Care Home: Roann House

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What has improved since the last inspection? The resident`s care/support plans and risk assessments have been re-done. They are now more tailored to meet the individual needs of the people at the home. Staff are offering care and support to people in the way that suits them best. They are supporting people to do as much as possible for themselves while keeping them safe. Staff are now receiving the guidance and direction they need to look after people. Visiting professionals told us that, "Care planning has improved and reviews are positive". They said "the people they saw are happy with the care they are receiving and like living at Roann House".Roann HouseDS0000057418.V375700.R01.S.doc Version 5.2 Page 8The medication practices and procedures are being followed by staff to make sure people receive the medication they need on time and safely. Staff monitor to make sure the medication is working as it should. We saw some staff talking to people and responding positively. Staff were listening to what people were saying and acting on their requests. They were seen offering reassurance and support in away that was caring and respectful. Some people told us that they feel they would be able to express concerns to the staff and management or make a complaint. One person said "I have never had any reason to complain. I am very well cared for and happy with the staff". Activities and leisure pursuits in the home have been developed so as to allow and encourage people to have meaningful and active lives that suit their preferences. The staff are recording the amount of food people eat so any problems can be quickly identified and acted on. This will make sure that people are receiving a balanced and healthy diet. There are enough staff on duty to look after the residents in the way they prefer. The staff have received the training they need to do their jobs effectively and safely and in a way that best suits the individual needs of the residents. At the random inspection concerns were identified about the risks around items of furniture and the room temperatures in the home. The manager has made sure that all the furniture is safely secured to walls. The home monitor the room temperatures regularly to make sure people are warm and comfortable day and night. People we spoke to at the random inspection in January 2009 told us that the home was warm and that they never felt cold. At this inspection they said the same. The requirement made in the report has been met. The service has developed a maintenance and renewal programme to make sure that they have identified the areas within the home that need work. They are continuing to improve the home make sure it is maintained to a good standard for the people who live there. The quality assurance systems have been improved to make sure the home is improving the service it offers to the residents. What the care home could do better: Roann HouseDS0000057418.V375700.R01.S.doc Version 5.2 Page 9The service needs to evidence that people are supported and encouraged to go out if they wish. This was identified an area for improvement in the AQAA. It will give people more varied and diverse ways to spend their time. Activities are being further developed. They service needs to further develop how people are involved in making more diverse choices and decisions that affect their lives. Some aspects of care need to more individual and person centred. This will encourage people to have say and control of their lives. The home needs to continue to improve the environment to make it a more pleasant and conducive place for people to live. Key inspection report CARE HOMES FOR OLDER PEOPLE Roann House 91 Bouverie Road West Folkestone Kent CT20 2PP Lead Inspector Ms. Mary Cochrane Key Unannounced Inspection 10:00 22nd June 2009 DS0000057418.V375700.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roann House Address 91 Bouverie Road West Folkestone Kent CT20 2PP 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) 01303 253705 01303 255057 roannhouse@onetel.com Roann House Ltd Mrs Sursatie Sanicharie Pieries Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 18. Date of last inspection 8th January 2009 Brief Description of the Service: Roann House is registered to provide accommodation and personal care for 18 older people. The home is a family run business. The property is a detached three storey house. There is a passenger lift that gives step-free access to the parts of the accommodation occupied by the people in residence. When full, there is provision for one of the bedrooms to be shared by two people. In practice, all of the bedrooms are used for single occupancy. Each bedroom has a private wash hand basin. There is a call bell system that helps people to get assistance from staff if they need it. There are various aids such as a hoist to help those people who have difficulty getting about. There is a lounge and dining room. To the rear aspect, there is a large conservatory. At the back of the property there is an enclosed garden. The Service is located in a quiet residential street that is quite near to Folkestone town centre. This means that there is easy access to shops and public transport services. There is a limited amount of off-street car parking and there is also local on-street parking. People who might want to move in can get information from several sources. There is a Service Users’ Guide. This is a brochure that outlines the principal features of the facilities and services available in the Service. There is also a document called a Statement of Purpose. This gives a more detailed account of the provision in place than does the Guide. The Registered Provider makes sure that a copy of the most recent Inspection Report from the Commission is Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 5 available for reference. The range of fees charged currently for each person’s residence in Roann House range from £325.86 to £396.00 per week. The Manager provided this information. Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star Good. This means the people who use this service experience good quality outcomes. The last key unannounced inspection to this service was completed on 28th July 2008. This visit to the service was an unannounced Key Inspection which took place over one day. The inspection started at 10:00 a.m and finished at 2:00 p.m. The registered manager and the provider were available during this time. The people living at the home and the staff on duty were helpful and cooperative throughout the visit. Four residents and five staff members were involved in the inspection. They told us things about the home and the support and care they receive and give. General observations were made during the day of how people are supported. We had a look around the home and various records were inspected. We looked at and discussed residents individual support plans and their risk assessments. We looked at medication procedures and records. We also looked at staff files and training records. We saw how the service recruits their staff and the homes quality assurance systems. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was used in the report. We sent five surveys to people who live at the home we received two back. Four were sent to staff and all were received back. Four were sent via the home to visiting professionals, but we received none back. The manager assured us that these were given out in lots of time, and is disappointed to find they had not come back to the Commission. The Commission have contacted named professionals. The information in the surveys will be referred to in the report. We also took into account the things that have happened in the service; these are called notifications and are a legal requirement. Since the last inspection there has been a social services led safeguarding adults’ alerts and subsequent investigation. This means the safe guarding team had concerns about the home and the care of the people living there. As a result of one of the alerts the commission did a random unannounced inspection at the home on 8th January 2009. The concerns have been fully investigated by multidisciplinary agencies and the alerts were closed in March 2009. This means the outcome of the safeguarding investigation concluded Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 7 that people are receiving the care that they need and are safe in the home. Any further information in respect of these matters can be sought from the registered manager. What the service does well: People who wish to consider staying at the home have access to information, which tells them about the service and the care they will receive if they decide to live at Roann House. People will be fully assessed before they come to stay. This makes sure the service can give them the support and care that they need. Family and friends are welcome at the home and are encouraged to be involved in the care of their relatives. The service told us that a relative made the comment in their quality assurance survey. They said,” I feel my mom is well cared for. Before she came to Roann House she was not responsive. After a short time she improved. I believe this is because the people care about her”. Health professionals and specialist services are contacted promptly if there are any concerns about a person. Each of the residents have their own room. If people want to they can bring their personalised belongings to help them feel more comfortable and at home. The home does meet the physical and healthcare needs of the people who live there. There is regular input from the local specialist team and G.P appointments are frequent. What has improved since the last inspection? The residents care/support plans and risk assessments have been re-done. They are now more tailored to meet the individual needs of the people at the home. Staff are offering care and support to people in the way that suits them best. They are supporting people to do as much as possible for themselves while keeping them safe. Staff are now receiving the guidance and direction they need to look after people. Visiting professionals told us that, “Care planning has improved and reviews are positive”. They said “the people they saw are happy with the care they are receiving and like living at Roann House”. Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 8 The medication practices and procedures are being followed by staff to make sure people receive the medication they need on time and safely. Staff monitor to make sure the medication is working as it should. We saw some staff talking to people and responding positively. Staff were listening to what people were saying and acting on their requests. They were seen offering reassurance and support in away that was caring and respectful. Some people told us that they feel they would be able to express concerns to the staff and management or make a complaint. One person said “I have never had any reason to complain. I am very well cared for and happy with the staff”. Activities and leisure pursuits in the home have been developed so as to allow and encourage people to have meaningful and active lives that suit their preferences. The staff are recording the amount of food people eat so any problems can be quickly identified and acted on. This will make sure that people are receiving a balanced and healthy diet. There are enough staff on duty to look after the residents in the way they prefer. The staff have received the training they need to do their jobs effectively and safely and in a way that best suits the individual needs of the residents. At the random inspection concerns were identified about the risks around items of furniture and the room temperatures in the home. The manager has made sure that all the furniture is safely secured to walls. The home monitor the room temperatures regularly to make sure people are warm and comfortable day and night. People we spoke to at the random inspection in January 2009 told us that the home was warm and that they never felt cold. At this inspection they said the same. The requirement made in the report has been met. The service has developed a maintenance and renewal programme to make sure that they have identified the areas within the home that need work. They are continuing to improve the home make sure it is maintained to a good standard for the people who live there. The quality assurance systems have been improved to make sure the home is improving the service it offers to the residents. What they could do better: Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 9 The service needs to evidence that people are supported and encouraged to go out if they wish. This was identified an area for improvement in the AQAA. It will give people more varied and diverse ways to spend their time. Activities are being further developed. They service needs to further develop how people are involved in making more diverse choices and decisions that affect their lives. Some aspects of care need to more individual and person centred. This will encourage people to have say and control of their lives. The home needs to continue to improve the environment to make it a more pleasant and conducive place for people to live. