Care Home: Rhodelands Care Home

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Rhodelands Care Home Babbs Lane Doveridge Derbyshire DE6 5JT One star adequate The quality rating for this care home is: 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: Janet Morrow Date: 0 3 1 0 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. They reflect the things that people have said are important to them: 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 Adults (18-65 years) 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Rhodelands Care Home Babbs Lane Doveridge Derbyshire DE6 5JT 01889562815 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): swtommo@tiscally.co.uk Milbury Care Services Ltd Name of registered manager (if applicable) Sarah Louise Jones Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 7 0 care home 7 learning disability Additional conditions: The provider may provide the following category of service only: Care Home (PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Learning Disability - Code LD The maximum number of service users who can be accommodated is: 7 Date of last inspection Brief description Rhodelands is a large detached home in a quiet secluded lane. It is surrounded by large well-maintained gardens. All areas of the home and garden are accessible to the service users. There are a number of communal areas including a large, wellfurnished conservatory. All bedrooms have en-suite bath or shower room. At the time of inspection there was a large log cabin being built within the grounds, it has a sensory room, an activity room and a small canteen with a vending machine to be fitted to meet the needs and expectations of service users. The home provides long term care for adults with a learning disability. Transport to access the community is also provided. 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: One star adequate Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: We watched how people spent their day and what the meals were like. We looked at the information in files for staff on how to support people. These are called support plans. We talked to three people who lived at the home and one persons relative. We met some of the staff who worked at the home. We looked at some of the policies and procedures in the office. Policies are rules about how to do things. Procedures tell people how to follow the rules. What the care home does well What has got better from the last inspection: A new manager has started to work at the home. What the care home could do better: Information needs to be passed on properly between different staff groups. Staff need more training to help them offer the right support to people living in the home. The manager needs to make sure there is always enough food in the home. There must always be enough information written down for each person when they choose things that may be risky. There must be more activities for people to choose from. A better storage cupboard is needed for some medicines. Special help should be asked for if people have particular needs. Records must show that peoples worries are acted upon. Cleaning materials must always be locked up to make sure they are stored safely. 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 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 . There was sufficient admission information available to ensure peoples needs could be met. Evidence: The written information supplied by the home in April 2008 stated that each file contained a detailed assessment of need from original assessment dates and reviews and that the home demonstrated the ability to meet the needs of the service users by providing appropriate staff training. Two peoples care files were examined and showed assessment information was in place. However, there was no assessment Information from external professionals available. The manager stated that this would now be archived as the people concernd had lived at the home for a few years. Detailed information about individual needs was available in the files examined. The records showed that although reviews were taking place, there had been none during 2008. The manager stated that he intended to review all peoples needs on a monthly basis. One relative spoken with stated that they had had the opportunity to visit the home before making a decision about whether their relative should move there. Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 . Detailed care planning and risk assessments ensured that peoples needs were met in the way that they chose. Evidence: Two peoples care files were examined and showed that a comprehensive care plan was in place that demonstrated how individual needs would be met. This included specialist needs such as dietary information, behavioural strategies and communication needs.The files and the details provided contained sufficient information to enable staff to deliver care in a consistent way. Risk assessments were available but these were generalized rather than being geared to the specific needs of the individual. Social and medical information was recorded in care plans and strategies for dealing with specific problems were in place. Independence was encouraged; for example, there were records and photographs available to show how one person was learning new skills such as using public transport. An activity chart was used by one person to ensure that they had the structure they needed. Observation during the inspection visit showed that people were offered choices and encouraged to make decisions according to their ability. The written information supplied by the home in April 2008 stated that staff supported Evidence: people to take responsible assessed risks and encouraged them to build and develop their skills wherever possible - for instance in the kitchen where they were supported by staff to be as involved as possible in making their own meals, choosing to cook and eat whenever they liked. One relative spoken with stated that their relative was doing well and that they were pleased with the way they were encouraged to be as independent as possible. Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . A lack of structure on activity and food planning had the potential to adversely affect peoples quality of life. Evidence: The written information provided by the home stated that we enable service users to experience a range of leisure activities including going to the pub, going to the cinema or bowling and that people had access to an annual holiday of individual choices or if they did not wish to have a holiday they may be supported to have several day trips instead, ensuring that they had a break. People living at the home were observed to have their own routines as far as possible, with some choosing to go out and one person occupying themselves in the grounds of the home. There were no formal structured activities such as attending college courses or day centres so it was unclear whether people were able to develop on a personal level and increase their skills. However, people chose what they wanted to do each day and were able to go on outings. During the inspection visit, some people had gone to the zoo and another to a park. The local village facilities were also used such as the shop. People were also involved in domestic tasks around the home such as assisting with meal preparation