Care Home: Rockley Dene Residential

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What the care home does well What has improved since the last inspection? There was an indication that efforts were being made to date the plan of care and put a time when the entry was made. The plan of care for people who were admitted on a respite basis and had been resident before, had, had their plan reviewed. This confirmed previous information about meeting their needs had been assessed and updated as required, to reflect any changing needs. Likewise, the review of risk assessments was now taking place to assess changing needs and risks. Records of medication in stock were being maintained. This meant there was an accurate record of medication so that auditing of medication could take place. Systems were in place to assist staff in knowing any allergies of people, so that they did not have an adverse reaction to medication they might be given. Staff administering medication had received training in the safe handling of medicines. The record for controlled drugs was now in a bound book with numbered pages, which reduced the risk of the record being altered. The training provided for staff in order to safeguard adults had now made it clear to staff the different types of abuse and that they now said they would report this to keep people safe. A protection of vulnerable adults first check had been carried out before staff had commenced employment so that people were protected from harm. A full Criminal Records Bureau check had then been obtained.There was 50% of care staff trained to NVQ level 2 or equivalent. This should ensure sufficient staff are on duty that are trained and competent to do their job and make sure people are looked after safely. The record of financial transactions identified from where the money had been received and the purpose for which the monies had been used. Notifiable incidents were being reported to the Commission for Social Care Inspection, so that they could monitor the action the service had taken as a result of any incidents. The manager had commenced a City and Guilds Care Management and City and Guilds Care Assessor course at Barnsley College. What the care home could do better: Although people, their relatives and health care professionals were clear the health and personal care that people received was based on their individual needs, this needs to be documented in their individual plan of care. This is so the service can demonstrate this, with the records they keep. Improve the record keeping for the receipt of medication and administration of medicines. This would support information people say and confirm they are receiving their prescribed medication. To demonstrate a thorough recruitment process the staff file should include a full employment history with written confirmation of the reasons for any gaps in that work history. Assess the level of risk should people require first aid in an emergency and take appropriate action to meet any action that is identified. Review the moving and handling plan of a person to make sure the move is safe for the person and staff. CARE HOMES FOR OLDER PEOPLE Rockley Dene Residential Park Road Worsbrough Barnsley South Yorkshire S70 5AD Lead Inspector Mrs Jayne White Key Unannounced Inspection 17th December 2007 08:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rockley Dene Residential Address Park Road Worsbrough Barnsley South Yorkshire S70 5AD 01226 245536 01226 280 187 none 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) Angel Care Plc Mrs Beryl Skidmore Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th December 2006 Brief Description of the Service: Rockley Dene is a care home providing personal care and accommodation for up to 39 people. The service accommodates people on a permanent basis and also for people wanting a short stay. There are 27 single rooms, 2 of which are en-suite and 6 double rooms, 2 of which are en-suite. Accommodation is over two floors. There is a passenger lift and stairs to access bedrooms on the first floor. There are car-parking facilities. The garden areas are well maintained and there are lawned areas with garden furniture. The area is accessible to people. There are 3 lounge areas and a large dining room. The home has sufficient bathing facilities. There is a central kitchen and laundry room. The home is situated in a residential area of Barnsley close to amenities and on the local bus route. Information of the services and facilities the home offer, including the service user guide and the most current Commission for Social Care Inspection (CSCI) report is in the entrance hall. A copy of the service user guide is kept in each person’s bedroom. The manager said the fee was £341.50. There are additional charges for chiropody and hairdressing. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. I visited the home on 17 December 2007 between 8:45 and 16:45 without giving them any notice. Before the visit I took into consideration other information I had received. This included: • An Annual Quality Assurance Assessment (AQAA). An AQAA is a document completed by providers. It gives them the opportunity to tell the CSCI how well they think they are meeting the needs of people using their service. Information contained in notifications from the home about any deaths, illnesses and other events, which affect the health and well-being of people living there. Surveys that were sent to a range of people, asking them about the home. Seven came back from people that lived there, two from relatives of people that lived there and two from health care professionals. • • During the visit I spoke with people that lived there, their relatives or