Inspection on 05/05/05 for The Rowans Care Home

This inspection was carried out on 5th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 Rowans Care Home 14/11/07

The Rowans Care Home 21/02/07

The Rowans Care Home 30/08/05

The Rowans Care Home 19/10/04

The Rowans Care Home 20/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE The Rowans Care Centre Owen Street Coalville Leicestershire LE67 3DA Lead Inspector Janet Browning Unannounced 5th May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Rowans Care Centre Address Owen Street Coalville Leicestershire LE67 3DA 01530 814466 01530 814455 rowans@highfield-care.com Highfield Care Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Under Application CRH 54 Category(ies) of Dementia (30), Dementia - over 65 years of age registration, with number (30), Old age, not falling within any other of places category (24), Physical disability (54), Physical disability over 65 years of age (54). The Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: No one under the age of 50 years of category PD to be admitted into the home. To be able to admit the person category LD(E) identofied in correspondence with the previous registartion authority dated 27th March 1998. No person under 55 years of age who falls within category DE may be admitted to the home. The service users admitted to the home who fall within category OP may only be accommodated on the ground floor. The service users admitted to th home who fall within the sole category of PD or PD(E) may only be accommodated on the ground floor. First Floor: The service users admitted to the home who fall within category DE, DE(E) or dual disability DE/PD, DE(E)/PD(E) may only be accommodated on the first floor. Maximum number of service users accommodated on the first floor shall not exceed 30. Maximum number of service users accommodated on the ground floor shall not exceed 24. Date of last inspection 19th October 2004 Brief Description of the Service: The Rowans is a care home providing personal care and accommodation for fifty-four older people which includes older people who have a physical disability and dementia.The home is owned by the Southern Cross group of care homes, who own other care homes in Leicestershire. The home is located close to the town centre of Coalville, close to shops, pubs, the post office and other amenities. The home is easily accessible by private or public transport.The home is a purpose built two-storey building with level entry access and access to both floors is accessible by use of the passenger lift or stairs. An adequate number of facilities are situated throughout the premise, namely washing, bathing and toilet facilities.The home has fifty-two single bedrooms, two with ensuite facilities and one double bedroom without ensuite facility. The home has a garden to the side and rear of the building which is well maintained and which is accessible to all service users residing in the home The Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 8 hours and was unannounced. A tour of the premises took place and some staff and care records were inspected as well as some home records and policies and procedures. Only one comment card was received from a resident and one from a relative. No comment cards were received from visiting health professionals. There was an opportunity to talk with four residents who were able, one relative and four members of staff. The acting manager of the home (who is waiting for completion of her registration) was present throughout most of the inspection. What the service does well: What has improved since the last inspection? What they could do better: There are shortfalls in many areas. Although many staff are signed on for NVQ 2 in care, the staff working in the upper unit with people with dementia are not The Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 6 adequately trained in dementia care. Indications are that staff are not confident that they are able to meet the residents’ needs without adequate training. Induction training for staff was for some insufficient and for others, not recorded. Adequate and robust training in dementia care was a requirement at the last inspection. Staff are performing monitoring of observations such as blood pressures and temperatures, when not fully trained in understanding the results. Assessments of residents are not completed fully and essential care needs are missing and care plans not generated. Robust care planning is essential for all residents but especially those with high dependency levels of care and for those who are unable to voice their needs, as the care plans give clear direction to staff as to what care is required. Monthly evaluations of the care plans did not give clear or accurate information as to the outcome of care for the resident. Although staffing levels meet the minimum recommendations throughout the week, outcomes for residents are that they are sometimes left unsupervised for long periods in communal areas without means of calling for assistance or are left until mid-morning before they can be assisted out of bed. Staffing levels throughout the week are inconsistent with higher levels on some days and reduced levels at the weekends. This has been addressed with the home following the inspection. Medication safety was an issue at the last inspection. Medication is still an issue with the correct recording and administration of medication needing to be addressed as this has the potential for mistakes to be made. Although the complaints and communications procedure is currently under review due to a complaint received, the documentation of complaints is at present very informal and does not display actions taken or outcomes of complaints. 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 Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 Residents, especially those with dementia needs, had inadequate assessments and care plans in place placing residents at risk of harm due to lack of direction for staff providing the care. EVIDENCE: One assessment record of a highly dependent resident was examined and some important aspects of his needs requiring detailed input from staff had not been identified on assessment. For example on examining the daily records it was evident that community nurses were required to visit when required to treat a complex health need which if left untreated could put the resident at risk. The resident is unable to communicate his needs. This was not identified in the assessment and therefore there was no corresponding care plan to give staff guidance of identifying when the nurse is to be called. The resident also had other needs linked to his dementia such as communication and choice, which had not been addressed. Residents on the upper floor are not able to voice their needs and therefore a robust admission assessment including