CARE HOMES FOR OLDER PEOPLE
Rowfant Residential Home Wallage Lane Rowfant Crawley West Sussex, RH10 4NG Lead Inspector
Mrs J Hough Announced 12 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. Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Rowfant Residential Home Address Wallage Lane, Rowfant, Crawley, West Sussex, RH10 4NG 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) 01293 718486 Rowfant House Limited Mr Viesturs Dude Care Home 19 Category(ies) of Dementia-over 65 years of age (DE(E))-1 Both, registration, with number Old age, not falling within any other category of places (OP) - 19 Both Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1, The total number of persons accommodated should not exceed 19. Date of last inspection 15 September 2004 Brief Description of the Service: Rowfant Care Home provides personal care and accommodation for nineteen older people over 65 years. It is owned by Rowfant House Ltd a non-profit making organisation which is affiliated to the Latvian Church. The registered manager responsible for the day to day running of the home is Mr Viesturs Dude and the responsible individual is Mr Mike Ward. The home mainly accommodates elderly Latvian people some of whom have lived in self catering accommodation in a large community/country club (Rowfant House) in the same grounds prior to moving into the care home but also admits residents who are not Latvian. The two-storey detached building was a converted stable block which as been extended and added to during the last five years. All the residents bedrooms are single and three offer en-suite facilities and there is a passenger lift giving access to all floors. The home is set in extensive grounds which include woodland and a river. There is a large patio area to the front of the property with a fishpond and raised flowerbeds which are accessible to the residents. Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The announced inspection took place over 7 hours and the registered manager Mr Viesturs Dude and the deputy manager Irene Cherry were present at the inspection and provided the necessary information. The deputy manager had completed a pre-inspection questionnaire and information provided from this document is also included in the inspection report. Comment cards from the Commission had been provided for residents to complete if they wished, but none had been completed or returned. A tour of the premises was made and some of the residents’ rooms were seen. Records examined were residents’ care plans and assessments, staff files, the maintenance log, medication and accident records and a selection of the policies and procedures. Eleven residents, and five members of staff were spoken with to gain their views on what it was like living and working in the home. Four visitors also gave their views of the home. On the day of inspection there were 17 residents accommodated. What the service does well:
The home is situated in a rural setting surrounded by extensive gardens, a lake and woodlands that are accessible to those residents who are able or wish to go for walks. There is a pleasant patio area with a fishpond, flowerbeds, hanging baskets and pots and table and chairs for the residents to sit and enjoy the pleasant views. The home was clean and fresh and decorated and furnished to a good standard. Some of the residents’ rooms were furnished with their own possessions and furniture and all rooms were bright and comfortable. The atmosphere in the home was homely, friendly and relaxed. All the residents looked well presented and said they were happy living in the home. They praised the staff saying they were kind and caring and looked after them very well. The quality and quantity of the food was also said to be good with a varied choice of meals on offer. The home is run in such a way that both the residents and staff said they were involved in the decision making process within the home.
Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 Page 6 Although the home does not employ an activities organiser the residents spoken with were happy with what was on offer with a weekly shopping trip and various indoor activities such as reminiscence sessions. The residents also have access to Rowfant House the country club situated in the grounds where they can socialise and have a meal and a drink if they wish. What has improved since the last inspection? What they could do better:
There are some training and administrative procedures within the home that are lacking or require improvement. The home needs to develop and induction and foundation programme for all new staff, commence formal staff supervision and document outcomes, and review recruitment procedures for staff coming from Latvia. Staff training should include food hygiene for all the staff who handle food, and evidence is needed that all staff have had training in infection control. Monitoring and recording of water temperatures is required, and some windows need window restrictors fitted. The responsible individual for the home should carry out an unannounced visit to the home at least once a month to assess the care provided, the premises, the complaints, and the conduct of the home, and prepare a written report of the findings, and supply a copy to the Commission.
Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 Page 7 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. Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 Page 8 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 Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 Page 9 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) 1,3,4 &5 Admissions to the home are well planned. EVIDENCE: The Statement of Purpose for the home was updated in April 2005 and contains all the information about the home and the services it provides. All residents considering moving into the home have a full assessment carried out prior to admission. The home encourages the resident to visit the home for a day to speak with the staff and other residents and look at the room available. A trial period of one month is given before the resident or their relatives need to decide if the home is right for them. Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,& 11 All residents have a care plan identifying their needs. The home needs to develop a system for monitoring and assessing those residents who take control of their medicines. EVIDENCE: The home has purchased a new system for the residents’ assessments and care plans. The staff have worked very hard to complete all the new documentation. Assessments were detailed in identifying the needs of each resident and risk assessments are completed where appropriate. Some of the care plans examined required more detailed information with regard to the level of assistance required by the care staff. The care plans seen were reviewed and updated monthly and contained a photograph of each resident. The residents spoken with were all very happy with the care they received and said the staff were kind and caring. The medication administration records were well maintained and the manager was in the process of including a photograph of each resident on their medication chart.
Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 Page 11 A Controlled drug being given to a resident should be recorded in a separate register as well as being signed as given on the medicine chart. The home needs to develop a risk assessment for monitoring and assessing those residents who wish to self-administer their medicines. It was also recommended that those residents who take their own medicines sign a declaration that states they take full responsibility for there safekeeping and administration. All the staff who are responsible for giving the residents their medication have undergone training in the handling of medicines in February 2004. The home has a policy on death and dying and arrangements for after death are discussed with the resident or their relatives and recorded on there are notes where appropriate. Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,14 &15 The residents are able to choose how they spend their time. The home offers a nutritious and varied choice of food. EVIDENCE: The residents spoken with said they decide how they spend their day and some of them were enjoying the company of other residents in the communal area, where as others said they were happy sitting in the privacy of their own rooms. The home does not employ an activities organiser or have a planned programme of activities. However the home offer a weekly shopping trip for those residents who wish to go and staff organise indoor activities including reminiscence sessions. The staff are available to assist the residents with any activity they choose such as doing a quiz or puzzle or writing a letter etc. There are plenty of opportunities for stimulation and exercise in the extensive grounds surrounding the home. The residents also have access to Rowfant House where they can go to have a meal or a drink and socialise with others outside the home environment. The menus seen offered a varied choice of food to suit all tastes and the residents choose where they want to eat their meals and some eat in the dining areas and some in their bedrooms. The new kitchen was clean and spacious and the food stored appropriately. Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 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 home has a simple and clear complaints procedure. The staff understand their responsibilities in reporting any incidents or suspicions of abuse. EVIDENCE: The home has no record of having received any formal complaints. The registered manager said that most complaints received had been minor and had been resolved satisfactorily. The residents said they would not hesitate to speak with the manager or the deputy manager should they have any concerns or matters they were not happy with. Staff training records showed that staff had received training on abuse in 2004 and all the staff spoken with said they would immediately report any suspicion or allegation of abuse to the manager or deputy. The home has the West Sussex Adult Protection procedures in place for reference purposes. Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 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) 19,20,22,23,24,25 & 26 The home offers a safe comfortable and pleasant environment for the residents. EVIDENCE: The home has a programme of routine maintenance and when jobs are identified someone from Rowfant House comes and carries out the necessary work. Since the last inspection two residents’ bedrooms have had en-suite facilities added, and six bedrooms had new carpets fitted. The home is decorated and furnished to a good standard and some of the residents’ rooms contain their own furniture and possessions. All residents’ accommodation is provided in single rooms, and there are two dining rooms, and a sun lounge. The home has one portable hoist which is appropriate for the needs of the residents accommodated at present. The home was clean and fresh on the day of inspection and the laundry facilities of one industrial washing machine and drier were appropriate for amount of laundry in the home.
Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 Page 15 A new call system has been installed and all care staff are provided with pagers that activate when the call system is used and identify who needs assistance. The home is surrounded by extensive grounds and a lake giving a very pleasant rural outlook. There is a patio area with a fishpond and flowerbeds and table and chairs for the residents to sit. Pre-set valves were fitted to basins but it was noted that the hot water in some taps was very hot and warning notices of very hot water were displayed over basins. It was recommended that water temperatures be monitored and recorded on a regular basis to prevent the risks from scalding. Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 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 The numbers of staff on duty are appropriate to care for the residents. The recruitment procedure in some cases falls below acceptable standards. The home needs to develop an induction and foundation training programme. EVIDENCE: The residents spoken with said the staffing numbers of each shift was sufficient for their needs. The staff also felt the number of staff on duty was right for them to provide the residents with a good level of care. The staff said that the manager and deputy manager were always available to help if needed. The home offers NVQ training to those care staff who wish to do it and at present four care staff are qualified to NVQ level 2 or 3 in care. One of the staff files examined of a new member of staff from Latvia and who commenced work in the home three months ago showed that the appropriate documentation had not been completed and no references were available. The Criminal Records Bureau check had been applied for but the results of the check had not yet been received. This matter was discussed with the registered manager. There was no documented evidence that new staff receive the appropriate induction training within the first six months of commencing work in the home. Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 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) 31,32,33,35,36,& 38 The home seeks the views of the residents to ensure they continue to provide a high quality service. Plans need to be put in place to commence staff supervision and review staff training. EVIDENCE: The registered manager has many years experience in a senior management position in a relevant setting. He is still planning to commence the National Vocational Managers Award in September 2005. There are clear lines of accountability within the home and the registered manager has the support of the deputy manager who is a qualified registered nurse. Both the residents and staff said that the manager was very approachable and they would not hesitate to speak with him on any matters. The staff felt he
Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 Page 18 gave them clear direction and they were included and consulted in any decision making within the home. The home has a quality assurance programme which includes residents’ questionnaires which are distributed each year, and the results are published and discussed with staff. The questionnaires are very detailed and can be completed anonymously if wished. The results from the last survey were very positive. The home does not include other professionals as part of the survey. The responsible individual for the home is required to do an unannounced visit to the home at least once a month to assess the care, the premises, any complaints and the conduct of the home and prepare a written report of the results of the visit and send a copy to the Commission which is not taking place. The home only handles small amounts of money for the residents that is kept in separate wallets for each resident, and locked in the safe in the general office. All transactions are recorded and signed and any receipts kept. Although the staff have regular contact with the manager and the deputy manager and those undertaking NVQ training have supervisory sessions, no formal supervision programme is carried out and documented. This was discussed with the registered manager who said he will ensure that a system is put into operation. Maintenance records show that arrangements are in place for the servicing and repairs of all equipment and installations. As previously mentioned there was no documentary evidence that risks from hot water were monitored or that water is stored at the correct temperature to prevent Legionella. A number of windows on the first floor were not fitted with window restrictors. Staff training records showed that staff had attended fire training and moving and handling training. However it was noted that new members of staff may wait several months to attend training for moving and handling depending when the next training session is planned. No evidence was available that all staff who handle food had undergone food hygiene training or that staff had attended training for infection control. All accidents were recorded and reported to the appropriate authorities. Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 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 N/A 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 N/A 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 N/A 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 N/A 3 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 N/A 3 3 3 3 N/A 3 2 N/A 2 Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 Page 20 No 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 25 Regulation 13 Requirement The registered person shall ensure that unnecessary risks to the health and safety of the residents are identified and so far as possible eliminated. Monitor and record water temperatures. The registered person shall not employ a person to work in the care home without first obtaining satisfactory references and a CRB check. The registered person shall ensure that persons working in the care home are appropriately supervised. The Responsiible Individual for the care home shall visit the home unannounced at least once a month and produce a written report of the findings of the visit. Timescale for action 31st August 2005 2. 29 19 31st August 2005 3. 36 18 30th September 2005 31st August 2005 4. 33 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations
H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 Page 21 Rowfant Residential Home 1. 2. 3. 4. Standard 9 9 30 38 The administration of Controlled drugs should be recorded in a separate register A risk management framework for assessing and monitoring self-administration should be developed with the home. Introduce an induction and foundation training programme in line with NTO specifications. All windows above ground level should be fitted with window restrictors. All staff who handle food should receive food hygiene training. All staff should undertake training in Infection Control which includes the safe handling and disposal of clinical waste, dealing with spillages, provision of protective clothing and hand washing. Rowfant Residential Home H60-H11 S14695 Rowfant V229726 150705 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 2nd Floor Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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