friends, staff, the manager, looked round parts of the building and read some records. I would like to thank the people, their relatives and friends, staff and the manager for their time and co-operation throughout the inspection process. CSCI have reviewed their guidance on requirements, therefore, some requirements have been removed if they would have no direct affect on the outcome of the service provided for people. What the service does well: The management and administration of the home was based on openness and respect, which was beneficial to people and staff. Staff morale was good and everyone I talked to spoke positively about the staff and manager. There was a relaxed and friendly atmosphere. People moving into the home received information to help them make the right decision. They had their needs assessed, to ensure the home was able to meet their health, social and care needs. People said “we viewed many care homes and returned to Rockley Dene at least twice. This was by far the most suitable”, “I didn’t want to come, but now I have, I’m happy and settled here”, “it’s better than I thought it would be when I’d looked round – it’s just like home”, “my son looked round, he knew the area well”, “I didn’t choose it, my son did, but he chose well” and “I looked at three or four places, before settling on this one”. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 6 People, their relatives and health care professionals were clear the health and personal care that people received was based on their individual needs. Their comments included, “I’m really happy and settled here – well looked after and all my needs are met”, “in my opinion the care my mother receives is excellent”, “they monitor my mother’s health very closely and take action when required”, “my relative is cared for very well. She regularly has the doctor and goes to hospital”, “everything they do is perfect. My relative is always happy and well looked after”, “I’m pleased with the care they give my relative”, “if there is anything wrong with my relative it is reported to me right away”, “I feel that all the residents are treated well. What I have seen they are well cared for, always clean and they have their hair done every week. There is nothing to worry about” and “all residents are monitored and treated for ongoing health needs”, “Rockley Dene are in frequent contact with me regarding the mental health needs of, not only my client, but also the needs of other residents who may have mental health concerns”, “I am continually impressed with Rockley Denes dedication and compassion with regards individuals health care needs. With regards to my client, Rockley Dene are proactive in meeting their complex needs”, “during the time I have been visiting Rockley Dene they have been flexible in meeting the needs of the elderly, often mentally ill clients. I also recall the individualised care they gave to a married couple, to enable them to stay together and respecting their race and culture”. Health professionals said the service were good at “identifying any problems and rectifying them”, “individualised care/holistic care”, “excellent liaison and communication with outside agencies”, “placing the needs of residents as paramount importance” and “involvement of residents and others in care planning”. The principles of respect, dignity and privacy were put into practice. People were assisted to make choices and decisions about their life style and the social and recreational activities available met people’s expectations. They said, “I like it here”, “there’s varied activities every day”, “you can’t expect to live on your own for 20 years and then expect to live with 30 other people and it to be alright. It has to grow on you”. They said, “having your personal possessions around you and your family visit is what makes it feel like home”. When I spoke to people they said their family and friends could visit “at any time”. The friend of one person said, “it’s one of the best places I’ve seen and I go to a few”. They said what makes it nice is that you’re made to feel welcome, you get a drink and staff chat with you. People were generally satisfied with the choice and quality of food offered, commenting, ‘it’s good’, ‘it’s substantial’ and ‘there’s a good variety’. People were confident their complaints would be listened to and acted upon. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 7 The building and its environment were clean, relaxing and well maintained so that people said they found the home comfortable relaxing and to their satisfaction. All residents spoke positively about their environment and the level of cleanliness commenting, “there are never any smells” and “Rockley Dene is immaculately clean, well decorated, homely and cosy”. Generally staff were trained, skilled and in sufficient numbers to support people and maintain the smooth running of the service. Descriptions of staff included, “they are extremely helpful and supportive”, “I’m happy with the staff”, “the care staff appear cheerful and caring towards all the residents and are sensitive and patient to their individual needs” and “the residents I have met have praised the home and staff extensively”. Effective quality assurance and quality monitoring systems were in place that sought the views of people who used the service. What has improved since the last inspection? There was an indication that efforts were being made to date the plan of care and put a time when the entry was made. The plan of care for people who were admitted on a respite basis and had been resident before, had, had their plan reviewed. This confirmed previous information about meeting their needs had been assessed and updated as required, to