Care Home: Rock Lea

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What the care home does well The manager and supervisors are making sure that people`s needs are fully assessed and that the home is able to provide a suitable service to them before they move in, particularly for people who are referred at short notice. People are able to visit the home or have a short stay so that they can "try it out first". Clear contracts are issued to people when they move in that explains the rules of the home and what they can expect for the fees paid. Care plans, which provide information for staff to help them care for a person in the way they prefer, are very detailed and make sure people get a personalised service that responds to their individual needs. The staff also work closely with families and other professionals to make sure people`s personal and healthcare needs are being met. Sometimes other professionals have provided specific training or guidance to help staff to support a person. A good example of this was the Palliative care training, which has proved very effective and improved people`s experiences, which were reflected in comments made in some thank you cards sent to the manager and staff such as, "Thank you for the excellent care". The staff team are working hard to develop the range of activities they are able to provide to people and there are new activities taking place which people are enjoying. These have been introduced based on discussions with people at the `Resident`s meetings` or through link worker contact, which is good practice. Mealtimes are a pleasant social occasion that people look forward to and good systems are in place to make sure people are getting the food and nutrition they need. The home has received six compliment cards since the last visit praising the manager and staff for the "excellent and wonderful care and attention" they have provided. Suitable aids and adaptations are in place that support people`s independence and keep both them and the staff safe. Staff consistently talked about the "good supervision and support" they receive and how staff "work well as a team". Relatives said they are always "made welcome" and that staff are "friendly and helpful". Staff receive suitable training with the majority of them having completed their NVQ 2 qualifications. This gives them the skills and knowledge for their role and helps them to provide a consistent and reliable service. People`s views and opinions are valued with link worker meetings and residents meetings making sure their voice is heard and that the home is run in their best interest. What has improved since the last inspection? The menus have been looked at and changed based on people`s preferences with fresh local produce now being used. The new four week rolling menu provides a good selection of nutritious food with specific tastes and diets catered for. The increase in staff hours and how these are being used at key times of the day has improved the service provided to people and the choices they can make about how they spend their day. The introduction of person centred plans for all the people in the home makes sure that individual needs are recorded and the service responds appropriately to them. What the care home could do better: When a medication risk assessment is completed to enable a person to self medicate it should be agreed and signed by a medical professional to make sure the person is competent to administer the correct dose and manage the medication safely. Risk assessments should be in place that promote a person`s independence but also support and safeguard them when they are outside of the home in the local community. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rock Lea Abbey Road Barrow in Furness Cumbria LA13 9SJ     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: Ray Mowat     Date: 0 2 0 2 2 0 0 9 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. that people have said are important to them: They reflect the things 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 26 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 26 Information about the care home Name of care home: Address: Rock Lea Abbey Road Barrow in Furness Cumbria LA13 9SJ 01229894546 01229894543 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cumbria Care Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 26 Number of places (if applicable): Under 65 Over 65 6 26 dementia old age, not falling within any other category Additional conditions: 0 0 The home is registered for a maximum of 26 service users to include: up to 26 service users in the category of OP (Older people) up to 6 service users in the category of DE(E) (Dementia over 65years of age) The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Standards. Date of last inspection Brief description of the care home Rock Lea is a care home providing personal care and accommodation for 26 older adults, of whom six may have dementia. The registered provider is Cumbria Care, an independent business unit of Cumbria County Council. The Home is located in a residential area on the outskirts of Barrow-in-Furness, close to bus routes into the town. The home was formerly a Victorian residence and has retained many original features. It has been extended and altered to provide accommodation on two floors, Care Homes for Older People Page 4 of 26 Brief description of the care home accessible by a passenger lift. The home has two good size lounge/dining rooms and a conservatory lounge/diner. The home has an EMI unit for six people with its own lounge/dining area with accessible toilet and bathroom facilities. All the twenty-six rooms are single occupancy, with eight having en-suite facilities. The home has extensive grounds to the front and rear, including well-kept gardens and parking facilities. Information about the home is made available to existing and prospective residents in the Service User guide and