Inspection on 27/06/08 for The Roan Rest Home

This inspection was carried out on 27th June 2008.

CSCI found this care home to be providing an Adequate service.

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

The Roan Rest Home 02/07/07

The Roan Rest Home 23/05/06

The Roan Rest Home 22/11/05

The Roan Rest Home 08/06/05

The Roan Rest Home 13/10/04

The Roan Rest Home 25/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Roan Rest Home 27/29 Pembroke Crescent Hove East Sussex BN3 5DF Lead Inspector Jennie Williams Unannounced Inspection 27th June 2008 11:30 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 The Roan Rest Home DS0000014253.V365474.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. The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Roan Rest Home Address 27/29 Pembroke Crescent Hove East Sussex BN3 5DF 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) 01273 772927 01273 738260 Roan@vigcare.co.uk Mr Joginder Singh Vig Mrs Beant Kaur Vig Mrs Beant Kaur Vig Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is nineteen (19) Service users must be older people aged sixty-five (65) years or over on admission 29th November 2007 Date of last inspection Brief Description of the Service: The Roan Rest Home is a residential care home providing social and personal care for up to nineteen older people. There are four rooms allocated to provide intermediate care. The home is owned by Mr and Mrs Vig who owns numerous care homes throughout the South of England, predominantly older people services. The home is situated in a quiet residential area of Hove within walking distance of local amenities. There is nearby access to public transport. There is no parking available at the home, but two hour restricted paid parking is available in adjacent streets. Accommodation is provided over three floors in a large property that has been converted from two houses. A passenger lift enables residents to access all parts of the home. However, there is a short flight of stairs to mezzanine levels that place some limitations on residents with restricted mobility. The home would not be suitable for wheelchair users. The dining room can be accessed by a stair lift. Seventeen rooms are for single occupancy, of which eleven have en suite facilities and one double room that does not have en suite facilities. There is a lounge/dining room on the lower ground level and a quiet lounge on the first floor. This quiet lounge is used as an office and for use by residents. There are suitable numbers of communal toilets and bathing facilities located throughout the home. There are grab rails placed throughout the home in areas where residents may require some assistance with mobilisation. Weekly fees range between £314 and £450. There are additional fees for; Hairdressing, Chiropody, newspapers and personal toiletries (at cost). This information was provided to the CSCI on the 1st May 2008. A copy of the most recent inspection report is available at the home. Residents/relatives know about the service through social service referrals, word of mouth and from living in the area. The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. It should be noted that following recent CSCI consultation, it was identified that service users prefer to be called people who use services. It was confirmed that the home uses the term residents or service users. For the purpose of this report, people who use the service will be referred to as residents. This unannounced site visit took place over six and a half hours on the 27 June 2008. Evidence obtained at this site visit, previous information regarding this service and information that the CSCI have received since the last inspection forms this key inspection report. Due to the number of Safeguarding Adults alerts being raised with the CSCI a random unannounced inspection was undertaken on the 29 November 2007. This random unannounced inspection was also to check that compliance had been achieved as required at the last key inspection undertaken on the 02 July 2007. The improvement plan received from the registered provider following the last key inspection was used during the random inspection. Findings of this inspection have been incorporated into this report. The Registered Manager and deputy manager facilitated this inspection. Six residents were spoken with throughout the site visit. All residents eating in the dining room at lunchtime were met and advised to let the Inspector know if they wished to speak with her individually. Ten surveys for residents to complete were sent to the home, of which two were returned and identified that the individual completed them without assistance. Three care plans were briefly viewed and specific area of care was viewed in another. Ten surveys for staff to complete were sent to the home prior to the site visit, of which one was returned. Two staff were spoken with at the site visit. Four staff files were viewed. A tour of the environment was undertaken and some individual rooms were viewed. Medication procedures were inspected. The quality assurance system was discussed and complaint and Safeguarding Adults records were viewed/discussed. An Annual Quality Assurance Assessment (AQAA) was received from the home prior to the site visit. This was to obtain information about the establishment to assist CSCI in the inspection process. The AQAA also provided the Commission with numerical information. The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 6 There were sixteen residents residing at the home on the day of the site visit, of which three were receiving intermediate care. What the service does well: What has improved since the last inspection? Work has been done to ensure compliance with the requirements made at the last random inspection. This included that information required under legislation is provided to the CSCI within the given timescales. This related to Regulation 26 and Regulation 37 reports. The random inspection undertaken identified that all requirements made at the previous key inspection had been met or action was being taken to address the shortfalls. This included ensuring the Statement of Purpose and Service Users Guide provided information on the limitations that the environment may pose for residents with a mobility problem. Care plans were implemented and reviewed with the residents/representative input to ensure choice and preferences are taken into account. The provision of food had improved at the time of the random inspection and the home was undertaking nutritional assessments to ensure that good nutritional status of individuals were promoted and maintained. Following consultation with a fire safety expert, adequate fire safety procedures were put in place to ensure the health, safety and welfare of all people within the home. The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 7 Work has been undertaken and is continuing to be done to improve the standards within the environment. 