Inspection on 03/06/08 for Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts

This inspection was carried out on 3rd June 2008.

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

The inspector 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,... 16/02/09

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 28/09/2008.

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 09:00 3 and 11th June 2008 rd 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.V365597.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.V365597.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.V365597.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 TA Bridge, Burton & Trent Courts DS0000063566.V365597.R01.S.doc Version 5.2 Page 5 Date of last inspection 27th November 2006 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 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. The fees for residency are not 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.V365597.R01.S.doc Version 5.2 Page 6 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. Three inspectors and an expert by experience completed this inspection. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. 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 who use this service told us they were happy with their care. They said “I could not wish for a better home for my husband he gets all the care and help he needs”. Others said “I have always been looked after especially as I have dementia” and “Staff always act on any comments we make”. “We appreciate that at times the staff are really busy and always make time if possible the care they give is very good”. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.R01.S.doc Version 5.2 Page 7 The home takes time to arrange activities and outings for people to take part in. There are dedicated staff who do this for the home. Recent trips have included Tamworth theatre and Trentham Gardens. Some of the people living in the home also choose to go on holiday. Meals are generally very good. The home has a good choice of meals for people to choose from. There is always a meat, fish or vegetarian choice on offer every day. People told us “The roast lamb on Sunday was lovely.” “There is a good choice at breakfast.” “ The food is very good. We are spoilt for choice. There is always something that we like.” People praised the staff and managers at the Rowans saying they were “like gold to us, care for us”, “we feel we could talk to them about anything”. Our Expert by experience gave the following summary “overall observations are that The Rowans is a well organised and comfortable home. The food seemed very good and a range of activities is offered regularly. I saw good interaction between staff and residents, which showed interest, care and was appropriate”. What has improved since the last inspection? What they could do better: The statement of purpose and service user guide for this service need to be updated to reflect the specialist care on offer in each of the three homes. It is also recommended the range of fees to be charged are included in the service user guide for people’s benefit. A person told us “No I didn’t get enough information before I moved in here”. The home needs to define its role in supporting people in intermediate care beds. There should be clear goals for people to work towards upon their admission and clear support pathways including specialist practitioners. The home has expressed their concerns over the conduct of one group of General Practitioners who have responsibility for some of the people living in the home. The manager must take steps to report concerns of poor practice to the Primary Care Trust to ensure that the people who live in the home are not placed at risk by potentially poor practice. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.R01.S.doc Version 5.2 Page 8 Assessments are in place for each person but the home could develop these further by adopting a more person centred approach to assessment and care planning. In doing this the home would offer a more individualised care service to the people who live there. The administration of medication must be improved particularly on Trent court where we observed poor practice. The home must also take action to control the temperature of the treatment room at Trent court to ensure that medicines are being stored safely and in the best interests of the people living there. Staff need to develop an understanding of the principles of the Mental Capacity Act 2005 and their roles and responsibilities in supporting people who do not have the capacity to make decisions for themselves. The home is in the process of updating the Safeguarding policy once this is done staff should have the guidance they need to report allegations of abuse should they need to do so. The programme of training in safeguarding adults needs to continue to make sure all staff are included and that they have an understanding of safeguarding and their role in protecting people. The complaints policy needs to be updated so that people can be sure of who to refer their concerns to. They will also need to know who will investigate concerns on their behalf and how long this is to take. We expressed serious concerns about the safety of bed rails and ill-fitting pressure relieving mattresses for some of the people we case tracked. We asked the home to address this immediately. It is pleasing to see that this has been done, the home has also checked everybody’s bed rail and pressure mattress to make sure people are not placed at risk. Staffing levels need to be kept under review and reflect changes in peoples needs. This will mean that people’s needs are being recognised and actions are taken to address this. 