Inspection on 16/02/09 for Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts

This inspection was carried out on 16th February 2009.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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

Rowans Care Homes Ltd TA Bridge,... 03/06/08

Rowans Care Homes Ltd TA Bridge,... 27/11/06

Rowans Care Homes Ltd TA Bridge,... 28/11/05

Rowans Care Homes Ltd TA Bridge,... 21/06/05

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts 17, 18 & 19 Ashby Road Burton on Trent Staffordshire DE15 0LB Lead Inspector Mandy Beck Key Unannounced Inspection 16th February 2009 09:00 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 Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.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. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts 17, 18 & 19 Ashby Road Burton on Trent Staffordshire DE15 0LB Address 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) 01283 512 915 01283 509 330 Rowans Care Home Limited Mrs Helen McVay Mr Peter Sturgess Care Home 99 Category(ies) of Dementia (28), Dementia - over 65 years of age registration, with number (56), Mental disorder, excluding learning of places disability or dementia (29), Mental Disorder, excluding learning disability or dementia - over 65 years of age (54), Old age, not falling within any other category (13), Physical disability (45), Physical disability over 65 years of age (45), Terminally ill (4) Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Minimum age of service users in MD category 40 years Minimum age of service users in DE category 40 years Minimum age of service users in PD category 50 years Date of last inspection 3rd June 2008 Brief Description of the Service: The Rowans care complex provides nursing and personal care to a maximum of 99 persons. The premises, consisting of Bridge Court, Burton Court and Trent Court, are situated on the Ashby Road near to Burton on Trent. The home, originally three large Victorian family houses, is set in grounds with adequate car parking. Services and facilities including laundry, catering and hotel services are good, with adequate staffing levels. All three buildings are served with a shaft lift, and access to all parts of the buildings is good. Bridge Court is a general nursing home with broad categories of registration, including terminal care. Burton Court provides care for people with dementia related conditions, and Trent Court provides nursing care for people with mental health problems and other dementia related conditions. The home also contracts for two intermediate care beds with the local National Health Service (NHS) trust. Activities, hobbies and entertainment all take place and transport is provided when required. The weekly fees range from £368 and £1500 included in the home’s Service User Guide. Readers of this report are asked to contact the home directly for this information. The inspection report for this service is available upon request from the home. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.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 that people who use this service experience adequate quality outcomes. This was an unannounced visit to the home, they were given no prior notice. We looked at all the information that we have received, or asked for, since the last key inspection. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. • Information we have about how the service has managed any complaints. • What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement. • The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. • Relevant information from other organisations. • We also spent time talking to the people who use the service and to the staff who support them. • We looked at the care of six people who use this service in depth. This is part of our case tracking process and helps us makes judgements about the home’s abilities to meet people’s needs. What the service does well: People living in the home told us “It is lovely, feels like home”. “I couldn’t have been put anywhere better”. Each person has an assessment of their needs completed by the home before they agree to move in. This gives people an opportunity to discuss their wishes and to make sure the home can meet their needs. We were told, “the food is very good and there is a lot of variety”, “My husband seems to enjoy all the food provided and eats it all up”. People are confident that their concerns will be listened to and addressed. They said, “Staff are extremely helpful and always listen to everything you have to say and act on it”. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 6 The environment is welcoming, clean and generally well maintained. People said, “The home is always clean and attractive. There are always fresh flowers in the entrance hall and very rarely can you smell anything else”. What has improved since the last inspection? What they could do better: Improvements have been made in the assessment and care planning systems in the home but more is needed. The home still needs to develop the activities it has on offer. Although there are activities for people to take part in people still told us “There is not enough activity for me to take part in” and “they do arrange activites but my wife can’t take part in them because of her disabilities”. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 7 The environment at Trent court continues to need redecoration and refurbishment. We have seen that this is currently underway and will offer and much better living environment for people once completed. 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. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 8 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 Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 9 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, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have their needs assessed prior to admission and the home will confirm they can meet people’s needs before they move in. People using the intermediate care facilities do receive care and support to improve their independence EVIDENCE: We looked at the care of six people as part of our case tracking process. We saw that people have an assessment of their needs that, is completed prior to admission. The home also obtains records from the Primary Care Trust Single Assessment Process and from the individual’s care manager where appropriate. All but one of the assessments we looked at give the home a detailed picture of people’s needs and will allow them to plan effective care. The manager told us that people are encouraged to visit and spend time at the home before they move in. This is positive practice as it will give people a Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 10 chance to “test drive” the service and meet with some of the people living there. The home does provide intermediate care services for people. On this occasion there were no people using this type of service but the home has good systems in place to be able to support people during their stay. All of the admissions to the intermediate care beds are emergency admissions. People are assessed by the community nursing critical intervention team and once people are admitted to the home they are supported by the enablement team. