Inspection on 18/08/05 for Rowden House

This inspection was carried out on 18th August 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rowden House 12/02/09

Rowden House 05/02/08

Rowden House 18/12/06

Rowden House 04/01/06

Rowden House 29/03/05

Rowden House 28/10/04

Rowden House 16/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Rowden House 2 Vallis Road Frome Somerset TA1 2PX Lead Inspector John Hurley Unannounced 18 August 2005 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 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. Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Rowden House Address 2 Vallis Road, Frome, Somerset, BA11 3EA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01373 462271 01373 454494 Somerset Care Limited Mrs Rebecca Jane Culblaith Personal Care Home only 39 Category(ies) of Old age (39) registration, with number of places Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 29 March, 2005 Brief Description of the Service: Rowden House is situated in Frome, close to local shops and facilities. The house is a Grade II listed building that has been extended to provide further accommodation. There are three day rooms at the home; one of which has been designated as a smoking room. There are also furnished patio areas at the front and rear of the home, which are used by service users and their visitors. Rowden House is registered with the Commission for Social Care Inspection to provide care to up to 39 service users over the age of 65 years who require assistance with personal care. The Registered Manager is Mrs Rebecca Culblaith. The home is owned by Somerset Care Ltd. Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two visits one announced one unannounced. The reason being that at the unannounced visit all senior staff was attending a training session and the possibility to discuss some issues was limited. The inspector viewed all areas of the home and met with some service users individually and as a group. The inspector spoke with four members of care staff and the registered manager. A number of records were examined including a sample of service users care plans, risk assessments, staff records and health and safety records. What the service does well: What has improved since the last inspection? What they could do better: The service needs to ensure that all care plans a reviewed following significant events such as a return to the home following discharge from hospital, when staff observe service users requiring a higher level of assistance as well as on a monthly basis. The service needs to ensure that not only the building but also individuals who use the building are protected by a robust risk assessment. The management need to ensure that the kitchenettes are maintained as fit for purpose and the storage of any foodstuffs is in line with the policies employed in the main kitchen. It would be helpful if the responsible individual carried out regulation 26 visits on an unannounced basis as proscribed in the Care Standards Act 2000, older persons. Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 6 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. Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,5,6 The assessment documentation is clear and concise and evidences the involvement of the service user, their family, advocates and other stake holders when appropriate. EVIDENCE: The service users assessment documentation was clear and concise. The care assessments sampled had been completed by social services or in one case a discharge assessment and summary from the local hospital. The documentation also included health care needs, likes and dislikes along with a commentary on how the individual likes to live. A care plan had been generated from these documents. Visiting relatives confirmed that they had been consulted on the general requirements of their relation as well as more detail on the service users social history and personal history. There is also evidence that the service user has been consulted Intermediate care is not a feature of this service. Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,11 The overall standard of care planning documentation was satisfactory. However significant changes to some individual’s circumstances had not been formally acknowledged and reviewed. In order for the service to improve these issues needs to be addressed. EVIDENCE: The care plans and associated documentation was sampled. These documents are reviewed after the first month and amendments made. The plans note health care needs and how these should be met. A group discussion with the service users after lunch informed the inspector that individuals felt that they can approach staff if they do not feel well and that they (staff) will take action on their behalf. The service users that the inspector spoke to confirmed that they had been involved in the care planning process. The plans that were sampled demonstrated that if all of the headings were completed in a timely fashion then the documentation relating to care planning would meet the required standard. There is evidence that some of the care plans are reviewed on a monthly basis but the documentation sampled did not fully evidence that all plans are reviewed robustly. For example one service users care plan was not reviewed following discharge from hospital. Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 10 The registered manager acknowledged that this service user needs had changed. Furthermore there was a need for a new risk assessment to be carried out. Medication Administration Records (MARs) were examined together with the homes medications policy. Senior staff within the home administers all medications. The Mars sheets were in good order, a signature sheet and handover log are used. Variable doses had been clearly recorded. At present no service users are responsible for their own medication. The records clearly state the reasons why the home has taken responsibility for this action. The service users documentation also contains details with regards to the arrangements that they wish to be made in the event of their death. Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 The routines of the home are unhurried and appear to suit most of the individuals needs. Observations made by staff must guide, inform and when necessary prompt a review of the service users needs EVIDENCE: Service users told the inspector of the activities on offer. One service user told the inspector that they enjoyed being able to go out in the garden during the warmer days. A dedicated activities organiser also provides activities, service user spoke highly of the effort made. Although at the time of the inspection no relative appeared to be visiting, The group of service users told the inspector that friends and family can visit at any reasonable time. The inspector joined a number of the service users for the lunchtime meal. The service users commented that the food was good and in sufficient quantities. A service user explained that if they did not like what was on offer an alternative would be provided. They also said that this rarely happened as they, (the staff) knew what I like. However when an alternative pudding was requested, a yogurt, there was non available on that day. Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 12 Whilst the staff were attentive to the service users needs and abilities the inspector observed one individual struggling with the meal. Through further discussion with this person, and subsequently with the registered manager, it was established that the time had to reassess the level of assistance given at meal times. One person has recently voiced their dissatisfaction at the quality of the food on offer. The inspector spoke with this individual and established that although some improvements had been made since the formal complaint they continues to be a level of dissatisfaction. The service user and registered manager both informed the inspector that they hoped to be able to continue to try and resolve this problem as soon as possible. Mealtimes are flexible to meet individuals wishes and needs and food can also be served in the service users rooms if required. Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The management is open and responsive to criticism. It continues to learn from the issues that are raised. EVIDENCE: The home has a complaints procedure that includes details of external agencies that service users and their families may contact, including CSCI. Service users spoken with stated that they would feel able to raise any issues of concern with the Manager or staff at the home. One formal complaint has been made. The management, complainant and their sponsors have had formal meetings to discuss a way forward with the issues raised. It is clear that through the management’s actions they have taken the issues seriously and tried to resolve them where possible. Further more the management have demonstrated that they have taken action to ensure that the issue is addressed. The home has appropriate policies relating to the Protection of Vulnerable Adults (POVA)and Whistle blowing. For the protection of vulnerable service users, the home ensures that a POVA First check and enhanced CRB disclosure is obtained for each staff member Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,26 The home continues to provide a good standard of accommodation that has retained a degree of domestic character; service users expressed a degree of satisfaction with their surroundings. The organisations building surveyors needs to consider reassessing the risks poised by the presence of asbestos as well as the laundry. Particular attention needs to be paid to the cleanliness of the kitchenette areas to ensure standards are maintained. EVIDENCE: There is a range of communal space within the home. On the ground floor there is the main lounge, a quiet lounge and further lounge that may be used by individuals wishing to smoke. Additional seating areas are available on the ground and first floors. There is also a large dining room. All communal areas within the home have been decorated and furnished to a good standard. Service user’s said that they have comfortable rooms and confirmed that they feel safe. One service user said that they particularly like the views of the garden from their room. Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 15 There are four assisted bathrooms at the home, including one that has a walk in shower. Twenty service user rooms have en suite facilities. Appropriate adaptations have been provided to meet the needs of the current service user group. A call system is installed at the home. The service user rooms seen had been decorated and furnished to a good standard. Service users are able to bring items with them into the home, and rooms had been individualised with photographs, pictures and personal possessions. Service user rooms have locks fitted. At the unannounced inspection, the home was found to be generally clean in most areas. During a tour of the premises it was noted that all toilet and bathrooms were found to be clean and hygienic. The small kitchenettes located on each floor required to be cleaned. A number of serving plates were found to be dirty, containers used to store dry cereals were broken and therefore not airtight, fruit