Inspection on 18/07/08 for The Rookery

This inspection was carried out on 18th July 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Rookery 01/10/07

The Rookery 04/08/06

The Rookery 19/01/06

The Rookery 01/08/05

The Rookery 18/01/05

The Rookery 09/08/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOME ADULTS 18-65 The Rookery Mill Common Road Walcott Norwich Norfolk NR12 0PF Lead Inspector Mrs Judith Last Unannounced Inspection 18th July 2008 10:30 The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 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 Rookery DS0000027307.V368789.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 Adults 18-65. 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 Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Rookery Address Mill Common Road Walcott Norwich Norfolk NR12 0PF 01692 650707 01692 650330 janithhomes.com@btconnect.com www.janithhomes.org Janith Homes Limited 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) Manager post vacant Care Home 30 Category(ies) of Learning disability (30) registration, with number of places The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st October 2007 Brief Description of the Service: The Rookery is a care home providing personal care and accommodation for 30 adults with a learning disability. It stands in a rural area on the outskirts of the Norfolk seaside village of Walcott. The service is owned and operated by Janith Homes Ltd, who also operate four smaller services for the same client group within the same area. It is based around a small farm where rare breed animals are raised. The complex also encompasses holiday accommodation which people use with their own carers. The service operates as a community with people attending for day services. There is also a strong artistic ethos with one of the farm barns having been converted into a large studio where artists work with and alongside service users. A separate company operates the holiday accommodation, working farm and art centre. These do not fall within the Care Standards Act and do not therefore need to be registered. The living accommodation is in the main house with some separate purpose built and converted units. Information about fees is set out in the Service User Guide as published on the internet. These are from £780 to £2000 per week. There are additional charges for transport and staffing for requested activities and outings, (but not for health care appointments,) hairdressing, dry cleaning and personal spending. The website and Service User Guide say that the inspection reports are available on request at the home. The Rookery DS0000027307.V368789.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. Before making our visit we reviewed all the information we have about the home and looked at detailed information that the manager was asked to send to us. We also wrote to people before we visited to ask what they think about the service. We had written comments from 12 people living at the home, 8 of their relatives and 6 staff working there. When we visited, our specialist pharmacy inspector, Mr Mark Andrews, looked at the way medicines are managed in the home. Mr Jerry Crehan, and Mrs Judith Last looked at the other “key standards” that we need to check. We spent over 8 hours in the home. Between us, we spoke to 5 of the people working at the home, the acting manager and newly appointed manager, general manager, the administrator and six of the people living at the home. We also looked around part of the home. We also used a method of inspection we call “case tracking”. This is used to see what records say about people’s needs and to find out from observation and discussion what happens in the daily lives of those people and the outcomes they experience. We also looked at and listened to what was going on while we were in the home. We used all this information and the rules we have, to see how well people were being supported in their daily lives. We concluded people were being supported much better than when we last visited and are confident that further improvements are being made. What the service does well: The home gets good information about the needs of people who think they might like to move to the home. The management team are working towards different ways that they can make information about the home easier to understand. People told us they have lots of things to do to keep them busy. This includes doing artwork, working on the farm, going on outings and holidays, and going to classes. There are lots of the things people have made in the Art Barn around the home, and sometimes there are exhibitions to show these, including exhibitions overseas. The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 6 The staff team work hard to try and make sure that people can do the things they would like to do. People can join in domestic activities around their home. They told us things like: “I can make tea and coffee in my own place”. “I do the veg in my cottage and help with the cleaning.” “I do my own washing.” “I’ve been doing the recycling”. The home is good at recognising the way people express their sexuality and staff try to support people with advice and counselling that might be needed. One relative says: “I feel the care home have a responsibility to treat everyone with fairness and respect. I see this is very well shown when I visit the care home.” People, especially in the cottages, have clean, homely places to live in where they can choose what their room looks like. Some people like to have lots of things they have collected or made around them. Others like things to be tidier. The kitchen, catering equipment and storage areas are clean and well organised so that people benefit from food that is safe and the risks of infection are kept to a minimum. Staff we spoke to speak highly of the new manager and the acting manager who ran the home from January this year. They say that they feel their ideas and problems are being listened to. What has improved since the last inspection? The management team has been changed and the manager does not have responsibility for other homes that are further away. This means that he is able to concentrate on monitoring and overseeing this one and just two other small ones in the area. The acting manager who has been running the home until the recent appointment of a new manager, has already made sure that lots of the 22 things we said needed to happen following our last visit have been attended to. The new manager has already identified areas that he needs to improve, without waiting for this inspection. Although he has not been in post for long he has been trying to improve record keeping. He has also started to tackle issues like staff sickness so that this improves and people benefit from a more consistent staff team. The information available to people who are thinking about moving into the home, has been updated so that it shows all the information the law says is The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 7 needed, and some work is beginning to see how it can be simplified and presented in other forms, like signing or video. There have been improvements in the way people’s needs are set out in their care plans and the guidance staff have about how to support people properly. Staff say that they are more involved in helping people develop care plans