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. The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5 & 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home. The pre admission process ensures that only residents whose needs can be met at the home are admitted. EVIDENCE: The home has a Statement of Purpose and Service Users Guide that is available at the home and provides prospective residents/representatives with information about the services and facilities provided at the home. These documents have been amended to provide information on the limitation the environment may pose for some individuals, identifying that some bedrooms can only be accessed by steps that residents must be able to step up and down independently. A stair lift has been installed on the stairs to the dining room to assist all residents in accessing this area. The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 10 The Registered Manager or deputy manager undertakes the pre admission assessments of all prospective residents who are being admitted for respite or long-term placement. There were pre admission assessments in place for newly admitted residents. These identified that the home also obtains information on the preferences of an individuals preferred routines ie: routines of waking and going to bed, daily routines and personal interests. It was observed that the home had undertaken their own assessment; following an intermediate care resident becoming a permanent resident at the home. It was confirmed that an assessor from the Intermediate Care Team undertakes assessments for the intermediate care residents. This information is sent to the home where the Registered Manager and deputy manager will make a decision from this information if the persons needs can be met at the home. The Registered Manager confirmed that they now send a letter to prospective residents, following their assessment, advising them if their needs can be met at the home or not. Residents spoken with confirmed that they or a representative visited the home prior to moving in. Some were unable to visit the home prior to moving in as they were admitted from hospital. One identified that they did not receive information to read prior about the home prior to moving in. Both resident surveys received identified that they received enough information about the home before moving in so they could decide if it was the right place for them. Residents were happy residing at the home and one comment received was ‘it is a home away from home’. Two representatives from the intermediate care team spoken with stated that they found the home to have a ‘friendly and relaxed atmosphere’. Prospective residents are encouraged to visit the home prior to admission. The first four weeks are considered a trial period to ensure the home can meet all needs and living at the home fulfils the individual’s expectations. It was confirmed that there was no one residing at the home from any minor ethnic community, social/cultural or religious groups with any specific needs or preferences. There are specific rooms that are contracted for intermediate care residents. Due to the passenger shaft lift not servicing all areas of the home, the location of the rooms available are taken into account when deciding if an individual should be admitted. The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 11 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): 7, 8, 9 & 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs are being met with the information provided in the care plans on the assessed needs of individuals and residents/representatives are provided with an opportunity to be involved in the reviewing process to ensure choice and preference is taken into account. Medication procedures need to be more robust to safeguard residents and staff. Residents’ privacy and dignity are respected. EVIDENCE: The random inspection undertaken in November 2007 identified that work had been carried out to ensure residents/representatives are involved in the implementing and reviewing of care plans to ensure choice and preference are taken into account. There was evidence that the residents are signing care plans wherever possible. It was confirmed that staff are reading care plans more to ensure they are kept up to date with the residents’ current needs. The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 12 At this site visit, it was confirmed that the care plan format has been changed. These were observed to provide guidance to staff on how to meet the assessed needs of residents. There was evidence that care plans were being reviewed on a monthly basis, however care plans are not updated to reflect these changes. A form is used for the monthly reviews and some sections have recorded no changes, based on the previous months review. There is a risk of the information of changes in needs not being retained, as care plans are not being updated to reflect these. With the main care plan not being amended to reflect changes in needs, the care staff would need to read through months of reviews to ascertain if there were any changes. Residents spoken with confirmed that staff discuss their care with them. It was confirmed that not all residents/representatives