CARE HOMES FOR OLDER PEOPLE
ROWENA HOUSE Old Road Conisbrough Doncaster DN12 3LX Lead Inspector
Mike Siegal Unannounced 26 April 2005 08:35. 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. ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Rowena House Address Old Road Conisbrough Doncaster South Yorkshire DN12 3LX 01709 862331 01709 858383 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) Doncaster Metropolitan Borough Council Post Vacant Care Home 36 Category(ies) of Dementia - over 65 years of age (12) registration, with number of places Old age, not falling within any other category (24) ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Day care places in the DE(E) unit must be limited to 1 when the unit is full with 12 residential service users. There is insufficient communal space to meet the required communal space standard when the number of service users goes above this limit of 13 persons. An additional member of staff should be provided when the number rises above 12. Date of last inspection 10 November 2004 Brief Description of the Service: Rowena House is owned by Doncaster Metropolitan Borough Council. The home is situated on Old Road, Conisbrough on the main bus route to Doncaster. Local shops, a public house and Conisbrough town centre are nearby. There are pleasant gardens including an internal courtyard equipped with patio furniture for residents to enjoy. The home is divided into two units with the elderly mentally infirm on the ground floor. The 1st floor is served by a lift. ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place from 8:35 a.m. until 5:00 p.m. Direct discussion took place with a number of residents individually and collectively. Discussions also took place with a range of staff. Views and comments were received from 2 relatives. Records were directly examined as well as the care plans of selected residents. Information gained from these was checked back with relevant staff and residents. Breakfast and dinner were observed, as was the administration of the medication in the morning. A tour of the home was undertaken at different times during the day to observe residents, staff as well as the various rooms in the home. The grounds were also seen as part of the inspection. What the service does well: What has improved since the last inspection?
The new manager has introduced a number of positive changes to continually improve care practices. These improvements include additional staff training and the employment of a shift manager to enable the home’s manager to focus on the role of staff. ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 Page 6 Improvements to staffing cover demonstrate that management have responded positively to the demands on the elderly mentally infirm unit. Staff work with other professional colleagues to review the more demanding needs to ensure individual needs are best met. Progress has been made to obtain the views of residents and their relatives to ensure their care arrangements meet their preferences and needs. A care worker has a lead role to oversee the development of activities with residents. This is a positive, initial step to address the aspirations and interests of residents. The residents have also benefited from improvements within the home and to the garden offering them increased safety in a pleasantly furnished home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 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 ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 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 and 3 Care assessments provide a range of information to enable the staff to determine if these care needs can be met. EVIDENCE: The provider continues to produce information about the services in various formats however this is not easily available to enable residents / carers to make an informed choice. A selected number of care plans were observed and these confirmed the progress to have residents / carers sign the assessments. This ensures that the staff take into account the expressed views of residents and / or their carers when identifying their needs & preferences. ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 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 Staff have access to good care planning arrangements, which effectively meets residents’ care needs. Health care staff are also effectively used to meet the varying needs of residents. The administration and management of medication largely ensures the residents’ needs are safeguarded through trained staff and good practice. Care plans need to be reviewed in accordance with the changing needs of residents to ensure the plans are up to date and that staff can effectively meet these needs. EVIDENCE: A selection of five care plans was examined. These include key information, such as personal details and an assessment to ensure staff can meet their needs. A key worker system ensures lead responsibility for meeting these needs are known by all staff. There is a need to undertake monthly reviews of each resident consistently to ensure their changing needs are identified. All Care plans need to include the signature of the resident. ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 Page 10 Risk assessments were not regularly reviewed and did not identify the changing needs of residents. Records indicate that residents attended clinics or were seen by the GP or district Nurse to meet their health care needs. Staff who administer medication have received appropriate training to ensure safe handling of medication on behalf of residents. Medication records are not always signed for those drugs to be taken as and when needed thereby ensuring residents are fully monitored. ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 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 & 15 There is some limited progress to develop activities. There is a need to develop a more structured range of activities, to obtain the views of residents and to post these activities to increase residents’ choice and stimulation. Residents receive a choice of food at meal times to meet their nutritional needs at a time convenient to them. EVIDENCE: There is a designated member of staff to overview activities. This should better meet the expressed interests of residents. However, current practice is to provide a number of activities on a now and then basis which limits the range, frequency and planning of activities, thus reducing residents opportunities and choice. One resident stated, “Staff try to organise things but there’s often too much work for them to do it.” A carer who stated, “If there was more going off it would be better for them”, reinforced this opinion. Breakfast and dinner was observed and the views of some residents, relatives, kitchen and care staff obtained about the quality and choice of meals provided. All confirmed a varied choice and that these were served in a relaxed manner to residents. Care staff offered appropriate support whilst encouraging
ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 Page 12 residents to maintain their independence. There was evidence of a good rapport between residents and staff, making the meal-time, an enjoyable experience for residents. ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 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) 18 The home largely meets the need to protect users from abuse by having clear and effective policies and procedures however staff have yet to receive appropriate training on this area. EVIDENCE: There are policies and procedures to protect residents from abuse. Management demonstrated their knowledge of these procedures to safeguard the well being of all residents and staff. These policies, including one on whistle blowing, are given out to the majority of staff at meetings to safeguard residents. There is a need to increase staff skills by offering appropriate abuse training to protect residents. ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 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, 21 & 26 The home has made a number of improvements since the last inspection to enhance the safety and overall maintenance of the home for residents. The home is clean, kept hygienic and largely free of unpleasant odours. This provides a pleasant environment for residents. EVIDENCE: A number of improvements to furnishings and decoration have been made to the elderly mentally infirm part of the home. Work in the outside grounds further improves the safety of residents and enables them to enjoy the garden area. Improvements to a WC along with washing facilities that provide separate sluicing facilities ensure residents personal needs are appropriately met. New washers and dryers have been purchased to maintain clean standards for residents and their personal belongings. ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 Page 15 A decision was taken not to provide shower facilities to increase the choice of care for residents. A letter detailing the reasons for this decision should be provided to CSCI. There is a need to ensure the monitoring of hot water in bedrooms is recorded to improve safety standards for residents. The home was observed throughout the day and there was evidence of a clean, pleasant and hygienic environment for residents. ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 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, 28, 29 & 30 Residents’ needs are better met due to changed staffing arrangements and lower occupancy. Further staff training is needed to better meet the needs of residents. There is an effective recruitment policy to safeguard residents. EVIDENCE: The staff rota was examined and staff discussed the care arrangements needed to safely meet resident needs. There is continuing pressure on staff, particularly in the elderly mentally infirm unit, to provide adequate staffing cover. Management have responded positively to this pressure by placing an additional member of staff on duty, when possible. This increase was described by one member of staff as it, “Made a 100 difference having the 5th member of staff.” However, given the demands made by one resident there is a need to continually monitor staffing cover to ensure the care and safety of residents’ is met. There are appropriate staffing arrangements for domestics and the kitchen to provide a clean environment and to prepare varied meals. There is a continuing need for care staff to obtain their NVQ 2 accreditation to enhance their skills and the care provided to residents.
ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 Page 17 Residents are supported and protected by the recruitment policies and practices including required checks before staff begin work. The existing code of conduct should be given to all staff. Staff undertake a range of training to improve care skills for residents. There was evidence of substantial in-house training development due to the new position of shift manager, enabling the Manager to focus on training needs. Staff should have a minimum of 3 paid days training per year evidenced in individual training plans. ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 Page 18 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, 33, 35, 36, 37 & 38 The management and administration of the home largely protects the residents’ health, safety and welfare. There is a need to more fully record some activities to safeguard residents and to obtain residents’ views to better meet their aspirations and needs. EVIDENCE: The new manager and the Deputy have submitted their portfolios for registered management training. The new manager now needs to register with CSCI as required. There was evidence that the new manager has made a positive impact to enhance staff skills to improve residents’ care. There is a need to develop a quality assurance programme that proactively obtains residents and carers
ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 Page 19 views to better meet their expressed needs / aspirations. This should build on previous efforts to organise resident and carer meetings. The residents would benefit from the production of an annual business plan. The quality assurance programme should enable residents and their carers to contribute and respond to any developments proposed in the business plan. The system for managing residents’ finances was examined and it largely safeguards residents’ finances. One member of staff had still to return receipts and money and was not following the policy of the management. There are recent improvements to staff supervision to better meet residents’ needs. This progress needs to be strengthened by ensuring all staff receive supervision at least 6 times per year and that individual training profile are recorded. Maintenance and fire safety records safeguard residents. There are regular fire drills and equipment tests to safeguard residents. Legionella testing was also recently undertaken. Small electrical testing must be tested as a matter of priority as this was last due in September 2004. Bedroom water should be in a scheduled maintenance programme and manual tests of bedroom water need to be recorded to ensure residents are safeguarded. ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x 2 x x x x 3 STAFFING Standard No Score 27 3 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 2 x 2 x 2 2 3 2 ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 Page 21 Yes 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 1 Regulation 5 Requirement The registered manager should provide all residents with a copy of the Service User Guide. (Previous timescale 1 January 2005) The registered manager should ensure that care plans are reviewed monthly, that there are regular risk assessments undertaken, that a more comprehensive annual review takes place for each resident and that the resident or their carer signs the care plans The registered manager should ensure that daily medication records are consistently signed The registered manager should ensure that a structured approach to organised activities takes place and that this is posted for residents. (Previous timescale 1 February 2005) The registered managed should arrange for staff training in preventing abuse The registered manager should ensure a written record is kept on water temperature checks in bedrooms The registered manager should Timescale for action 7 June 2005 2. 7 15 25 August 2005 3. 4. 9 12 13 16 7 June 2005 25 July 2005 5. 6. 18 21 18 13(4) 25 July 2005 23 May 2005 7 June
Page 22 7. 21 23(2)(j) ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 8. 30 18(1) 9. 31 10 10. 33 24(1)(2) (3) 11. 35 16(2)(L) 12. 36 18 13. 14. 38 38 23(2) 13(4) arrange for a letter to be sent to CSCI setting out the findings about installing showers and the options considered. (Previous timescale 1 March 2005) The registered manager should arrange for staff to have a minimum of three paid days made available and that staff training needs are identified in their personal file The registered person should apply to CSCI for registration. (Previous timescale 12 December 2004) The registered manager should develop an annual business plan that takes account of feedback from various quality assurance sources. (Previous timescale 1 February 2005) The registered manager should ensure that all receipts for spending residents money are returned in a timely manner and that an audit of residents finances should now be undertaken. The registered manager should ensure that all staff are formally supervised at least 6 times per year. (Previous timetable 1 February 2005) The registered manager should ensure small electrical equipment is tested The registered manager should arrange for water in residents bedrooms to be placed on a planned maintenance programme 2005 25 August 2005 7 June 2005 25 August 2005 7 June 2005 25 July 2005 7 June 2005 7 June 2005 ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 Page 23 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 28 Good Practice Recommendations 50 of care staff should achieve NVQ Level 2 by 2005 ROWENA HOUSE CS0000032204.V203878.R01.doc Version 1.20 Page 24 Commission for Social Care Inspection 1st Floor, Barclay Court Heavens Walk Doncaster DN4 5HZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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