Statement of Purpose, which are displayed in the foyer along with the previous inspection report. The range of fees currently charged range from £363 to £422 per week. Care Homes for Older People Page 5 of 26 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: The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. During the visit we (The Commission for Social Care Inspection) met with people living in the home, visitors and relatives and spent time with the manager and supervisory staff on duty. We also met with care staff individually and talked to them as they went about their duties. The manager completed a self assessment questionnaire called an Annual Quality Assurance Assessment (AQAA) and sent it to us before the inspection visit. This provided us with information about how the home is run and the managers views on what the home does well, where they have improved and plans for the future. There is Care Homes for Older People Page 6 of 26 also information about the people who live in the home and the staff working there. Surveys were sent out as part of this inspection to people living in the home, staff and other professionals with their views being used to formulate the judgements in this report. We also examined records relating to the running of the home that are required by legislation, which included care plan files that guide staff in supporting people to achieve their goals and lead independent lives. We examined staff files and records relating to the maintenance and safety of the home. What the care home does well: What has improved since the last inspection? The menus have been looked at and changed based on peoples preferences with fresh local produce now being used. The new four week rolling menu provides a good selection of nutritious food with specific tastes and diets catered for. The increase in staff hours and how these are being used at key times of the day has improved the service provided to people and the choices they can make about how they spend their day. The introduction of person centred plans for all the people in the home makes sure that individual needs are recorded and the service responds appropriately to them. Care Homes for Older People Page 8 of 26 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 9 of 26 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 10 of 26 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 are given suitable information about the home and the terms and conditions of their stay. Appropriate assessments are completed to make sure their needs can be met and suitable equipment is in place to support their independence. Evidence: People are provided with suitable information when considering a move into the home, with the homes statement of purpose and service user guide being provided and the most recent inspection report made available. Visits to the home are encouraged but it is not always possible for people to do this. The majority of the referrals taken by the home come from either the local social work teams or the hospital. Increasingly of late the home has come under pressure to take people at short notice as emergency placements. When this happens it does not allow time for visits or for the manager or supervisor to visit the person and complete their own assessment of need, however they always make sure they receive a full assessment from the social worker or Care Homes for Older People Page 11 of 26 Evidence: hospital before agreeing to take a person in. Some people are at an advantage as they have stayed in the home previously for short respite stays, which gives them an insight to home life allowing them to make an informed choice about moving in permanently. The manager works closely with the supervisory team and other professionals invoved in a persons care to make sure the home has the appropriate resources and equipment to safely manage their needs. The manager gave a recent example where she had to refuse a person, as she felt the persons needs could not be met in the home environment. We examined some pre admission assessments, which are completed with the person, their relatives and any professionals who are involved such as the Occupational Therapist or Social Worker. They were very detailed, which gives staff an insight to the persons needs and preferences about the support they require and how they like to live their lives. Care Homes for Older People Page 12 of 26 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. The new person centred care plans provide staff with valuable information that helps them to support people in the way they prefer, providing a very personalised service that meets their individual needs. Evidence: Improvements have been made to the care plans making them more person centred and reflecting individual needs and desires about how people like to live their lives. Historical infomation is also recorded in detail, such as family history, significant events and relationships in peoples lives and also smaller details that are equally important for staff to know such as likes, dislikes, what makes people happy, sad or angry. This level of information is particularly important when supporting people with Dementia or memory loss and enables staff to provide a very personalised service. We observed this level of person centred care being provided during this visit and discussions with visitors to the home confirmed this, which is captured in the following comments. Its a marvellous home, the staff are so caring, I call it the Rock Lea Hilton. Care Homes for Older People Page 13 of 26 Evidence: Healthcare records are maintained within the care plan and record all routine and unplanned health interventions and contact with health professionals. It was evident from our discussions with people who live in the home, their relatives and other professionals that staff have good relationships with the health agencies and ensure people get the service they