wish to be involved in the monthly review. It was discussed with the facilitators that they obtain written confirmation from individuals to evidence how often individuals wish to be involved in their reviews. The AQAA identifies that improvements planned for the next 12 months is to look into accessing additional training with regards to person centred care planning. Feedback from a staff member identified that they found the care plans clear and provided them with information on how to meet the needs of the individuals. For any area where a risk has been identified, it was confirmed that a more detailed risk assessment is implemented. It was noted at the random inspection that work was continuing to be done to improve the information contained in risk assessments. At this site visit, it was confirmed that two staff have attended risk assessment training which they found beneficial, which resulted in them changing the care plan format. The AQAA also identifies that risk assessments is an area that they have improved in the last 12 months. Some documentation in an individuals file was titled ‘risk assessment’, however the information contained was not reflective of what is expected in a risk assessment. This was discussed with the facilitators who confirmed they will review the information contained within residents files. It was observed that some assessments were completed in grey lead pencil. All documentation or assessments pertaining to individuals must be written in pen to ensure alterations are not made, information is not lost and to ensure clear records are maintained. Writing in pen will better safeguard staff and residents. Residents spoken with confirmed that the staff are ‘quick to get the GP out if someone is not well’. Two representatives from the intermediate care team were spoken with at the site visit who confirmed that staff demonstrate a good knowledge of residents needs and had no concerns regarding practices within the home. It was confirmed by the facilitators and on speaking with residents that good support from the intermediate care team is provided regularly eg: physiotherapy, occupational therapists and district nurses. Both resident The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 13 surveys identified that they always receive the care and medical support they need. At the random inspection, medication procedures were viewed due to two Safeguarding Adults alerts being raised in relation to medication, of which both were upheld. No concerns were noted and staff had been updated with a lecture regarding medication procedures. A recommendation was made at the random inspection that staff checking the controlled drugs record the number of tablets left, so a clear audit trail is maintained. This would ensure staff and residents are better safeguarded. At the key site visit, it was observed that this has been implemented. Medication procedures were viewed at this site visit identified that further work is needed to further safeguard residents and staff from errors occurring. New Medication Administration Record (MAR) charts were in place, so there were limited entries to view. Medicines are supplied to the home in blister packs. Where staff have had to hand write a prescription, they were not writing the dose or times for administration. They identify the medicine needed and were not identifying the dose required, they are just administering from the blister pack. Correct prescriptions must include the dose required to be administered. The Inspector was informed that monthly audits are undertaken on medication procedures, this shortfall should have been identified during these audits. Controlled drugs were viewed that identified that accurate records are being maintained. The Registered Manager needs to obtain information and ensure controlled drugs are stored in line with current guidelines. This is currently not in place. It was confirmed that residents are provided with an opportunity to self medicate, based on a risk assessment being undertaken, to ensure it is safe for an individual to do so. A resident spoken with confirmed that they manage their own medication and was aware to ensure these are kept securely in their room. Residents spoken with confirmed that staff respect their privacy and dignity and always knock on their room doors prior to entering. They confirmed that staff encourage their independence and allow them to do as much as they can for themselves. The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 14 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ lifestyle within the home is generally their own choice and residents are provided with sufficient stimulation to fulfil their interests and needs. Residents are provided with varied nutritional meals and are provided with choice to ensure their preferences are catered for. EVIDENCE: There is an activities person employed at the home for four hours in the afternoon, two days a week. Residents spoken with confirmed that their lifestyle within the home is their own choice and choose their own bedtimes, to participate in activities or not and what clothing to wear etc. One resident commented ‘I could shower every day if I wanted to’. Some residents will independently go out into the community and staff will assist less independent residents to visit local amenities. Residents spoke positively about recent outings that had been arranged by the home. The AQAA identifies that plans for improvement in the next 12 months is to provide more trips for residents to interesting places and to have more entertainers to The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 15 come to the home following feedback from the resident meetings. They also propose to encourage residents to take an interest in planning the outings. One resident survey received identified that there are usually activities arranged by the home that they can take part in and one identified there are always activities provided. It was confirmed that there are no visiting restrictions imposed at the home. There was an advertisement in the home advising residents and visitors