and this was included as part of their social skill training. Evidence: There was an activity space located at the rear of the home. This included a sensory space, a space for activities and a cinema. The manager stated that he intended to make greater use of this area to extend the opportunities and activities available to people in the home. On the day of the inspection visit, all service users were involved in activities of their choosing and there was no evidence to suggest that people were spending prolonged periods of time in bed, as indicated in the recent complaint. People living at Rhodelands were encouraged to maintain links with their families as appropriate. Families were welcome and one person went to visit their family regularly. One person spoken with described the home as welcoming, another relative stated that their relative did a lot and that they were pleased with what the service were doing. A recent complaint had stated that the home had run out of food on one occasion and did not have sufficient to make an evening meal. This had been confirmed on a visit by the Local Authority. This is not acceptable and proper systems are needed to ensure that there is always sufficient food available. The kitchen was examined during the inspection visit and food stocks were found to be good with a variety of tinned, frozen and fresh food being available. Menus were also examined and showed that a variety of nutritious meals were available. Clear dietary information was in place for those people who had specialist needs. Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 . Access to health professionals and clear systems ensured that peoples health and personal care needs were met. Evidence: Two peoples care records were examined and showed that there were details about individual preferences available and the type of assistance and guidance needed to meet health care needs. Records showed that attention was paid to hair care, oral health and foot and nail care. One person had received nail care during the visit and was able to express pleasure with the results. Both files examined also had a health action plan that covered basic health information on each individual including vaccinations received, medication taken and any illnesses. Staff spoken with, and records confirmed, that visits to chiropodists and opticians took place. Other professionals were involved in reviews of care but there were no care reviews recorded since 2007 on the two files examined. One relative spoken with confirmed that access to health professionals was made available and that health needs were addressed well. The recent complaint about the dietary needs of one person had stated that specialists such as dietitians were not involved with the eating plan. Although records about food requirements were clear and comprehensive, there was no record of any intervention by a dietitian and staff spoken with confirmed that a dietitian had not been involved with the particular individual. A relative spoken with stated that that their relative was really settled and that they Evidence: had been really pleased with the way the home had addressed an eating problem. It was observed during the visit that personal support was offered sensitively and warm relationships existed between staff and people in the home. A general check for accuracy of recording was undertaken on the medication administration record (MAR) charts for all six people in the home. This showed that charts were generally completed properly with the amount of medication received recorded on each chart. Two peoples records were then examined in more detail. These were both completed accurately with the exception of one medicine for one person on one day that was missing from the blister pack but had not been signed as given. The MAR charts had useful information attached to them that stated how each person liked to receive their medication and also a list of side effects of each medication. There was also a homely remedies policy that stated what medicines could be purchased over the counter. The manager stated that there were no controlled drugs in stock. However, there was inadequate secure storage for such medicines should they be required as there was no double locking facility. The complaint received stated that medicines were left insecurely on the top of a cabinet. However, as there was no date on the information received, it was not possible to check whether this had occurred. There was no medication seen out of the storage cupboard on the day of the inspection visit. Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . A lack of consistency in dealing with complaints and issues regarding safeguarding has the potential for people not to be fully protected. Evidence: The written information supplied by the home in April 2008 stated that there had been two complaints received at the home. However, there was no written record of the response to these complaints available at the time of the inspection. It also stated that the service provided a clear and effective complaints policy and ensured all service users were aware of its existence and how to use it. There had been two complaints received at the Commission for Social Care Inspection. One had been responded to by the responsible individual and another was in the process of being addressed. The issues raised are referred to in the relevant section of the report. One relative spoken with stated that they had made a complaint and that the home had adhered to what was asked. The service had a policy on safeguarding vulnerable adults and staff spoken with were aware of the need to report any suspicions of abuse. Training records confirmed that safeguarding training had taken place in December 2007. The written information supplied by the home stated that there had been five safeguarding referrals over the previous twelve months. At the time of the inspection visit, there was a safeguarding referral that was being dealt with by the Local Authority and the outcome was not known. There was also a policy on safeguarding peoples finances and procedures stated that monies were checked on each shift. Two peoples financial records were examined and the amount of cash held corresponded with the written record. Receipts for individual purchases were also available. 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 was well maintained and provided safe and comfortable accommodation for people to live in. Evidence: The home was reasonably well maintained although paintwork around the home was marked and scratched. It was clean and tidy and there were no offensive odours. Three peoples bedrooms were seen and all were furnished and decorated in accordance with individual needs and wishes. Those people spoken with stated that they had what they wanted in their rooms and relatives spoken with also confirmed this. The laundry was suitable for the needs of the home and equipment was in working order. Cleaning materials were stored in a lockable cupboard in the laundry although this was not locked at the time of the visit. The kitchen was clean and tidy and food stocks were good. 