require. One relative described how their relative was not well but the staff were onto it straight away and got it sorted out. Through the assessment process and ongoing reviews of care plans all aspects of healthcare are monitored including oral hygiene, foot care, nutrition assessments and pressure care, making sure concerns are responded to in a timely manner. We examined medication records against the stock held in one of the medication cabinets. MAR (medical record sheets) were found to be up to date and accurate and medication stock levels were accurately recorded. Photographs were used in the MAR charts to ensure the person can be easily identified. PRN (as and when required) medication was recorded with a management plan agreed about how and when it should be given. One person had a protocol in place to support them self administering medication, this was signed by one of the supervisory staff. This should be agreed with and signed by a health professional to ensure the person is assessed as competent and can safely manage the medication as prescribed. During this visit we observed staff providing unobtrusive support to people and dealing sensitively to their personal care needs at all times respecting their privacy and dignity. Staff were respectful in the way they addressed and spoke to people and encouraged and supported them to help themselves and maintain their independence. Care Homes for Older People Page 14 of 26 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 home is developing the range of activities it provides to help people pursue their leisure interests and hobbies and lead a fulfilling lifestyle. Evidence: The home now has a member of staff who takes a lead role in coordinating the activities both in the home and local community, based on peoples wishes. Residents meetings are used to discuss ideas for new activities, from such a meeting there was a request for a film afternoon, which was successful and more are planned. Some activities are taking place on a weekly basis and prove popular such as the hairdressers weekly visit, church services and a Bingo session. One person we spoke to was very enthusiastic about the activities and said how much they enjoyed them, particularly the bingo. Another person said how they like to make special cards for family and friends. Entertainers come into the home for concerts or a sing-a-long, which also prove very popular. Fund raising events have also been organised, which people told us about and showed us the photographs recording the event. These have raised funds for the home but also have been held to raise money for other charities, such as the Pink day in aid of breast cancer research. This is a very positive thing to do rather than reinforcing the Care Homes for Older People Page 15 of 26 Evidence: image that older people need charity. Peoples social needs and interests are well documented within the care plans making sure staff are aware of individual preferences and what support people require. Everbody spoken to were complimentary about the food being provided. The manager and cook explained how they had been working hard to improve the menu based on feedback from people living in the home. Fresh produce is used as much as possible such as local fresh vegetables and free range eggs. Individual food preferences are recorded as well as special diets. These are recorded in the care plan with the cook also having a copy in the kitchen. Good practice guidance has been followed with regard to nutrition and peoples diets and food intake are closely monitored. There is always at least two hot meals on offer at both lunch and tea, with the introduction of home made soups proving popular. Afternoon tea has also been introduced when home made cakes and pastries are served, which has also gone down well. We joined two different groups of people for lunch, which is served from hot trolleys on each unit. The mealtime was a relaxed social occasion with staff supporting people as their needs required. Some people had aids in place to maintain their independence at mealtimes such as plate guards. The range of support provided by staff ranged from verbal prompts and encouragement to staff physically feeding someone. However whatever level of support a person required this was done in a dignified manner that encouraged people to be independent. Comments such as its a good home, the grub is lovely and the foods always nice and plenty of it, captures the majority of peoples views about the food in the home. Care Homes for Older People Page 16 of 26 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. People living in the home have their views respected and are safeguarded from abuse. Evidence: The home has an appropriate complaints policy and procedure in place in line with National Mininmum Standards (NMS). This is issued to people in the service user guide and is displayed in the home. It clearly explains the complaints process and timescales involved. There were no recorded complaints, however there were six compliments cards from friends and families of people who had stayed in the home. These included the following comments. Thank you for the wonderful care. We always receive a friendly welcome. Thank you for the excellent care and attention. Survey feedback confirmed that people are aware of how to complain or raise a concern. Most of the staff have now completed safeguarding training helping them to identify potential or actual abuse and how to report it. We met with three staff individually who were able to explain what abuse is and their responsibility in safeguarding people from it. Two safeguarding referrals have been appropriately referred and investigated ensuring people were safeguarded through the process. The manager is aware of her responsibilities and has worked closely with other agencies to maintain peoples safety. Care Homes for Older People Page 17 of 26 Care Homes for Older People Page 18 of 