that a barbecue was going to be held at the home the following month. The AQAA identifies that an area that they could do better is to have links with the community so residents can access local activities and the community can be involved in the home activities. A new cook has been employed since the random inspection was undertaken and residents were very complimentary about the meals. They confirmed that they are provided with choice and some residents have been involved in devising menus for the home. Comments about the food ranged from ‘very good’, ‘marvellous’ to ‘out of this world’. One resident confirmed that they do not like a certain food and they are always offered an alternative and it is ‘no bother at all’. The cook was spoken with who confirmed that he had devised the menus with some of the residents, taking into account peoples preferences. There is a list of residents likes/dislikes/allergies in relation to food available in the kitchen. It was confirmed that all meals are cooked fresh at the home and there are no restrictions imposed on the ordering of the food. The cook is very pro active and restricts other staff from entering the kitchen and ensures they have a hair net and apron on prior to entering the kitchen area, ensuring good food hygiene and infection control procedures are promoted. Residents were observed to be enjoying their lunchtime meal on the day of the site visit. The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 16 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents feel comfortable to complain, reassuring them that they are being listened to and that action will be taken, if necessary. Residents are not fully protected by Safeguarding Adults procedures as it is identified that not all staff feel comfortable raising concerns or whistle blowing within the service. EVIDENCE: There had been six Safeguarding Adults alerts made since the last key inspection undertaken in July 2007. This resulted in the Commission undertaking a random inspection in November 2007. All alerts had been made from other professionals visiting the home and all related to residents receiving intermediate care services. Two alerts were inconclusive that related to verbal and psychological abuse. One relating to physical abuse was raised, however the individual did not want this to be pursued or any further action to be taken. An allegation of financial abuse was raised with the police and this has not been investigated. Two Safeguarding Adults alerts were raised in relation to medication issues. These were both substantiated. The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 17 At the random inspection the Registered Manager felt that they were being victimised and felt that not all alerts were warranted. She has been informed that this is not within the CSCI remit and to address any concerns she has with the Safeguarding Adults team who are the leading authority. The random inspection identified records were being maintained of complaints and Safeguarding Adults alerts made. One concern had been expressed to the home, which was not upheld and documentation was in place identifying how the home responded to this. The Commission had not been informed by the home of all Safeguarding Adults alerts that had been made. The Registered Manager stated that she had been informed that social services would notify the CSCI. As the Registered Manager/Provider she was reminded that the management of the home are responsible for ensuring all information required under regulations are notified to the Commission within the given timescales. The AQAA identifies that staff have undertaken Safeguarding Adults training or are on the waiting list for this training, however have received in house training. It identifies that policies and procedures are in place that reflect the Sussex Multi-Agency policy and procedures for Safeguarding Vulnerable Adults. Feedback from staff identified that an individual did not feel comfortable raising concerns or using the whistle blowing policy within the service. Concerns regarding some potentially abusive practices had been raised with the Commission, however the individual did not wish the Inspector to deal with their concerns and would address the issues with the Safeguarding Adults team themselves. The Inspector has liaised with the Safeguarding Adults team who have confirmed that the allegations have been reported and they will be investigated through their Safeguarding Adults procedures. There have been no complaints made to the home since the random inspection. Residents spoken with confirmed that they had no complaints about anything in the home, were ‘overall satisfied’ and would feel comfortable raising any concerns that they may have and knew who to speak to. The AQAA identifies that an area in which they could do better is to assess residents and for those whom lack capacity and do not have a friend/relative with whom it is appropriate to consult, they may need to consider the use of an Independent Mental Capacity Advocate (IMCA), following the introduction of the Mental Capacity Act. The facilitators confirmed that they propose to implement surveys to send to complainants following completion of their investigations into any concerns raised, to ensure that the complainant is happy and to identify any areas in which they may be able to improve. The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 18 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a homely environment and are provided with comfortable indoor communal facilities. EVIDENCE: The random inspection undertaken in November 2007 identified that work had commenced to ensure the cleanliness and maintenance within the home are improved and maintained. Some rooms had new carpets fitted and the home had documentation in place identifying what further work is required and all jobs were being prioritised. It was confirmed that beds are being replaced as needed and new mattresses provided where needed. At this key site visit, the facilitators confirmed that work is continuing on improving the environment. Some of the areas that