than they used to be. We saw staff dealing with someone shouting in a way that respected the person, reassured them and resolved the issue without confrontation. There is better monitoring and more checking of monies that are held on behalf of people who don’t manage their own, to make sure that they are protected from exploitation. Where people might want to spend quite a lot there are better ways of showing how decisions are made. The home has improved the way that it stores medicines and also the way that these are given - which is now more organised. There is a new checklist that is used when staff are being recruited, to make sure that all the information they need is collected before someone starts work, to make sure that the person applying is properly suitable to work with vulnerable adults. There have been improvements in the way training is recorded and monitored. This means it is easier for the management team to make sure that it is up to date and staff have attended courses that are relevant to help them understand people’s needs, including their health care needs. The management team have also provided some “in house” training, made sure there are more regular meetings, and taken into account more of the difficulties and ideas that staff have. Overall, despite the short time that the acting manager has run the home, and the very short period since the new manager was appointed, we were pleased with the improvements that have been made and the way that the manager recognises areas for improvement and has plans for tackling these. What they could do better: Last time we visited there were 22 things the home needed to do by law. This time there are 7. Four of these things are to do with medicines and the way they are handled in the home. Three of these are things we said last time that need to happen to make sure that people get the right medicines at the right times in the right doses and to make sure that staff are properly trained and competent to give medicines safely. The manager has already recognised some problems and has started to take action to address them. The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 8 Staff already have information about the signs that someone might have had food or drink that has got into their lungs. However, they do not have clear guidance set out in the care plan, about how to reduce the risk of this happening when someone is eating and drinking. Although supervision has improved, it still does not show staff are having one to one meetings with a manager as often as they should do. This is needed to monitor their work and to support them with understanding their roles and dealing with problems. There are some other things that the manager could think about doing to make things even better and he can tell you about these. 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 Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 9 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 Outcomes Statutory Requirements Identified During the Inspection The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People (or their representatives) would have access to the information they need to decide whether the home is suitable to meet their needs. People’s needs are assessed properly so that they could be sure the service would be able to meet them. EVIDENCE: The service users guide and statement of purpose have been updated to show recent management changes and the information that the law says must be included. It is available in hard copy or via the company’s website and shows what the service can offer, fees and the aims and objectives of the home. This means that people (or more likely their representatives), can have the information they need to make a decision about whether the home is what they are looking for. 11 out of the 12 people living at the home who wrote to us say that they were asked if they wanted to move there (one person was told by another agency). 10 of the 12 people say that they had enough information about the home before they moved. We are told that work is underway to present the information in different forms. This has been proposed for some time. The management team were The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 11 able to tell us about work that is now going on to simplify the information so that a version could be supplied in sign language and spoken word on a DVD for people to take away. It is intended that there will also be video version of a day in the life of the Rookery. This work seems now to be making some welcome progress. As at previous inspections, we found that information about people’s needs was gathered from a variety of sources including other health professionals, so that the service could be sure they could meet people’s needs appropriately. This confirms what the management team told us in the annual quality assurance assessment they sent. The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in many decisions about their lives, and the manager has ideas about how the service can increase their participation in planning the care and support they receive. EVIDENCE: We looked at care plans and keyworker files for 5 people, and at the keyworker file only for one other person. Since we last visited there has been an effort to revise the information that is held in care plans so that it is clear what is the most up to date information and what programmes are no longer to be followed. The records all show a pen picture of the person concerned, an assessment of their strengths and needs, and of likes and dislikes. We saw that additional information was incorporated where there were issues that other professionals wanted to be addressed and where staff needed to take action to support someone properly (for example in relation to foot care). The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 13 Each file still contains standard “policy” type guidance (which is the same for everyone although with individuals’ names at the head of it) for how staff are to manage and respond to challenging behaviour, although references to withdrawal of privileges noted at the last inspection, have been removed. This is a welcome improvement. One file contained specific guidance about triggers for difficult behaviour and how these could be avoided. (It also linked into guidance about medication that might be needed from time to time, to help the person calm down and cross-referenced with the procedure for giving and authorising it.) This is good practice. However, information of this sort was not available in all cases and documentation did not always make clear what form any aggression might take, to whom it was likely to be directed, and what might increase or decrease the likelihood of this happening. We asked a long-standing staff member about this. The carer was able to give us information about the sort of triggers the staff team were alert for and how these were managed even though this is not recorded in each support plan, as guidance for staff about triggers and how to avoid these or diffuse situations should they arise. For this reason we cannot consider the requirement we made at our last visit, to be wholly met although there have been some improvements. Support plans contained a review sheet showing when reviews had taken place and whether these had resulted in amendments or additions to the