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides information about the service for prospective residents. People who are thinking of moving into Roann House will be asked about what support they need and how they want this to be given. They will only be admitted if the home are confident of meeting these needs. EVIDENCE: We looked at the homes has a Statement of Purpose and a Service Users Guide. The Statement of Purpose contains the information needed. It sets out the objectives and philosophy of the service and is up to date to reflect the present situation in the home. The Service Users Guide has been reviewed and updated and contains information to assist people in making a decision about Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 12 whether the home is the right place for them to live. Each person thinking of coming to the home will receive an information pack which contains a brochure with pictures of the home. The guide is written in a format that makes it more accessible for the people the home caters for. It includes information on how to make a complaint, charter of rights and terms and conditions. The service user guide also contains information about the results of the homes quality assurance and comments they have received from people who are involved in the service. One person told us “I have everything I need here”. There have been no new admissions to the home since the last key unannounced inspection in July 2008. The service has reviewed their pre-admission procedures. They have a new assessment format which looks at the person as a whole. We saw that the assessment procedure identifes all the persons care/support needs and also looks at all aspects of their lifes. It includes information of the persons, physical and mental health, level of dependency, mobility and risks. It also gives information about their past, their likes and dislikes, pastimes and preferences. The home have gathered some of this information from exsisting residents so that it can be used in support and care planning. This will be used as baseline information to monitor whether people improve or deteriorate after they have come to live at the home. As the home have not have had no new admissions the pre-assessment tool is yet to be tested. The service does not provide intermediate care Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with the personal and health care they need and are supported by a multi-disciplinary health care team. People can be sure they will receive their prescribed medication on time. Staff respect the privacy and dignity of the people in the home. EVIDENCE: On the day of the visit there were 6 people at the home. One person was in hospital. Since the last inspection the home has changed the way it plans care for the residents. Care planning for people who live at the home has improved. Generally the plans gave a clear account of how people like to be supported. Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 14 Each person has an individual plan in which people can say what assistance and support they want and how they want it to be done. Also, the plans give information to care workers so that they know what to do. We looked at three of these plans in detail. Some parts of the plans were not fully individualised and person centred and some parts were. The manager told us she would rectify this to make sure that all aspects of care are given in away that is individual and personal. There was clear and precise guidance in place for people who need the use of the hoist. There was clear information in place about how people like to be supported with their personal care and about the medication people needed for pain relieve. The plans also gave details on how best to support people with regards their nutrition and skin care. One person is being monitored by a dietician as their body weight is low due to stomach related problems. All health professionals have been informed and the home are following the programme of care set out by the GP and dietician. We spoke to care workers and they were able to explain about the support and care they give to people and how they do this in a way that best suits that person. We saw evidence that they did this according to the individuals care plan. We did find that the part of a care plans did not include exact guidance about what staff should do if a person needed to use an inhaler to assist them to breathe easier. When we spoke to staff they did know what to do. The manager told us this information would be added to the plan. Residents told us in the surveys “Everything is well done. You get the care that you need”. The home told us that a care manager reported in the quality assurance surveys “the care plan format is much improved. On review of my client they appear happy, settled and well cared for”. We saw that care plans are reviewed on a monthly basis and more often when necessary. We found that people have visits from doctors or other specialists when they need them. A record of this is kept in the in a different part of the plan. We evidenced that changes to care are monitored on a daily basis and plans had been updated. During the random inspection and at this visit we found risk assessments covering important areas such as mobility, falls, skin viability and pressure area risks were in place. These had also been reviewed. If people have had an accident, the staff have completed accident records. Injuries to the person Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 15 were documented on a body map, which showed exactly where and what type of injury had been sustained. Accidents and incidents were reviewed 12 hours later, and the outcome of this was documented too. Daily records are kept and contain relevant information. It