reflect any changing needs. Likewise, the review of risk assessments was now taking place to assess changing needs and risks. Records of medication in stock were being maintained. This meant there was an accurate record of medication so that auditing of medication could take place. Systems were in place to assist staff in knowing any allergies of people, so that they did not have an adverse reaction to medication they might be given. Staff administering medication had received training in the safe handling of medicines. The record for controlled drugs was now in a bound book with numbered pages, which reduced the risk of the record being altered. The training provided for staff in order to safeguard adults had now made it clear to staff the different types of abuse and that they now said they would report this to keep people safe. A protection of vulnerable adults first check had been carried out before staff had commenced employment so that people were protected from harm. A full Criminal Records Bureau check had then been obtained. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 8 There was 50 of care staff trained to NVQ level 2 or equivalent. This should ensure sufficient staff are on duty that are trained and competent to do their job and make sure people are looked after safely. The record of financial transactions identified from where the money had been received and the purpose for which the monies had been used. Notifiable incidents were being reported to the Commission for Social Care Inspection, so that they could monitor the action the service had taken as a result of any incidents. The manager had commenced a City and Guilds Care Management and City and Guilds Care Assessor course at Barnsley College. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 9 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 Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): The outcome for standard 3 was inspected. The service did not provide an intermediate care service (standard 6). People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People had information available to assist them in choosing the home, but some of this information was out of date. People moving into the home had their needs assessed, to ensure the home was able to meet their health, social and care needs. EVIDENCE: All surveys received from people confirmed people or their family received enough information about the home before they moved in. This helped them to decide if the place was right for them. One person commented, “we viewed many care homes and returned to Rockley Dene at least twice. This was by far the most suitable”. Surveys from relatives also confirmed they received sufficient information. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 11 When I spoke to people about moving into the home they said, “I didn’t want to come, but now I have, I’m happy and settled here”, “it’s better than I thought it would be when I’d looked round – it’s just like home”, “my son looked round, he knew the area well”, “I didn’t choose it, my son did, but he chose well” and “I looked at three or four places, before settling on this one”. The AQAA stated there had been some alterations at the home. When this was discussed with the manager it became apparent this affected the registration of the service. Previous discussions and correspondence had taken place with the owner explaining what he needed to do, dependant on the alterations that took place. The owner had not acted on that information, which meant a variation of registration as a result of the alterations had not been submitted. This is necessary because the service can no longer take forty people as stated on the certificate of registration and therefore the certificate needs amending. The manager said the service user guide had not been amended to reflect the changes. The majority of people returning the survey said they had received a contract. One who hadn’t clarified this by saying, “I am aware there is a contract possibly in one of the families possession”. The AQAA stated: • The home manager would visit a client and do a full assessment to be able to set up a care plan. • The person would be given all the information they needed, for example, costs, so that their needs are met. • Brochures would be taken and the client would be invited to visit the home for a meal or for the day. I looked at three peoples’ files for the assessment that was undertaken. A needs assessment was carried out for all of them prior to their admission. This confirmed that the service was appropriate for the person and provided staff with the information to formulate an individual plan of care. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 7, 8, 9 and 10 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People, their relatives and health care professionals were clear the health and personal care that people received was based on their individual needs. However, this was not reflected in their individual plan of care. The principles of respect, dignity and privacy were put into practice. EVIDENCE: Surveys returned by people identified they always or usually received the care and medical support they needed. One commented, “I’m really happy and settled here – well looked after and all my needs are met”. The surveys from relatives identified they also felt the care needs of their relatives were always met and that they kept them up to date with important issues. They commented, “in my opinion the care my mother receives is excellent”, “they monitor my mother’s health very closely and take action when required”, “my relative is cared for very well. She regularly has the Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 13 