plan. Where possible and people are able, they have signed their own plans to show they are involved. Five out of six staff who wrote to us, say that they always have up to date information about people’s needs, for example from the care plans. One person told us that care plans “are useful. Care plans help you treat someone the way they want to be cared for”. The manager says that they are planning to develop a more “person centred” approach to care plans and this would help reflect people’s individual goals and aims and should provide for information being more accessible to those who find communication difficult. Three people named their keyworkers to us and one said, “I like my keyworker”. Staff that we spoke to who are keyworkers, say that they are now more involved in the development of care plans with people than they were before Christmas. Records we saw were clear, factual and up to date. However, not all available record sheets were being used appropriately and not all entries were signed and dated, as is good practice. The manager says he is aware of difficulties with record keeping and has provided recent training (confirmed by staff) so he aims to improve this further. The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 14 We saw record sheets for “choices and opportunities” that had been offered to people. Written surveys from people living at the home tell us that 7/11 people (one did not answer) feel they always make decisions about what they do each day. Nine out of twelve people say that staff always listen to and act on what they say. Three out of twelve people say they do sometimes. One person specifically named a staff member that they felt did not listen to them as well as they might. Training in signing, has been provided for 13 staff working in the home within the last 12 months. A further training course for 7 people (“signing introduction”), is proposed in September. This is welcome in helping to increase the skills and abilities of staff in communicating with people living at the home who find this difficult. The manager has taken into account people’s abilities to make informed decisions and has forms for decisions about people’s finances so that these are more transparent and take into account people’s capacity to make the decision. (This was present on one file but has not yet been used.) There are systems in place for checking and auditing personal allowances for people, following some problems last year. These provide for audits at the main office, checks against receipts and random checks within people’s homes where they do not manage their own money. One person told us “I look after my own money”. Risk assessments have been more regularly reviewed and are countersigned by either the newly appointed manager, or the acting care manager. This represents an improvement in showing overall accountability, from the last inspection. They show risks associated with a range of activities are taken into account (for example in relation to independence and accessing the community). They also reflect where risks have changed due to increasing age and frailty on the part of some people and show what action is needed to minimise these (for example in relation to falls). Although there was no risk assessment for someone who as identified as possibly subject to aspiration (this is when food or drink enters the lungs), when eating or drinking there was general guidance in the person’s own accommodation for staff to be aware of. (See personal and health care.) All of the eight relatives who wrote to us say that the staff are able to meet people’s needs “usually” or “always”. One relative went on to comment that, “I feel the care home have a responsibility to treat everyone with fairness and respect. I see this is very well shown when I visit the care home.” The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services are able to make choices about their life style, and supported to develop their life skills. The manager has identified a need to monitor social, educational, cultural and recreational activities to make sure everyone can access a full range of opportunities to fulfil their expectations. EVIDENCE: Records show that people have opportunities to participate in classes and in activities in the community, subject to abilities. The manager has introduced a new sheet for recording activities so that he can monitor everyone has opportunities to go out and make use of the local community or to travel further afield. He says this is because he recognises staff may find it easier to take some people out than others due to behaviour or communication, and some people might therefore not have so many opportunities. The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 16 However, in some cases staff are not using the forms properly to aid this monitoring process and more than one form was in use for the same person over the same period of time. Those that have been completed show a wide range of activities for people, such as going to Church, disco, music night, pub, for meals out, to a café, walk and to the cinema. Staff recognise their responsibilities to support people with activities and skills. One staff member told us “my job is to give residents the best quality of life they can possibly have in all aspects of their life.” The service has its own vehicles to help people get out and about. The home retains its strong focus on art-based activities and one person showing us their room produced a blanket they were clearly proud of saying “I made that”. One person told us, “I go to English classes now in North Walsham”. The person used to go to craft classes but has decided to change. The home’s adult education tutor is leaving in the near future and the manager says that they intend to recruit to the post. There is a “classroom” on site that can be used to do particular work with individuals and help promote their learning and skills. One person told us “I go horse riding sometimes.” One person told us that, “on Fridays I go with staff to the supermarket to get my sweets.” Some people work on the adjacent farm. Relatives’ comments about opportunities include: They do take {resident’s name} out, walking and shopping. {Resident’s name} also go away on holidays and goings abroad. And Care for my {relationship stated} who has difficult and aggressive behaviours in a way that allows {resident’s name} to have a full and active life within {resident’s gender} limited ability to conform to socially acceptable behaviour. Two people told us about going on holiday and one said, “I chose the Isle of Wight”. Another said they were going on holiday soon and looking forward to “lots of rides and lots of things to do”. People told us about the visits they have from friends or family members. One said, “My sister comes on Sunday afternoons sometimes”. One person, whose file we saw, has no family contact. Although one other person had an advocacy contact, this person did not. The person is ageing and we were told some relatives have passed away. The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 17 The organisation has a history of supporting people with personal relationships and in expression of their sexuality and personality, some of which shows up in the way people have chosen to dress, their artwork, or the way they keep their rooms. There was evidence on record to show that people