was possible to cross reference information to show that care plans and risk assessments are being used to provide the necessary care and input on a daily basis. However the same information was also been duplicated in other places. There is now a lot of paper work in place for each resident. The staff told us that now they have all the information in place they will start to stream line it so the plans are easier to use on a daily basis. Medication is stored safely and at the right temperature. Only people who have received the necessary training administers the medication. Two care staff have recently done medication training and are waiting to have competencies checks by the registered manager before they are able to give medication to the residents. A sample of prescription sheets was seen. All prescriptions sheets had been signed. The home has policies and procedures in place. The recording of receipt, administration and disposal of drugs is sufficient to allow an audit trail. This means that residents have received their medication safely and on time and the staff are monitoring the effects to make sure it is working properly. Through observation and from talking to the residents and staff there was evidence to show that privacy and dignity is up-held. Residents appeared happy and relaxed, they responded positively to conversations and care interactions. Everyone at the home was well clean and well dressed in clothing appropriate for the season. The AQAA told us that all staff use the term of address preferred by the residents and are instructed during induction on how to treat service users with respect at all times and to ensure service users are consulted in matters relating to their own personal care. We did see that people had been consulted and had signed their own care plans. This is enforced throughout other aspects of training and care at the home. We observed that staff are polite courteous and attentive to the residents. Staff spoke quietly and politely to people. They were discreet when supporting people from the lounge to the bathroom. We saw that they knocked on doors before entering peoples rooms. Residents told us that the staff are approachable and obliging. Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does provide the residents with some opportunities and facilities that enable them to maintain an appropriate and fulfilling lifestyle. Family links are encouraged and maintained wherever possible. The home provides nutritious and varied meals for the residents. EVIDENCE: There was a friendly and relaxed atmosphere on the day of our visit. Some people were having their hair done by the hairdresser who told us that she visits every 2 weeks. Other people were reading magazines. Some people had chosen to stay in their room to watch T.V. One lady told us that she follows all the soaps on the T.V and has magazines about the soaps in case she misses any thing. Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 17 The home are now taking into consideration what people like to do and this is recorded in their care plans. We saw that the home had a weekly activities programme displayed in the dining room area. People said that they chose whether they join in or not. One person had said that they did not wish to join in any group activities and this was recorded in the persons care plan. Activities included arm chair exercises skittles, reminiscence, manicures and bingo. There was records in place to show if people had joined in and whether or not they had enjoyed the activity. Residents told us their favourite was skittles. The garden area has improved and people are encouraged and supported to go out-side in the better weather. On the day of the inspection one lady sat out-side with a staff member. She said “It’s lovely out there. It’s so nice to get into the fresh air”. What people do in the home and how this is evidenced has improved since the last visit. One person told us you join in if you want to, you have a choice. No one forces you to do any thing you dont want to. The AQAA stated “The Home has sought the views of the service users and considered their varied interests when planning the routines of daily living and arranging activities both in the home and the community” Staff and residents told us that people go out on occasions with relatives but this is not incorporated into the homes activities. The manager told us she would look at this. She did say that they do ask people if they want to go out but they say ‘NO’. She is going to look at other ways of encouraging people to do different things. The home provides support and care for people with different abilities, capabilities and likes and dislikes. Activities could be more invidualised to meet the individual needs of the residents depending on their abilities and interests. The home are providing a generic programme of activities. On the day of the visit no relatives came to the home. But we were told that people are encouraged to maintain contact with family and friends and are able to receive visitors in the privacy of their own room if they wish. One lady told us that she has regular visits from her friend. Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 18 The people we spoke to felt they are able to have choice in regards to their day-to-day lives. Examples given were that they could get up and go to bed when they liked. They could choose what to eat and where to eat their meals. We did observe that people were asked by staff about what they wanted. The home does have an understanding about diversity and choice about but this is difficult to evidence. All residents are invited to attend residents meetings, which are held at regular intervals. The meetings give people the opportunity to express their views and make suggestions on how they would like things to improve or be done differently. The manager told us that suggestions are listened to and acted on. The service doesnt get involved in handling peoples financial affairs. Instead, most people get help from members of their family or advocates. People are encouraged to make their bedrooms personal. They can bring in things for their own homes so that they can have personal items around them. We saw examples of this. People have their own photographs and ornaments so that their bedrooms feel more like home. The service told us that Roann House