26 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. Rock Lea is furnished and decorated to a good standard and provides a safe and comfortable home. Evidence: The organisation has an accommodation manager who liaises with the homes manager to complete an annual buildings survey and agree a programme of repairs and renewal to maintain the building. All areas of the home we visited were clean and hygienic and free from hazards or lasting malodours. Decorators were in the home and were redecorating the hallway and two bedrooms. The furnishings and decor are maintained to a good standard and provide a safe and homely atmosphere. The grounds and gardens are well kept, with a secure garden area to the rear of the home that provides good space for people to enjoy the summer weather. All the bathrooms and toilets examined were clean and accessible and were suitably equipped to enable peoples personal care needs to be met. Dedicated domestic staff make sure the home is clean and hygienic and free from offensive odours. There is a well equipped laundry with industrial quality machines that ensure clothes are appropriatley laundered and free from infection. Care Homes for Older People Page 19 of 26 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. There are suitable numbers of competent and experienced staff to meet the needs of the people living in the home. Evidence: We examined the staff rota and talked to the manager, staff and people living in the home. From this it was evident that there were suitable numbers of staff in place to meet the needs of the people currently living in the home. The new manager has been reviewing the deployment of staff and has recently increased the staffing levels in the home at key times of the day. This has relieved the pressure at mealtimes and enables activities to take place in the afternoons. The home currently has a full compliment of staff, including relief staff, and enjoys the benefits of having a stable staff team, who have developed good relationships with people living in the home and are committed to providing a personalised service. Over 50 of staff have completed their National Vocational Qualification level 2 (NVQ), with more staff working toward the qualification. Induction training is provided for all new staff in line with Skills for Care standards. The manager and supervisors are monitoring the training needs of staff with individual continuing professional development files in place for all staff to record all training and development activity. Sound recruitment procedures are in place that make sure all new staff are suitable and safe to work with vulnerable adults and that they are aware of their roles and Care Homes for Older People Page 20 of 26 Evidence: responsibilities in the home. Care Homes for Older People Page 21 of 26 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 new manager is providing clear leadership and support and ensuring the home is run in the best interests of the people living there. Evidence: The new manager Rachel Martin is suitably experienced and is working toward her NVQ Registered Manager award. She is aware of her role and responsibilities and the legislation and good practice that guides her. There is a clear management structure in place that is working effectively. Staff, people living in the home and their relatives have developed good relationships with the manager and there is a mutual respect that was evident. Staff we met with talked about receiving regular supervision and that they were well supported. They felt positive changes have been made and that they can contribute to the running of the home and that their views are listened to and respected. An annual quality assurance survey takes place that is due again soon. This provides the manager with good feedback about peoples views and their hopes for the future. In addition to this link workers are appointed for each person who work Care Homes for Older People Page 22 of 26 Evidence: closely with them to make sure their care plan is up to date and reflects their changing needs. Regular residentss meetings are also used to consult with people and get feedback from them about all aspects of home life, including what is working well and suggestions to improve things. Only small amounts of personal finances are held by the home with clear records maintained of all transactions. People are encouraged and supported to manage their own finances and have suitable lockable space in their rooms. We examined a selection of staff files and found these to be in order including regular supervision sessions with notes recorded of discussions and any actions agreed. The organisation provides clear policies and procedures for the home in relation to Health and Safety and safe working practices. Staff spoken to are aware of their responsibilities and the policies that guide them. We examined a range of risk assessments including an updated Fire risk assessment and COSHH assessments and data sheets. Personal risk assesments have also been developed for in house activities, however risk assessments to support activities outside the home should be strengthened. The fire log was examined and was up to date with all routine safety checks and instructions taking place at appropriate intervals. Care Homes for Older People Page 23 of 26 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 24 of 26 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 1 9 When a person wishes to self administer medication a multi disciplinary assessment and agreement should be in place ensuring they can safely store and administer the medication as prescribed. Risk assessments to support activities outside the home should be strengthened to make sure people are safeguarded but their independence is encouraged. 2 38 Care Homes for Older People Page 25 of 26 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. 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