were supported with contraceptive advice from other professionals where needed, and also that staff discussed relationships and sexuality with people. During our visit we saw that staff knocked before entering people’s accommodation. All of the rooms were lockable and people who are able to, hold their own keys. Others have chosen not to use them. People’s preferred names are recorded in their care plans. On this occasion we saw people taking food to their cottages so that they could prepare their lunches with staff support as needed. One person did not cook but says “I can make tea and coffee in my own place”. Another had cooked their own sausages the night before we went. One person told us in writing that “I do the veg in my cottage and help with the cleaning. I do my own washing.” One person was encouraged to assist staff with laundry and another told us “I’ve been doing the recycling”. One person told us that they kept their own room clean and another said “my keyworker helps me with things”. The manager says meal times are flexible and that lunch for example could last an hour and a half depending on people’s programmes. People told us “the food is good”, and “[staff name] cooks us lovely dinners.” Lunchtime food was being prepared when we visited and was freshly made seafood pie with creamed potatoes, vegetables and fresh fruit to follow. The supper menu displayed was mixed meat salad, French bread, rice pudding and jam. There are also some pictures that can be used in selecting and planning menus and we saw people going to the dining room to check the menu for later on. There is a catering committee that residents can join and where suggestions for changes to food can be made and taken forward. We saw minutes from this for February, May and June. The chef was present at the June meeting and discussions include a new summer menu, continental breakfasts at weekends, Sunday roasts and suggestions for a barbecue. The chef also has lists of people’s likes and dislikes posted so that these can be taken into account. We asked about one person who was recorded in information sent to us before we visited, who is recorded as Jewish. We were told that the person has said they do not wish to practice. However, we were not able to establish that there were clear guidelines about diet (for example relating to kosher foods) – The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 18 or last offices so that the person was supported with associated lifestyle issues even if they did not wish to actively pursue worship in their own faith. The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs and preferences. However, the manager is aware that there remain significant concerns that the management of medicines does not wholly protect people and ensure they receive the treatment they need. EVIDENCE: This is a mixed staff team so people are able to have some choice of the gender of staff member who will assist them with personal care if this is required. We saw and heard staff knocking on doors before entering rooms, helping show that they respect people’s privacy and dignity. We noted one minor concern in that a staff member woke one person sleeping in a chair in the lounge rather abruptly (by touch). The manager noted this and said he would address it later. We heard staff responding calmly, quietly and reassuringly to someone who became agitated and started shouting. There was no confrontation and the staff member distracting and reassuring the person quickly resolved the situation. The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 20 The training records show that 20 of the 28 staff have had training in autism within the last year, to help them understand people’s needs and to be able to work with people living at the home who have the condition. This will help staff to better understand how to meet people’s needs, including those relating to their health, personal and emotional wellbeing. Thirteen staff have up to date and valid training in crisis intervention and training has been arranged for a further 6 people. This will help ensure that there is a core of staff who are skilled to respond to emergencies and problems that may arise with people living at the home, due to their behaviours. Twenty-three of the staff have up to date and valid training in moving and handling techniques to help make sure people are not at risk from this being done in the wrong way. A further 17 staff have had training within the last 6 months, to update their awareness and knowledge of how to support someone with diabetes and during the same period 8 staff have had training in awareness of epilepsy. These things represent a considerable improvement from what we found at our last visit. At our last visit, we commented that only four people had dementia training, although there were people living at the home who presented with this. The manager says that three people are currently being assessed to see if they are showing signs of this and a trainer has already been identified so that staff can develop skills in understanding and responding to the condition. This is a welcome development. One person is at risk while eating and drinking and there is guidance about “signs of aspiration” in the person’s cottage so staff would be alert to problems. However, there is no risk assessment showing how the risks are to be minimised or a care plan setting out the support or supervision the person needs with eating and drinking to minimise the likelihood that food or drink might “go down the wrong way”. Seven out of 28 staff have had training in “eating, drinking and choking” during the course of 2006 but there has been none recently. One experienced staff member told us about the guidance provided when they were working alongside new staff. This included the sorts of observations staff needed to make while delivering personal care or working alongside people, that might help identify the first signs of a developing health problem. This is good practice. The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 21 Staff are shortly to receive training in “health action plans” we were advised, and will be completing these with people living at the home. This will help ensure people’s health care needs are recorded fully and nothing is missed. We saw from records that people are referred to other health professionals where this is needed. This includes the consultant psychiatrist and continence advisor. Records for one person showed details of hospital treatment and follow up with the local surgery. One relative has commented to us in writing that, “With regards to caring for [resident’s name] I feel that they have improved and moved forward and continue to do so.” One relative comments that the person is very healthy and happy living at the home. We checked the health records for one person admitted to hospital following a severe seizure and found that rectal diazepam had been administered as prescribed and that the protocol didn’t allow for a second dose should the first one not work. An ambulance had been summonsed promptly when the person’s condition did not improve after the diazepam was administered. This shows that staff responded properly when a health emergency happened. Our specialist pharmacy inspector looked at the way medicines are managed in the home and has written to the manager separately with all the details, setting