Care Home: Rathmore House

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What the care home does well People moving into the care home have a thorough assessment. This ensures that staff have all the information they need to meet the persons needs and match their aspirations. Prior to and during this inspection, we received some very positive comments about the home itself, the staff and manager as well the quality of care. The staff in the care home provide a good standard of personal care for the people they look after. There is a support system in place for friends and relatives who visit the care home and they are made to feel welcome. There is a pleasant and open atmosphere in the home, which make people feel confident to raise any concerns they may have. What has improved since the last inspection? This care home has always worked well with us and have been responsive to put right any requirements. Work has been in progress to improve the quality of the care plans. These are more detailed and reflect the personal choices of the people who have been admitted. The management team intend to make sure that all staff are confident and competent in developing care plans prior to the implementation of an electronic system. There has been progress in developing the activities within the home including one to one sessions between key workers and their key residents. This has had a beneficial impact on the well being of the people living in the home. Since the last inspection there has been work carried out on the communal areas. These have been redecorated and there is now one dining room and one lounge. Repairs to window frames have been carried out. The systems for the administration of medication have been looked at and improved. What the care home could do better: There were no requirements made at this inspection. Any areas for improvement were discussed with the registered manager and head of clinical care. The AQAA showed that the management team have a clear idea of the areas for development. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rathmore House 31 Eton Avenue London NW3 3EL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Pippa Canter     Date: 1 3 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Rathmore House 31 Eton Avenue London NW3 3EL 02077943039 02077946169 michael.mckeon@ccht.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Central & Cecil Housing Trust care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 20 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Rathmore House is a listed building that has been adapted to become accommodation for older people. It is situated in a residential area of Swiss Cottage bordering Belsize Park. The home is owned by Central and Cecil Housing Trust. The aim of the service is to provide care to elderly people of both sexes, aged 65 years and over, who require a high level of support because of having dementia. Permanent care will be provided for service users assessed as having dementia and who may need some nursing care. Accommodation for service users is over three floors. There is a shaft lift, which gives access to all floors. There are a total of 20 bedrooms. Thirteen of which have ensuite facilities comprising a toilet and a hand basin. All floors have assisted bathrooms/showers and additional communal toilets. Since the last inspection there Care Homes for Older People Page 4 of 24 20 0 Over 65 0 20 Brief description of the care home has a re-organising of the communal accommodation. There is now one lounge and one dining room on the ground floor with a small quiet lounge off the main reception area. All rooms are linked via a call bell system. Service users have access to landscape grounds and a secure garden. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was completed over one day from mid morning to late afternoon. A total of 6 hours was spent in the care home. We last visited this care home for an unannounced key inspection on 9th September 2007 Prior to the inspection, we reviewed the information that the Commission for Social Care Inspection had about the home. This included the Annual Quality Assurance Assessment (AQAA), which was completed and returned by the registered manager. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We reviewed and summarised the incident reports supplied by the home. Postal questionnaires have been circulated however the replies were not available prior to and Care Homes for Older People Page 6 of 24 during the inspection. Any comments will be included in the final report. We have looked at the information collected from the previous inspection and relevant information from other organisations. During the visit we looked at the premises and visited the rooms of the people we were case tracking with their permission. An expert by experience accompanied the inspector and spoke to people living in the service, the staff and was in the dining room when lunch was served. Staff were observed going about their duties and interacting with residents. We followed the care for four people who are currently living in the care home. The care plans were compared with the care being given. The choice of care plans reflected peoples gender specific health care conditions and cultural needs. The inspection focused on aspects of care daily activities staffing complaints and adult protection. Staff recruitment and training records were discussed. Samples of health and safety records were seen. All those who have contributed to the inspection process are thanked for their input. The. expert by experience will send a report and this will included in the final version of the inspection report. However she said that she had found visiting the care home a positive experience. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 this service will be in receipt of good information about the care home in order to make an informed choice about whether the service is right for them. There is a comprehensive and personalized needs assessment process which means that peoples diverse needs are identified and planned for before they move into the home. Evidence: We looked at the care records for four people two of whom had been admitted since the last inspection. The case tracking process confirmed good evidence. The Head of Clinical Care had visited prospective service users at the referral stage. A thorough initial assessment of the persons care needs had been completed. Also on file were reports from Occupational Therapy Departments, discharge summaries from hospital wards and Care Programme Approach assessments. Care Homes for Older People Page 10 of 24 Evidence: Feedback from a relative confirmed that they were able to view the service prior to admission and had found the staff to be approachable and ready to answer all their questions. This was confirmed by another relative who said that the staff had been very supportive during the admission stage and continued to assist them whenever they raised further queries. Discussions with the manager revealed that the Service User Guide is under review. We discussed that the review is to incorporate ways in which the guide can be more user friendly for people who are elderly and have a diagnosis of dementia. Consideration is being given to producing the document in large print and perhaps in a pictorial format. Care Homes for Older People Page 11 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 live in the care home can be confident that they will get support from staff who understand their care needs. The health needs of people living in the car ehome are being met with evidence of good multi disciplinary working taking place. The systems for the administration of medication are have been improved. There are now clear and comprehensive arrangements in place to ensure service users medication needs are met in a safe way. Evidence: Prior to this key inspection we had carried out a specialist Pharmacy inspection and a random inspection. Concerns had been raised that when the Community Nursing