy should be provided for the staff team. A review of the security of the home should be undertaken. Rowandale DS0000045627.V255169.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Chorley Local Office Levens House Ackhurst Business Park Foxhole Road Chorley PR7 1NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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