out what he needs to do and by when. Since the previous pharmacy inspection of 02/10/07 the home has obtained two medicine trolleys. There are also two wall-mounted cabinets located in this room for the secure storage of controlled drugs and medicines prescribed for occasional use. These arrangements have improved the way that medicine is stored and administered. Medicines requiring refrigeration are stored in a secure container within one of the kitchen refrigerators. However, sometimes these are being stored at too low a temperature – as low as 0°C – when they should be between 2 to 8°C. The manager says he has ordered a thermometer capable of monitoring maximum and minimum temperatures to help improve and monitor this. We saw some of the administration of medicines at lunchtime. These are no longer administered to people across the hatch between the kitchen and dining room in the main building. The medicine trolley is taken to living areas where medicines are given to people prescribed them so the approach is more organised. Staff said that they prefer this method of administering medicines. Each person’s medication chart has a person-profile alongside it with an identifying photograph and a list of prescribed medicines. The staff member The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 22 selecting medicines for administration referred to this profile rather than the medication chart. This presents a risk of error because recent changes to medication may not be taken into account and records of most recent doses given are not first checked. There were also duplicate medication charts in the folder of charts currently in use. This means that staff have to handle more charts than is necessary so increasing potential for errors and making the process more complicated. The manager says they have done some recent auditing of medicines. He has identified some errors where records of medicine administration had not been completed by staff. He says that there have also been medicines remaining in containers where records are signed to say they have been administered. We found that not all medicines left over when they were no longer needed could be accounted for in records of disposal. We checked medicines not in the monitored dosage packs and found some discrepancies. These were surpluses where more medicines remained than should have, based on records of administration. These findings were discussed with the manager as well as how staff could be more easily reminded about medicines that are not in the monitored dosage packs. Before we visited, we received anonymous reports of medication errors. We considered these reports during our visit. We found that an incorrect dose of antibiotics had been written on one person’s medication chart. This was later corrected. We found that there was a deficit of 4 tablets of this medicine indicating more of the medicine was given than the doctor had prescribed. This confirmed the anonymous report we had been given. There were also allegations that a medicine had run out so the person could not have the medication prescribed to help keep them well. We did not find clear, recorded evidence of this and there were no discrepancies in the audit for this medicine. We did have some concerns about signatures showing different staff gave medicines on the same days and the manager is looking at why this happened. We looked at the use of medicines prescribed for administration at the discretion of care staff. For most of these medicines there was written care plan information available alongside the medication charts for staff to refer to, but not in all cases. There was written guidance for Zopiclone tablets for one person who is no longer prescribed this medicine. Care plan guidance for two people - written in September 2007 – shows that staff can give particular tablets up to a total maximum daily dose of 4mg. We could not find written confirmation of this from prescribers. The manager told us after our visit that he has taken action to secure this confirmation and so to make sure care plan guidance about people’s needs is accurate and up to date. The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 23 Overall, staff only find it necessary to administer such medicines to people occasionally. This means that they have developed other ways of intervening to support people with behaviour that challenges rather than using medication as a first resort. Staff say that Primary Care Trust pharmacists visited the home on 12/05/08 primarily for the purposes of medication reviews. The home is awaiting changes to some medicines as a result of this visit. The manager confirmed that all people living at the home have at least one outpatient consultant appointment each year when their medication is reviewed. The manager says he held a meeting with staff to discuss audit discrepancies the day before we visited. He says he provided training on medication recordkeeping to help improve this situation. There are arrangements to up date staff training for rectal diazepam administration for the management of seizures. Training has been provided to carers authorised to administer insulin by injection. Community nurses provide this training (but only annually). This will help ensure that staff are competent to support people with serious health conditions. Records show that two members of care staff currently authorised to handle and administer people’s medicines have not had formal medication training. In addition, there is a lack of evidence that staff are also having their competence regularly monitored and assessed to ensure they follow safe procedures for recording and administering medicines to people. These concerns mean that we cannot conclude all of the requirements we made at our last inspection have been met. The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to an effective complaints procedure. There are measures in place to help protect them from abuse. EVIDENCE: Eleven out of twelve people living at the home who wrote to us (with staff support) say that they know how to make a complaint. Two people we spoke to say that they would speak to their keyworkers and that they do not have any concerns at the moment. Three relatives out of the eight who wrote to us do not know how they would make a complaint about the service if they needed to. Five relatives do know what to do and say that the service has always responded appropriately if they have needed to raise concerns. This shows that people’s concerns are taken seriously and addressed. We saw the complaints record which contained information about actions taken in response to concerns. There is also a record of compliments. This reflects overall satisfaction with the standard of the service. For example, one comment from a relative says “Thank you so much for looking after [resident’s name] so well. I have never had a worry about [resident’s name] all the while [resident’s name]stayed at the Rookery.” Anonymous concerns were expressed to us about the service before we went. There were concerns about medication that we have addressed elsewhere in The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 25 this report, and about staffing. We were not able to conclude in the latter case that there were breaches in regulations and the situation was being managed, taking into account people’s needs. Staff have access to