Care Home: Rockmount North West

What the care home does well Risk management is given a high profile with good support plans in place. These help to protect people from harm, but allow for some independence. Daily activities, leisure and educational classes all help to promote the personal development of those living at the home. Service users are involved in the recruitment of staff, demonstrating that their opinions are valued. Opportunities for qualification training for staff who don`t already hold a qualification, such as in nursing or social work, are good. A high number of these staff having achieved NVQ (national vocational qualification) level 2 or above. This means that they have had their work practise assessed and have been deemed competent workers. The home has a variety of communal lounges and dining areas, meaning that people can choose where to spend their time. Each bedroom has en suite facilities and those spoken to were extremely satisfied with their accommodation. The home is well maintained and provides a lovely environment for those staying there. There are some good quality assurance and auditing measures in place and the service is well managed. Staff are given different areas of responsibility, which appears to work well and contributes to the personal and professional development of the staff team. What has improved since the last inspection? This is the first inspection at the new premises. What the care home could do better: Care plans need to be regularly reviewed and updated when necessary. Then staff will have up to date information and guidance regarding how identified needs are to be met. Some files were very muddled, with duplicated information and unsigned, undated documents. This should be addressed and will help to provide clear and chronological information about each service user. Medication practises are generally good, with regular audits and checks taking place. The procedures could be strengthened by dating medication when it is first opened and by having two staff check and sign any handwritten entries on the medication records. These improvements will help to ensure that medication can by accurately audited and will help to prevent mistakes being made. Key inspection report Care homes for adults (18-65 years) Name: Address: Rockmount North West 1 Blackburn Road Rishton Blackburn Lancs BB1 4HD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lesley Plant     Date: 0 7 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Rockmount North West 1 Blackburn Road Rishton Blackburn Lancs BB1 4HD 01254236987 01254236987 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Nafis Iqbal & Mr Afzal Hussain Name of registered manager (if applicable) Mrs Aisha Joy Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories; Learning disabilities - code (LD) Mental Disorder, excluding dementia and learning disabilities code (MD). The maximum number of service users who can be accommodated is 16. Date of last inspection Brief description of the care home The home is situated close to the centre of Rishton, near to a range of shops and facilities and on a bus route to other towns in the area. The building has three floors, some garden areas and good space for parking. All bedrooms have en suite facilities and the home is able to accommodate people with physical or mobility disabilities. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 0 16 16 Brief description of the care home There is a good range of communal dining rooms and lounges. The home is registered to provide care and accommodation to people with a learning disability and to people with mental health problems. The owners and the manager are qualified and experienced in these areas and are also able to provide a service to individuals who have a dual diagnosis or a personality disorder. Fees vary acccording to the assessed needs of the individual concerned. More information about the range of fees and the service provided can be obtained by contacting the manager at the home. Care Homes for Adults (18-65 years) Page 5 of 31 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection focused on the outcomes for people who use the service and involved gathering information about the home from a range of sources over a period of time. The inspection was unannounced and was carried out over two days. At the time of the inspection visits there were 13 people living at the home. All of the key national minimum standards, plus the standards relating to; introductory visits, personal development, leisure and staff supervision were assessed. Time was spent talking to service users, staff and the manager of the home and staff were observed carrying out their duties. Records were viewed and a tour of the building took place. Care Quality Commission surveys were received from 11 service users and 5 members of staff. Some service users had been supported by a fellow service user or a member of staff, when completing their survey. Information from these surveys is included within this report. Care Homes for Adults (18-65 years) Page 6 of 31 The Annual Quality Assurance Assessment (AQAA) completed by the manager of the home, also provided some useful information. This is a self assessment focusing on how well positive outcomes are being achieved for people using the service. The service previously operated from different premises and re registered with the CQC in November 2009 when a change of premises took place. This is the first inspection since that date. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre admission assessments and introductory visits take place, which help to ensure that people are only admitted to the home if their needs can be met. Evidence: A copy of the Service User Guide is given to all prospective service users and this is produced using symbols, to aid the understanding of people with a learning disability and can also be made available in audio or video format if required. Prospective service users are able to visit the home, to meet the staff and residents prior to making a decision regarding moving in. This written information and the opportunity to visit, help individuals and their representatives to make an informed decision regarding whether Rockmount is suitable for them and can meet their needs. The records for one person who has been living at the home for five months were viewed. The written pre admission assessment addresses all areas of potential need, including mobility, health and sociability. An accommodation checklist is completed to ensure that each person has all that they need in their bedroom. Further, more detailed information is then gathered once the individual has moved in. This includes Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: more detailed dietary preferences and a comprehensive list of interests and activities. Records show that for this individual a full report had been completed by the manager approximately one month after admission. This reflected on the first few weeks of the placement, how the person was settling in and how areas of need such as personal care and community activities were being met. Once resident at the home on going assessment continues, acknowledging the changing and fluctuating needs of individuals with complex mental health issues, often accompanied by personality disorder and some degree of learning disability. Key worker meetings with a nominated staff member take place and risk management plans are put in place. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place and service users are supported to make decisions about their lives. Robust risk management plans help to keep people safe from harm. Evidence: Each service user has a care plan identifying needs and detailing how these are to be met by staff and a number of these were viewed. Some care plans had not been dated at the time of writing and had not been reviewed for over six months. For one person the support and observation required at night had changed but this was not reflected in the written care plan. Although there was nothing to indicate that changes were not being responded to, it is important that written up to date care plans are available to staff. Not all care plans were available on the first day of the inspection as these were being updated. On the second day of the inspection visit some updated care plans were viewed. At present a member of staff is working hard to ensure that all care planning information is current and accurately reflects the needs of each person and how these are to be met. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: For some people there is also a Care Programme Approach (CPA) care plan in place and staff liaise with mental health professionals regarding the implementation of the CPA care plan. The home has also established a system of person centred planning, with the manager being an accredited coach in this area. Each service user has a person centred planning file and has regular meetings with their key worker. The manager tries to ensure that each person has an annual person centred planning meeting, involving relatives and other professionals as appropriate. The individual service user remains the central focus and is supported to explore their strengths and identify goals for the future. Staff keep good daily progress records and the manager writes regular progress reports which feed into the person centred planning process. Service users are supported, within a risk management framework, to make decisions regarding their day to day life. Individuals are involved in menu planning, selecting leisure activities and staff recruitment. Regular service user meetings take place, chaired and minuted by a service user living at the home. Individual key worker meetings also take place. Guidance regarding managing money is provided and senior staff have a good knowledge of the benefits system and legal rights of service users. Individuals are involved in any agreements such as receiving spending money each day instead of just once a week, for service users who find money management difficult. Risks are assessed and active management plans are put in place to minimise and/or manage the identified risk. All risk management plans are kept in one file for ease of access by staff, as well as having a copy on individual files. Records were seen of risk management plans addressing issues such as; drugs, alcohol, self harm and absconding. Some service users require one to one support from staff when out in the community. Staff work closely with health and social care professionals from other agencies, with risk management plans being shared and jointly agreed as appropriate to the individual. Where appropriate, files contain contact details for the local mental health crisis team and there is also an on call procedure in place, with a senior member of staff or one of the owners of the home always being available for any emergency. Records are kept of any serious incidents and a member of staff explained that a meeting is held after any such incident, where staff reflect upon the circumstances and their role in risk management. There is a system in place whereby each member of staff takes responsibility for knowing the whereabouts of three service users each. This hourly check is to prompt people to take part in planned activities, to provide oversight regarding identified risks Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: and to ensure that people get the support they need. Staff provide support and information regarding personal safety. Some service users have taken part in fire training and have also attended a recent Safe and Sound programme provided by an external facilitator, which looked at personal safety as well as other topics. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good opportunities for individuals to take part in meaningful activities, to develop skills and to integrate with the local community. Service users are involved in the running of the home and positive relationships are supported. Evidence: Service users have been involved in various training and development programmes such as fire safety and infection control. A Safe and Sound learning package has recently been provided, facilitated by a college trainer, comprising different modules over several weeks, addressing areas such as personal health, relationships and keeping safe. In the past external college courses have also been accessed and one person has recently completed a period of voluntary work. There is an incentive chart in the large living room used for activities. This forms part of a behavioural approach to help individuals with their personal growth and Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: development. Each person has a personalised plan which is built into the activity plan for the week. Skills and abilities are recognised and supported, with individuals being given certain responsibilities, such as chairing and recording service user meetings. Community links and social inclusion are promoted. Service users visit local facilities such as shops and pubs. Wherever possible people use public transport, such as buses or taxis and two service users have bikes.The home has a seven seater vehicle for trips out further afield. Records are kept of activities and trips out. Each person has an activity plan for the week. A popular rambling club has been formed. One of the lounges at the home has recreational items including a pool table and another large lounge/dining area is used for activities such as art and craft, as seen during this inspection. On the second day of the inspection visit a number of service users were enjoying playing badminton outside. A member of staff spoken to explained that he supports an individual to attend a football group each week and one of the service users spoken to talked about how she enjoyed dancing at a local club. Four service users regularly attend this weekly event. Another person spoken to explained how she enjoyed shopping with staff. The service users spoken to explained that visitors are made welcome, with one person saying that she was looking forward to her husband visiting later in the day. An individual is being supported to visit a close relative who is very ill and living in another part of the county. For another person, staff support is provided when they receive visitors, due to potential risks. And for another service user, who gets anxious prior to family visits, arrangements are made with the family to meet in a nearby pub, with the planning of the meeting not being made apparent to the individual concerned. Some service users have recently completed a college course held at the home, facilitated by a tutor from Lancaster College. This included looking at issues regarding relationships. It is clear that positive relationships are promoted and that individual needs in this area are supported. The needs of those living at the home, mean that some structure regarding daily routines is required. Service users are involved in household tasks according to their abilities, wishes and motivation. Staff support individuals with laundry, cleaning and kitchen tasks. Each person has a key to their bedroom and is supported to keep their room clean and tidy. A member of the support staff who has previous experience as a chef, takes the lead role in the kitchen. This staff member has developed a cook book of popular recipes. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: Service users help in all aspects of menu planning, meal preparation and washing up. Some service users have also completed NVQ (national vocational qualification) units in hospitality and catering, and there is a popular cooking class held each week. Themed days are arranged, with meals reflecting the theme, such as Indian food and one night each week a take away meal is ordered. Service users are able to eat in the dining room, the activities room or in their bedroom. Personal, cultural and religious preferences, such as providing halal meat are catered for. The service users spoken to responded that they are happy with the meals provided at the home. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health care needs are given a strong focus and medication is generally well managed. Evidence: The people living at the home have different needs regarding personal care, with some requiring prompting and others needing more support. Although none of the current service users have mobility difficulties, the home is well equipped to accommodate individuals with a physical disability if required. The key worker system promotes consistency and the daily handover system helps to ensure that each person receives the correct support. Independence is promoted with individuals being encouraged to manage their own personal care needs where possible. Although a number of the staff team are qualified nurses, their role is more in regard to behavioural analysis and risk management rather than clinical nursing input. The home is not registered to provide nursing care, with community health and community nursing input being used as necessary. Staff are involved in monitoring blood pressure, weight and blood sugar levels for some people at the home. Staff receive training regarding various health issues such as mental health, and Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: epilepsy. Health care needs are given a strong focus and there are good links with the GP and other health professionals. There is a clear health pathway which is followed from the point of admission into the home. Referrals are made to the dentist, chiropodist and optician to ensure that any issues are addressed. A health action plan is developed