Inspection on 31/08/06 for Rowans Care Limited

This inspection was carried out on 31st August 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rowans Care Limited 27/02/06

Rowans Care Limited 13/12/05

Rowans Care Limited 11/03/05

Rowans Care Limited 26/11/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Rowans Care Limited 50 Newbridge Road Tiptree Essex CO5 0HX Lead Inspector Kathryn Moss Key Unannounced Inspection 31st August 2006 10:00 Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 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 Limited DS0000060695.V310476.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rowans Care Limited Address 50 Newbridge Road Tiptree Essex CO5 0HX 01621 819850 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) Rowans Care Limited Dr Taranga Vilasini D K Don Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Eight persons of either sex, under the age of 65 years, who require care by reason of a learning disability, who may also have a physical disability 27th February 2006 Date of last inspection Brief Description of the Service: Rowans is a detached chalet bungalow situated on the outskirts of Tiptree in a residential area, registered for eight individuals with learning disabilities, some of whom have physical disabilities. All the bedrooms are single occupancy on the ground floor. Five of the bedrooms have en suite shower facilities. The home also has a lounge, separate dining area and a relaxation room with sensory lights and music. Aids and adaptations have been installed in the property in order to meet the needs of the individual service users accommodated. There is a good-sized garden at the rear of the property. The home owns a vehicle suitable for wheelchair users. The home has a service user guide that provides information about the home, and which is available to service users and visitors. Information provided by the provider in January 2006 (in a pre-inspection questionnaire) indicated that the fees in the home at that time were £889.56 per week, with additional charges for personal items (hairdresser, toiletries, personal clothing and belongings, etc.). Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place on the 31.8.06, lasting eight hours. The inspection process included: • • • • • • Discussions with the manager and responsible individual; Discussions with three staff; Observations of service users’ appearance and of staff interaction with service users; An inspection of the premises, including the laundry; Inspection of a sample of records; Feedback questionnaires received from five relatives, and an interview with one relative during the inspection. 27 Standards were covered, and 2 requirements and 8 recommendations have been made. On the day of this inspection, the home was satisfactorily maintained, and staff were observed to give service users good care and support. Relatives who provided feedback indicated that they were satisfied with the service, and happy with the care provided. One relative particularly commented on the way staff related to the service user, and reported that “I don’t think staff could do any more than they do – they have the residents’ interests at heart”. What the service does well: What has improved since the last inspection? The home had very few requirements at the last inspection. Although quality assurance remains a requirement for further action, since the last inspection the home had carried out a survey to seek the views of relatives and staff about the service, with positive feedback received. Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 6 The home has not yet achieved 50 of staff trained to at least NVQ level 2, but arrangements had now been made for six staff to begin an equivalent level of qualification specific to the needs of service users with a learning disability. This shows positive action to ensure that staff have appropriate qualifications, and is commended. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home had information available to help service users make a choice about where to live. The home ensured that prospective service users’ needs were assessed prior to admission, and that the home could meet their needs. EVIDENCE: A copy of the home’s ‘statement of purpose’ and ‘service user guide’ had previously been provided to the CSCI in July 2004, and met regulatory requirements. However, the statement of purpose did not include room sizes (just a reference to a floor plan, which was not included), and this should be added. There were a couple of references to the NCSC (precursor of the CSCI) in the statement of purpose and service user guide, and it is recommended these are update. The Service User Guide included a pictorial version of the complaints procedure, but was not itself available in any alternative formats. It was suggested that the staff should explore whether this could be developed in a format that would be more accessible to service users (e.g. audio or video tape). No new service users had been admitted to the home over the last year. The admission process was discussed with the manager, who confirmed that even though the person had lived a long distance away, staff from the home had Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 9 visited the person prior to admission to assess them in their previous situation and to gather information on their abilities and needs. A comprehensive report had been produced from this assessment, and was the basis for the home deciding that they could meet the person’s needs. Throughout the inspection visit, from discussion with manager and staff, observation of service users and feedback from relatives, the home demonstrated that it had the capacity to meet the assessed needs of the individuals admitted to the home. Staff had received training, and showed knowledge, in both general and specific areas of care (e.g. from moving and handling, to communication skills), and the home had appropriate equipment available to meet the needs of individuals (e.g. vehicle with tail lift, overhead hoists in bedrooms and bathroom, level access showers, etc.). Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Assessed needs and personal goals were reflected in care plans. Service users were assisted to make decisions, and risks were appropriately assessed. EVIDENCE: Care plans were viewed for four service users. These were comprehensive and clear, covering all individual needs (personal care, health care, communication, social/behavioural needs, etc.). They provided good detail of how the person liked their care to be delivered, and of the action required of staff. Care plans included a section detailing any risks relating to the meeting of each need, and reflected the need to promote privacy and dignity, to offer choices, and to promote independence. The person’s ability to make choices, or how staff did this on their behalf, was also detailed in the care plans. Care plans were typed so they were clear and easy to read, and there was evidence that they had been reviewed within the last six months. Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 11 A few service users had particular healthcare needs that on occasions required staff to carry out a more specialised healthcare procedure (e.g. administering medication using an invasive technique, and care of a gastrostomy). Although these procedures were referred to in the care plans, and the manager confirmed that staff had received appropriate training in this, care plans did not contain clear protocols or procedures for carrying out the procedures. The manager advised that there was relevant guidance located in other office files, but care plans should include clear guidance on these tasks. None of the service users currently living at Rowans had the capacity to make significant decisions about their lives, or to evaluate and comprehend information about risks. However, staff were seen to offer appropriate choices on day to day matter, capacity to make choices and an evaluation of risks was recorded in care plans, and staff were able to describe how they made choices on a service user’s behalf. Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home supported service users to engage in appropriate leisure activities, and promoted access the local community. The home encouraged and supported relationships with family and friends. The home promoted choices and flexible daily routines, and provided a good range of well-balanced meals. EVIDENCE: Due to their levels of dependency, none of the service users at Rowans have the capacity to do any paid or voluntary work opportunities at the time of this inspection, or to engage in further education or training. Standard 12 has therefore been considered not applicable at this current time at Rowans. One service user currently attends an arts and crafts course at a local college, but none of the others were able to participate in this kind of activity. Most of the activities provided for service users were therefore social and leisure activities. The home had a weekly programme of daytime and evening Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 13 activities that included: swimming, visits to local parks and pubs, bowling, going out for drives in the minibus, and Gateway club. This was interspersed with activities within the home, including: art, cookery, watching TV, activities in the quiet room, listening to music, etc. Although many of the activities take place as group activities, there was also evidence of some individual activities, including a regular opportunity for one or two service users to go out for a meal. On the day of the inspection, staff were observed spending time with individual service users (e.g. doing physical exercise, doing someone’s hair, looking at picture books, etc.), and one person attended a hydrotherapy session (supported by their relative). Individual interests were encouraged, and rooms were well personalised and showed attention to individual needs (e.g. sensory stimulation in the form of music, wall lights, mobiles, etc.). The home made good use of local community facilities, and had two minibuses that are owned by the service users, with tail lifts to enable wheelchair access. Service users were taken on holiday last year, and staff reported that they were hoping to arrange another holiday for this year. The home promotes contact with relatives, including providing transport for visits home, and helping service users to send cards and presents at birthday and Christmas times. The manager reported that many relatives are very involved in the home, as evidenced by the number of feedback questionnaires received by the CSCI from relatives as part of this inspection. It was noted that relatives could spend time in private with service users in their rooms. One visitor spoken to was appreciative of the fact that, because they often had a meal with their relative in the person’s bedroom, staff had provided a fold-away table for them in the room. They reported that they felt welcome in the home, and that staff communicated with them promptly if there were any concerns relating to their relative. Daily routines were observed to be flexible; where able, service users were seen to be able to move around the home, and to choose where they spent their time. No resident had the ability to manage a key to their room, but rooms had an internal lock that could be over-ridden from the outside. Staff reported that one person used this lock when they were in their room. Whilst staff carried out most household tasks, it was good to see that one person’s care plan clearly identified that they did not have the capacity to participate in domestic tasks, and another person’s care plan had a ‘skills development’ care plan which aimed to develop their skills in laying the tables for meals. The home had a four weekly menu that showed a good range of balanced meals. Staff stated that menus were developed around staff knowledge of service users’ likes and dislikes, and aimed to provide a balance of meals. It was good to see different flavours being introduced to service users, with the manager reporting that all enjoyed the curried meals produced. On the day of the inspection the main meal looked and smelt appetising, and a visitor praised the extra effort made by staff to make food tasty (e.g. by putting fried onions in the gravy). Meals included fresh vegetables, and staff were aware of Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 14 specific dietary needs, which were carefully met (e.g. one person was on a dairy and egg-free diet). The staff provided assistance with eating where required, and adapted plates and utensils were available. Menu records were maintained as evidence of food served, with amendments made to reflect dayto-day changes. It was recommended that staff also record the vegetables served on this record, to provide a more complete record of nutrition. Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home provided personal support in the way service users preferred and required, and ensured that healthcare needs were met. The home had appropriate procedures for the administration of medicines, but not all aspects of the recording of medicines was satisfactory. However, based on previous knowledge of the provider the CSCI is confidant that appropriate action will be taken to address medication issues identified. EVIDENCE: Care plans provided good information on the personal support required by service users, and on their preferences regarding this; care plans also referred to promoting privacy and dignity. As previously noted, current service users had limited capacity to make choices: nevertheless, the home made every effort to offer choices and to encourage independence. Service users were observed to be dressed individually, with clothes that reflected their age and personalities. Care was taken to match service users with key workers who could relate to them. One relative who was spoken to observed that staff ‘have time for residents as individuals, and know each one as an individual’. Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 16 Many of the service users in the home are quite physically dependant, and had a variety of specific health care needs. As service users lacked the capacity to take control of these needs themselves, this placed responsibility on staff. Observations from documentation and from discussions with manager and staff indicated that staff had good knowledge of healthcare needs, and responded promptly and professionally to these. The manager reported that the home had a good relationship with the local doctor’s surgery, and that the GP was supportive. Care records provided evidence that staff monitored relevant healthcare issues (e.g. records were seen of standing and sitting exercises, arm massages, epileptic fits, behaviour monitoring, weights, gastrostomy tube fluid monitoring, etc.). It was confirmed that the home used the same policies and procedures as its sister home, where their policy and procedure on the administration of medicines was viewed and seen to cover storage, administration and recording of medicines. This described appropriate practices and procedures, but it was recommended that it should also include guidance on returning unused medication to the pharmacist (including retaining medication for seven days in the event of a death). Medication dispensed to the home was stored in secure lockable storage facilities. The home did not have a controlled drugs cabinet as no service users were on any controlled medication; the manager was aware of the need to provide one if the need arose. Bottles of liquid medication were observed to have been clearly dated on opening. The home maintained data sheets on any medication prescribed, so that information on purpose and side effects was easily available to staff. Evidence of staff training in medication practices was not specifically inspected on this occasion. Medication administration records (MAR) were handwritten by the manager: details appeared accurately transcribed, showed the quantity of medication received by the home, and were dated and signed. Records of medication administered were generally satisfactorily maintained. However, in some instances where the prescribed dosage was ‘one or two’ tablets, staff were not recording the quantity administered on each occasion, resulting in an unclear record of administration for these specific drugs; this must be addressed. It was noted that a number of service users were on the same two medications for maintaining regular bowel activity. As these were in bulky or heavy containers, and staff had to carry medication downstairs each time it was administered, although each service user had their own supply of the medication the home was using one supply at a time, and using this for all residents on that medication. This practice was only in relation to these specific medications, presented no risk to service users (the medications were of standard concentration, and individual dosages were clearly transcribed on the MAR), and was done for practical and understandable reasons. However, the registered person is advised to discuss this practice with their pharmacist, to ensure that they are not in breach of the requirements of the Medicines Act 1968. Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has procedures for listening to and responding to concerns. Practices and procedures in the home protect service users from abuse. EVIDENCE: The home’s complaints procedure was described in the service user guide, which also included a pictorial version. The manager advised that an audiotape version was also available. None of the relatives who provided feedback at the time of this inspection had had cause to make a complaint to the home. One said that they were not aware of the complaints procedure, but the manager said that this has been addressed and relatives of new admissions now receive a copy of the service user guide. No complaints have been received by the CSCI in relation to Rowans, and the manager stated that no complaints had been received by the home. He confirmed that any complaints received would be recorded. It was confirmed that the home used the same policies and procedures as its sister home, where their policy and procedure on ‘suspected abuse’ was inspected and seen to include definitions of different types of abuse (it was recommended this should also include institutional abuse), indicators of abuse, and procedures to follow in the event of suspicion of abuse (including reference to clear recording). It was good to see that the procedures incorporated referral to social services or the police, and referred to guidance published by the Essex Vulnerable Adults Committee. It was recommended that the Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 18 procedure should also include the requirement to notify the CSCI of any abuse concerns. Individual training records were not specifically inspected on this visit (see Staffing section). The manager reported that all existing staff had attended Protection of Vulnerable Adults (POVA) training previously, and that three new staff were booked to attend this training in September 2006. A staff member spoken to confirmed that they had attended this training, and was clear on the need to report any concerns to the managers. All staff had recently attended a training workshop in ‘Non-Violent Crisis Intervention’. Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 28, and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users live in a homely, comfortable and safe environment, which was clean and hygienic at the time of this visit. Bedrooms provided were decorated and furnished to suit service users’ needs and lifestyles. The home provided a range of shared space that met service users’ needs. EVIDENCE: The premises are in keeping with the local community, and are suitable for the purpose of the home, providing level access, ground floor accommodation, with single bedrooms, many of which have ensuite shower facilities. The home has a separate bathroom with assisted bathing facilities (including a ceiling track hoist over the bath, and a level access shower cubicle). Whilst some areas of the décor was in need of some repair, it was noted that the needs and abilities of service users place heavy wear and tear on the property, and it was clear that there was an ongoing programme of redecoration, with work on the corridors in progress at the time of the inspection. The home was homely, clean and tidy, and service users’ rooms were individual and well personalised, reflecting their personalities, and with appropriate leisure equipment (music Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 20 systems, TVs, sensory lighting, etc.). There is a large communal lounge, a dining area, a quiet/sensory room, and a garden area outside. This provides a range of space that is varied and which meets service users’ needs. The home was clean and free from offensive odour at the time of this inspection. Infection control training and policies were not specifically inspected on this occasion. In one person’s care plan it was noted that there were clear instructions for dealing with any soiled linen. The home had a laundry area that was away from areas where food was prepared or served, had washable flooring, and was equipped with washing and drying machines. Machines were domestic in style, allowing 60°C and 95°C wash cycles. The manager stated that the home has little soiled linen, as most body fluids are contained in incontinence pads or disposable cleansing wipes. He confirmed that any soiled items would be washed on a 95°C wash cycle to control risk of infection. The home had facilities for the disposal of any soiled waste. Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Staff were appropriately trained, and the provider was progressing plans to ensure that staff achieved suitable qualifications. The home provided sufficient numbers and skills of staff to meet service users’ needs. The home’s recruitment practices protected service users. EVIDENCE: On the day of the inspection, there were five staff on duty throughout the day, including the manager. The manager stated that there were five staff on duty most mornings to meet service users’ needs, and usually only four on duty in the afternoons. However, staffing could be flexible when required – for example, on Thursdays there were five staff on duty in the afternoons because service users went to the Gateway Club in the evening. Rotas viewed confirmed that these staffing levels were consistently maintained. It was noted that some staff, including the manager and responsible individual, were working several long days each week, including successive long days. Whilst staff are commended for their dedication in covering shifts, and it was clear that this was staff choice, the manager should monitor this to ensure that the long hours are not causing excessive tiredness that could put staff and service users’ welfare at risk. Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 22 A senior support worker interviewed showed good knowledge of service users’ needs, and had a special interest in communication skills. This staff member had previously done some Makaton training and had provided some in-house training with staff; they hoped to attend some further communication skills training in the near future, and reported that the home received good support from the speech and language therapist at the PCT. The senior support worker was able to describe appropriate communication techniques and tools used with individual service users. Staff spoken to were motivated and interested in their work, and were observed to be caring and supportive of service users, treating them individually and showing and understanding of their needs. The managers had extensive experience and qualifications in this field: they were part of the daily care team and through this provided staff with very good supervision and support. Staff found them approachable and supportive, reporting that the managers always found time to provide advice and teaching, and that they received regular one-to-one supervisions. The files of two new staff were viewed during this inspection: both contained completed application forms, a declaration of criminal record, a statement of health, and an employment history. Applicants had not always recorded the actual dates of their previous employments (just the years), and the manager was advised to ensure that dates are recorded in order to verify whether there were any gaps in the employment history. Files contained evidence of all required checks being carried out prior to the person starting work, including references and criminal bureau/POVA checks. The file of one person who had been in post several weeks included evidence that they had started the home’s ‘five-day induction’ programme: this included essential aspects of the home’s procedures and practices that were covered in the person’s first two days, and further issues to be covered during their first three months. The checklist used to evidence this showed the topics covered on each day, but did not specifically reflect the Skills for Care Common Induction Standards (CIS). The manager was advised to cross-reference the home’s programme with the CIS, so that the home can evidence that the CIS are being covered. Training records were not viewed in detail on this occasion: the manager stated that there was not yet an overall summary record of staff training completed, only individual records (certificates) on individual files. He stated that all staff were expected to complete moving and handling and fire safety training annually, and food hygiene and POVA training biannually. He confirmed that all existing staff were up-to-date with this training, and a two day training course covering these four subjects was arranged for September 2006 for three new staff. Two staff had completed NVQ level 2, and the manager reported that six more staff were due to start the new LDAF Level 2 training qualification, which he understood to be equivalent to NVQ level 2. Therefore, although the home does not currently meet the Standard for 50 staff trained to at least NVQ level 2, arrangements were in process to achieve this. Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There were no significant weaknesses in areas relating to health and safety issues or management. Service users benefit from a well run home, and health and safety practices promoted service users’ safety. Although there was insufficient evidence to demonstrate formal quality assurance processes to underpin the review and development of the home, the provider had made progress in this area since the last inspection, and the CSCI is confident that the provider can manage this area of improvement. EVIDENCE: Both manager and responsible individual have now completed the Registered Manager’s Award (NVQ level 4 in management), and both are qualified nurses with extensive experience. This is reflected in their knowledge and approach, and staff were positive about the level of internal training and advice they receive from the manager and responsible individual. Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 24 Since the last inspection the home had completed a survey of relatives views, and had received a good level of response from relatives. The responsible individual reported that he intended to evaluate and summarise the responses in a report, but had not yet done this. A survey of staff views on the service had also been carried out. Although it was noted that the current residents did not have the ability to provide direct feedback on the service, the responsible individual was encouraged to explore other ways of evaluating the quality of the service from service users’ perspectives. The manager and responsible individual informally monitored processes and practices in the home through their daily involvement in the home, but there were no formal (recorded) internal auditing processes in place at present. Similarly, although staff and managers acted on any development issues as they arose, there was no annual development plan for the home to demonstrate a planned approach to developing and reviewing the service, reflecting outcomes for service users. The home therefore needs to explore ways of developing the home’s quality assurance and quality monitoring processes. No policies and procedures were specifically inspected on this occasion. It was confirmed that the home used the same policies and procedures as its sister home, where it was noted that the organisation had a health and safety policy that described employer and employee responsibilities. Staff had received (or were due to receive) training in relevant health and safety topics (e.g. food hygiene, moving and handling, fire safety, etc.). The home appeared safe and well maintained on the day of the inspection. Records viewed showed that appropriate internal and external checks on utilities and equipment were carried out (e.g. gas and electricity, fire equipment, hoists, electrical equipment, bath temperatures, fire drills, etc.). Some of these were due for renewal, and it was clear that arrangements had been made, as the hoist engineer was due on the day of the inspection. With regard to preventing risk of Legionella policy, although the water in the home had been tested earlier this year, there were no other formal systems for controlling risk of Legionella (e.g. monitoring of central hot water storage temperatures to ensure they remain above 60°C). It was suggested that the home seek advice on this, and include this issue in the home’s risk assessments. The manager stated that shower temperatures were pre-set to a safe temperature, and there was evidence that bath temperatures were tested daily. Radiators viewed were guarded to prevent risk from scalding. Accident records and Risk Assessments on safe working practices (including use and storage of chemicals) were not inspected on this occasion; it was noted that any chemicals were safely stored in a locked outside storage facility. Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 N/A 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 Requirement The registered person must ensure accurate records of all medication administered. This is in relation to clearly showing the number of tablets administered on each occasion. The registered provider must ensure a system of quality assurances are established and maintained with the outcomes of review and audit being available for inspection. This is a repeat requirement for the second time (last timescale 30/04/06). Timescale for action 14/09/06 2 YA39 24 31/12/06 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 Refer to Standard YA1 Good Practice Recommendations It is recommended that the home’s statement of purpose and service user guide includes room sizes (ref Reg 4, Schedule 1.16). DS0000060695.V310476.R01.S.doc Version 5.2 Page 27 Rowans Care Limited 2 YA1 3 4 5 6 YA17 YA20 YA23 YA33 7 8 YA35 YA39 It is recommended that the home explore the development of the service user guide (and any other relevant information) in formats that are more accessible to service users. It is recommended that daily menus (records of food served) include details of the vegetables served with main meals). It is recommended that the registered person seek advice from the pharmacist on medication prescribed for one service user being used for a number of service users. It is recommended that the home’s policy/procedure on responding to suspicion of abuse include reference to notifying the CSCI. The registered provider should ensure that staff do not work excessive continuous hours within the care home, and should monitor the health and welfare of any staff working long hours. It is recommended that all staff have an individual training and development assessment and profile, in order to inform the planning of the individual and the staff team. It is recommended that the registered person implement and annual development plan and systems for internal monitoring/auditing, as part of the home’s quality assurance processes. Rowans Care Limited DS0000060695.V310476.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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