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 11 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. People who use this service do have their needs met but improvements in record keeping are needed. Medication practices in the home have improved so that people are protected from unsafe practice. EVIDENCE: We have visited the home four times since our last key inspection. We have found on each occasion there were improvements to be made to the record keeping systems in order for staff to be able to give people the care they needed. Since our last inspection the home has introduced a complete new set of paperwork that is easier for staff to complete and is more individualised in its approach. We looked at the care records of six people during this inspection. Although new paperwork is in place we found that there were still some gaps that needed to be addressed. For instance, we saw that one person had diabetes Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 12 but did not have a clear care plan to guide staff in caring for this. In another case a person had chronic alcohol dependence but again there was no care plan in place. It was evident however after talking to the staff they had a very good understanding of people’s needs. Staff were able to tell us in detail about each of the people’s care records we had looked at and the risks associated with that. Staff must also make sure that they keep people’s care plans under regular review. We saw that recently some reviews had not taken place. The manager was aware that care plan reviews have been missed and was in the process of taking action to rectify this. In previous visits to the home we have expressed our concerns about the pressure relieving equipment in use at the home. We have found during these visits that air mattresses were not inflated to the correct setting for people’s weights and in some instances were not secured to people’s beds as they should have been. During this visit we looked at the care of people who were at risk of developing pressure sores, their risk assessments had been regularly updated. This means the home will be aware of any change in a person’s condition and increased risk of developing pressure sores. We visited people’s bedrooms and checked the pressure equipment that was in use. We found it to be appropriate and inflated to the correct setting. We looked at people’s care plans for dealing with challenging behaviour. We found a great deal of improvement. Each plan we saw gave a detailed description of the challenging behaviour likely to be displayed by people and a description of how staff were to manage this. Since our last visit to the home staff have also received training in non violent physical interventions. They told us; “it has been really helpful, it helps you to try and see what it must be like from the persons point of view. You have to put yourself in their shoes and then you understand how they must be feeling and why they can get so upset”. The home is now recording people’s weights on a regular basis. They also completed a nutritional screening tool for each person. This means that those people considered to be at risk of malnutrition or dehydration are being monitored. We saw that when people have unexpected weight gain or weight loss they are being appropriately referred to the doctor and for specialist assessment from the dietician and speech and language therapist when needed. In addition to this those people with specific risks associated with swallowing and choking are being recorded in care plans and staff have received training in this area. We saw the home has now developed the use of the short term care plan for people with short term problems such as chest or urine infections. This was a requirement from our last inspection and is now considered to be met. People living in this home do have access to their own doctor when they need it. There is also support from community mental health nurses, psychiatrists Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 13 and other specialist practitioners for people as they need them. People told us “I always get the medical assistance I need” and “sometimes if there is an emergency with another resident they may not always be immediately available but any delay is minimal”. One person told us “my hair and nail cutting is often neglected, my glasses are not kept clean and maintenance of my hearing aid is neglected”. The medication systems in the home have improved since our last inspection. The home has also been visited by our pharmacist inspector. The requirements made as a result of that visit were assessed during this inspection and have been met. It was possible to audit people’s medication and to show that people are receiving medication as the doctor has prescribed it. We saw that people who require medication on an “as required” or “PRN” basis had a care plan that clearly detailed the circumstances for administration. When we spoke to staff about this type of medication administration they were able to tell us when they would administer it and monitor its effectiveness. Staff do need to consistently record the variable dose of medication when prescribed. For instance, when people are prescribed one or two tablets. Staff should record whether they give one or two tablets, this will help staff keep track of people’s medication when auditing it. The home continues to have difficulty maintaining a safe temperature for storage of medication. The manager told us that plans are in place to relocate the medication storage room on Burton Court so that this issue can be addressed. New cabinets for the safe storage of controlled drugs have been ordered and will be delivered in the near future. This means once they have been installed the home will be meeting the current legislative requirements. We spoke to people about their care and asked them if they felt they were treated with respect and dignity. They told us “yes, I feel safe and comfortable here”, “the staff are very good”. We saw people knocking doors before entering people’s bedrooms and before assisting them in the toilet. Staff we spoke to gave us good examples of how they would keep people’s privacy and maintain their dignity, they said “try to put them at ease, cover them with a towel when we do the washing so they are not to exposed”, “we ask how they like things done”. “one lady needs support because she gets anxious we try and make her feel calm and relaxed”. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. People living in this home do have the opportunity to take part in activities and are encouraged to make some choices about their lives but improvements could be made. EVIDENCE: The home continues to employ two activity coordinators. Their role is to plan activity and occupy people living in the home. Recent events have included the Valentine biscuit baking, Christmas parties and sing alongs. The home also produces a newsletter for people’s interest and information. People told us “they do arrange activites but my wife can’t take part in them because of her disabilities” and “there is not enough activity for me to take part in”. Other people said “ I would like to go out more often”. People are encouraged to have visitors at any time they choose. They can be seen in the privacy of their own rooms if they choose to do so. Relatives said “the staff are very good and always make us feel welcome”. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 15 People living in the home are encouraged to personalise their rooms as much as possible to make them feel for homely to them. We saw some people’s rooms during our visit. They had been furnished to individuals own tastes. Some of the staff have received training in the principles of the Mental Capacity Act 2005, the manager told us that more staff will attend this training. This training should give staff an understanding of their role in supporting people who have reduced mental capacity. Meals continue to be well received by the people living in the home. They told us; “there is always a lot of choice”, “the food is lovely can’t fault it”. Some people were not so happy with the food and said “sometimes the food is cold and does not look appetising” and “there is a choice but not a wide variety of fresh fruit or veg this is in short supply”. During one of our visits we identified that staff appeared to be confused about the terms “blended, liquidised and soft” diets. On each of the three homes the terms seemed to mean something different. This was bought to the manager’s attention as a matter of concern. Staff training was given and now staff have a consistent understanding of each of these terms throughout the home. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.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. Generally, people who use this service can feel confident their complaints will be listened to and acted upon by this home although processes could be improved upon. The home has improved its practices and staff knowledge of safeguarding to make sure people are protected at all times. EVIDENCE: The home managers deal with complaints and concerns. The home has a complaints procedure that is on display in each person’s bedroom. People gave us a mixed response, they said, “My family act on my behalf some complaints have been acted upon whilst others remain unaddressed” and “Staff do listen to what you say but some requests can take a while to work through the system”. The home has been subject to a large scale investigation by the local authority under its safeguarding protocols. The investigation took place from June 2008 until September 2008. During this time each person in the home was re assessed and their needs identified. The investigation took place after concerns were raised about the care of some of the people living in the home. We have visited the home four times during the investigation and have made requirements and recommendations on each visit. The home has taken steps to meet the requirements and recommendations. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 17 The home has worked with the local authority in making improvements in their practices, the environment, staff training and knowledge. During this investigation there was a very serious incident at the home. The home again worked with the local authority in making sure that people living there were protected from further harm. The control and restraint policy has been reviewed. It is now more robust and does give staff guidance about the different types of non physical interventions they are to use. Staff have also received training in non violent physical interventions and they told us they felt more confident in dealing with challenging situations in the home. A new bed rail risk assessment and a better bed rail maintenance programme has been has been introduced. This will reduce the risk to people using this type of restraint. We checked some of the bed rails in use during this inspection and found them to be appropriately fitted to people’s beds. The new risk assessments have been completed and had been reviewed by the care staff in order to continue the safe use of bed rails. We spent time talking to staff during our visits about their knowledge and understanding of safeguarding issues. We had raised concerns about the apparent lack of staff understanding about their role and responsibility in reporting safeguarding issues. The managers of the home have made sure that staff have had further training and that staff are aware of the different types of abuse and the actions they must take in protecting the people they are caring for. The home has also improved the way it alerts the local authority and the commission of safeguarding issues. We also looked at the recruitment of staff to make sure the home is continuing to protect people by refusing to employ unsuitable people. It was pleasing to see that checks against the Protection of Vulnerable Adults list (PoVA) are being done and Criminal Records Bureau disclosures are being obtained for each worker. This will help safeguard the people using this service from unsuitable workers. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.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 good. This judgement has been made using available evidence including a visit to this service. Generally, people live in homes that are maintained and comfortable for them. Improvements are needed but the home is taking steps to address this. Infection control procedures have been improved in order to protect the people living in the home. EVIDENCE: Relatives told us last time we visited “the home is nice and tidy although it is a bit sparse on Trent Court but this is because of the problems of challenging behaviour on here”. Concerns had also been raised by social workers and other professionals visiting the home about the “bare look” of Trent Court. They said, “It looks like there’s nothing for people to enjoy there”. The home told us in their Annual Quality Assurance Assessment (AQAA) “we plan to refurbish Trent court in the next few months”. It was pleasing to see during this Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 19 inspection that the refurbishment of Trent court is underway. New furniture and decoration have been supplied and it is hoped once completed Trent court will offer a more “homely and welcoming” environment for people to live in. The home should give consideration to replacing those window handles that have been cut off. They are sharp to touch and could pose a risk to both residents and staff when opening or closing the windows. The home should also seek advice from the Fire Officer about their suitability because it makes opening and closing windows difficult. The other areas of the home were seen to be pleasantly decorated and the environment was well maintained. People are encouraged to decorate their own rooms and to personalise them with belongings from home if they choose to. We saw the home has made some provision for the prevention of the spread of infection. There is liquid soap and paper towels in toilets and bathrooms for hand washing purposes. Staff training needs to be improved, the home is aware that there are gaps in the knowledge of staff in infection control and is taking steps to address this. Laundry facilities are satisfactory, the home has cleaning schedules for staff to follow so that the laundry remains clean and infection control guidelines are followed. The home has had one outbreak of an infectious condition and this was dealt with promptly and with the assistance of the Health Protection Team. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Staff need training so that they are aware of current best practice this will make sure that peoples health and welfare are not adversely affected. Recruitment practices within the home are good and should prevent unsuitable people from working with vulnerable adults. EVIDENCE: During this inspection people told us “The staff are all very caring and kind” and “the staff are very helpful and cooperative. Sometimes if there is an emergency with another resident they may not always be immediately available but any delay is minimal”. Staffing levels are being kept under review and the home is taking active steps to recruit new staff. Over the past three months the home has reduced the amount of agency nursing staff with the recent recruitment of trained nurses. Staff are supported through training and the home has above 60 of its care staff with an National Vocational Qualification (NVQ) level 2 in care. The home has supplied us with a training matrix that shows what training each member of staff has undertaken in the past year. There are gaps in this matrix but the manager has showed us that these will be addressed. There are posters Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 21 displayed throughout the home that show when staff training is due and inviting staff to take part. We looked at the recruitment of staff and saw four staff files during this inspection. We found that staff had the appropriate safety checks in place such as a check against the Protection of Vulnerable Adults list (PoVA) and Criminal Records Bureau disclosure (CRB). We saw that in two cases people have been employed with only a PoVAfirst check until the CRB disclosure is returned. We have recommended that the managers must risk assess these situations and take steps to reduce the risk to the people living in the home. Once people do begin working in the home they are supported through an induction. The induction booklet we looked at meets the Skills for Care Common Induction Standards. The home does need to improve upon its record keeping so that it is clear staff have completed an induction. We did speak to staff who were able to confirm they had done this. They told us “I have done training and I was helped by senior staff”. The manager confirmed that some of the current new employees are still waiting to complete mandatory training and that she was in the process of organising this through the company’s external training providers. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 22 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. Managers recognise the services shortfalls and are keen to make improvements. The home does consult with the people who live there and does take action to address their issues. People’s need for health and safety is promoted. EVIDENCE: The home is managed by Peter Sturgess and Helen McVay. Both of the managers are committed to the improvement of the service in the best interests of the people living there. They have identified some of the shortfalls in practice within the home and are taking steps to improve. For instance they are taking action to manage poorly performing staff. They understand the Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 23 importance of person centred planning for people and are in the process of putting this into practice in the home. Both managers have worked with the safeguarding team during the recent ongoing investigation. The home has a quality assurance process that covers all aspects of living within residential care. Surveys are sent out to people living at the home, their relatives and other interested parties. The findings of the surveys have been produced within a report that is available within the home. The Acting Manager told us that she has to do a number of audits each month. Audits are identified as tasks to be completed each month these include medication, care plans, accidents, night visits and staff meetings. People are encouraged to manage their own money but the home will keep monies safely on their behalf if requested to. The home manages monies for some people; they told us that this is in the process of being referred to the Court of Protection so that people’s money is better protected. The manager said that advocacy services had been contacted. The involvement of advocacy services would be a positive action and mean that an independent person will be acting on behalf of the people who use this service. Staff continue to need mandatory training in health and safety related subjects such as infection control, moving and handling, fire safety and first aid. Both managers are able to identify when staff are due for refresher training from the training matrix. They must however make sure that this is kept up to date so this can happen. The current training matrix shows significant gaps that need to be addressed. It is positive that when we spoke to staff they were able to tell us they had received training, for instance “I have recently done my moving and handling training”, when we checked the records this has not been recorded. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 24 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 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 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 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 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 OP3 Good Practice Recommendations The home should consider adopting a more person centred approach when assessing people’s needs. This will give more of an individual feel to assessment and reflect individual’s needs and wishes. People’s care plans should be kept under regular review by staff. This will ensure that people’s changing needs are addressed. All people who are sharing a bedroom should have suitable screening to ensure they have some privacy, particularly during times of personal care and attention. Written risk assessments should be in place for those members of staff who begin work with only a PoVA first check until the return of a satisfactory CRB disclosure. More consideration should be given to extra supernumery hours for both managers, to enable them time to work upon the improvements needed for the service. The home should produce a report that shows the results DS0000063566.V374060.R01.S.doc Version 5.2 Page 26 2 3 4 5 6 OP7 OP10 OP29 OP31 OP33 Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts of annual survey and any actions they will be taking to meet issues raised as part of the quality assurance system Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V374060.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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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