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Lack of relevant training and supervision and insufficient skill mix of staff on occasions did not ensure peoples needs were always met. Evidence: The staff rota for the week beginning 29th September 2008 was examined. This showed that there were either six or seven members of staff on duty plus the manager. There was one waking night staff member and one sleep in member. The recent complaint had alleged that there were frequently agency staff on duty and that staff were working 60 - 70 hours per week. Two agency staff were on duty on the day of the inspection visit. However, these staff regularly worked at the home and one had been undertaking shifts at the home for the past sixteen months. Information received that there were regularly no female staff on duty at night was discussed with the manager ; the rota was examined for the period 1st August 2008 - 5th October 2008 and there were three occasions when there was no female staff on duty at night. The manager stated that this problem was now resolved and there were female staff available for the night shifts. The response to the complaint by the company stated that some staff had worked the number of hours stated but that this was not a regular occurrence and that those who had worked these hours had signed an agreement to work in excess of the European Working Time Directive. Staff spoken with stated that there was good access to training. As well as mandatory health and safety training, staff confirmed that they had undertaken training on epilepsy, non-violent crisis intervention and medication administration. However, there was some additional training that would be of benefit to staff in areas such as visual awareness, nutrition and mental health needs. Support for staff was discussed with the manager as some staff. particularly agency Evidence: staff, did not appear to receive supervision and communication between staff groups was identified as a potential issue. One staff file seen showed that supervision had occurred in July 2008. However, there was no record that this had occurred on the other file seen. Two staff files were examined for recruitment information. Although confidential information such as Criminal Record Bureau (CRB) checks and references were not available in the home, there was a signed checklist for both files saying that the relevant information had been received. The original information was stored at the companys head offices. Both files had identity information available such as photographs and birth certificates or passports. Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Lack of a manager has not ensured the smooth running of the home. Evidence: The home was in a period of transition regarding managerial arrangements. A new manager had been appointed and had commenced work at the home during the week of the inspection visit. Prior to this, temporary arrangements had been in place with an acting manager having oversight of the home. The lack of a manager had led to some issues regarding managerial arrangements that were identified in a complaint received, as referred to earlier in the report, such as the home running out of food and having to borrow cash to ensure an evening meal was available. The new manager was experienced and knowledgeable and was able to demonstrate in discussion how he intended to improve the service. The complaint received stated that the minibus used by the home had been driven without an MOT. Vehicle documentation was not available during the inspection visit but was provided after the inspection and showed that it was valid and had not been used without an MOT. The company had clear processes for quality assurance and completed an annual service review when they tried to obtain views and comments from a range of different people including visiting professionals and relatives. An action plan was then devised and followed up on the following month. This was in addition to the usual monthly visits undertaken in response to Regulation 26 of Care Homes Regulations 2001. The review supplied by the service indicated that people generally liked living at the home but that there were areas for improvement, particularly in relation to the environment and the supply of information. Evidence: The written information provided by the home in April 2008 confirmed that maintenance checks were undertaken regularly; for example fire equipment and alarms had been tested in July 2007, a fire risk assessment had been undertaken in January 2008, portable electrical appliances had been checked in September 2007 and the heating system in April 2008. However, the fire detection and fighting equipment and portable electrical appliances tests were due for renewal and the certificates regarding this could not be located during the visit. It was also noted that cleaning materials were stored in an unlocked cupboard at the time of the visit. Staff spoken with confirmed that health and safety training was undertaken in food hygiene, moving and handling, first aid and fire safety and this was confirmed in the staff training information seen, which showed that this training had occurred in 2008. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action 1 9 13 01/12/2008 Risk assessments must be personalised and be relevant for each individual. To ensure that each person is safe and able to take responsible risks according to their needs and abilities. 2 12 16 There must be a planned programme of activities that enables people living at the home to develop personally and learn new skills. 03/01/2009 To ensure peoples social and developmental needs are met. 3 17 16 There must be clear 05/11/2008 guidelines for staff regarding the purchasing of food and maintaining food stocks. To ensure the home does not run out of food. 4 20 13 There must be proper secure 01/02/2009 storage for controlled medicines that meets recommended guidelines. To ensure that medicines are stored safely and that the risk of theft and misuse is minimized. 5 22 22 There must always be clear records of how complaints have been dealt with. 01/01/2009 To ensure that people in the home and their representatives are confident that their concerns will be dealt with. 6 33 18 There must be an adequate skill mix and sufficient numbers of staff on each shift. 01/01/2009 To ensure peoples needs can always be met. 7 36 18 All staff must receive regular 01/12/2008 supervision. To ensure they are competent in their roles and work. 8 37 9 The manager must make an application to be registered with the Commission for Social Care Inspection. 01/04/2009 To ensure that they are a fit person to run the service and that it is run in peoples best interests. 9 42 13 Cleaning materials must always be stored securely. 01/12/2008 To ensure the safety of people in the home and minimise risk of accidents. 10 42 23 Up to date certificates to 01/12/2008 show fire detection and fighting equipment and portable electrical appliances are safe to use must always be available for inspection. To ensure the helath and safety of all in the home is addressed. 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 1 2 18 35 Where eating needs are identified, the input of a dietitian or other professional should be requested. Staff should receive training in areas specific to the needs of the people they care for, such as in visual awareness, nutrition and mental health awareness. 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 © (2008) 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. - 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!