doctor and goes to hospital”, “everything they do is perfect. My relative is always happy and well looked after”, “I’m pleased with the care they give my relative”, “if there is anything wrong with my relative it is reported to me right away” and “I feel that all the residents are treated well. What I have seen they are well cared for, always clean and they have their hair done every week. There is nothing to worry about”. In addition, surveys from health professionals said the service always meets the health care needs of people and they seek advice and act upon it to manage and improve individuals’ health care needs. They commented, “all residents are monitored and treated for ongoing health needs”, “Rockley Dene are in frequent contact with me regarding the mental health needs of, not only my client, but also the needs of other residents who may have mental health concerns”, “I am continually impressed with Rockley Denes dedication and compassion with regards individuals health care needs. With regards to my client, Rockley Dene are proactive in meeting their complex needs”, “during the time I have been visiting Rockley Dene they have been flexible in meeting the needs of the elderly, often mentally ill clients. I also recall the individualised care they gave to a married couple, to enable them to stay together and respecting their race and culture”. They were asked what they thought the service did well and they commented, “quick to identify any problems and rectify them”, “individualised care/holistic care”, “excellent liaison and communication with outside agencies”, “placing the needs of residents as paramount importance” and “involvement of residents and others in care planning”. When I spoke to people they described how they had access to health care services to promote and maintain their health care needs. This included going to hospital as a result of their deteriorating conditions and giving them their medication to reduce the effects of their medical conditions. All people I spoke to said that they felt well cared for and that staff treated them with respect. I looked at three care plans. The files were tidy, well organised and the information was easy to find. The plans contained some good information, including records of medical treatment and risk assessments for mobility and falls, nutritional screening and pressure areas. However, on two of the files the nutritional and pressure area risk assessments identified both people were at risk. This was not reflected in the care plan and there was no action identified that staff needed to take to reduce this risk. This is necessary as it is an integral part of the plan of care and ensures that the changing needs of people are reflected in their plan of care. The plans had been reviewed and there had been some effort to record the time of entry. Healthcare records were in place. However, where there was an identified action to maintain peoples’ health needs this again wasn’t in the plan of care or daily report. This meant it was not possible to clarify health professionals instructions were being carried out and peoples’ conditions monitored. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 14 When I spoke with staff they were aware of the need to treat people with respect and to consider dignity when delivering personal care. Examples given were knocking on peoples’ doors before entering, closing toilet doors when in use and putting the ‘care in progress’ signs on bedroom doors when delivering personal care. I saw staff approaching people in a respectful manner and respecting individual preferences. There were good relationships between people and staff. People were clean, as was their hair and nails and they were well dressed. This confirmed staff were maintaining respect and dignity for them. The AQAA stated care staff had been trained in the safe handling of medicines and the pharmacy visits to do regular checks. It also stated there was a policy and procedure for the control, storage, disposal, recording and administration of medicines. Senior care staff administered medication. I saw the administration of medication. The medication was given to people before the record was signed to confirm the person had taken the medication, which was good practice. People had a glass of water when they were given their medication to help them swallow their medication. I looked at the recording and storage of medication on a sample basis. Medicines were securely stored. On the whole, medication received was clearly recorded on the person’s medication administration record and medication administered had been signed for. However, the administration record did not reflect information provided in the case file or what people had said they were receiving. An example was an injection that had been given. This meant there were gaps in the audit trail to confirm people were receiving their prescribed medication. The receipt and administration of controlled drugs were recorded in a bound book. The record of the dosage of medication to be given in one instance was incorrect, but inspection of the actual medication confirmed the person was receiving the correct dosage. This highlighted staff were not adhering to safe practices regarding the administration medication by checking the record against the actual medication in order to protect people. The record and the amount in stock correlated. Staff responsible for administering medication had received medication training. However, the error on the controlled drug record meant they were not always putting their training into practice, demonstrating their competence in the safe administration of medication to people. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 12, 13, 14 and 15 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People were assisted to make choices and decisions about their life style and the social and recreational activities available met people’s expectations. EVIDENCE: The AQAA stated: • Changes have been made so that clients with different religious needs are supported by their local church or organisation • The home brings in outside entertainers to put on shows for clients. Staff also do shows • Songs of Praise is put on TV • Some clients take communion when the church visits • One family have taken the responsibility to do arrangements on the mantelpiece in the foyer dependant on the time of year and mood of the home The General Report and Business Plan stated a professional artist attends the home one afternoon a month. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 16 The manager said they’d recently appointed a new activity co-ordinator and a programme of activities was being developed listening to what people said they wanted to do. The surveys returned by people said there were always or usually activities arranged by home that they could take part in. One person commented, “I like it here” and “there’s varied activities every day”. When I spoke to people the majority told me they were happy with their lifestyle at the home. They described this as just relaxing and talking to one another, watching what’s happening, watching TV and going out sometimes. They said they were just comfortable in each other’s company. They told me they played bingo and that staff came regularly to see if they were alright. One told me they liked reading. Another said they liked company in the morning and reading the papers, then spending time on their own in the afternoon watching TV. They said they could get up and go to bed as they wished and do what they wanted, within reason. One person said, “you can’t expect to live on your own for 20 years and then expect to live with 30 other people and it to be alright. It has to grow on you”. They said, “having your personal possessions around you and your family visit is what makes it feel like home”. During the visit there was a relaxing atmosphere and I saw people that were able, spending the day as they wished, following their preferred routines. The majority of people were spending their time in the lounges. Whilst doing this they were watching television, reading, writing cards and chatting. The activity co-ordinator spent some time with them playing hangman. The health professional surveys that were received stated the care service always or usually support individuals to live the life they choose. They commented, “as far as I am aware individual choices are taken into account and actioned whenever possible”, “residents report extreme satisfaction with care and meals and activities provided”, “flexibility and ‘thinking out of the box’ is evident to meet the complex health needs of my client. This improves their quality of life considerably” and they identified varied and daily activities as something the service did well. The AQAA stated family and friends are encouraged to visit and food and drinks can be taken with clients. Surveys returned by relatives stated the service always helped their relative to keep in touch with them. When I spoke to people they said their family and friends could visit “at any time”. I spoke to the friend of one person who said, “it’s one of the best places I’ve seen and I go to a few”. They said what makes it nice is that you’re made to feel welcome, you get a drink and staff chat with you. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 17 The AQAA stated: • Meals can be taken in clients rooms and eating times are staggered • Jugs of juice and water are available in lounges all day • Hot drinks and snacks are offered in between meals • Residents are given a menu the day before to choose from a choice • The clients helped put together the menus with the help of Barnsley District General Hospital for the heart beat award • Menus are displayed and worked from in the kitchen • Certificate for Food Award is displayed in the office Surveys from people indicated they always or usually enjoyed the meals at the home. Their comments included, “nice meals. Plenty of variety” and “happy with food”. When I spoke to people they were generally satisfied with the choice and quality of food offered commenting, ‘it’s good’, ‘it’s substantial’ and ‘there’s a good variety’. The dining room was clean and bright making a welcoming environment for people to eat their meals. The tables were set with cloths, cutlery and teapots and menus were displayed on the tables. I saw the lunchtime meal being served. It was relaxing, people were given sufficient time to eat and plenty of attention was provided by staff. This made it an enjoyable experience for people. There was conversation between people and staff. Staff were courteous and respectful to people when they served their meals. I saw carers assisting people who needed help to eat in an appropriate manner. I looked at the menus and saw that there was a variety of different foods offered. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 16 and 18 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service were able to express their concerns and had access to a complaints procedure. They were protected from abuse and had their rights protected. EVIDENCE: The AQAA stated: • The service has a simple information (complaints) form for people to follow • There have been no complaints for several years • The complaints form is in the hallway for people to pick up The response from the survey identified people always or usually knew who to talk to should they be unhappy about any aspect of their care. It also confirmed people knew how to make a complaint. Comments from the survey included, “this (complaints) is not a problem. The manager and staff keep me well informed about all things”, “I have never had any reason to complain”, “there is always someone willing to talk to you” and “I have never had to complain about anything. The service is top class”. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 19 All surveys from relatives also confirmed they knew how to make a complaint. They said the service always took appropriate action if they had raised any concerns about the care of their relative. In addition, surveys from health professionals also stated the service always took appropriate action if they had raised any concerns about a person’s care. They commented, “senior staff have discussed and addressed any queries relating to residents I have visited to the satisfaction of all concerned” and “I have not encountered any concerns or difficulties which would not be amicably resolved”. When I spoke to people the majority said that they had ‘no complaints’ or ‘grumbles’. The complaints procedure, available in the entrance hall ensured that people and their relatives were aware of how to make a complaint and who would deal with them. The manager kept a central record of all complaints, although no complaints had been received since the last visit. The AQAA stated to help keep people safe all staff are shown the whistle blowing policy, staff are CRB checked, all monies kept on behalf of residents are double signed and a receipt kept and no bank accounts are kept for clients in the manager or company name. When I spoke with the manager they were aware of the review of the adult safeguarding policy and procedure for South Yorkshire. When I spoke with staff they had a good understanding of the types of abuse that may occur and were clear of the action they would take to protect people. Apart from newly appointed staff, they said they had received training in the safeguarding of adults. When I looked at staff training records there was a programme in place to train all staff in safeguarding adults and some individual records confirmed this had taken place. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 19 and 26 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The building and its environment were clean, relaxing and well maintained so that people said they found the home comfortable relaxing and to their satisfaction. EVIDENCE: The AQAA stated: • The quality audit shows a positive response from clients and families for the high standard of cleanliness • There is a full time handyperson who maintains the home to a high standard • There is a CCTV camera outside the building round the back where rooms face on to the allotments for the protection of clients from intruders Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 21 • • • • • • • There is a laundry assistant seven days a week Red linen bags are used for soiled laundry and laundry trolleys are colour coded to control the spread of infection All radiators have covers and thermostatic valves to regulate heating All clients personalise their room with pictures and ornaments etc Some rooms have en-suite facilities Bacterial soap is supplied in all rooms plus hand gel and paper towels The laundry have a cross infection certificate The AQAA stated improvements to the environment have included a new carpet to the upstairs landing, putting up blinds in all lounges and the dining room to keep out the sun and replacing some bedroom carpets. When I spoke with people they told me they thought their home was comfortable and were pleased with their living environment. They said they had a comfortable bedroom and were able to bring items of their own furniture and possessions with them. There were three lounges and a dining room. They presented a pleasant and homely environment for people to live. People had access to indoor and outdoor communal facilities. When I looked round the home it was clean, tidy and odour free, which promoted a comfortable and homely environment. Areas were well maintained and pleasantly decorated. There were homely touches of pictures and flowers and it was apparent that the manager and staff took pride in providing a homely environment for people. Furnishings and furniture were of a good standard. I looked in several bedrooms, due to alterations that had been made. These again were clean, tidy, appropriately furnished and pleasantly decorated. The rooms had been personalised by the person that lived there. I saw a number of friends and relatives who were visiting for the first time. All were complimentary about how the home was presented. One comment included, “it’s lovely isn’t it. You don’t expect places to be like this”. Surveys returned by people stated the home was always fresh and clean. Comments included, “the home is kept to a very high standard”, “very clean. You would think you were walking into a hotel”, “very impressed with cleanliness” and “very clean and tidy”. Comments on surveys returned by relative and health professionals were also complimentary about the environment including, “provides an exceptionally clean and hygienic environment”, “Rockley Dene appears to be a welcoming environment”, “excellent hand washing facilities in bedrooms to aid the control Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 22 of infection – wash basin, liquid soap, paper towels and bins” and “it is very clean and always smells nice”. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 27, 28, 29 and 30 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Generally staff were trained, skilled and in sufficient numbers to support people and maintain the smooth running of the service. EVIDENCE: The AQAA stated: • The home is fully staffed at all times • Ancillary staff include a handyperson, cleaner, laundry assistant, cook, kitchen assistant and a dining room assistant. They are on shift seven days a week All surveys returned by people stated staff always treated them well and acted on what they said. They also stated there were always or usually staff available when they were needed. Their comments included, “they are extremely helpful and supportive” and “I’m happy with the staff”. Comments about staff on the health professionals survey include, “the care staff appear cheerful and caring towards all the residents and are sensitive and patient to their individual needs” and “the residents I have met have praised the home and staff extensively”. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 24 All people that I spoke with spoke highly of the staff team. I saw good relationships between people and staff and staff responding to people who needed assistance without them having to wait an unreasonable amount of time. When I spoke with staff they said staffing levels were sufficient and included 1 senior care and three carers on duty during the day and 1 senior care and 2 carers at night. Several staff I spoke with had worked at the home for many years, which meant a consistent service was provided to people, by someone they knew. Ancillary staff were employed to ensure standards relating to food, meals and nutrition were met and the home was maintained in a clean and hygienic state. The AQAA stated: • Staff are trained at induction to promote human rights of clients, visitors and staff irrespective of race, gender, disability and religion. • The Skills for Care induction programme inducts staff to the principles of care and the needs of the service user • 50 of care staff are NVQ trained • 100 of catering staff have received training in food handling, 90 of care staff It states improvements have included access to a lot more training including safe handling of medication, first aid, dementia and fire safety. I looked at three staff files. A recruitment process had been followed including the completion of an application form, a Criminal Records Bureau check or a Protection of Vulnerable Adults first check being obtained prior to the member of staff commencing employment and obtaining references. It did not include a full employment history with written confirmation of the reasons for any gaps in that work history. When I looked at the training and development files for staff the training was not comprehensive as people had not been in employment long. Their initial training, some, which was in-house, had included fire drills, health and safety and protection of vulnerable adults. Some of the staff had received relevant training before working at Rockley Dene including first aid, people moving people, basic food hygiene, recruitment and selection, HIV and Aids, obtaining a management certificate, CPR and health and safety. This training, however could not be verified as certificates to confirm attendance had not been obtained. The manager said this was because the previous employer would not release their certificates. When I spoke with staff they said training since my last visit had improved with more continuous training. This included health and safety, fire and adult Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 25 safeguarding annually. In addition, first aid, food hygiene, safe handling of medicines and infection control. When I spoke to the manager she said all staff had received training in emergency aid. This meant there wasn’t a member of staff on shift qualified to administer first aid. Neither was a risk assessment in place. This meant there was no information to confirm the services assessment of their competence to administer first aid in an emergency, if necessary. Surveys received from relatives stated they felt staff always had the right skills and experience to look after people properly. The surveys from health professionals also supported this stating they felt the care staff always had the right skills and experience to support individuals’ social and health care needs. A comment included, “training programmes are evident, with dedicated care staff to manage and promote this”. Rockley Dene Residential DS0000018277.V355758.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. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 31, 33, 35 and 38 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management and administration of the home was based on openness and respect. It had effective quality assurance systems developed by a competent manager. EVIDENCE: The AQAA stated the manager has been in post seventeen and a half years, working at the home for twenty years. It stated she was attending Barnsley College to achieve City and Guilds in Care Management and City and Guilds Care Assessor. The length of time the manager had worked at the home had given her good experience in the caring profession. She had a good knowledge Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 27 of the needs of people, was committed to providing a good quality service and communicated a clear sense of leadership to staff. Discussions with people demonstrated the manager promoted an atmosphere of openness and respect where people and their representatives felt their opinions mattered. Staff felt that there was good teamwork within the home and that they enjoyed working there. The AQAA stated to ensure the views of people are promoted and incorporated into the running of the service: • People are involved in 3 monthly client meetings and audit questionnaire • The manager