showing how individual health needs are to be met, with specialist input where appropriate. Files show that staff keep good records of all health care appointments and the daily progress notes kept by staff help to give an overview of how each person is each day and also through the night. Each person has a document All about Me which would go with the person if they had to be admitted to hospital or attend a hospital clinic. This contains useful information regarding the support required and would be shared with health professionals involved in the persons care. The aim being to make sure that health professionals have all the information they need, to help the service user whilst in hospital and reduce any anxieties. Each person has a separate medical file containing all the information regarding their health and there is a staff communication book used solely for health and clinical matters. For one person there were two different health action plan documents, which could cause confusion for staff. Other documents viewed were not always signed or dated by staff, such as the All about Me information for one service user. All records maintained by staff should be signed by the person making the record, to create ownership of the record. It is important that all documents are dated as this helps to build up a chronological record for each service user. Service user records were discussed with the manager of the home. Files contain a great deal of important information, however some information was difficult to find, some was duplicated and some files had historical information which may be better stored elsewhere. The manager explained that she was currently reviewing the filing system, with a view to condensing the information held. It is also advised that the use of the communication book is reviewed. On viewing, this showed that personal service user information is being included in the messages left for the staff team, so creating a joint record. Wherever possible each service user should have an individual record, with communication books containing information about several service users being avoided as this system does not meet data protection good practise guidance. Medication is securely kept in a dedicated room. One member of staff takes the lead role regarding medication arrangements at the home, does the ordering and carries Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: out regular audits and checks. All staff who administer medication have received accredited training. Good storage facilities are in place, including separate storage for controlled drugs and a locked fridge for medication needing to be stored at a low temperature. Information regarding each medication is provided in an easy read format aimed at people with a learning disability, which provides information regarding what the medication is for and any important potential side effects. At present no one self administers medication, however this has happened in the past and is given consideration where appropriate. The medication administration records for two service users were viewed and these had been completed appropriately. Each medication record includes a photo of the individual concerned, which is good practise and helps to reduce the chance of mistakes being made. A stock check of one medication was carried out, showing the correct amount of medication in relation to the written record. There are individual protocols in place for some people at the home. One person may be at risk due to retaining medication in his mouth, or spitting it out and there is a specific risk management plan in place to minimise opportunity for this to take place. Some service users have been prescribed additional medication to be administered in relation to certain challenging behaviour or fluctuations in their mental health. This is included within a risk management plan, and although this medication can only be given following approval of on call manager, the manager was advised to keep a copy of the risk management plan alongside the medication administration record. This will help to ensure consistency regarding the use of this medication. It is recommended that two members of staff check and sign any handwritten details of prescribed medication as this will help to ensure that no errors are made. It is also recommended that medication, particularly liquid medication, is dated when first opened. This will help to prevent medication being used past its use by date and also allow for a full audit trail to be conducted if required. Care Homes for Adults (18-65 years) Page 20 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies, procedures, staff training and good practise all promote the protection of those living at the home and help to ensure that any concerns would be responded to. Evidence: A copy of the complaints procedure is available in the reception area of the home. This is produced with symbols to aid the understanding of those with a learning disability and would also be made available on audio tape or video if required. Surveys are regularly given to service users in order to gain feedback about the service provided. Responses are then collated. Some surveys completed last year showed that not all service users had retained their copy of the complaints procedure and this was quickly responded to, with fresh documents being provided to all those living at the home. Regular service user meetings take place and the minutes of some recent meetings were viewed. These meetings are chaired by a service user, who also writes the minutes of the meeting. Individuals are also able to raise any concerns or issues during individual meetings with their key worker or more informally during their day to day interaction with staff. A record is kept of any complaint, how this was dealt with, the outcome and any remedial action taken. Responses from the CQC surveys completed