Inspection on 28/06/07 for Three Roses

This inspection was carried out on 28th June 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Three Roses 14/12/05

Three Roses 31/05/05

Three Roses 20/10/04

Three Roses 06/04/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Three Roses Bromsgrove Road Holy Cross, Clent Stourbridge West Midlands DY9 9QP Lead Inspector Sue Davies Unannounced Inspection 28th June 2007 5:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Three Roses DS0000018490.V334730.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. Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Three Roses Address Bromsgrove Road Holy Cross, Clent Stourbridge West Midlands DY9 9QP 01562 730730 01562 730310 threeroseshome@aol.com 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) Three Roses Homes Limited Ms Isobel Bowen-Shaw Care Home 14 Category(ies) of Learning disability (14) registration, with number of places Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th December 2005 Brief Description of the Service: Three Roses is registered to provide residential care for up to fourteen younger adults who have learning difficulties. The home is under the control of Three Roses Homes Ltd., a registered charity, which is run on the basis of a non-profit making company. The Board of Trustees have appointed three Directors, one of these being Mr Michael Noott, who acts as Company Secretary and also maintains regular oversight of the home. Mrs Isobel Bowen-Shaw, the registered care manager, has responsibility for the day-to-day running of the home. The fundamental philosophy underpinning the operation of the home was said to be an adaptation of the Rudolph Steiner approach to care and many of the existing resident group previously attended schools that had been run on Steiner principles. The premises have been developed and upgraded over the years to provide suitable and very pleasant accommodation. The building is single storey, and set in extensive grounds which border open countryside. The stated aim of Three Roses is to provide an environment which enhances the dignity, self respect and individuality of residents, where they are assisted to develop independence in self-care, domestic competence and daily living skills by Learning through Doing. Current weekly fees for this service range from £386 to £628. Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine, unannounced key inspection. The focus of this visit was on the quality of outcomes for service users in relation to key National Minimum Standards. Preparation for the inspection consisted of reading previous reports and the history of contact with the service, responses to surveys sent to service users and their families and the pre inspection questionnaire returned by the service. The inspection began during the late afternoon of Wednesday the 28th of July 2007, and continued the following day. Eleven hours were spent in the home. During the inspection time was spent with the service users, staff and manager, viewing the home and garden, observing, and reading documentation. Three support staff were on duty on the first evening , with the manager and three staff on duty the following day. At the moment fourteen people live here, five men and nine women. The people here are middle aged or older, and most have come here from school or college and have known each other most of their lives, so that they say they feel like one big family. All the service users said that they like living here and are very happy at here Roses Survey responses indicated respondents were generally very satisfied with the service, and comments have been included in the report where appropriate. The inspector was made very welcome, and appreciated the co-operation and time of the service users and staff. What the service does well: This is a large, comfortable secure and safe home for fourteen people with a learning disability. At the moment fourteen people live here, five men and nine women. All the service users say that they like living here. The house has a welcoming atmosphere, the people who live here are very friendly with each other and all get on well together. They say they know that if there are problems staff help sort these out. Service users here enjoy living in a big house with large gardens and lots of space that is well looked after, very comfortable and safe. They have very Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 6 good facilities including a craft room and different rooms where they can spend time relaxing. People who live here feel staff understand them well. The staff listen to what is important to them and help them to plan and do the things they want in and out of the home. There are many activities they enjoy. The service users have good support from staff they know, and who know them well. The manager and staff have worked here a long time, they are trained and experienced, and the home is well run. The manager and staff are trained to keep service users safe, and service users say staff treat them well so they do feel safe here. One service user who moved in recently says she has settled in well. She found it helped a lot to spend time visiting to get to know the home, other service users and staff so she made the right decision about moving in. Care records are very carefully written, with lots of important information, and include service users’ comments. Staff and service users write them together so they are written from service users’ own point of view, the manager and staff have had training to help them do this well. Service users and staff, and service users families all say they think the service is run very well, and that the manager gives good support to everyone involved with the home. What has improved since the last inspection? What they could do better: Service users need to know there are always enough staff on duty to give them the help they need as they get older, for example managing everyday life and personal care. This means the service needs to plan properly for this so that service users can go on enjoying life to the full. The Commission needs to be told of any event that may affect service users’ well being, so that it can offer advice and support in difficult situations. Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 8 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 Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 9 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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users needs are fully assessed before a decision is reached on moving in. EVIDENCE: Service users know their needs are carefully assessed before they move in, to make sure the service is right for them. Their personal records contain community care assessments, there is a careful process of introductory visits and discussions and the home itself carries out a thorough and detailed assessment of their needs, fully involving family friends and advocates, to enable everyone to reach the right decision about moving in. Most service users who live at Three Roses came here as young adults some years ago. As this is a stable group, the service is gradually changing its focus towards the needs of older people. The service has responded well to provide appropriate support for some older service users with special needs associated with ageing (but see Staffing section). The manager recognises the need to develop the service so that it can meet the needs of older people effectively, although it is not intended to provide for people with very challenging needs or those who require nursing. All service users here can therefore be confident the service will be able to meet their changing needs, as they get older. This is Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 10 being taken into account when the needs of prospective new service users are assessed, and some new service users within this age group have joined the home more recently. Service users say: ‘My Mum and Dad brought me to Three Roses to have a look round and I had lunch and stayed the night’. ‘I went with mummy to look around Three Roses. I met (the director and staff) and had a chat with them.’ ‘I like living here with all my friends’. Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Service users have up to date plans clearly showing their needs, preferences and goals. This helps ensure staff understand them well and can support them to be as independent as possible so that their lives are personal and fulfilling. EVIDENCE: Each person living here has a comprehensive service user plan that is based on the initial assessment. They take part in regularly reviewing and updating their plan, involving their family and social worker, and any other relevant person they wish included. Each service user has a key worker known as their ‘special friend’ who provides personal support and helps to ensure continuity. Service users spoken to showed examples of their life books and explained how they work with their special friend to produce them. These are illustrated with photographs and show the important events, activities and people in their life. Together with the Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 12 service user plans they help make sure each person presents a full picture of himself or herself, their life story, and what is important to them. Service users’ plans are person centred, showing their needs hopes and goals and how these are to be met. Their personal information is very detailed, coordinated and well integrated so that service users and staff are readily able to see and understand how they reflect the whole person. Service users say they feel staff understand them well. Plans include a skills assessment and an assessment of how the service user understands and deals with risky situations in their day-to-day life, showing how that person is to be supported to deal with these and to lead a fulfilling life. Each plan includes a detailed communication assessment, and around the home a variety of ways to communicate with service users about matters relating to their day-to-day lives to make sure they are included and have the information they need for making their own decisions. For example service users have activity charts showing all the things they plan to do in and outside the home each week. Talking with service users shows they feel well supported and involved in planning and making decisions about their life, and this is clear from their plans. Service users needs and personal preferences in the way they are supported and enabled are recorded with them in their plans, and kept up to date with an effective system of reviews. Each day, as a means of discussing the day’s events, each service user reviews their activities with their special friend and writes a diary. Service users review their plans monthly with their special friend, updating as necessary and both signing to show they agree the record, and a formal review takes place annually. There is a clear system of recording that shows the service user has shared and agreed the records in their plan, while a record in their This Is My Life book tracks how plans for the future have been agreed and acted upon. This is an excellent process, ensuring service users have the support they need to take the central, real and effective role in managing their own life. Although this home has many service users staff spoken to showed they value, know and understand each service user as an individual person. This means each person benefits from the level of support that is right for him or her, to develop their personal skills, make decisions and take responsibility for themselves in a way that promotes personal development. Service users say: ‘I like to help out by sweeping and cleaning the tables after lunch.’ ‘I can choose what I do, I have activities rotas to help me’. ‘I choose, but I have a rota to help remind me what I am doing. Its in my room and has pictures.’ Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 13 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): 11,12,13,14,15,16, and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users enjoy a variety of individual and group activities both within and outside the home, which are appropriate to their age and interests. They generally have good contact with their families and the local community, enjoy taking part in the life of the home, and have a healthy balanced diet. EVIDENCE: Each service user is being supported to develop a fulfilling lifestyle based on who they are and how they want to lead their life. Most service users have lived here for very many years, have made their home together and know their local community well. They have been well supported to explore to the full the range of opportunities available to them, developing talents, extending skills and building confidence, and widening their circle of friends and acquaintances. Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 14 People here lead varied lives with a wide range of activities in and outside the home in keeping with their interests, abilities and creative talents, such as crafts, music and drama. Within the home environment there are games, books, television, videos and DVDs, and a wide range of crafts are available e.g. pottery, painting, weaving, sewing, rug making etc. and service users are justly proud of the fine examples of their work around their home. All service users enjoy using the computer and especially email facilities for keeping in touch with families far away. Some service users are skilled musicians on keyboard, recorder or mouth organ and also singing, and enjoy taking part in local community performances. Impromptu and very enjoyable performances were offered during the inspection. Service users have good contact with their local community, use facilities such as the leisure centre, swimming pool, ten-pin bowling alley, and visit various places of interest. There is an active link with the local church. They have a wide range of personal interests, enjoy horse riding, yoga, go to the theatre, cinema, meals out, have regular holidays and travel widely, and one person has travelled round the world. Their rights as citizens are respected. Service users here enjoy supportive personal and family relationships and have staff support to keep in touch by phone, letters, email, cards and gifts as well as regular visits. One service user has been helped to make contact with their wider family and supported to visit them abroad. They take part in caring for their home for example in cleaning and gardening, and in the planning shopping and preparation of meals. Mealtimes are a social and supportive occasion. Service users enjoy a healthy and nutritious diet most of which includes produce they have grown and harvested themselves. Meals are tailored to individual health requirements and special dietary needs are met as required. Service users say: ‘I like it here because it feels like a family.’ ‘I like sewing, rug pegging, watching telly and music in my room and doing gardening.’ ‘Weekends I have a day off. I go to college during the week.’ ‘I listen to football. I go home to daddy’s house (at weekends).’ ‘I’m going on holiday soon to Devon. I like working in the garden.’ ‘Good food. I get on alright with my friends here.’ ‘I have a special diet and the staff make sure I have the right food and choices.’ This enthusiasm was echoed many times in relatives survey responses, for example in answer to the question ‘what does the home do well?’: ‘Everyday life – contact with the outside world – such as going to college – holidays to various places – theatre – ballet - you name it, they do it!’ Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 15 Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Service users are supported well to take responsibility for their own personal and healthcare as far as possible, and given help in a way that reflects their wishes where this is needed. There is very good liaison with health care agencies to promote sound health, particularly in recognising the needs of older service users. EVIDENCE: Service users here have a range of needs from basic support for more able service users, to more extensive support for people with increasing levels of dependency. Each person has the support they need to take responsibility for their own personal and healthcare as far as possible, and where help is needed this is given sensitively in a way that has been discussed and agreed with them and recorded in their personal and health care records. Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 17 Service users can generally be confident that staff have the information they need to understand and support them properly because there is an emphasis on careful record keeping and good communication. This is so that staff know what they need to do to help service users keep themselves well and active as far as they are able to, and enjoying their life. In addition to care practice training staff have training in areas of specialist need, for example epilepsy and stoma care, and there is very good liaison with and support from health care agencies. People living here can be sure that staff have a good knowledge and understanding of their personal and health care support needs. This is because staff have training in meeting both their general and specialist needs, and use other agencies well for advice and support to do their job properly. Discussion and records show close links with a full range of health services including specialists, with good liaison and support to ensure service users benefit from optimum health care. Each service user has their own health action plan. These are very detailed, well coordinated and kept up to date so all aspects of their personal health are clear. They are supported to use these plans effectively to understand and take a full part in managing their own health. These plans show clear evidence of good practice. Two service users have needed treatment involving surgery for cancer, and this has been well managed including enabling them to provide each other with mutual support. A physiotherapist was pleased how well the service worked well with her following surgery in another service user’s best interests, and noted the dedication of staff to ensuring service users received the best health care for their needs. Service users have a full annual health check, a monthly health check up with the practice nurse at their GP surgery and regular sight, hearing and dental checks. There is an emphasis on maintaining good health through sound nutrition, exercise (regular in house classes are held in Eurhythmy) and high standards of personal health care, for example, careful oral hygiene is recognised as an important basis of good health and encouraged for all service users. Service users can be reassured the service is paying attention to the health care needs of older people. They are supported to obtain health assessments