has a four weekly menu rota. The AQAA told us that all menus were devised with input from the residents and relatives. Menus are written daily on a board in large print so people can see what is on offer. All meals are recorded on separate breakfast, lunch and supper lists – The weekly menus are posted on the notice board and all residents are made aware of this. Likes and dislikes are recorded in resident’s profiles and a chart of all service users likes/dislikes is also displayed in the kitchen. Breakfast, lunch and supper lists are already in place and completed daily by staff. Residents told us that they did have a choice about the menu and their preferences are considered. A lunchtime meal was observed; this was relaxed and unhurried with residents able to take their time to enjoy the food. Tables and the food were well presented. We saw that staff were available to offer discreet assistance if required. People were given time to eat their meals without feeling hurried. Staff were seen to ask people what they want and offer them a choice of food and drinks. The home employs a cook to work throughout the week. She prepares the main meal at lunchtime. The staff keep a record of meals and who has chosen what. They record the amount of food eaten by the residents. This means any dietary issues can be easily identified and acted on. People have snacks and drinks throughout the day and there is a snack and drink before they go to bed. Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 19 Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are confident complaints will be listened to and dealt with appropriately. People who use the service are protected from abuse. EVIDENCE: The home has a complaints procedure which is on display. New residents also receive a copy of the complaints procedure which is included in their information pack when they move in to the home. Some of the residents we spoke to were able to tell us what they would do if they had a complaint or a concern. They said that the manager would listen to them and would act on their complaint. The services AQAA told us “that if service users wish to make a complaint or register a concern, they should find it easy to do so. The ethos of the Home is Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 21 that it welcomes complaints and suggestions about the service as it gives us an opportunity to learn from them. Individuals and others associated with the Home say they are extremely satisfied with the service, feel safe and supported. All staff working at the Home know the importance of taking the views of service users seriously and of listening to and responding to raised issues. Our complaints policy is intended to ensure that complaints are dealt with promptly and that all complaints by service users, relatives and carers are taken seriously”. This procedure has improved since the last visit to the home. We were told that there have been no direct formal complaints made to the home since the last inspection. When we visited the home last year a concern was raised which prompted us to initiate a safe guarding alert. This had not been resolved when we made our last report. Since then, the concern was looked at by the local social services safe guarding adults team. This was dealt with through safe guarding procedures and the alerts have now been concluded and closed. The home have followed all the recommendations made through these meetings, and have worked to improve the outcomes for people. At our Random Inspection dated 8 January 2009, people were receiving the care and support that protected their wellbeing. The care staff have received training in safe guarding adults. Staff were able to tell us about abuse and what they would do if they if they suspected or evidenced that someone was not being treated as they should be. Staff told they knew about the whistle blowing policy and would have no hesitation in reporting any suspicions or concern immediately. The homes recruitment procedure includes undertaking formal checks to ensure that potential employees are suitable to work with vulnerable adults. The home does not handle residents finances. Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been some improvements made to the premises since the last key inspection. It is important that the ongoing programme of redecoration and refurbishment continues. EVIDENCE: The home now have a maintenance plan which identifies the areas of the home that need re-decorating and refurbishing. Improvements have been made since the last visit. The hallways and dining area have been painted. The conservatory has been tided up. The garden has also improved and there are plants and flowers and a seating area. People said that they do go into the Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 23 garden and enjoy spending time there in the better weather. During our visit we saw people in the garden. The AQAA told us that the home would like to improve the decoration of the home at a more rapid rate but budget issues have been a barrier. The maintenance programme continues with the painting of the upper floors”. The home was clean and smelt fresh. As the home only has 6 residents at the moment care staff are doing the cleaning. The provider told us they would employ a cleaner as soon as the number of residents increases The bathrooms are clean and serviceable. Cupboards and items that had been cluttering one bathroom have now been removed. There are bath lifts for residents who need assistance. Some areas of the home do have radiator covers. Some people have chosen not to radiator covers in their bedrooms. We were told that this has been documented in their care plans. People who are able can move freely around the home. Others are provided with wheelchairs or walking aids to assist them and they are supported by staff to get around. They said they had no complaints or concerns and liked living at Roann House. We saw that people were relaxed and comfortable in their environment. In January 2009 concerns had been raised about the home not being warm enough. This information was passed to the local safe guarding team and an alert was opened. The commission did a random inspection on 08/01/09 following the alert. This means that we visited the home and just looked at the areas that were of concern. We found that all the areas used by people, such as bedrooms, lounge / diner and bathrooms were warm. We found that bedrooms were comfortably warm. The delivery of bath water temperature was checked weekly and each time a person had a bath. This was clearly recorded. The safe guarding team conducted further investigations and recommendations were made. The home acted on these recommendations and the alert was close in March 2009. At this inspection we saw that temperatures throughout the home continue to monitored and are within the recommended temperature range. At the random inspection we found that the home was generally safe. At this visit all furniture identified as a risk had been securely attached to the walls. The requirement made at the random inspection has now been met. Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are adequate numbers of staff with sufficient training and experience to meet the needs of the residents. The staff have a good understanding of the residents and positive relationships have been formed. Recruitment practices protect residents. EVIDENCE: We looked at the duty rota and saw that there is consistently enough staff available day and night to look after the residents. We spoke to staff and they are aware of their roles responsibilities to the service and its users. At the time of the visit the care staff are undertaking cleaning and laundry duties. The Manager told us that this is because they only have six people living at the home at the moment and care staff have the capacity to do this. She told us it is not to the detriment of time with the residents. Residents told us that there is staff available when you need them. They said the staff are very good and very kind. Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 25 A survey we received said “Staff are caring and well trained”. At the visit we saw peoples needs being anticipated and promptly met by staff. The staff told us they have developed good relationships with the residents. We observed that the staff are accessible and approachable and exhibited good listening and communication skills. We saw people laughing and joking with the staff. The training provided by the service has improved since the last inspection. The home has an NVQ programme for care staff and the service told us that all the care staff who have NVQ level 2 or above. The home has a training matrix and the staff are up to date with mandatory training. Training has been planned to make sure any gaps are filled. Staff have now received the specialist training they need to do their jobs effectively and safely. They have received training in safe guarding adults, care planning, and record keeping. They have also had training in the mental capacity act, diabetes, epilepsy and continence and dementia. Further training is planned. New staff at the home receive an induction which included the Common induction standards. This means that people are supported by staff who have the competencies, skills and knowledge to do their jobs effectively and safely. The requirement made at the last inspection has been met To make sure the residents are kept safe and are protected the home has thorough recruitment practices in place. We looked at the staff files of the 2 most recent staff to come and work at the home. One person had just started and was waiting for a full police check to come through. The home had got a POVA 1st check and the staff member was working under supervision until the full check arrived. Staff records show that the recruitment practice includes references and police safety checks. The home also kept a record of questions they asked at interview and explored any gaps in employment. Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager has the qualifications and experienced to run the efficiently and safely. There are quality assurance systems in place to improve the service and for auditing and recording purposes. The health, safety and welfare of the service users is promoted and protected. Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 27 EVIDENCE: The Registered Manager and the Responsible Individual share the management of the Service. Both are registered mental health nurses and have operated residential homes for a number of years. They, along with another family member complete the administration duties in the home. They also undertake care support duties and at least one of them is on duty on all daytime shifts. To make sure people have a say in how the service is run and how things are going for them, quality assurance surveys are sent to residents, relatives, and other stake holders and some had been returned. The surveys have identified some of the strengths and weaknesses of the home. These have been discussed in residents meetings and there is a summary of the findings and what people said about the service included in the service user guide We received an AQAA from the home when we asked for it. The information in it was sufficient to assist us with the main parts of the inspection process. The AQAA told us how the service has improved and how it plans to improve in the future. The AQAA would have more meaningful if it gave a more personal account of the home. The service has no involvement with people’s finances. Staff receive regular supervision and annual appraisals. Staff receive the support they need to do their jobs effectively and safely. There are regular staff meetings. Policies are in place to strengthen safe practices. The home has informed us that all the relevant checks and inspection of equipment and system have been undertaken. An accident book is maintained. We looked at the fire and water checks. Fire assessments and checks are done the required intervals. Water temperatures are taken and comply with regulations. Drug cupboard and fridge temperatures were also evidence and were within the stated ranges. The manager is aware of untoward incidences to the Commission under Regulation 37. Containment of Substances Hazardous to Health (COSHH) products are locked away safely. Environmental risk assessments are in place. Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Roann House DS0000057418.V375700.R01.S.doc Version 5.2 Page 30 Care Quality Commission South East The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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. 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