Inspection on 21/07/05 for Rowland House

This inspection was carried out on 21st July 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rowland House 11/12/08

Rowland House 24/01/07

Rowland House 03/05/05

Rowland House 14/09/04

Rowland House 10/06/04

Similar services:

Thorndene

Sutton Lodge Nursing Home

Wingham Court

Bethany Lodge

17 John Street

Red Oaks

Clare House Nursing Home

Broad Oak Manor Nursing Home

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

CARE HOME ADULTS 18-65 Rowland House 1a Lime Tree Avenue, Weston Green, Thames Ditton, KT7 0NY Lead Inspector Suzi Magnier Unannounced 21 July 2005 13:00 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Rowland House Address 1a Lime Tree Avenue, Weston Green, Thames Ditton, Surrey, KT7 0NY 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) 0208 972 9143 0208 399 8771 info@titleworth.com Tileworth Ltd To be confirmed. CRH Care Home 6 Category(ies) of LD Learning disability, 6 registration, with number PD Physical disability, 6 of places Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be:20-55 Years. 2. Services users may be admitted in either the category LD (Learning Disabilities) or PD (Physical disabilities). Date of last inspection 3-May-2005 Brief Description of the Service: Rowland House is set in a residential area of Surrey. The house has recently extended its accomodation and facilities to provide care for six residents with physical and learning difficulties. The accomodation is adapted to support people who use wheelchairs. The home has a lift to all three floors. The lower floor contains a physiotherapy and fitness centre, a Hydropool and sauna. The home has an extensivly landscaped rear garden that is purpose built for wheelchairs and is a prominent feature to the home. Each resident has their own bedroom three of which are en suite. The communal areas are spacious and bright and well decorated. Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspection was announced to the newly appointed Manager the day before it took place. The purpose of the inspection gave the inspector and the Manager the opportunity to meet and discuss the progress of the care home following the previous inspection. The inspector also spoke with the Manager regarding an anonymous complaint, received by the Commission for Social Care Inspection (CSCI) on the 27th June 2005. Titleworth Ltd had investigated the complaint and CSCI have concluded that all elements of the complaint were not upheld. The inspection lasted 5 hours and included looking through the statutory requirements made at the last inspection in May 2005. It was positive to note that the majority of requirements had been met and those remaining were in the process of being met. A tour of the premises took place and the inspector met with the residents at home and the three care staff on duty. No visitors were in the home during the inspection. The inspectors looked at paperwork in the home that included residents care plans and risk assessments and other documentation related to the operation of the home. What the service does well: What has improved since the last inspection? The residents at home spoke favourably of the new Manager and one resident told the inspector that ‘she’s the best we’ve ever had’. Another resident told the inspector that they were happy with ‘how things are now’. The Manager and staff are proactive in promoting individual resident’s wishes and aspirations for example helping one resident to purchase specialist fitness equipment. The serving, preparation and storage of food represents good safe working practice. Menus have been reviewed and the resident’s comments in their meeting were positive to the changes. Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 6 The Manager has been proactive in ensuring the specialist health care needs of residents are met for example a referral to the speech and language therapist. The Manager has reviewed the homes medication policy and procedure to ensure that all residents receive their prescribed medication in a safe and professional manner. Titleworth Ltd has successfully recruited several new care workers to and the staffing rotas have been revised to suit the needs of the residents. A referral was made to the Surrey Multi Agency Protection of Vulnerable Adults in March 2005. A planning meeting was held and several residents Care Managers met with the residents in order to seek their views. The referral was concluded and no further action has been taken. The general awareness of resident’s health and safety has been highlighted in order to reduce risks for residents as far as is reasonably practicable. 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. Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1. The home has updated the Statement of purpose and the service user guide. A recommendation has been made that the new Manager further develops the service users guide to make it a more interesting document for the residents. EVIDENCE: The home has updated the Statement of purpose and the service user guide. The inspector and Manager discussed the recommendation that the service user guide is further developed in a format that is more appropriate for the residents and for example could contain photographs of the home. During the last inspection one resident asked the inspector if they were able to keep pets. It was pleasing to see that the new Manager has a dog and that the dog often visits the home. One resident was very happy about having the dog and told the inspector that they take it for walks down the road. Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9. The Manager discussed with the inspector the way forward in reviewing the care plans and risk assessments to enable residents to express their aspirations, needs and continue to have opportunities in their lives. The inspector looks forward to seeing these developments at the next inspection. EVIDENCE: The newly appointed Manager explained to the inspector that following the last inspection she had given considered priority to some requirements made. Additionally as she was new to the home she felt it important that the resident’s and her had the opportunity to get to know each other. The Manager advised the inspector that following the last inspection the care plans and risk assessments are going to be further developed and reviewed in order that the plans reflect the current needs and care provided for the residents. The Manager told the inspector that this was obviously a large piece of work and due to that it would take some time to complete. The initial requirements timescale has been extended in order that the Manager can begin to undertake the work. Whilst undertaking the general review of the care plans with the residents the Manager explained that residents, where able and if they chose to, would be Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 10 involved in signing their care plans and the ‘in house’ care plan reviews each month. The Manager and inspector spoke at some length regarding the risk assessments used in the home, which could be further developed to include a more holistic approach. The inspector showed the Manager an illustration of a risk assessment, which the home may choose to adapt if it is assessed as suitable for residents to safely promote independence and control over their lives. Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,13,14,15,17. The resident’s continue to lead busy lives and opportunities are available for them to continue to have contact with their family and friends. The staff members on duty actively engaged with residents and there was a general sense of calm and order in the home. The arrangements for the preparation, storage and serving of food have been improved to meet with safe working practice. EVIDENCE: The home continues to be a busy environment with residents attending various day centres, going out with friends and acquaintances and attending therapeutic sessions to assist in their specialist development. One resident told the inspector about their holiday and how much they enjoyed having the dog in the home. During the last inspection concern was raised that one resident had told the inspector that they were unable to use their exercise bike as it would not fit into their bedroom. It was encouraging to note that the home had made a concerted effort to fulfil and promote the residents wishes and the resident has purchased a specialised bike, which adapts to their wheelchair. Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 12 The Manager and the inspector discussed ways in which the home could develop evidence that activities, leisure interests and development of individual residents skills and abilities could be recorded. This would enable and support staff and the residents in a planned way to help residents relearn and maintain their skills. Ways of evidence for example could include the use of daily diaries, goal setting or activity plans. During the last inspection concerns were raised regarding the preparation storage and serving of meals. It was encouraging to note that the staff members attending residents during their meals did so in a competent manner. Staff wore protective clothing whilst preparing meals and there was evidence that food was stored in the homes refrigerator in compliance with food hygiene standards. There was evidence in the homes kitchen of fresh fruit and vegetables and the residents spoke favourably of the improvements in the menu, which they had helped to change. The home had also improved the recording of food, which individual residents liked or disliked and what type of diet, for example soft diet, and the type of crockery and cutlery residents preferred to use during their meals. Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20. The new Manager has undertaken a proactive approach to the general and specialist health care needs of the residents. The requirements made regarding the homes policy and procedure for the administration of the medication has been met following the previous inspection. EVIDENCE: The inspector spent some time during the inspection talking with the residents and they spoke favourably of the changes in the home. The atmosphere in the home was relaxed and comfortable. It was evident that the Manager had made professional links with a variety of health care professionals and this was demonstrated by her referral of one resident to the Speech and Language Therapist due to the resident’s difficulty in swallowing. Additional professional liaison, included advise re continence management, physiotherapists and psychiatrists. The home operates a communication book and a daily diary, which the inspector evidenced. Records indicated that the home supports residents to attend booked appointments with the G.P District Nurse, and other health care professionals and annual reviews of care with residents are held. Ongoing therapeutic sessions e.g. physiotherapy and attendance to specialist day centres are also maintained on a regular basis. Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 14 Following the requirements made during the last inspection the home has reviewed the medication policy and procedure, which was evidenced by the inspector. Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23. The residents continue to have a knowledge and awareness of who to talk to if they are not happy with the care they receive. EVIDENCE: Titleworth Ltd has investigated an anonymous complaint received by CSCI in June 2005. During the inspection the inspector discussed all the elements of the complaint with the Manager and confirmed with Titleworth that all elements of the complaint were not upheld. A referral was made to the Surrey Multi Agency Protection of Vulnerable Adults in March 2005. A planning meeting was held and several residents Care Managers met with the residents in order to seek their views. The referral was concluded and no further action has been taken. Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29,30. The home was clean and has a homely atmosphere. EVIDENCE: During the tour of the premises the Manager showed the inspector that the requirements made during the last inspection regarding health and safety in the home had been met. There was a noticeable difference in the cleanliness and order of the kitchen area, which was encouraging as the kitchen on the whole, was noted as being one of the busy places in the house. The inspector spoke with several residents regarding their home and their rooms all of which said they liked their own rooms and also were happy with the house. The residents told the inspector that they were happy with the standard of personal and communal accommodation. The toilet and bathroom areas were viewed as suitable to meet the needs of the residents and reflected a homely atmosphere for residents whilst bathing. The home continues to provide equipment to suit the needs of the residents with physical disabilities, which includes overhead hoists. Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,36. The Manager must continue to ensure that staff training and supervision are maintained. EVIDENCE: The Manager advised that she had reviewed the staffing rotas to reflect the current needs of the residents and the rotas will continue to be kept under review. The rotas have assisted to promote the residents quality of life as the residents are now supported more often to access the local community for example more visits to the local pub! Additionally the Manager told the inspector that the rotas will be reviewed and additional staffing would be made available when a prospective resident moves in to the home to assist them in settling down. The inspector sampled the rotas, which indicated that there was sufficient staff to meet the needs of the residents whilst they are at home. The anonymous complaint received by CSCI in March 2005 and investigated by Titleworth Ltd regarding staff employment rights to work in this country has been concluded and not upheld. Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 18 Titleworth Ltd has recruited a full compliment of staff and has reviewed the staffing structure to include two Senior Care Workers. No records related to the employment of staff were available at the home and the Manager advised the inspector that she had not been involved in the recruitment of staff and thus was unable to advise the inspector fully on the recruitment process. The inspector has made a recommendation that Titleworth Ltd include the residents and Manager in the process of the selection of staff for Rowland House in order to promote choice for the residents and ensure that the Manager has the opportunity to assess the skills of the applicant to meet the needs of the residents. As part of the regulatory practice the inspector advised the Manager that staff recruitment records must be available to the inspector and have requested that Titleworth Ltd have the staff records available to the inspector for any announced inspections. The Manager told the inspector that the newly appointed staff had undertaken their staff induction at another registered care home owned by Titleworth Ltd. Additional induction training was also undertaken at Rowland House. No staff induction records were sampled during the inspection. Whilst speaking with the Manager she advised that of the newly recruited staff, two had yet to attend the Basic Food Hygiene training, which was booked for completion in September 2005. A further requirement has been made that this is attended and a copy of the training plan and staff attendance sent to CSCI local Eashing office. The home has not yet achieved the target for 50 of their staff achieving their NVQ training by the end of 2005. Out of the five day staff two staff members have registered with a local college to undertake their NVQ, one staff member is waiting to register and another staff member is studying for a BSC IN Health and Social Care. The Manager is proactive in promoting and supporting staff to achieve their NVQ. A further requirement has been made that the Manager must ensure that staff receive formal documented supervision of their work to ensure their satisfactory performance and the safety and well being of the residents. Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,42. Titleworth Ltd has appointed a new Manager who demonstrated a proactive and enthusiastic approach to the management of the home and support of residents and staff. The Manager and staff must ensure that all events affecting the welfare and wellbeing of residents are reported to CSCI. EVIDENCE: The certificate of Registration and insurance liability was displayed in the home. The previous requirement that a safe bathing policy be implemented in the home had been met to ensure that safety of residents whilst bathing and records have been kept. During the inspection it was noted that Titleworth Ltd had not informed CSCI of an incident on the 3rd May 2005 regarding a resident falling from a fitness bike and sustaining an injury to their head. The records indicated that the resident’s primary diagnosis is as a result of a previous head injury and that the carers took no immediate action until the following morning when the previous Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 20 Manager was notified and sought advice from the District Nurse and General Practitioner. A letter of concern was sent to the Titleworth Ltd advising that CSCI must be informed of all events, which affect the welfare and wellbeing of residents and immediate medical action must be sought in the event of a resident sustaining any blow to the head. Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 2 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 x 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score x 2 3 2 x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Rowland House Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x 2 x H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 Page 22 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 6,7,8,9, Regulation 15.(a)(b)( c)(d) Requirement Timescale for action 21.11.05 2. 32 3. 36 4. 42 The Registered Persons must ensure that all residents care plans, risk assessments and montly revision of care needs are available to residents and or thier representatives. (Timescale of 3.6.05 not met) 18.(1)(c The Registeterd Persons must (i) 1.(2)(i) ensure that the remaining staff members attend a Basic Food Hygiene training course to ensure competency whilst preparing and supporting residents at mealtimes. A copy of the training plan and staff attendance to be sent to the local CSCI Eashing office. 18.(2)(a) The Registered Person must ensure that all staff receive formalised supervision. (Timescale of 3.5.05 not met) 37.(1)(e) The Registered Persons must inform CSCI of any event which affects the wellbeing and welfare of the residents. 30.9.05 21.10.05 Immediate 21.7.05 Rowland House H58 s13893 Rowland House v240812 210705 stage 4.doc Version 1.40 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. 2. Refer to Standard 1 34 Good Practice Recommendations The service user guide is further developed to make it a more interesting document for service users. Titleworth Ltd include the residents and Manager in the process of the selection of staff for Rowland House in order to promote choice for the resident and ensiure that the Manager has the opportunity to assess the skills of the applicant to meet the needs of the residents. 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