they are entitled to, to aid health care planning. For example psychiatric support and monitoring records are currently being maintained for one person for early indications of dementia, although assessment has shown no problems at present. Most service users who live at Three Roses came here as young adults, when the service focused on extending their contact with the wider community and making good use of opportunities outside the home, promoting personal awareness and skills development to attain more independence and control Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 18 over their lives. Over time, their support needs have diversified and now range from low to medium/high dependency. Discussions with service users and staff show staff are sensitive to these changes, and remain attentive to ensuring all service users lead lives that are healthy, interesting and emotionally fulfilling. One service user with a progressive health condition was very unwell and in bed at the time of inspection. This person is receiving good support from staff and health services with input from district nurses, although to date the primary care team had been unable to provide a specialist adjustable bed to assist care staff providing support. This situation is further challenging for the service as staff time can be stretched when two staff are needed for support. The service user has been supported by an advocate to seek additional funding from the placing authority to meet the additional needs. In the meantime it is the service responsibility to ensure sufficient staff are on duty to meet the needs of all service users. The situation is currently unusual for this service but does highlight the need for forward planning. Staffing levels must be adequate to meet the current needs of all service users, so additional staff must be available to meet this service user’s increased support needs without detracting from the support available to other service users. Future provision needs to be kept under regular review to make sure the service can continue to meet the needs of all people living here as they get older (see also Staffing section). In view of increasing age and emerging needs it would be good practice to establish policies and training on continence management and skin care. Respect for bathroom privacy needs to be balanced with up to date assessments of any emerging risks and an intimate care policy, so service users know they are safeguarded and their dignity maintained by staff who are alert to any need for discreet support and know how to manage this. A review of the way medication is managed showed service users have a system they can be confident in. This is because there are suitable arrangements for managing medication, staff are appropriately trained and medication is handled with care. The GP who responded to the survey was entirely satisfied with the quality of the service from his point of view. A health care professional commented on the homely atmosphere and holistic care promoting the best quality of life, and also made the following observations: ‘(the service) actively sought out advice as insufficient information when (a service user) discharged from hospital following surgery’ ‘Supports and carries out treatment programmes to aid recovery’; ‘looks ahead and does everything possible to prevent problems arising, e.g. planning Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 19 accommodation at holiday destinations’; and it is a well run establishment.’ ‘A high standard of care is provided A service user who had an operation was very pleased with the help and support given by staff, and felt it had made a big difference to getting mobile again as soon as possible. Service users say: ‘When you are very poorly the staff helps you out. My mouth is a bit sore, the staff take me to see the dentist and the doctor.’ Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are safeguarded by robust and effective systems for ensuring their interests and well-being are protected. EVIDENCE: Relationships between all staff and service users are characterised by warmth, mutual respect and courtesy. Service users have a reliable system for making sure any concerns they have about the service are brought to the attention of staff and are put right. There is a complaints procedure which is available to service users in a suitable format. When asked if they knew how to make a complaint, service users were confident about what to do and said ‘This has been discussed in citizenship (service users meetings).’ ‘We tell the staff, they help you out.’ ‘If I am upset tell staff.’ ‘I would speak to the staff or my special friend, or Isobel (manager) or Michael Noott (director).’ ‘If it wasn’t right I’d tell Isobel.’ There are sound systems in place to make sure service users are supported by staff they can trust who understand the signs of abuse and know how to Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 21 respond to keep them safe. Staff training is kept up to date, and staff are familiar with local procedures for reporting suspected abuse. Checks on recruitment practice showed a very careful and thorough process of staff selection and appointment that includes robust recruitment checks, and this is confirmed in staff records. These records are kept secure and are accessible only by the manager, for confidentiality, so a system needs to be in place for inspectors to view essential recruitment information should the manager not be present for an inspection. The manager is to undertake this. All relatives who responded to the survey said they are aware of the system for raising concerns or making complaints, and the following comments were made in surveys received: ‘We have never needed the complaints procedure or access to an inspection report, but know how to access them if we need to.’ (friends of one service user) ‘Open and frank discussions are encouraged. Our opinions have been respected and a satisfactory solution reached.’ Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The accommodation is safe, clean, well-designed, well-equipped and well maintained, suits service users and they have a key role in decisions about it. It is homelike, spacious, and welcoming, with extensive extra facilities for service users occupation and leisure EVIDENCE: The fourteen service users enjoy living in a home that is very well suited to their needs. Three Roses is a single storey building that has been extensively improved over several years to provide excellent accommodation for them, Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 23 with easy access throughout and specialist craft facilities. There are several communal areas within the home that can be used for a variety of purposes. These include a craft room and adjacent kiln room, a spacious living room with different areas for a range of leisure activities, a smaller conservatory sitting room, and dining room. The kitchen and food storage areas are well equipped and spacious so that service users can readily take part in all aspects of preparing food. There is a planned programme for the maintenance of the home, which includes redecoration throughout. Service users are involved in decisions about improvements to their home. Each service user has their own spacious bedroom with ensuite toilet, and they have all chosen colour schemes and personalised their rooms reflecting their very different personalities. The large gardens and greenhouses are used to produce organic fruit and vegetables. Service users help with harvesting and it is frozen for use over the year. Service users say they still enjoy taking part in this although it is recognised this is likely to be to a lesser extent as they get older and a little less able. The premises are very suitable for their purpose and are safe, comfortable and clean. Reports of the recent inspections by the fire officer and the food hygiene officer show service users can be assured of good standards, as these officers are quite satisfied with the standards maintained. Service users say: ‘I like living here.’ ‘My housekeeper does the house’. ‘ We have a housekeeper she is a good lady’. Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 24 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be confident in the staff who work at the home and that they can generally meet their needs at present, because there are usually enough staff to support service users in the way they wish and need, robust recruitment procedures are always followed and staff are well trained and supported. Staffing levels do need to keep up with increasing dependency levels as service users get older. EVIDENCE: Service users know there are enough staff employed to give them a minimum of three staff on duty during the daytime and early evening and two staff sleeping in at night. This can be flexible according to planned activities and staff also undertake additional activities such as going out for a birthday treat in their own time. This level of staffing aims to support them with sufficient opportunities for community involvement, personal development and interests. The rota, records and discussion with staff and service users all show this is well planned to provide support at the times service users need this. However staff have lately found themselves stretched when some service users have Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 25 needed more support due to more dependency and illness, as they get older. For example one service user increasingly needs the support of two staff at times, and on the day of the inspection was ill in bed (see Personal and Health care support) which has sometimes meant fewer staff available for other service users. Service users do need to be sure that there will be always be enough staff to give them all the help and support they need, as they get older. The manager recognises this is a matter that needs attention, and she is aware of the need for future planning to make sure the service can continue to meet all service users’ emerging needs with increasing age. Service users are getting older as a group, and at Three Roses this group is a large one. For them to remain confident the present quality of service can continue for them all, it is therefore highly likely they will need to see an increase in staff hours. Service users need to be able to contribute their own views, while their commissioning bodies and the trustees should be involved in determining how this need is to be met. As part of this process consideration will need to be given to updating needs assessments, to make sure funding arrangements reflect service users’ individual needs. Service users can be sure staff have the knowledge and skills they need to support them. This is because staff training and development are very important at Three Roses. Staff training needs are assessed individually and as a team, and an ongoing National Vocational Qualification training programme is in place. The training programme has enabled 90 of the care staff to gain the National Vocational Qualification Level 2 in Care. 70 of staff have also achieved Level 3 in Care. Consideration is currently being given to some staff progressing to Level 4. There is a sound approach to induction, foundation and practice training and staff are provided with additional specialist training as needed. The training programme is designed to make sure staff keep up to date with emerging needs and new knowledge and practice skills. Epilepsy and stoma care training have been provided. Reflecting the emerging needs associated with ageing, dementia care training has been established and continence training is to be set up following discussion during inspection. The manager is planning to arrange training on the needs of older people for all staff. This means service users can be sure that staff understand and have the skills to support them in the way that suits them best, and that their skills are being kept up to date. Evidence from discussion and records shows a very thorough well thought out approach to staff supervision, which tracks training needs ensuring these are followed through, personal progress and development. This means service users are assured that staff who work with them do their job well, because staff have a sound and well managed support system to make sure of this. Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 26 The priority given to staff training and supervision is welcomed and appreciated by staff. This is reflected in the abilities and commitment of all staff employed at the home, and in the stability of the staff group. This has been very important in helping service users feel secure and benefitting from a service that continues to evolve and develop in a way that is right for them. Service users supporters feel welcomed and supported by staff: ‘The staff (were) helpful and friendly and the residents very happy when I visited’ ‘A very high level of care and commitment at all times.’ ‘They are dedicated and caring with a sense of humour…always a warm and pleasant atmosphere.’ ‘They are excellent.’ They appreciate that their relatives will need more help as they get older, and anticipate this will mean more staff will be needed. One relative was particularly aware of this from her own experience and says the home could improve with: ‘More funding as service users age – allowing more staff hours and less stress for a caring team who always give of their best.’ In responses to surveys all service users replied that staff always treat them well and listen and respond to what they say. Service users say: ‘The staff are nice. I am happy to talk to staff.’ ‘The staffs is ok.’ Yes staff are nice. They talk to me.’ Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 27 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, 42 and 43 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Management arrangements at Three Roses are sound, and staff and service users benefit from the positive leadership they receive. EVIDENCE: There is a suitably qualified and experienced manager with full time responsibility for this home, and able to meet all the responsibilities of registration. The manager takes care to keep her own training and skills up to date, and ensures management responsibilities are carried out sensitively and fulfilled effectively to enhance the well being of everyone living and working in the home. Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 28 The manager feels well supported by the trustees, who participate very actively in the service, and ensure sound oversight through monthly visits and regular meetings the manager attends. The Commission receives copies of the monthly visit reports, which are detailed and informative reflecting the commitment to the experiences and best interests of the service users. The service is well run with the interests of the service users the foremost priority. Service users and key people actively contribute their views and with support have a role in planning and developing the service. Service users take part in interviewing the staff who are employed to support them. They know their views are valued, with a well-developed process for consulting with them, obtaining their views on the quality of service they receive, and incorporating these into forward planning for service development. There is a creative approach to quality assurance, with two service users on a Quality Assurance Team. It is proposed their next task will be to interview other service users on selected topics to obtain their views, with this process being videoed. A copy of the annual report provided to service users and their supporters reflecting the outcome of this process should also be provided to the Commission. The health, safety and welfare of service users is promoted and protected in respect of all safe working practices. Records sampled showed sound health and safety procedures are in place and carefully followed to make sure service users and staff are safeguarded, and that staff know what to do because they have up to date training in all safe working practices. Policies and procedures in place for the sound running of the service are kept up to date, and were last reviewed and updated as needed in early 2007. Service users supporters gave very favourable comments on the service in their survey responses, with words and phrases such as ‘exemplary care’ ‘wonderful care and can’t praise the home too warmly’ ‘a wonderful caring well organised home, comfortable and lots to motivate the people there’. Asked what the home does well one respondent’s reply summarises these views as follows: ‘Everything. It keeps the residents fit and healthy and makes them feel wanted and loved and important.’ Service users say: ‘It is a nice place. I have lived here for three years now. I am going to be on the Quality Assurance Team next year.’ Among many comments showing how positive all the service users here feel about their home and the service they receive, one service user summed it up for everyone: ‘I am happy here that’s it.’ Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 29 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 x 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 4 25 X 26 X 27 X 28 X 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 x 3 x LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 x 4 x 3 x x 3 x Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 30 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 YA33 Regulation 18(1)(a) Requirement There must be sufficient staff on duty to meet the needs of all service users at all times. Provision must be made for additional staff when necessary to meet exceptional needs, for example when due to illness a service user is confined to bed or needs regular support by two staff. Timescale for action 06/08/07 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 YA21 Good Practice Recommendations Consideration being given to staff training regarding increased support needs associated with ageing should include for example skin care, continence management and intimate personal care, and establishing associated policies and procedures. Staffing levels need to be adequate to meet the needs of all service users at all times. They should therefore be kept under review to make sure emerging needs can be DS0000018490.V334730.R01.S.doc Version 5.2 Page 31 2. YA33 Three Roses 3. YA42 met as service users needs increase with ageing, so that there are always enough staff on duty to meet the identified needs of all service users Notification should be made to the Commission regarding any event that may adversely affect the wellbeing of a service user. Three Roses DS0000018490.V334730.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Worcester Local Office The Coach House, Perdiswell Park John Comyn Drive Droitwich Road Worcester WR3 7NW 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 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!