training in awareness of abuse issues. One staff member has been trained to deliver this. One of the deputy managers has had training in how managers should respond to allegations. Two staff we spoke to were clear about their responsibilities to “blow the whistle” if they have any concerns about people’s welfare and say that the management team is approachable. Staff have had training in crisis intervention to help them to respond to challenges appropriately. One staff member has been trained to deliver staff training in this area. This means that measures are in place to help ensure staff respond appropriately to people’s needs in difficult situations. One recent incident of a sexual nature was not appropriately referred to the adult protection team for advice, although the management team had taken action to make sure that the incident was not exploitative and later took advice from the team. Checklists have been implemented more robustly to ensure that prospective staff are appropriately “vetted” before they start work and the organisation has recently started renewing enhanced criminal records bureau checks on all existing staff. The general manager indicates the intention is to repeat this every three years. This is good practice in contributing to protecting people from those who may be unsuitable to work with vulnerable adults. People have financial risk assessments on file and improved audit processes have been put in place to protect people from financial abuse. The general manager has explained these to us and they provide for checks on amounts transferred to people’s cash tins, checks on receipts, and random checks on balances during quality monitoring visits. Staff also double check one another when they are accessing people’s monies on their behalf and we saw this in action. Where people might want to spend a lot of money, the manager takes into account their ability to make decisions and who else might need to be involved to help them. This means that the management team have acted in response to previous problems, to help improve measures for protecting people. We saw from records that people are asked for their views in questionnaires when the quality of the service is being checked annually, and in discussion with one of the directors who monitors the service quality each month. There are also residents meetings where people can express their views and minutes are kept. The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in an environment that is homely, clean and safe and suited to their needs. EVIDENCE: We looked at some of the individual rooms in the small cottages, and at communal areas, including in the main home. We also saw laundry and catering arrangements. Areas we saw were well maintained and decorated with furnishing that was homely and in good condition. There was evidence in records of regular testing of the fire alarm including weekly tests on call points. Emergency lighting was tested very 6 months by service contractors. People told us that they have chosen the colour of their rooms and they are able to keep them as they would like. Those we saw reflected the interests and preferences of their occupants. One room we saw was plain white but the person whose room it is says, “I like it”. The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 27 One person we spoke to does not hold a key for their room but recognised that they needed a key to access it and that they could lock it behind them. One person we spoke to showed us that they did hold their own key. Not everyone is able to control the temperature of heating in their own rooms. No one currently needs a hoist although there is one available and maintained should this be necessary. (Assessment would be needed to ensure that it is suitable depending on size and nature of the client.) There are some level access showering facilities, to help people who would find it difficult to get in and out of a bath. One person told us they “help with the cleaning. I do my own washing”. Maintenance issues are checked on a monthly basis by the person who does quality monitoring reports. Health and safety concerns are reported routinely. There are records of maintenance, repair and redecoration work undertaken. One relative wrote to us that they consider the home does well in that they “Keep the place very tidy and clean.” Information the management team sent to us before we went shows that a quarter of staff have had training in infection control and that there is supporting policy guidance for staff to follow. We saw that protective clothing (gloves etc) is provided. Since the manager submitted information, additional staff have had training, based on the database the company uses for recording this. This shows that fourteen people have had training, the most recent training being delivered to eight people in April. The laundry used by the main home and smaller units with no facilities, is sited in outbuildings so that linen does not need to be carried through food preparation areas. The manager has plans to improve this area so that it becomes more like a local community laundrette, providing improved décor and seating. The training database shows that 18 staff have had training in food hygiene although four are shown as expired (three in April this year and one in September 2005). However, cleanliness in the kitchen has improved since our last visit, particularly in reference to the top of the medication cupboard that was dusty, and window ledges that were cluttered so making them difficult to clean. Fridges well organised so that stock could be seen as rotated, with food dated. There was no food debris on shelving. Other dry goods storage was well The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 28 organised and the kitchen staff are commended for their efforts. We had no concerns about the cleanliness of kitchen areas in the cottages that we saw. These things mean that there are measures in place to help control the spread of infection and maintain hygiene in the home. The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 29 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by competent and skilled staff. There remain occasional concerns about the adequacy of staffing levels and supervision that the manager is aware of and improvements are being made. EVIDENCE: On the day we visited there should have been seven staff on in the morning but due there were five. An additional person (one of the deputy managers) had come in to cover the shift later, meaning that, for most of the morning, there were 6 people. The manager acknowledges that sickness has been a problem and has implemented return to work interviews on a regular basis so that he can continue to monitor and address any problems that arise. Staff say that one person requires one to one support, and another needs considerable additional support “amounting to one to one” at times. Staff also told us that the lounge in the main home is always staffed and we noted this on several random checks during the day. We spoke to three staff on duty about staffing levels. All said that they felt that staffing was adequate. One person living at the home said that there The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 30 were enough staff for the person to be able to do what they wanted at the weekend. They added that they were going to Yarmouth, the day after we