were confirmed as being The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 19 improved were: placing new non-slip vinyl flooring in bathrooms, six bed bases and four beds and mattresses have been replaced, carpets are being changed as an ongoing programme, some toilets in en suites have been changed and some rooms have been repainted, of which residents were consulted regarding the colours. The home has purchased additional manual handling equipment to assist in raising residents from the floor should they have a fall. Some bedrooms can only be accessed by steps, where residents must be able to manage these independently. The Registered Manager confirmed that they are unable to install stair lifts in these areas due them being too narrow and has been advised that installing them in these areas would pose a risk to the health and safety of residents. A resident spoken with was positive about a new bathroom hoist that had been installed. Another resident spoke positively about the stair lift that had been installed on the steps to the dining room. Individual rooms were noted to be personalised to reflect the individual’s choice and character. Some residents expressed their interest in gardening and have recently planted bulbs. It was discussed with the facilitators that consideration be made to building raised garden beds to provide easier access for residents to fulfil their interest in gardening. The home appeared clean and was free from offensive odours on the day of the site visit. Visiting professionals spoken with confirmed that they always found the home free from offensive odours. The AQAA identifies that five staff have received training on the prevention of infection and management of infection control. Management must ensure all staff receive this training. Both resident surveys received identified that they always find the home fresh and clean. There is no sluice machine provided at the home and it was confirmed that commodes in use are emptied down the toilet and bleached. Staff must ensure that full protective clothing are used when emptying commodes and it is recommended that the home seek advice from the Health Protection Agency in regards to good infection control practices when no sluice facilities are available. The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 20 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs are being met with the number and skill mix of staff on duty and are generally safeguarded by the recruitment procedures in place. EVIDENCE: Residents spoken with were complimentary about the staff at the home and confirmed that there are always sufficient staff on duty to meet their needs. Comments received about the staff were ‘very nice’ and ‘helpful.’ The staff survey received identified that they felt there are always enough staff on duty to meet the needs of the residents. The random unannounced inspection undertaken in November 2007 identified that since the last key inspection, two staff now work a waking night. The improvement plan and the rota provided at the random inspection demonstrated that this was in place. The AQAA identifies that there are 12 permanent care staff working at the home of which 10 have achieved National Vocation Qualification (NVQ) level 2 or above. An additional two staff are undertaking these studies. Staff files viewed identified that some areas in recruitment could be better improved. Gaps in employment need to be explained. A reference observed The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 21 did not have any indication who the referee was from and in what capacity they knew the applicant. The front page of the reference was missing. The Registered Manager confirmed she will address this. Protection of Vulnerable Adults (POVA) First checks were observed to be in place, prior to an individual commencing employment. The Registered Manager confirmed that where an employee has commenced work with just a POVA check in place, the individual works supervised until a full enhanced Criminal Record Bureau (CRB) check is returned. This may prove difficult with only two staff working at night. The staff survey received identified that CRB checks and references were carried out before they started to work. Where information has been returned from the CRB regarding an individual, a risk assessment had not been fully completed to identify that this person did not pose a risk to residents. The Registered Manager completed this document on the day of the site visit. It was confirmed that staff are kept up to date with mandatory training. There was evidence that a newly employed staff member had commenced the Common Induction Standards are set by Skill for Care. The staff survey identified that they are given training that is relevant to their role, helps them to understand and meet the individual needs of residents and keeps them up to date with new ways of working. The staff survey identified that their induction covered very well everything they needed to know to do the job when they started. The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 22 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, 35 & 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst residents express satisfaction of living in the service they are not fully protected by the effective leadership of a suitably qualified manager. EVIDENCE: Previously there had been two Registered Managers employed at the home. Mrs Vig, who is also one of the registered providers, is now the only Registered Manager. She is a registered nurse, who confirmed her registration with the Nursing and Midwifery Council (NMC) is still current. The Commission had previously been informed that the deputy manager had completed the Registered Manager Award course and it had been proposed that this person The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 23 will put forward an application to the CSCI to become the Registered Manager. This is no longer being implemented. The Registered Manager has not undertaken any relevant managerial qualifications and was informed that as she is remaining the Registered