Service withdrew their services and support that the nursing staff may not have the necessary skills and knowledge to meet the assessed needs of the people being admitted to the care home. An inspection of four care plans was made. Two of these were for people who had been recently admitted to the care home. These care plans showed clear signs of Care Homes for Older People Page 12 of 24 Evidence: improvement. They were detailed and reflected individual needs their wishes and included aspirations for independence, privacy, dignity and choice. There is evidence that relatives have been included in the development of the care plans. There are opportunities for residents and relatives to sign their care plans. Staff are able to describe the needs of the people they care for and these were accurately reflected in the care plan. Relatives are being involved in the development of the care plans and this has helped to making the plans more individualized. The sample of supporting documentation such as assessments, behavioural charts, diet monitoring sheets and wound maps were all being completed and the outcomes were being evaluated. Care Homes for Older People Page 13 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 staff have a good understanding of the service users support needs. This is evident from the positive relationships that have been formed between the staff and the people who live there. Routines in the home are flexible and residents can expect more activity and stimulation. The menu is varied and the food is nutritious. Evidence: Routines in the care home are flexible with residents choosing how to spend their day. People living in the care home commented that the only routine was meal times and the arrangements for activities otherwise people were able to follow their individual routines. People were able to choose whether they sat with company or to sit alone, where to eat their meals and what past times to engage in. The home has an activity programme but there is also an increase in one to one activities. Each key worker is expected to engage in periods of individual activities with their key residents. Such periods of engagement are being recorded and we observed pockets of this activity throughout the visit. This has made an impact on residents behaviour and there is an increase in the level of well being. Care Homes for Older People Page 14 of 24 Evidence: Visiting is flexible and friends and relatives were seen being welcomed into the home. Staff foster positive relationships with relatives as their visits and contributions are viewed as therapeutic to the well being of the residents. The dining area has been made more attractive and it was well laid out as well as clean. Residents are able to choose from a varied menu and request an alternative. Peoples likes and dislikes are documented and made known to the catering staff. Care Homes for Older People Page 15 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to raise any concerns with the manager and staff, knowing that they will be listened and responded to without delay and any issues resolved. People living in the care home are protected from harm. Evidence: The last inspection identified the quality rating of this outcome area to be good. The service has a comprehensive complaints procedure that is on display and made available through the service user guide. The manager also logs all complaints as well as compliments. Feedback from residents and relatives showed that they were well aware of whom to raise concerns with, and those who commented stated that they never needed to when asking about complaints. All provided positive comments about the way in which the manager enabled residents to discuss any concerns. Adult protection procedures remain in place along with the Inter Agency Guidelines for the local authorities. There is clear evidence of all staff being trained in protecting adults from abuse and staff had a sound knowledge of how they would deal with such incidents and an understanding their role in referring incidents on. It is clear from discussions with residents that they feel safe and secure in the home and feel comfortable with staff. Care Homes for Older People Page 16 of 24 Care Homes for Older People Page 17 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 provides a warm, safe and homely place to live. It is very well maintained, both internally and externally, and is clean and fresh. Evidence: The home provides a warm, comfortable and homely environment for those living there. Since the last inspection there has been a programme of decoration and some refurbishment. With the input from relatives, residents private rooms are being personalised and have the necessary furniture. Residents have access to mobility aids, profile beds, assisted baths and grab rails are fitted where required. The home was of a satisfactory standard of cleanliness throughout, with no offensive odours. The laundry was similarly well maintained and had adequate washing facilities in place. As part of the refurbishment, the window frames have been repaired and painted. Care Homes for Older People Page 18 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff provide a good quality of care to those living in the home. Training continues to improve to ensure staff are able to fully meet individuals needs Evidence: The staffing structure has been reappraised following a re-assessment of residents needs. Staffing level not take account of one to one attention where this has been assessed as a need. The staff team maintains a gender balance similar to that of the resident group. Therefore gender specific care can be possible where this is requested. The nursing skills take account of the mental and physical health needs of the people living in the home. Nursing staff have undertaken or updated their training to enable them to have a holistic approach to the residents. The care home will no longer receive input from the Community Nursing Services. earlier in the year there had been concerns that the nursing staff may not have the skills and knowledge necessary but this is now resolved. The feedback received about the quality of the staff was positive, stating staff were supportive, and were caring and sensitive to their needs. The recruitment checks and employment documentation required were discussed, and these are all well documented. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 run in the best interests of the people who live there. Evidence: The management arrangements continue to be a registered manager and a head of clinical care. Both have the required qualifications and experience and are competent to manage their individual areas of responsibility. Feedback shows that the management team are caring and approachable. There are both formal and informal processes that monitor the quality of the care provided, including reviews and auditing of procedures. Residents and relative meetings are also facilitated. This enables people using the service to give feedback. A representative of the provider visits regularly to monitor procedures. The Annual Quality Assurance Assessment (AQAA) was sent within the correct time frame by the manager. The focus was mainly on social care and in future the AQAA needs to reflect the nursing element in the home. Nevertheless the AQAA contains clear, relevant information and is supported by a wide range of evidence. The AQAA informs us about changes they have made and where they still Care Homes for Older People Page 20 of 24 Evidence: need to make improvements. All care plans record who is responsible for managing residents monies. These are generally maintained by residents, their relatives, or a legally appointed representative. A sample of health and safety documents were looked at and together with the evidence recorded in the AQAA, the home continues to have a consistent record of meeting relevant health and safety requirements. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - 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!