CARE HOMES FOR OLDER PEOPLE
Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts 17, 18 & 19 Ashby Road Burton on Trent Staffordshire DE15 0LB Lead Inspector
Mr David Cowser Key Unannounced Inspection 27&28 November 2006 09:30 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 T/A Bridge, Burton & Trent Courts DS0000063566.V355599.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 T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Rowans Care Homes Ltd T/A 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 Homes 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 T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The Registration Categories are as follows Bridge Court (45 beds) Care home with Nursing Physical disability (45 beds) Physical disability over 65 years of age (45 beds), Terminally ill (4 beds) Dementia over 65 years of age (2 beds), Mental disorder, excluding learning disability or dementia (1 bed), Old age, not falling within any other category (13 beds). Burton Court building (26 beds) Care home with Nursing Dementia over 65 years of age (26 beds) Mental disorder, excluding learning disability or dementia, over 65 (26 beds). Trent Court 28 beds Care home with nursing Dementia over 65 years of age (28 beds) Dementia (28 beds) Mental disorder, excluding learning disability or dementia, over 65 (28 beds). Mental disorder, excluding learning disability or dementia (28 beds) The care manager must commence a recognized course for RGN’s in Dementia Awareness and Management (EN35) by December 2005. That the care managers achieve NVQ level 4 certificates in Management by September 2006. For 4 beds (max) in Terminal Illness category; A nurse must be employed with a suitable qualification in Care of the dying (ENB 931) All care staff directly involved in palliative/terminal care must receive appropriate training 5. 6. 7. Minimum age of service users in TI category 60 years 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 2. 3. 4. Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 5 Date of last inspection 28th November 2005 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 (45 beds), Burton Court 27 beds and Trent Court 26 beds, 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. The Burton Court provides care for people with dementia related conditions, and Trent Court provides nursing care for people with more severe mental illnesses and dementia related conditions. The home also contracts for intermediate care beds with the local NHS trust. Activities, hobbies and entertainment all take place and transport is provided when required. Families and friends are encouraged to take part in activities and trips out. Trained nurses, both RGN and RMN, and teams of care assistants provide care. They are all responsible to the registered care managers; one is a Registered General nurse and the other a Registered Mental nurse. Health service professionals such as district nurse, community psychiatric nurse, and physiotherapist are accessed when required. Several local GP practices and a pharmacist service the home. Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This key unannounced inspection was made on the 27 & 28 November 2006 @ 09:30hrs. The inspection was undertaken using the National Minimum Standards for Older People as a reference. The total time spent for the inspection, including pre and fieldwork, amounted to 26hrs. The two registered care managers (RGN & RMN) were in charge of the home accompanied by four first level registered nurses and sixteen care assistants. A student nurse was also present. The ancillary staff on duty included; 6 domestic workers, 2 laundry workers, maintenance person, 4 catering staff, and two activities organisers. The business support person was also present throughout the inspection. These staffing levels were adequate to meet the needs of the current 85 service users in the home. The total of 85 residents included; Bridge Court - 32 people receiving nursing care for physical needs (including 2 terminally ill patients), and 5 receiving personal care for needs associate with old age. The three intermediate care beds were in use. Burton Court – 24 patients with dementia related needs. Trent Court – 24 patients with mental health related needs. The inspection included the following elements; a tour of the building, observation and inspection of records relating to provision of care, discussions with eight residents and four visitors, discussions with staff members on duty, observation and sampling of other services provided such as catering and laundry, and an inspection of the managerial aspects such as staffing issues, quality assurance and health & safety. Since the last inspection on 28 November 2006 there had been no changes to the management of the home. No additional visits had been necessitated by CSCI. Residents and visitors made positive comments about the home, including; ‘I am happy here and have no complaints’. ‘I am well satisfied with the home’. ‘The girls are good and work very hard to look after us’. ‘I have settled well and they make all my family welcome to see me’. ‘The food is good and my room is very comfortable’. Current fees range from; £327 to £1030 per week. What the service does well:
Residents and/or their representatives had been able to choose the home, following an assessment undertaken by the nursing staff and an invitation to visit, prior to admission. Asking residents and visitors, and inspecting the
Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 7 admission documentation, confirmed this. Intermediate care was undertaken well. The above aspects had assisted in ensuring that each resident had been suitably placed, and that the home had the ability to meet their assessed needs. It was evident, from discussions with residents and staff, and an inspection of the relevant documentation, that the provision of health and social care had been addressed. Service user plans seen had been completed and regularly reviewed. The plans were based on the community care plans completed by social workers, and agreed by residents/representatives. There was a safe system in place for the receipt, storage, administration and disposal of medicines. No errors were noted concerning medicines, and residents asked said that they had their right medicines on time. Privacy, dignity and choice aspects for residents were seen being upheld during the caring process. When asked several residents and relatives said that they were happy with the health and personal care being delivered by the home. During the past 12 months the number of accidents and incidents in the home was low. Activities and entertainment, arranged by two dedicated members of staff, had taken place and were seen documented. Residents told the inspector that they had appreciated and enjoyed the recent events and activities, and that they were able to choose whether or not to take part. Visitors confirmed that links had been maintained with them and links had also been maintained with the local community. Catering aspects were good and records seen showed that individual dietary requirements had been met. Residents spoke of choices and said that they were generally pleased with the food provided. The inspector observed the main meal of the day, which met all requirements and was well presented. Assistance was seen being given to people with mental health or dementia care needs to help them to make a choice, by staff who had knowledge of the residents likes and dislikes. All of the above had assisted the residents in their daily living and social activities. There was a system in place for the reporting of incidents or reports of abuse of any kind, and policies and procedures seen covered these issues. One complaint had been received by CSCI via the social worker, and this is currently being investigated. Residents and relatives understood the complaints procedure. These aspects had contributed to the protection of service users. The home was fit for purpose, and provided a safe and secure environment for the residents, staff and visitors. A homely atmosphere had been created and the premised were clean, warm and tidy. Adequate areas for residents were provided including; communal space, dining/activity space, bathing/toilet facilities, and bedrooms. Services and facilities were generally adequate, with the exception of the kitchen layout. All residents asked stated that they were happy with the environment and facilities, and that they were comfortable with their surroundings. Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 8 The registered care managers (RMN and RGN) and teams of nurses and care staff provided care. A good working relationship was evident with the local GPs and pharmacist. NHS facilities and both community and hospital health professionals had been accessed when required. Community Psychiatric Nurses were also accessed if required. The homes RMN staff were meeting the mental health needs of service users. The clinical nurse specialist for wound care was currently visiting and advising the home, which were administering the correct intervention and treatment. Staffing levels and skill mix had been adequate to meet the assessed needs of the existing residents. Recruitment of staff and employment aspects was good. Staff training had been given a high priority, with induction training being followed by NVQ training. In addition to the trained nurses 23 of care assistants were qualified to NVQ level 2 or above. NVQ training and in house training in relevant subjects is on going. These aspects had contributed to the high standards of care being provided by the home. The general nursing care manager (RGN) is experienced and qualified. The RMN registered care manager is experienced, but has not yet achieved the registered managers award. The general management, and management of health and safety issues was very good. The documentation seen evidenced that the premises were adequately maintained. All records had been correctly filed and stored. Assurances were given regarding the positive financial viability of the home, and that suitable accounting/business procedures were adopted. The current public liability insurance certificate was seen. There was a safe system of accounting for residents day to day monies and the ledgers reconciled with the money held. Quality assurance systems are in place. All the above had contributed to the protection and well being of residents in the home. Throughout the inspection the people who use, or have contact with, the home expressed only positive views. A folder containing thank you cards and complimentary letters from appreciative relatives was seen. What has improved since the last inspection? What they could do better:
Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 9 Test records for gas (landlords certificate) and electricity (NIC) relating to all parts of the home must be available for inspection, as agreed. The requirements made during the Environmental Health officer’s inspection 15/11/06 must be complied with, as agreed. Training should continue to enable 50 care staff achieve NVQ level 2. The RMN nursing manager should complete his studies for NVQ level 4 management qualifications, as agreed. The CSCI inspection reports should be made available to residents, visitors and staff, as agreed. The fragmented catering facility should be adapted/altered to enable the central kitchen to include dishwashing, food storage and freezers, all as agreed with a former director of the company. It is understood that this is currently being reviewed. Items raised on the residents ‘have your say’ replies to CSCI included; set visiting times, misplaced items of clothing, staff cover for sickness. These items had recently been satisfactorily addressed prior to this inspection. 