Manager, she must obtain the relevant management qualifications. It is reflected in the AQAA that their plans for improvements in the next 12 months is for the Registered Manager to complete a recognised management qualification and it was confirmed at the site visit that training is being looked into. This had been made an outstanding requirement in the past, however action was being taken to address this. Due to the proposals changing again, it is now made a requirement. The lack of formal management training is evidenced by the shortfalls highlighted throughout the report. Examples of this are; better monitoring of documentation and importance of robust record keeping (eg. Care planning/medication records, using pen for writing records), keeping up to date with changes within current guidelines and importance of robust recruitment procedures. This home has been involved in management review meetings as part of the CSCI improvement and enforcement agenda. These were related to all the services owned by the registered providers/Responsible Individual. Warning letters have been sent and meetings have also been held with the registered providers to remind them of their legal obligations to ensure the services they provide meet the aims and objectives of the service and their Statement of Purpose. The registered providers have employed a trainer and a consultant to assist them in meeting their legal obligations. Regulation 26 visit reports from the registered provider were available at the home for viewing. In light of the concerns the CSCI had in respect of the current level of supervision within the home and the registered providers not monitoring their services, it had been advised that these reports be forwarded to the CSCI on a monthly basis. Management have also been reminded of their legal obligations to inform the CSCI of significant events that may occur within the home. This sharing of information has improved. The AQAA provided identified what the service does well, how they have improved in the last 12 months, what they could do better and what their plans are for improvement in the next 12 months. A brief discussion was had with the facilitators on how some sections of supporting evidence could be expanded. The facilitators confirmed that they undertake surveys for residents/representative/visitors and visiting health professionals twice a year, as part of their quality assurance and quality monitoring system. There is a suggestion box at the home that provides people with an opportunity to anonymously make suggestions/complaints. It was confirmed that there is no formal system in place to obtain feedback from staff. Staff are provided with The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 24 an opportunity to have an input into the service at staff meetings. It was discussed with the facilitators ways in which staff should be provided with the opportunity to have their say anonymously. It was confirmed that the results are analysed and action taken wherever identified as being needed. Discussions were had with the facilitators on ways to display the results for all interested stakeholders to view. She confirmed that they have already been discussing ways in which to do this. The AQAA identifies that this an area for improvement in the next 12 months. Some comments noted from the homes previous quality assurance surveys stated ‘Care is to a high standard’, ‘Very Friendly staff’ and ‘All the food is cooked to perfection’. It was confirmed that regular health and safety checks are undertaken within the environment and medication audits are undertaken. The AQAA identifies that equipment has been serviced or tested as recommended by the manufacturer or other regulatory body. Due to an allegation of financial abuse being raised, the practice for safe keeping residents monies was viewed at the random inspection and at this site visit. Records viewed evidenced that good practices are in place, ensuring that residents’ monies are safeguarded. It was confirmed that the home is holding personal allowance for one resident, of which only management is able to access. Concerns noted at the last key inspection, relating to the fire procedures within the home, resulted in the Inspector sharing their concerns with the local fire authority. At the random inspection documentation was available at the home to evidence the findings of their visits and confirmation was received that management is working to ensure action is taken to address the shortfalls, ensuring the safety of residents, staff and visitors within the home. No fire records were checked at this site visit as a fire officer had previously been monitoring the home to ensure compliance with their regulations. Dorguards were observed to have been put in place. The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 25 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 3 X 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 26 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. 1. Standard OP9 Regulation 13(2) Requirement That staff ensure that clear directions are provided for any handwritten prescriptions, including the dosage, to ensure residents and staff are safeguarded from errors occurring. That all controlled drugs are stored within compliance of current legislation, to ensure residents and staff are safeguarded. That the Registered Manager enrols to undertake a relevant management course to ensure service users live in a home which is run and managed by a qualified person and are fully protected by the effective leadership of a suitably qualified manager. Timescale for action 30/07/08 2. OP9 13(2) 27/09/08 3. OP31 9(2)(b)(i) 30/10/08 The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 27 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 OP26 Good Practice Recommendations That the home seeks advice from the Health Protection Agency in regards to good infection control practices when no sluice facilities are available. The Roan Rest Home DS0000014253.V365474.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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