adopts an open door policy for both staff and families and the home reflects the supportive family atmosphere that is created It stated as a result of client meetings menus have been changed and blinds have been put up to shade the sun. It stated future plans were major changes to the gardens, due to some grant money received from the government. Some of this work had started and included a fishpond and pagoda type sitting area for people. A general report and business plan was provided for 2007, which included consultation with people who used the service. As described throughout the report feedback about the home was positive, complimentary and all those surveyed expressed satisfaction with the service. Visits to the home as required by the provider to demonstrate their opinions of the quality of the service provided were being completed. When I spoke to people they said either the home or their family looked after their money. I looked at the systems that were in place to safeguard peoples’ monies where they were unable to manage their monies themselves. This included their money being securely stored. I looked at transactions that had taken place for three people, including the record of the transaction and checking this against the money the service held for them. Written records of all transactions were maintained. The majority of financial transaction contained two signatories, but this had been insufficient to make sure the record of the transaction correlated with the actual monies, in one instance. The manager was asked to do an audit of the finances the next day to find out the error and correct it as necessary. The AQAA stated servicing and maintenance was in place for: • Premises electrical circuits • Portable electrical equipment Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 28 • • • • • Lift Fire Detection and fighting equipment Emergency call equipment Heating system Gas appliances I looked at the servicing for the hoists and the contract for soiled waste disposal as these had been omitted from the AQAA. These were in place and satisfactory. When I looked round the building, hazardous substances were securely stored and fire exits had been kept clear, which should make it easy for people and staff to leave the building should there be a fire. When I spoke with staff they said they had sufficient equipment to move people safely. I saw them doing this. On the whole, I did see good moving and handling techniques. The manager was asked to review the moving and handling of one person as they were moved using a turntable and handling belt, but the person was unable to weight bear. This meant the staff must have lifted the person, which could cause injury to themselves and the person. The person, staff and the manager said it was because they didn’t like the hoist. This is understandable, but the health and safety of people and staff is paramount. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 30 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. 1. Standard OP38 Regulation 13 (5) Requirement The moving and handling of the identified person must be reviewed to confirm how they are moved is safe for themselves and staff. Timescale for action 18/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations A variation of registration should be submitted as required by the regulations. This will mean the certificate accurately reflects the categories of registration and people using the service know for how many people the service is registered. The service user guide should be updated to accurately reflect the number of people who could use the service and the facilities available. This will ensure people receive information about the service that is correct. When a risk assessment takes place and a risk is identified, the action to reduce the risk should be recorded in the plan of care. For example, nutrition. This will demonstrate action has been determined to reduce any DS0000018277.V355758.R01.S.doc Version 5.2 Page 31 2. OP1 3. OP7 OP8 Rockley Dene Residential 4. OP7 OP8 5. OP7 OP9 6. OP9 OP28 OP30 OP28 OP30 OP38 7. 8. OP29 9. OP35 risk and the review of the care plan will ensure the level of risk continues to be monitored. The plan of care should contain sufficient information to demonstrate instructions given by health professionals have been carried out. This demonstrates the care service is taking action to comply with those instructions to meet the person’s health care needs. Medication administration records should have a record of medication that is administered to people, for example, injections. This would provide information to clarify people were receiving their medication as prescribed. Staff should check the medication administration record against the actual medication that is given so that people are protected from receiving the wrong dosage of medication. An assessment of risk should be undertaken to determine the services competence to administer first aid in an emergency. This is so that people can be assured adequate systems are in place to maintain their safety should an emergency arise. Staff files should demonstrate a full employment history, together with a satisfactory written explanation of any gaps in employment. This is to demonstrate sufficient information has been obtained in order to keep people safe. When staff are signing to confirm a financial transaction, they must check all aspects of the transaction, so that errors are identified and corrected at the time. Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rockley Dene Residential DS0000018277.V355758.R01.S.doc Version 5.2 Page 33 - 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. 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