all risk assessments is essential for staff to generate care plans. The Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 9 Some of the staff working on the upper floor with residents with dementia were not adequately trained in dementia awareness with new starters working with these residents after only two hours of watching a training video. It is noted that a senior carer also works on this floor, but inexperienced staff did feel that they needed more training in dementia awareness. This, linked with insufficient guidance from assessments, could lead to poor practice for people with dementia. It is noted that the assessments of residents on the lower floor who are more able to voice their needs had, on the whole, adequate assessments in place, but one resident who was in for short-term care did not have a completed assessment and there was no care plans generated. The Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 There are shortfalls in ensuring that all the health care needs of residents are identified and met, which has the potential to place the residents’ health and welfare at risk. EVIDENCE: When talking with staff it was evident that they were not always aware why they were performing some aspects of care. For example senior carers are recording blood pressures and temperatures with no clear guidance or understanding of what to do with that information. There was good paperwork in place for risk assessments, but they were not always completed. Care plans for a resident with highly dependent complex needs were insufficient and a resident admitted to the home for short-term care of eight weeks, did not have any care plans at all. Care plans examined were evaluated and updated monthly, but some residents’ needs had changed, which were not reflected in either risk assessments or care plans. For example, the daily records in one set of notes of a resident who had unpredictable and complex needs indicated that many issues had occurred linked to his care needs within the last months. This was The Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 11 not reflected in the evaluations of his care plans which had the same evaluation documented for every care need for every month of; • “No changes reported all care needs met” There was evidence of access to most health care professionals such as physiotherapist, community nurses, but one relative stated • “My mum needs a chiropodist, but the home says they are having difficulty getting one.” The staff had recently had training from the community continence nurse on management of incontinence and catheter care, which the staff found very useful in providing care for the residents. There was shortfalls evident in medication administration in that one resident was having medication signed as being administered when there was no evidence of the medication being available. This could not be explained by deputy manager or acting manager. The home were instructed to take immediate action. Staff were observed treating all residents with respect and residents stated • “Staff have always been nice and friendly” • “Staff are lovely” The Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and13 The home has developed a good activities programme to meet residents’ recreational needs, but the home does not always determine what the residents’ preferred daily routine is on assessment and therefore it can not be satisfied that it meets all the residents’ preferences. EVIDENCE: There is an activities organiser who works Monday to Friday spreading her time between the two floors. A record is kept of what residents have joined in which activities and the home has a varied activities agenda. Many of the residents on the upper floor are assisted up, washed and dressed in the morning by the night staff before the day staff come on shift and it was noted that many residents on the lower floor were still in bed having breakfast. The preferred time for rising was not always documented in the care plans. For residents who are unable to express a preference, it is therefore important that their choice of time of getting up is ascertained and followed. One resident, whose assessment had not been completed, stated, • “One time I was still in bed at 10:30am and many times I have my breakfast before I am washed and dressed. I prefer to be washed before I have my breakfast.” Relatives were seen to come and go throughout the day and observations of general communication between staff, residents and relatives displayed a warm friendly approach, which residents responded to positively. The Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 and 18 Although there is a complaints system in place and adult protection awareness is adequate, both require improvement to ensure that residents and relatives are confident that concerns will be listened to and that residents are protection from risk of harm. EVIDENCE: Following a complaint, the service providers and the acting manager have recently examined its complaints procedure and are looking at improving the communication system between the home and relatives. The acting manager could not locate the current complaints policy and staff spoken to did not know where policies were kept. A relative and a resident spoken to during the inspection knew who to complain to and found the acting manager approachable. A complaint record was kept, but it did not show actions taken and outcomes of complaints. It was election day on the day of the inspection and the acting manager stated that postal votes had been sent for those who wished. Staff spoken to were generally aware of adult protection procedures but some staff were not aware of whistle blowing or the Department of Health adult protection “No secrets” guidance. One member of staff had not received training yet on her induction and another member of staff’s training consisted of reading the policy and procedure. The “No secrets” document was stored in the locked medication cupboard making it inaccessible for some staff. The acting manager was going to move it into the staff room. The Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22 and 25 The environment is safe, homely and spacious and on the whole residents feel safe, but residents are not always able to call for assistance in communal areas which can cause some anxiety and potential harm. EVIDENCE: The home had been re-furbished recently which relatives and residents noted as positive progress in the home. The grounds looked neat and tidy with the maintenance man seen working on the front garden. The interior had a homely feel with plenty of space and a large lounge overlooking the front gardens. Residents in the lower lounge were observed left unsupervised for approximately thirty minutes without equipment to call for assistance. For example one resident was observed requesting for assistance to mobilise