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 Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.R01.S.doc Version 5.2 Page 9 be made available in other formats on request. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.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 TA Bridge, Burton & Trent Courts DS0000063566.V365597.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): 1,3,4,5,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People choosing to live in this home will have some of the information they need to help them make choices. Each person will 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 but improvements could be made. EVIDENCE: The home is currently in the process of updating both the Statement of Purpose and Service User Guide. The manager told us this is being done to reflect the specialist care each of the three homes provides. We have also recommended the range of fees are included in the new Service User Guide. Once this is completed people thinking about using this service will have up to date information upon which to base their decision. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.R01.S.doc Version 5.2 Page 12 We looked at the care of six people as part of our case tracking process. We saw that each person has an assessment of their needs which, is completed prior to admission. The home also obtains records from the Primary Care Trust Single Assessment Process and from individuals own 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 chance to “test drive” the service and meet with some of the people living there. The home provides intermediate care services and is contracted to provide two beds for this purpose. People using this facility will be supported by the Primary Care Trust and specialist services like physiotherapy and occupational therapy. We looked at the care of one person who was using this service. We found at times the home has struggled to get medical attention for this person. The manager reported several problems with a particular surgery visiting the home. We have recommended the manager writes to the Primary Care Trust and expresses her concerns to them. The home must also be clear about the admission criteria for intermediate care facilities and be confident about refusing admissions if they feel they are inappropriate. For instance one person’s care we looked at appeared to be more of an admission for crisis intervention to assist the family rather than a planned admission to help rehabilitate the person back to health and independence. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.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): 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 are needed. Medication practices in the home must be improved so that people are protected from unsafe practice. EVIDENCE: We looked at the care plans and risk assessments for six people who live in this home. Each person had risk assessments in place that looked at their risk of developing pressure sores and malnutrition and also the risk of falls and moving and handling. In most cases these risk assessments had been reviewed and kept up to date. We did find some instances where the risk assessments did not reflect the current needs of the people we looked at. For instance one persons nutritional risk assessment clearly indicated they had consistently lost weight since admission but the score did not show this increased risk or the actions staff needed to take in order to address the weight loss. We were also unable to determine what action the home had taken to address this problem when reading the daily notes. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.R01.S.doc Version 5.2 Page 14 We looked at the pressure area care for people and found it to be generally satisfactory but improvements were needed to the equipment the home had provided for one person. The air mattress was not secured to the bed as it should have been and posed an increased risk to the service user. This was bought to the manager’s attention immediately and it was pleasing to see that immediate action was taken to put this right. We have written to the home and asked them to make sure that all pressure relieving equipment is fitted safely and securely for all people who use it. Care plans for dealing with challenging behaviour contained limited information about the care and attention staff should give to people when this happens. Other care plans appear to show a limited understanding of the persons needs in this area. One care plan stated, “Once calm will apologise for her outbursts, will be compliant with medication, will recognise that behaviour is inappropriate”. Other care plans instructed staff to use “verbal reinforcement techniques” but no further explanation as to what this meant. This was discussed with the manager who agreed that these entries did not offer staff the guidance or show the understanding that staff need to meet this persons needs. Other care plans seen were generally satisfactory and did give a realistic picture of peoples needs. These plans are kept under review by the staff but we have asked them to write care plans for people’s short-term health problems as well. We saw evidence to show us that people had chest infections and urinary tract infection but no care plans to demonstrate how the home would meet these needs. People living in this home do have access to their own doctor when they need it. We also saw evidence to show that other health care professionals also visit the home to offer advice and support to the people who live there. People told us “I get the care and support I need” and “I have always been looked after especially as I have dementia”. We have also received comments from some of the healthcare professionals who visit the home, they told us “I am able to see my patients with an effort in private”. And “sometimes I don’t think they meet my clients needs because they don’t understand them”. “The care they get in there is good I have no complaints”. Medication practices were generally satisfactory on two of the homes but improvements were needed on the third. We saw evidence of poor practice during medication administration. The nurse in charge had dispensed everybody’s medication into medicine pots on top of the medicine trolley. This is unsafe practice and places people at increased risk of medication errors occurring. This was bought to the manager’s attention during the inspection. She told us she was already aware of areas of poor practice in medicine management and was taking steps to improve this with individual members of staff. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.R01.S.doc Version 5.2 Page 15 The temperature in the office/medication storage room on one of the homes was in excess of 28oC, this means that medicines are not being stored as manufacturers recommend and may place people at risk. We have recommended the home begins to record the temperature of this room daily and they must take steps to reduce the temperature in the mean time to ensure that medication is stored at 25oC or below. We saw people are prescribed medication on an “as required” or “PRN” basis. We found no individual care plan to guide staff when considering administering this medication. We also noted that one person was regularly being given “as required” medication, we discussed this with the manager and have recommended in these circumstances people’s need for this medication should be reviewed by their doctor. The home does have good systems in place for the ordering, receipt and returns of medication. Controlled drugs were stored appropriately and other medications such as Temazepam were kept securely too. At present none of the current service users administer their own medication. 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.V365597.R01.S.doc Version 5.2 Page 16 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 adequate. 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: We spent time with the people who live here talking to them about their daily life. They told us “It is all right.” “It is a bit boring, there are not many activities and the outings are not often.” “There is not much chance of going out, eg shopping. I feel stuck in.” Other people said “we do get time to go out”, “there are two people here that help us, we have our hair done and they try their best to do things for us”. “We’ve been to Tamworth theatre, Burton Park, Trentham Gardens and the pub for lunch” The home employs two dedicated activites coordinators who also do the hairdressing for some of the people who live here. The AQAA tells us that the home would like to improve on the amount of activities hours per week. We saw during the inspection people taking part in arts and crafts and sing a longs. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.R01.S.doc Version 5.2 Page 17 Visitors are encouraged to come to the home as people want them to. One visitor told us “I cannot complain about the care at all, they keep me informed and I know my wife is looked after”. We looked at people’s bedrooms as part of our case tracking process. Mostly rooms were pleasantly decorated and people had taken time to bring in their own possessions to personalise their rooms. “My relatives room is neat and tidy. He can have his own furniture, bed, TV, etc. in his room.” We spoke to staff about the support they give to people when they are unable to make decisions for themselves because of a lack of mental capacity. Some of the staff were not able to tell us how they would do this. They said “I don’t know”. Other members of staff told us “we have heard of the mental capacity act, the manager gave us a booklet to read I think we have training to do as well”. We discussed this with the manager at the time of the inspection. They confirmed that training is in the process of being organised for staff. This training will help staff to understand the principles of the Mental Capacity Act 2005 and of their roles and responsibilities towards people as a result. We spent time with people during lunchtime. We saw staff were attentive to people’s needs and when necessary helped them. People said, “ The food is very good. We are spoilt for choice. There is always something that we like.” “The roast lamb on Sunday was lovely.” “There is a good choice at breakfast.” We looked at the menu’s that are planned on a four weekly basis. It was very pleasing to see that there is three choices every day from a meat, fish or vegetarian dish. The manager also told us the home is able to provide other choice if people do not like what is on offer. One member of staff said “we could look at the ordering system because we ask people the day before and they forget what they have ordered, it can cause confusion for them sometimes”. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.R01.S.doc Version 5.2 Page 18 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. People who use this service can feel confident their complaints will be listened to and acted upon by this home. The home must take steps to improve 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. We looked at the home’s current complaints policy and have recommended that improvements be made. For instance, adding timescales for completion of investigations and the name of the person who is responsible for responding to complaints within the home. This will give people a clear process of who to talk to if they have concerns, and how long the process is likely to take. The manager told us this was already being done by the company and a new policy should be in place soon. We have visited the home recently in addition to this inspection. We visited as part of an on going safeguarding investigation and looked at staff knowledge and understanding of safeguarding issues. We spoke to 11 staff members and we concluded that further training and an update of the homes safeguarding policy is needed. The manager told us that training has already taken place for some but not all staff yet. We asked staff what they understood by the Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.R01.S.doc Version 5.2 Page 19 term safeguarding or adult protection they told us “its drawing attention to something that may be happening”. We also asked them if they were aware of the home’s own safeguarding policy they said “there is a safeguarding policy they showed it to me during my induction”, “ I don’t know about whistleblowing”, “there is a policy but I have never read it” “its drawing attention to something that may be happening”, “I had a copy of the abuse policy with my contract”. The home will also need to obtain a copy of the most recent guidance from the local authority. This needs to be done so that all staff have the most current contact details for the Safeguarding teams should they need to refer an allegation to them. When we looked at care plans for some people we saw evidence to suggest some people’s needs are more difficult to meet than others. The home does take action in getting people reviewed by medical and other professional staff when they need it. Care plans that should guide staff when dealing with violent or aggressive behaviour lack the information to do so. For instance one care plan states “use a verbal reinforcement technique” but gives no explanation what this is or how staff should do it. One behavioural plan was appropriately based upon de-escalation and re-assurance, but insufficiently detailed regarding the use of PRN medication and restraint, “use of restraint as per home policy”, without detailing the type of restraint and when PRN medication is to be used. The use of control and restraint was also referred to in another persons care plan wihtout sufficient detail of they type or level of restraint to be used. This was discussed with the manager who confirmed that under no circumstances do staff in the home use any type of physical restraint. It was recommended this persons care plans be re written so that they do reflect the care and attention they need. All staff need to understand that physical restraint is not to be used. If the home feel that physical restraint is needed to manage people’s behaviour then it must be clearly risk assessed and only used as a last resort. Staff must also be suitably trained and understand the policies and practices of the home. It is acknowledged that one of the home managers has recently completed training to enable him to train staff to use physical intervention if it is needed. We expressed serious concerns about the safety of bed rails and risk assessments in use. We sent an urgent action letter to the home asking them to tell us what action they have taken to make bed rails safe for the people using them. The home has told us this has been done, new risk assessments are in place and as a result of this action many of the bed rails that had been in use have now been removed for people’s safety. 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.V365597.R01.S.doc Version 5.2 Page 20 Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.R01.S.doc Version 5.2 Page 21 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): 19,24,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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 could be further improved in order to protect the people living in the home. EVIDENCE: This is what the expert by experience wrote about the home environment. “Photographs of all the staff were displayed in the entrance hall. As a visitor I would find this useful. All areas were well decorated and were clean. A staff member told me there was a rolling programme for decorating. I saw routine maintenance being carried out. The corridors and rooms were spacious and would allow wheelchairs to be manoeuvred around easily. There were keypads on all doors between sections and a coded bolt on a stair gate giving good security. All radiators are covered for safety. The residents who can use the Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.R01.S.doc Version 5.2 Page 22 toilets have been given rooms close to the toilets. This is a very thoughtful action”. People living in the home told us “you could not find a better place for older people.” “I cannot fault it.” “xxxx’s room is neat and tidy. He can have his own furniture, bed, TV, etc. in his room.” “We have nice easy chairs to sit in”. Relatives told us “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 have 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”. They plan to keep up with the redecoration and refurbishment of the home by replacing worn out and damaged equipment, providing a new laundry and a kitchen extension. They also told us they have bought two new hoists and a “stand aid” for people’s comfort when moving. Ten airwave mattresses have been supplied to help prevent pressure damage occurring”. 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. Laundry facilities are satisfactory but the home must make sure that it has cleaning schedules for staff to follow so that the laundry remains clean and infection control guidelines are followed. Walls and flooring must also be impermeable for ease of cleaning. It is recommended the flooring be recoated to enable it to be easily cleaned. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.R01.S.doc Version 5.2 Page 23 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. People are generally satisfied with the care they receive to meet their needs but improvements are needed. 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: The home usually has enough staff on duty to meet the needs of the people living there. What they must do is keep this under regular review so that staffing levels change with the needs of the people using the service. One person told us “Usually I get the care and support I need”, another said “at times we have to wait but we appreciate that the staff are really busy and always make time if possible”. We also spoke to social workers and other health professionals they told us “I think there could be more staff on duty, I was told 7 but only saw 2 people”. “we are concerned that people may not get the one to one care they need”. These comments were discussed with the manager who confirmed that in this particular house there are 7 people on duty during the day and if people’s needs change and extra care is needed they will ask the relevant agencies for a reassessment of their needs to secure funding for extra staff. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.R01.S.doc Version 5.2 Page 24 Some of the care staff have completed their National Vocational Qualification (NVQ) level 2 in care. The home told us in their AQAA that more care staff are currently working towards NVQ level 2 or above. Given the turnover of staff and new workers beginning employment the number of staff completing the NVQ has been diluted. The home will need to improve upon this so that all care staff have achieved their NVQ training. We looked at staff files so that we could check the home recruitment practices and make sure they are not placing people at risk by poor practice. They also make sure that two written references are obtained for each new worker. The home employs some overseas staff, the manager told us that they are presently awaiting confirmation from the Home Office for some of the new workers before they begin working in the home. 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.V365597.R01.S.doc Version 5.2 Page 25 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. Both the 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 but improvements in risk assessments, staff training and equipment maintenance are needed. 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.V365597.R01.S.doc Version 5.2 Page 26 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. Mr Sturgess has also recently completed a Train the Trainer course in Non Physical restraint to enable him to teach staff good practice when interventions are needed. The home has their own quality assurance system in place. They consult on an annual basis with the people living in the home and their families. Some of the recent comments from the questionnaires people completed included the following, “ I am very satisfied with the way that you look after my mother” “ I am very satisfied with my mothers care and the staff at the home are very helpful” “ sometimes mum not able to get any one to attend to her as she has a quiet voice and they don’t always think that she has a valid reason. She tried to get attention today as her tea had burned her stomach but it wasn’t addressed till we arrived. Sometimes we find that they are a bit rough with her when washing.” “ My husband has been here 4 weeks I feel he is having the best care here, that’s why I insist on travelling the distance I do.” “ I have never left the home thinking that my mums care and needs are not the most important thing to all the staff that work here. I thank them for all their continued efforts and attitude.” We have recommended the home publish a report on the results of these questionnaires and what they are going to do to improve on some of the issues raised. In addition to this the area manager completes a monthly visit to the home where she will also report on the quality of the service the home is providing. In addition to this we, the commission, also ask the home has complete the Annual Quality Assurance Assessment (AQAA). The information supplied in this document has been used to help us plan our inspection and form judgements about the service the home is providing. They told us that they would continue to improve upon redecoration and refurbishment of the home. They will continue to improve upon the care planning and risk assessments so that service users requests are met and better guidance will be in their care plans. The home does manage some people’s money but this could be done better. We have recommended that receipts and two signatures be recorded for all transactions. We found receipts that showed people have paid for “lunches out” but could not determine how much each person had spent doing this. The home manages monies for some service users; 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. One person has recently bought a reclining chair for their use but the home was unable to show how they made the decision to buy it for them. The manager said that advocacy services had been contacted so that this would be addressed in future. The involvement of advocacy services Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.R01.S.doc Version 5.2 Page 27 would be a positive action and mean that an independent person will be acting on behalf of the people who use this service. The health and safety practices in the home are generally satisfactory but improvements to risk assessments for individual’s use of bed rails is needed. The risk assessments we saw were insufficient and would not readily identify the risks to people using bed rails. We also looked at the equipment in use for those people we case tracked. We expressed serious concerns about one person’s ill fitting bed rails and pressure relieving mattress because they posed a serious risk of entrapment or other injury. We asked the manager to check the bed rails and pressure mattresses for all of the people using them in the home to ensure that no body else was being placed at risk. The home has written to us following the inspection to tell us that this has been done and new risk assessments are now in place to protect people. 