Inspection on 18/12/06 for Rowden House

This inspection was carried out on 18th December 2006.

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

Rowden House 12/02/09

Rowden House 05/02/08

Rowden House 04/01/06

Rowden House 18/08/05

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 BA11 3EA Lead Inspector John Hurley Unannounced Inspection 08:45a 18 December 2006 th 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 Rowden House DS0000016013.V320046.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. Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rowden House Address 2 Vallis Road Frome Somerset BA11 3EA 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) 01373 462271 01373 454494 Somerset Care Limited Mrs Rebecca Jane Culblaith Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 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 DS0000016013.V320046.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced key inspection of Rowden House. The inspection process followed the Commission for Social Care Inspection Inspecting for Better Lives methodology. Prior to the visit the registered manager of the service completed a pre inspection questionnaire. The views of the service users and people important to them were also sought; where appropriate their comments are included in this report. The inspector toured the building, spoke with the management and staff on duty and spoke privately with service users on both an individual and group basis. They inspected a sample of the service users documentation along with records relating to staff and other documents required by regulation. What the service does well: What has improved since the last inspection? The inspector noted that there have been improvements to the implementation of the health and safety polices within the home. The management of food stocks in the small kitchenettes has improved. Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information available for prospective service users is good. Care assessments are clear and concise and accurately reflect the needs of the individual when they first enter the home. EVIDENCE: The documentation relating to the new service users continues to contain good details relating to the individuals presenting issues as well as a good social history. Their assessed health and social needs are clearly recorded and evidences that health care professionals, care managers and the individuals family had been involved in the admissions process. The feedback received from service users and people important to them confirms that they were included in the admissions process. This feedback further confirmed good levels of satisfaction of the process. Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 9 The homes management continues to carry out their own initial assessment to ensure that they can meet the needs and aspirations of any prospective placement. These assessments include areas such as pressure sore management issues, manual handling issues as well as individual risk assessments. Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The care plans and associated reviews need to accurately reflect the changing circumstances of the individual. The recording of medication administered and rationale for Per Required Needs administration of medication must improve. Service users are treated with dignity and respect. EVIDENCE: The inspector observed staff being kind and caring towards service users. Staff spoken with demonstrated a good awareness of how to meet resident’s needs. Service users comments included ‘staff couldn’t be kinder or more friendly’ and ‘the staff are very good’. The feedback from people important to the service users further confirmed these observations. Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 11 The inspector sampled the service user documentation and found that care plans are maintained for each service user. These include details of individuals’ needs, daily routines and preferences. The care plans observed had a number of areas that required improvement. For example although there was a falls risk assessment there was no detailed directions to staff of the level and type of assistance to be provided to each person in order to minimise the risk of falls, the manual handling assessment not being referenced in the risk assessment. Similarly the evaluation of falls indicated that the care plan had been updated following significant events but this was not referenced in the review or in some cases the plan its self. Pressure-relieving equipment is provided as required but not all care plans had been regularly reviewed and updated as required. In order to have a robust approach to pressure sore management it would be helpful if all service user had an assessment relating to tissue viability which was regularly reviewed. Similarly it would be helpful if the home could evidence that all service users had a nutritional assessment and their weight monitored on a regular basis in line with the organisational policy. Medication is supplied by a local pharmacy and dispensed using a NOMAD system. A list of staff trained to administer medication and a sample of their signatures is available at the beginning of the medication recording sheets. All medications are stored securely. The inspector viewed the medication administration recording sheets and noted a number of issues that needed to be addressed. Some directions required medication on a Per Required Needs (PRN) basis but the rationale for administration on this basis was not always available (either on the medication sheets or service users file). The inspector found gaps in the recording of administration of medication. It was also noted that for those service users who self medicate the home collects the medication on the individual’s behalf and gives it to them. However they (staff) do not record when and what has been given to the individual, which does not provide a full audit trial. Service users are able to meet privately with visitors in their bedroom or in one of the lounges. Interaction between staff and service users was friendly and respectful. Through discussion with the service user the inspector established that the care staff fully respected their privacy and dignity and that they were not made to do anything they did not wish to, such as attending activities or having meals in the dining room. They further confirmed that all personal care was provided in the privacy of their bedrooms or bathrooms. The care plans and associated documents supported these representations. Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pace of life appears to suit the service users expectations and aspirations. The food is home cooked and appears to offer a balanced diet but more needs to be done to ensure service users have a real choice. EVIDENCE: The service users confirmed that they could spend their time as they want to and that they are given choices. The inspector toured the building and noted that many of the service users rooms were personalised with their own possessions. Service users spoken with were satisfied with the activities provided, some liked to join in others did not. Visitors are welcomed at the home. There are planned activities, which provide extra stimulation to the service user group. These range from singing and bingo, gentle exercise, ball type games and outings. Several service users told the inspector that they knew what activities were taking place, some they liked others they did not. Given Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 13 that the home provides two good sized communal areas those who choose not to participate do not have too. Those service users requiring support during meal times were assisted in a dignified manner. Service users further confirmed that the food is good, home cooked and plentiful. The dining room was pleasant with the tables attractively laid with tablecloths. Some service users choose to have some of their meals in their own rooms, staff work hard to ensure that service user wishes are met. Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 14 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 good This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure that is available to residents and staff. Residents are protected from the risk of harm. EVIDENCE: The home has a complaints procedure. This is displayed on the home’s notice board. The home had received a complaint since the last inspection. The records that were viewed evidence that the matter was dealt with in accordance with the organisations stated policy. Service users confirmed that they knew who to speak to if they had any concerns. There was good evidence to say that staff support service users in raising issues in an objective manner Four staff files viewed contained POVA first checks and completed CRB disclosure checks. The home has policies relating to whistle blowing and abuse. Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has been decorated and furnished to a good standard. There are sufficient communal areas and bathroom facilities to meet service users needs. Service users rooms are personalised to reflect their individual tastes. More domestic staff would assist in maintaining the home. EVIDENCE: The inspector toured the premises unaccompanied when they first entered the home inspecting a number of communal areas. They found that the home was generally clean in all areas observed. It was noted that all toilet and bathrooms were found to be clean and hygienic, although it was noted that some areas were cleaner than other. At the last inspection the inspector was informed that there was vacancies for cleaning staff. As these vacancies still exist it is Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 16 considered that the lack of cleaning staff is beginning to have an impact on the cleanliness of the home. The service user accommodation is provided over three floors. There is a passenger lift, assisted bathroom and call system available to service users. Service users commented that call bells are answered promptly. There a two large communal lounges and one dining room. The communal areas are domestic in nature providing comfortable seating and dining facilities. The corridors are well illuminated with a number of prints on the walls. There are a number of seats discreetly placed in recesses of the corridors allowing individuals to rest if needed, handrails are also provided to aid independence around the home. Service users are able to bring personal possessions with them into the home. Service user rooms seen had been personalised with pictures, furniture and photographs. The inspector noted that the laundry door is now held open by an approved automatic closure and that a re assessment of the environment had been carried out by the organisation in relation to any asbestos in the building. Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. The staff team are well trained and knowledgeable with regards to the service users needs and aspirations. The home needs to ensure there is sufficient domestic staff on duty to keep the environment clean. EVIDENCE: The registered manager confirmed there is enough staff on each shift to meet the service users needs. This was also confirmed by service users who commented that staff are always available to help and were very attentive. As mentioned earlier the home does have domestic vacancies, which for the overall smooth running of the home need to be filled. New staff confirmed that they have undergone a thorough recruitment and selection process by way of a formal interview and statutory checks to establish their suitability to work in the home. All new staff receives a comprehensive induction when they start at the home, one staff member has responsibility for supporting each of them through this process. All elements of the induction process are signed by both parties to confirm the element has been completed and understood. In addition to this new staff complete the mandatory training required by the regulations. This induction process is Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 18 excellent as it ensures that new staff have the skills required to start supporting people at the service. Staff receive regular supervision, and appraisals are completed on an annual basis. Staff stated that they enjoyed working at the home, and received appropriate support. Staff have undertaken mandatory training such as Fire Awareness, Moving and Handling, Food Hygiene and Infection Control. Some staff have also attended various day courses. Some care staff has undertaken the NVQ Award in Care at varying levels. Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 19 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): 31,33,38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home continues to be well managed and provides a needs lead service. EVIDENCE: There have been no changes to the homes management since the last inspection. The management continue to have a good understanding of the National Minimum Standards required and how they should be met, but more attention should be paid to their responsibilities with regards to the administration of medication. The inspector spoke at length with the registered manager regarding the changing needs of the service group and the increasingly complex and demanding requirements that new or prospective service users demonstrate. Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 20 These needs often require a multi agency approach, close working with many other agencies as well as the service user and people important to them. The inspector noted that the registered manager continues to be on the rota carrying out care shifts. The inspector considers that this practice needs to be reconsidered as their experience is best placed in other areas of service delivery. The staff continue to appear relaxed and confident in their roles and demonstrated good understanding and empathy with the service user. The feedback from the service user confirmed that they felt a sense of belonging living at the home and gave examples of how staff do that little bit extra to help out. They informed the inspector that they can raise issues with the management, can identify who the manager is and are confident that issues are dealt with promptly and effectively. They further confirmed that they have residents meetings where there is forum to discuss the running of the home. The health and safety of the service users and staff are dealt with adequately with some attention to risk assessments required to further improve in this area. Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x x x 3 Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 2. OP10 13(2) The registered person shall make 31/01/07 suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This is with specific reference to ensuring that all medicines administered via the PRN route are done so in line with the homes policies and procedures and a rationale for giving medication via this route established. Reasons why the staff gave the medication and the outcome of the intervention must be recorded. Also the responsible individual must ensure that all medication administered is recorded in line with the homes policies and procedures. The previous requirement stated that The registered manager must ensure that any medication administered is recorded on the appropriate MAR sheets by Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 23 31/01/06 was not met. 3. OP7 15 (1)(2)(a) (b)(c)(d) 13 (4)(c) Unless it is impracticable to carry 31/01/07 out such consultation, the registered person shall, after consultation with the service user, our a representative of his, prepare a written plan (“the service users care plan”) as to how the needs in respect of his health and welfare are to be met. The registered person shall – make the service users plan available to the service user; Keep the service user plan under review; Where appropriate and unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service users care plan and notify the service user of any such revision. The registered person shall ensure that unnecessary risks to health or safety of the service user are identified and so far as possible eliminated. This is with specific reference to 1. Carrying out full and comprehensive risk assessments following significant incidents ie falls, which are robustly evaluated and guide and inform the monthly reviewing process carried out by the home. 2. Ensuring that nutritional assessments are in place for each service user. 3. Ensuring that all service users have a tissue viability assessment. Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP32 OP26 Good Practice Recommendations The organisation should consider taking the registered manager off of the care rota. The registered manager should make arrangements to ensure that all areas of the home are cleaned to the same standard. Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Rowden House DS0000016013.V320046.R01.S.doc Version 5.2 Page 26 - 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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