visited (that would be Saturday). However, staff written comments show they do not feel there are always sufficient numbers of people on duty. These show only 1/6 can confirm there are always enough staff on duty to meet people’s needs. Three say usually, and 2 (33 ) say sometimes. One says if people are off sick there are not enough, and one says that it has got better over the last few months. One staff comments specifically that weekends can be short staffed. Three people who live at the home wrote to say that they could not always decide what they want to do at weekends. We had an anonymous complaint about the demands upon staff at night to provide supervision to someone with a very disruptive sleep pattern. The complainant considers staffing support is compromised where another staff member carries out laundry tasks while the resident concerned is supervised, so leaving the main home without night cover. We spoke to the manager about this and he was very clear that the expectation on night staff was that they would attend to the needs of service users as a priority and domestic tasks would have to wait if there was a problem. He gave information about various things that were being tried in order to resolve the demands upon staff at night (such as relocating a pressure mat), and showed these things were reflected in the person’s care plan. He says he intends that, if problems cannot be resolved in this way, the person may be moved to the main home. Staff told us that team spirit is good and one said how much morale has improved, and one also said that they felt the staff turnover has decreased in the last six months. The manager sent us information to show that (at the point it was submitted) 10 staff had left in the last year. The staff member said it seemed like this had gone down a lot with possibly only one of those people having left in the last 6 months. We were told this made it much easier to work, as established staff could feel more confident that others were gaining experience and skills rather than constantly undergoing induction. The overall “effectiveness” of the staff team in terms of increased morale, lower sickness and lower staff turnover has an impact on the consistency of support available to service users. Given that comment cards were submitted earlier on in the year, that staff told us things have improved recently, and that the newly appointed manager has been in post for a short time, we will not repeat requirements. The manager has already started to address sickness and timekeeping issues. He is proposing reviews of duty rosters to see if hours can be provided more flexibly to meet people’s needs. The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 31 Staff told us about the training that they had completed. Information from the home’s database showed us the range of training that people can access. This has improved in that there is better monitoring to make sure that time limited training (where there is an expiry date such as for moving and handling or first aid) is monitored more effectively to make sure that it can be followed up. The management team and one staff member say that there are plans to provide training in dementia awareness should forthcoming assessments confirm this diagnosis for people. The management team are clearly looking at what is needed in relation to the needs of individuals and have acted to improve “gaps” in training we identified at our last visit. The home is maintaining its commitment to offering staff training for national vocational qualifications. We updated the information the manager provided to us before we went, as things had changed. The management team say, and the database confirms, that 10 care staff have NVQ level 2 or above, 6 staff are currently in training and a further four have recently enrolled. If the organisation is successful in retaining these staff then there will be a good proportion who have the underpinning knowledge and skills they need to help them work professionally as well as competently with people. One staff member we spoke to told us that there are increments available to encourage staff to complete the training programmes that the organisation offers. Two people told us that training was very good; one commenting that they liked it and felt that much more was available lately. Staff members confirm induction and one person confirmed supervising and supporting new people on shift during induction. We saw one completed workbook with written answers to questions (rather than work just being “signed off”) to show evidence that the new staff member had understood the information they had been given and what they had learnt. The service received renewed Investors in People certification in June 2008. Staff say that they receive supervision (formal one to one discussions with a senior member of staff or manager), and one person told us that this had improved and that they had had three supervisions this year where they had only had one or two in the preceding two years. Two other people told us supervision was formal and recorded and one person says this happens every two months. However, records we saw do not support that this happens for everyone. We checked staffing records for three staff recently recruited. These show a more robust approach to completing the necessary checks before people start work at the home, including enhanced criminal records bureau checks, checks on their suitability to work with vulnerable adults, references and employment histories. . The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 32 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being effectively managed, taking into account the views, health and welfare of people living and working in it. EVIDENCE: We looked at our previous requirements and found that they were met. Since the end of December an acting manager has overseen the service. A new manager has recently been appointed says he intends to apply for registration with the Commission. At present, he is being supported by the acting manager and they are working together during his induction. There is a general manager who supports with administration issues including recruitment, performance issues, quality assurance surveys and maintenance of staffing levels. The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 33 The new manager was very open in discussions with us, about issues that he has identified as problematic and need addressing. He has set himself targets for addressing these. He told us about visits to the home around the general shift pattern to monitor what was happening, as well as spot checks that are being made to ensure procedures are followed. Staff we spoke to felt that improvements were being made. They told us that the manager is very approachable and one person added that they felt the former acting manager and new manager “are listening to people’s ideas and problems and are doing something about them”. The new manager was spoken of as “approachable and professional”. Another person says that they are “confident in all my managers.” They added that the manager “asks for your view about things and is bringing in new ideas”. Staff identify improvements that have been made within the last six months (such as reduction in staff turnover, improved supervision, better staff meetings with added training sessions.) They say that there is