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.V365597.R01.S.doc Version 5.2 Page 28 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 2 X 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15 (1) Requirement People’s care plans must be reviewed regularly and reflect the changes in need. Plans must contain clear information for staff to follow so that peoples needs can be met. The home must make sure that when people are diagnosed with short term health problems such as chest infection, they are recorded in a care plan for that person. The home must record their actions when people loose weight, this must be clearly documented in their care plans and risk assessments. This must be done so that people’s needs are met. People who are prescribed “as required” medication must have a detailed care plan that clearly indicates the circumstances when the medication can be administered and the effectiveness of it. “As required” medication must not be routinely administered. If people need “as required” DS0000063566.V365597.R01.S.doc Timescale for action 01/08/08 2 OP8 15(1) 01/08/08 3 OP8 13(4) 01/08/08 4 OP9 13(2) 01/08/08 5 OP9 13(2) 01/08/08 Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts Version 5.2 Page 30 6 OP9 13(2) 7 OP9 13(2) 8 OP18 13(4) 9 OP18 13(4) 10 OP18 13(7) 11 OP18 13(7) 12 OP38 18 (1) (c) medication on a regular basis the home must arrange for a review of the person’s condition from their own doctor. The excessive temperature in the office/medication storage room on Trent court must be addressed. This must be done so that people’s medicines are being stored safely and risks to service users are reduced. The practice of dispensing medication en masse must cease. (as witnessed in Trent court) Medication must be administered to one person before staff move onto another. This will reduce the risk of errors occurring and safeguard people living in the home. The home must make sure that bed rails and pressure relieving mattresses are fitted as per manufacturers instructions and do not pose an increased risk to the people who are using them. Immediate requirement Risk assessments for bed rail use must be comprehensive and thoroughly assess the risk of using bed rails for residents. Immediate requirement The home’s policy and training in control and restraint must be reviewed so that all staff are very clear about the circumstances when this is to be used, if at all. People’s individual care plans must be very clear about the type of interventions that are to be used when dealing with challenging behaviour and kept under regular review. Both managers must make sure that all staff have the mandatory training they need to perform their duties. DS0000063566.V365597.R01.S.doc 01/08/08 03/06/08 03/06/08 03/06/08 01/08/08 01/08/08 01/08/08 Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts Version 5.2 Page 31 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 OP1 Good Practice Recommendations The homes Statement of Purpose and Service User Guide should be up dated to include details of the specialist service provided in each home. The details of the range of fees charged should also be included for people’s information. 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. The temperature of the medication storage room should be recorded daily to make sure people’s medication is being stored as per manufacturers recommendations. The home should arrange training for staff so that they understand the principles of the Mental Capacity Act 2005 and their role and responsibility in supporting people who cannot make choices for themselves. The home’s complaint policy and procedure need to be updated so that people have a clear direction about who to refer complaints to and the timescale for completion of any investigation. The managers should make sure that staff are aware of the different types of abuse and be able to recognise them. This will help safeguard people using the service. The managers should take steps to ensure that all staff are aware of the homes whistleblowing policy, that they understand it and know when to use it. They need to do this so that the people who use this service are protected from harm. The home should have cleaning schedules for the laundry area. The flooring in the laundry should be recoated to make sure the surface is impermeable and suitable for easy cleaning. 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.V365597.R01.S.doc Version 5.2 Page 32 2 OP3 3 4 OP9 OP14 5 OP16 6 7 OP18 OP18 8 OP26 9 10 OP31 OP33 Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts 11 OP35 of annual survey and any actions they will be taking to meet issues raised as part of the quality assurance system The managers should continue to seek the support of the advocacy services and social workers for those people who are not able to manage their own money. Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands 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. Extracts may not be used or reproduced without the express permission of CSCI Rowans Care Homes Ltd TA Bridge, Burton & Trent Courts DS0000063566.V365597.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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