juices stored in the fridges did not have date on them indicating when they were opened and the fridge temperature was not monitored as is the norm in the main kitchen. The registered manager acknowledged these observations and made an undertaking to ensure that these areas are managed properly and do not undermine the organisation policies in areas such as infection control. The laundry area was generally clean. The door to the laundry was held open with a pair of tights appearing to compromise the effectiveness of the fire door. The window did not open and the door to the outside was locked. The registered manager agreed to look at this area to ensure that staff are able to have fresh air whilst maintaining the integrity of the fire precaution measures. During the tour of the building it was noted that several doors to the cellar storage area have been sealed off, notices on these doors warn of asbestos. The inspector noted that several of the plastic door covers/ seals have degraded over time and are no longer forming what appears to be an effective seal. The documentation available does not make it clear if this is a problem or not. As it was on the 18/06/2002 when this issue was last risk assessed it is clear that the organisations experts need to ensure that the measures taken are still valid and useful. The cellar area had been used for storage, which has now been denied to the home, and so storage can be problematic. Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 Staff are well trained and deployed in numbers sufficient to meet the needs of the service user group. The management need to think about how they manage long-term sickness so that acceptable standards of cleanliness are maintained. EVIDENCE: The rotas viewed indicate that there is sufficient staff on duty most of the time to meet the service users needs. However there are a number of issues over sickness cover and vacant hours for cleaning staff and senior night care staff. The vacant hours being backfilled by existing staff .The nightshift is normally ran by two waking night staff. The registered manager informed the inspector that these staff are supported by an on call member of staff. It is further reported that this works well. The inspector spoke with several members of staff. One member of staff considered that there are good training opportunities at the home going on to to say that they have undertaken training in such areas as manual handling, first aid, safe administration of medication and vulnerable adults training. The well-kept records further evidence that training is ongoing and the management have good systems in place to monitor that the training is up to date. The inspector sampled the staff files that demonstrated that comprehensive checks are undertaken on all staff to ensure the suitability of any prospective new member of staff. Again the files were well laid out and comprehensive. Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,38 The home is well managed and provides needs lead service. The management needs to ensure that standards of cleanliness are maintained and the risk assessments remain robust and valid not only for the environment but also for service users. EVIDENCE: The registered manager has been in post for a number of years. They are both open and frank in their style of management and contributed positively to the inspection process. the staff informed the inspector that they feel they are fairly treated by the manager and that they appreciate that they (manager) will work alongside them when necessary. Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 18 In general terms Health and Safety policies are adhered too. However a updated risk assessment of the building is required which should encompass identified areas such as the laundry and areas where asbestos is present. Residents meetings are held on a regular basis and the minutes are available should they be required. The Registered Provider visits the home on a regular basis and completes a regulation 26 report. It would be helpful if the visit was made on an unannounced basis as described in regulation 26 of the Care Standards Act 2000 Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 x 3 x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x x x 2 Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard op38 Regulation 13(4) Requirement Timescale for action 14/11/05 2. op38 13(4) 3. op7 15(2)(b) 4. op38 13(4) 23(2)(d) The registered manager must ensure that there is an up to date risk assessment for the premises. Action must be taken to minimise any risks established The registered manager must 14/11/05 ensure that there is an up to date risk assessment for the service users and staff. Action must be taken to minimise any risks established The registered manager must 14/11/05 ensure that service users needs are reviewed either on a monthly basis or following significant events. The registered manager must 14/11/05 ensure that the kitchenettes are maintained in a good clean order and that the storage of foodstocks is in line with the homes policies and agreed guidence RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 21 No. 1. 2. Refer to Standard regulation 26 Good Practice Recommendations The responsible individual should consider carrying out regulation 26 visits on an unannounced basis. Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier TA1 4AL 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. Extracts may not be used or reproduced without the express permission of CSCI Rowden House D53 - D02 S16013 Rowden House V244188 180805 Stage 4.doc Version 1.40 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!