a “good team spirit”. When we toured the home with the new manager, observations of interaction between him and people living at the home showed that (although he is newly in post) residents knew who he was and felt comfortable chatting with him. He plans to relocate office accommodation so that deputy managers are able to deal with issues appropriately and so that he can be more “on the spot” within the home to monitor issues and support staff and residents. We concluded from our discussions that the manager had communicated a clear sense of vision about where the service should be going, was tackling problem areas, and was willing to take on board the suggestions of both staff and residents. There are residents meetings and surveys to enable people to raise any concerns and staff are surveyed for their views of the service. The management team say the response rate was disappointing and there are plans to make the staff survey anonymous so that people may feel more free to express their views. In addition to the surveys that are being used for ideas about improving the service, there are regular monthly visits by one of the directors that provide for discussion with staff and people living at the home to find out their views. Resident’s meetings and a catering committee also allow for people to express their views about what they would like to see happen. At present, there are no surveys of other professionals (for example, care managers and health professionals) in contact with the home. There have been improvements in the monitoring of training to make sure that training in relation to safety is updated more regularly. This includes training The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 34 in health and safety, first aid, fire safety, infection control and food hygiene. The database indicates that some people do not have current first aid training but we were also given a list of training proposed showing people without this had been invited. The hoist is not currently being used for anyone but is being maintained (July 08). The manager says that he intends to ensure people are trained to use it properly so that they are prepared should it be needed by anyone living at the home already or moving there in the future. The manager is identified the need to revamp and update procedures for evacuating the home safely in the event of fire and is involving selected staff in the process. He has also identified that risk assessments for people or activities need to take more account of the severity of risks and likelihood of hazards presenting themselves. Records showed regular servicing and testing of equipment (for example of the boiler, wiring and fire detection equipment) to ensure that equipment and premises remain safe. The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 35 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 Standard No Score 1 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 x 2 3 3 x x 3 x The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 36 Are there any outstanding requirements from the last inspection? YES 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 YA6 Regulation 15(1) Requirement Partially outstanding requirement. Where people have behaviour that is difficult to manage, guidance must be clear and specific for each person. This is so that each person receives intervention that is properly tailored to their own needs, abilities and understanding. Timescale of 31/11/07 unmet. There must be a clear guidance as to how staff are to minimise the risks associated with eating and drinking for one person. This is so staff are proactive in supporting the person and do not expose them to avoidable risk. Outstanding requirement People who use the service must have their medicines requiring refrigeration stored within the correct temperature range. Daily records must evidence this. This is so people receive the medicines they need and these The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 37 Timescale for action 30/09/08 2. YA19 13(4) 31/08/08 3. YA20 13.2, 13.4 08/08/08 are still effective and safe to use. 4. YA20 13.2, 13.4, 17 Timescale of 31/10/07 unmet. Outstanding requirement People who use the service must have their medicines administered in line with prescribed instructions. This must be evidenced by recordkeeping practices. This is so people receive the medicines they need at the time and dose is considered necessary to keep them well. 5. YA20 13.2, 37 Timescale of 31/10/07 unmet. An investigation must be conducted in relation to the administration and recordkeeping relating to a medicine identified by this report. The findings and conclusions of this investigation must be provided to the Commission in writing Outstanding requirement People who use the service must have their medicines administered by staff who have received recent and appropriate training and have been designated competent. This is to help protect people from errors and to make sure they receive the treatment they need safely. 7. YA36 18.2.a Timescale of 31/10/07 unmet Outstanding requirement Staff must be supervised with the agenda and frequency set out in national minimum standards. This is so staff receive adequate supervision and support to ensure they DS0000027307.V368789.R01.S.doc 08/08/08 22/08/08 6. YA20 18.1.c 22/08/08 30/09/08 The Rookery Version 5.2 Page 38 understand their roles fully, can support people in line with the home’s philosophy and so that any initial problems with staff performance can be addressed. Timescale of 31/12/07 unmet. 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 YA15 Good Practice Recommendations Where, as the result of increasing age, family contact decreases or is absent, other sources of befriending or advocacy should be explored. This is so people have the opportunity to maintain or develop contact with others outside the service who can help them express their views and advocate on their behalf. Care should be taken that, even where people might not choose to actively follow their religion, any relevant issues (such as diet, appropriate foods and funeral arrangements) are discussed with them and/or their representatives to ensure these are not overlooked in meeting their diverse needs. Where people might need the support of relatives to raise any concerns, those relatives should be informed about how they can make a complaint. This is so they know who to speak to if they have any concerns and know how their complaint will be dealt with. The proposed review of fire procedures and risk assessments, should take into account increasing the frequency of testing of emergency lights in line with government guidance. This is to make sure that any faults developing between contracted maintenance sessions are detected promptly and do not adversely affect the evacuation of staff and residents in an emergency. The monitoring of service quality could take into account the views of other professionals connected with the service. This is so the manager would see whether any improvements could be made to ensure the service works well with them in promoting the interests of service users. 2. YA17 3. YA22 4. YA24 5. YA39 The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Rookery DS0000027307.V368789.R01.S.doc Version 5.2 Page 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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