to the toilet and there was no call system in place. The inspector had to search for staff to provide assistance. Random checks were performed during the inspection of hot water and the maintenance check records were seen and both complied with Health and Safety regulations. General risks are addressed such as hot water valves on bath taps to regulate temperature and windows fitted with safety restrictors. The Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Staffing levels were variable resulting in inconsistency in care especially at the weekend and insufficient staff training could result in residents being at risk. EVIDENCE: Examination of staff rosters indicated that they met, and on some days were well above, the required numbers as indicated in the Department of Health guidelines. However, residents and relatives spoken to indicated that on some days they felt that there was not enough staff. A complaint received by the home and a resident spoken to indicated that there were times when residents were left waiting until late morning to get up and washed. On the day of inspection residents in the lower lounge were left unsupervised for long periods, approximately 30 minutes, with some residents requiring assistance with no means of calling for help. The layout of the home means that some highly dependent residents are in their rooms along the corridors which can take staff away from the communal areas. A relative spoken to raised concerns that staffing numbers dropped at the weekend with only two members of staff being on one of the floors. Staff spoken to also stated that staffing levels were reduced at the weekend, which was confirmed by looking at the staffing rosters. At the weekends there were times when senior staff felt they needed more management support, as they felt inexperienced to deal with any with relatives concerns. Senior staff were performing tasks such as blood pressures and temperatures without being fully aware of the theory behind what they were doing, relying on management for guidance who were not always there at weekends. The Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 16 Staff recruitment records examined showed the home’s recruitment procedure was adequate to ensure residents were protected. Two staff members did not have induction records within their files to indicate what level of training they had received. However three members of staff are doing NVQ 3 and sixteen members of staff are signed up to start NVQ 2 in care. The Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36, 37 and 38 The home is managed generally well by the acting manager but the position of Registered Manager must be filled as soon as possible to ensure stability within the home. The service providers need to ensure continuing support for the acting manager in improving the quality of care for residents. EVIDENCE: The Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 18 There is no manager registered at present but an acting manager has been in post since November 2004 and has started the registration process. She is being supported by the new owners in developing a management style and has a mentor from one of the other homes under the same ownership. The acting manager has started formal supervision with the staff and is generally found approachable by most staff. There are regular team meetings. One relative stated, • “It has changed for the better since the new owners took over, much brighter.” And a resident stated, • “The manager is lovely.” Records are kept safe and secure. Accident records were followed up by the acting manager, but not audited. Moving and handling training and first aid training was evidenced with a senior member of staff but no training records are kept within the home. Complaints records were incomplete not detailing actions and outcomes. The acting manager had started to audit the care records to meet requirements made from the last inspection, but the shortfalls she had identified had not been actioned. A discussion with the acting manager demonstrated that it was an area she will be discussing with her mentor. The Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 1 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 x x 2 x x 3 x STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 2 x x x x x 3 2 3 The Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 20 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 14 Requirement All residents admitted to the home must be fully assessed by an appropraiely trained person and assessments reviewed effectively. All staff must be adequately and effectively trained in Dementia Care before working with residents who have dementia. Residents must have all care plans in place to meet all of residents needs and that care plans are evaluated effectively. Residents must have access to a Chiropodist. Residents identified at assessment at high risk of developing pressure sores must have care plans generated including details of equipment required and interventions required from staff. The correct administration and documentation of medication must be maintained at all times The wishes of residents in regard to times of getting up and going to bed must be documented in assessments and followed by staff when providing care. C51 S39579 The Rowans Care Centre V215139 050505.doc Timescale for action 16/06/05 2. 4 18 16/06/05 3. 7 15 Immediate 4. 5. 8 8 12 15 16/06/05 16/06/05 6. 7. 9 12 13 12 Immediate 16/06/05 The Rowans Care Centre Version 1.30 Page 21 8. 16 & 37 17 Schedule 4 9. 18 13 10. 11. 22 27 23 18 12. 30 18 A record of all complaints made by residents, representatives, relatives of residents or staff and the actions taken in respect of the complaints must be kept in the care home. All staff must be trained in adult protection to prevent residents of harm or suffering abuse or being placed at risk of harm or abuse Residents must have the ability to be able to call for assitance in all communal areas of the home Staffing numbers must be consistent throughout the week and weekends and adequate to meet the needs of residents residing in the home Staff working in the home performing tasks such as blood pressures and temperatures must receive training to ensure they understand the consequences of the results of their monitoring. 16/06/05 Immediate 16/06/05 16/06/05 16/06/05 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 Good Practice Recommendations The Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 22 Commission for Social Care Inspection 5 Smith Way Grove Park Enderby Leicestershire LE19 1SX National Enquiry Line: 0845 015 0120 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 Rowans Care Centre C51 S39579 The Rowans Care Centre V215139 050505.doc Version 1.30 Page 23 - 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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