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 T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 10 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 T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 11 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): Standards3,6 The quality outcome for the above standards is good. This judgement has been made using available evidence including a visit to this service. Residents have been correctly placed in a home of their choice, which has the ability to meet their assessed needs. Intermediate care was undertaken well in this home. EVIDENCE: The documentation seen, and a discussion with both residents and their representatives, evidenced that residents had been assessed prior to admission and they had been able to make a choice about the home. All had been given the opportunity to visit the home prior to choosing to stay. Two residents spoken to had visited the home, and had a meal prior to deciding to stay, and this was seen documented within the care plans. A full assessment of each resident’s needs had taken place before admission and this was seen documented. The community care plans provided by the social worker, as part of the individual needs assessment process, were seen within the service user
Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 12 plans. Residents asked confirmed that they had been fully involved and were in agreement with the assessments. Intermediate care was undertaken well in this home. The documentation and anecdotal evidence indicated that residents had benefited from their stay before returning to the community. All of the above had contributed to suitable placements and the residents needs being met. Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 13 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): Standards 7,8,9,10 The quality outcome for the above standards is good. This judgement has been made using available evidence including a visit to this service. Individual health, personal and social care needs, as documented within care plans, had been adequately addressed with privacy and dignity afforded during the caring process. There was a safe system for the receipt, storage, administration and disposal of medicines. NHS health care facilities and professionals had been accessed when required. Particularly attention had been paid to meeting mental health and dementia related needs. EVIDENCE: The service user plans and associated documentation seen was well written, meaningful and reflected the current condition of residents. The care plans seen and the associated documentation, and a discussion with both residents and staff members, evidenced that health and personal care needs were being met. A total of 8 care plans were examined in greater depth. The dementia/mental illness related needs of residents had been documented when applicable, and staff training had been provided covering these issues.
Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 14 NHS facilities and professionals including community nurses, medical consultants and clinical nurse specialists had all been accessed when required, and these events were seen recorded. A good working relationship had been established with community nurses and the community mental health team, and the documentation seen evidenced this. Local GP practices and a pharmacy service the home, and there is a good working relationship with them. Records of their visits and outcomes were seen documented. Currently there are 8 residents with pressure areas (4 acquired elsewhere), and tissue viability aspects were being dealt with in the correct manner and recorded. The clinical nurse specialist for wound care is also involved when required and is currently attending and advising the home on the above. The medicines within the home, medication administration records, controlled drugs books and drugs disposal books, were all checked and no errors were noted. There was a safe system in place for the receipt, administration and disposal of medicines. The documentation seen evidenced that only trained nurses administered medicines. No resident was ‘self medicating’, but locked facilities were available throughout. During the inspection it was observed that privacy and dignity were being afforded to residents, and there was very good interaction with staff. Care staff were seen knocking on doors before entering. Several residents told the inspector that they were treated with respect, and that the staff were very kind. Residents, and several relatives, all commented positively about the care being provided. There had been only 16 deaths in the home during the previous 12 months, which is acceptable in view of the numbers of poorly nursing patients and terminally ill patients admitted over this period. All of the above evidence satisfied the inspector that the individual health, personal and social care needs of residents had been addressed in the correct manner. Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 15 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): Standards 12,13,14,15 The quality outcome for the above standards is good. This judgement has been made using available evidence including a visit to this service. Social contact had been maintained and the daily activities, along with autonomy and choice, had contributed to the resident’s lifestyle experiences meeting their expectations. Catering aspects met individual needs and preferences. EVIDENCE: The residents asked told the inspector that their views had been listened to, and that they had been able to influence some aspects of the running of the home e.g. mealtimes, menus. These comments had been documented along with the feed back from the resident/relatives questionnaires, and they had been acted upon. Contacts had been maintained with relatives and friends and this was seen documented. Residents spoke of their visitors and their involvement with the home. Visitors attending the home during the inspection, told the inspector of the good links, communication and the homes involvement with them. Trips out to the community had been organised and transport provided. The two dedicated staff had coordinated and recorded the events, and residents
Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 16 commented that these had been appreciated. The external events included; pub visits, river trips, shopping centre, garden centre and visit to Twycross zoo. The residents spoke of their satisfaction with the meals and choices offered. The menus and catering records were examined and evidenced that the dietary requirements of residents were met. A discussion evidenced that individual likes and dislikes had been established and complied with. The cook had established resident’s choice of food for the day. The records evidenced that residents’ needs with diabetes had been met. The cook when asked said that fresh good quality food from local suppliers was purchased on a daily/weekly basis, the records seen confirmed this. Adequate supplies of fresh vegetables and fruit were also seen. The mid day meal seen was well presented and met all nutritional requirements. The meals were seen being served in a caring and unhurried manner. All of the above had contributed to the satisfaction expressed by service users/representatives during the inspection. Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 17 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): Standards 16,18 The quality outcome for the above standards is good. This judgement has been made using available evidence including a visit to this service. An open culture existed where complaints or grumbles are listened to and acted upon. Residents are protected from all forms of abuse. EVIDENCE: An examination of the complaints records, the relevant policy and procedure documentation, and a discussion with staff and residents, evidenced that complaints and grumbles were listened to and dealt with. It was agreed that a central complaints register be kept. One observation relating to care had been received by CSCI since the last inspection, and this was recorded in the home. This was an internal matter and has been satisfactorily dealt with by the home. From a discussion with residents and visitors it was evident that they knew how to make a complaint if they needed to. A folder was seen with ‘thank you’ and complimentary cards from appreciative relatives. The policy documentation seen, and a discussion with staff and management on the day of this inspection confirmed that residents are protected from all forms of abuse, and that correct procedures are in place to deal with any issues raised. Documentation seen also evidenced that these issues had been discussed during staff induction, training and on-going supervision. The above had satisfied the inspector that residents are protected from aspects of abuse.
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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): Standards 19,26 The quality outcome for the above standards is good. This judgement has been made using available evidence including a visit to this service. The home, was clean, pleasant and hygienic, and provided a suitable and safe environment for the provision of care. EVIDENCE: A tour of the building, and a check on the maintenance documentation, verified that the premises were fit for purpose, clean warm and tidy. The senior staff when asked told the inspector of their knowledge on infection control, and showed him the relevant documentation. Adequate hand washing facilities were available throughout the home. The laundry and sluicing facilities were seen to be compliant. Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 20 The bedrooms and communal spaces seen were decorated well and a homely atmosphere was observed. Residents asked expressed satisfaction with the environment, and had made their rooms comfortable. The fragmented catering facility should be adapted/altered to include dishwashing, food storage and freezers, all as agreed with a former director of the company. It is understood that this is currently being reviewed. The records evidenced that the premises were being maintained. Hot water temperature checks, and emergency lighting/fire alarm tests were seen up to date and correct. There are no outstanding issues known from the Fire Prevention officer. The requirements of the recent Environmental Health officers inspection is referred to under Standard 38 of this report. All of the above had contributed to the comfort and protection of people using the service. Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29,30 The quality outcome for the above standards is good. This judgement has been made using available evidence including a visit to this service. Adequate numbers of suitably trained and experienced staff are correctly employed to meet the assessed needs of residents. EVIDENCE: The two registered care managers (RGN & RMN) were in charge of the home accompanied by four first level registered nurses and sixteen care assistants. A student nurse was also present. The ancillary staff on duty included; 6 domestic workers, 2 laundry workers, maintenance person, 4 catering staff, and two activities organisers. The business support person was also present throughout the inspection. These staffing levels were adequate to meet the needs of the current 85 service users in the home. The total of 85 residents included; Bridge Court - 32 people receiving nursing care for physical needs (including 2 terminally ill patients), and 5 receiving personal care for needs associate with old age. The three intermediate care beds were in use. Burton Court – 24 patients with dementia related needs. Trent Court – 24 patients with mental health related needs. Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 22 The duty rosters seen, and a discussion with the care managers and the staff, evidenced that adequate numbers of staff had been on duty to meet the needs of the existing service users. The following care staff had been on duty or exceeded for the 85 service users; a.m. 4 RGN/RMN 15 care assistants p.m. 4 RGN/RMN 14 care assistants Night 3 RGN/RMN 8 care assistants In addition to the above adequate ancillary staff were rostered on duty throughout the week. Several residents asked stated that care staff were available when they wanted them, and that the staff were capable. The records seen evidenced that, in addition to the trained nurses, 48 care assistants were employed, of which 11 (23 ) were trained to NVQ level 2 or above. NVQ training is continuing to meet the 50 target, with care staff also taking level 3. The homes recruitment policy, procedures and documentation were examined and recruitment issues had been handled correctly. Staff had been subject to POVA/CRB comprehensive checks, and these were seen recorded. Staff asked stated that they had job descriptions and contracts of employment. Training had been given a high priority and the training records of individuals were seen. The records evidenced that care assistants had benefited from ‘in house’ and external training, which had covered the needs of the registered client group. Staff told the inspector that they had been afforded the time off and encouraged to study. The records seen and a discussion with the staff evidenced that, individually and collectively, they had the necessary experience and skills to meet the assessed needs of the current service users. Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 23 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): Standards 31,33,35,38 The quality outcome for the above standards is adequate. This judgement has been made using available evidence including a visit to this service. Experienced registered care managers are managing the home, in the best interests of service users, and in an open an inclusive atmosphere. The home is on a sound financial footing, and has safeguards for the health and well being of residents’ staff and visitors. The two requirements identified must be addressed. EVIDENCE:
Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 24 The registered care managers are are well experienced. The RMN nursing manager should complete his studies for NVQ level 4 management qualifications, as agreed. An open, positive and inclusive atmosphere was observed during the visit and confirmed to the inspector by service users, staff and relatives. Staff when asked also said the manager’s portrayed leadership and direction, which enabled them to relate to the aims and objectives of the home. From observations made, discussions with service users and staff, it was evident that the home was being run in the interests of service users. Quality assurance, including feedback from residents and their representatives, was seen documented. Documentation seen evidenced that the views of visiting professionals had also been established, and included in the review process. Staff supervision sessions, six times per year, had all been completed and documented. A check on the records and a discussion with both residents and representatives evidenced that all service users had the opportunity to handle their own finances and residents and families had chosen to do so. Day to day monies of residents was checked, and money held reconciled with the ledger. Inventories of valuables and belongings brought into the home were seen recorded. The documentation seen for checks and examination of plant and equipment was all correct and up to date and included; fire precautions, fire equipment, gas testing, boiler servicing, wheelchairs, equipment, hoists, lifting equipment, shaft lift servicing and tests, portable electrical appliances, water treatment, water temperatures, electrical completion/test certificates. There were two exceptions to the above; Test records for gas (landlords certificate) and electricity (NIC) relating to all parts of the home must be available for inspection, as agreed. The requirements made during the Environmental Health officer’s inspection 15/11/06 must be complied with, as agreed (EHO’s report to follow). The manager gave assurances that the home was financially viable, on a sound footing, and that suitable accountancy and budgeting procedures were adopted. The current public liability insurance certificate was seen up to date and correct. The above evidenced that the service users are protected and safeguarded. The CSCI inspection reports should be made available to residents, visitors and staff, as agreed.
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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 3 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 4 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 4 X X 2 Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 13(4)(a) Requirement Test records for gas (landlords certificate) and electricity testing (NIC) relating to all parts of the home must be available for inspection, as agreed. The requirements made during the Environmental Health officer’s inspection 15/11/06 must be complied with, as agreed. Timescale for action 27/12/06 2 OP38 16(2)(g) 27/12/06 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 Refer to Standard OP28 OP31 OP38 Good Practice Recommendations Training should continue to enable 50 care staff achieve NVQ level 2. The RMN nursing manager should complete his studies for NVQ level 4 management qualifications, as agreed. The CSCI inspection reports should be made available to
DS0000063566.V355599.R01.S.doc Version 5.2 Page 27 Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts 4 OP19 residents, visitors and staff, as agreed. The fragmented catering facility should be adapted/altered for the central kitchen to include dishwashing, food storage and freezers, all as agreed with a former director of the company. It is understood that this is currently being reviewed. Rowans Care Homes Ltd T/A Bridge, Burton & Trent Courts DS0000063566.V355599.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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
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