by staff confirms that staff know how to respond should anyone raise a concern or complaint. To the question, what does the home do well? one staff member stated, Meeting the needs Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: of different service users and listening to their concerns, making sure everyone is well informed. The responses from service users indicate that people know who to speak to if they are unhappy and that they know how to make a complaint if necessary. The manager has undertaken a train the trainer course regarding safeguarding and protection and has run training sessions for staff. This cascade training is ongoing. New staff complete the Skills for Care (national training organisation) induction standards, which includes responding to abuse or neglect and these issues are also addressed within NVQ (national vocational qualification) programmes completed by staff. All staff complete a two day training programme, which looks at challenging behaviour, de escalation and diversionary techniques. A restraint policy is in place. There are good systems in place regarding the safekeeping of money belonging to service users. Each person has an individual record of all income and expenditure, two members of staff sign each transaction and service users sign to confirm the spending money they have received. Money is only handled by senior staff and regular checks and audits take place. The money held for one person was checked and showed to be correct against the record of money held. Care Homes for Adults (18-65 years) Page 22 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, well maintained and provides a pleasant environment for service users. The variety of communal rooms allow people to choose where to eat and where to spend their time. Evidence: The home is situated close to the centre of Rishton, near to a range of shops and facilities and on a bus route to other towns in the area. The building has three floors, some garden areas and good parking for staff and visitors. A gardener is employed and the building firm employed to carry out the redesign and refurbishment of the home, remain contracted to attend to maintenance and repairs. Bedrooms are sited on all floors and each bedroom has full en suite facilities of a toilet, wash basin and shower. Two rooms have a wet room en suite area suitable for people with physical disabilities. There is also a bathroom, for people who prefer to have a bath rather than a shower and toilets on the main corridor, one of which has grab rails fitted. Bedrooms vary in size but all are large and have plenty of room for personal possessions. There is a lift between the ground and first floors. The home is well equipped to accommodate people with physical disabilities should the need arise. There is a good range of communal dining rooms and lounges. One lounge is equipped Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: with games, including a pool table and a table tennis table. Another lounge has a large television and comfy seating. The main dining room is next to the kitchen and there is also another large room with comfy seating, a table and worktops, where activities take place. The large bedrooms and the range of communal rooms mean that people can choose where to eat and where to spend their leisure time. As well as offices and a meeting room there is also a hairdressing/beauty treatment/therapy room. The home appeared clean. There are no separate cleaning staff employed at the home. Night staff carry out some domestic duties as do day support staff, alongside service users. One service user has entered into an agreement whereby they do a certain amount of cleaning in exchange for the home paying for a sky package for their personal television. The home has a well equipped laundry room, where service users, with the support of staff, take care of their individual laundry. There is a rota system in place, which appears to work well. Staff undergo infection control training, with one member of the team taking a lead role in this area, attending meetings with other professionals in the area and keeping staff up to date with best practise initiatives. Some service users have also received certificated training regarding infection control and hand washing techniques facilitated by a community nurse. Care Homes for Adults (18-65 years) Page 24 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by well trained, qualified and well supported staff. The robust recruitment checks, help to ensure that only suitable staff are appointed. Evidence: Rockmount employs an external consultancy organisation for employment advice and to ensure that they are kept up to date regarding all employment matters.There is a good mix of skills and experience within the staff team, with some having nursing or social work qualifications. Other staff have completed national vocational qualification programmes, which have been adapted to ensure that the work is relevant to this complex service user group. The majority of staff have gained a qualification appropriate to their work. Some staff have been given a lead role in certain areas, such as medication and infection control, showing that staff are encouraged to use their skills and interests. This system of delegation appears to work well and also supports the personal and professional development of staff. Recruitment records for a recently appointed support worker were viewed. Documents include an application form, a record of the interview, references, a health questionnaire and a criminal records bureau disclosure. This member of staff was spoken to and he confirmed that the recruitment process had been thorough and fair and that service users had been involved in the interview and had asked certain Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: questions regarding his hobbies and interests. Involving service users in the recruitment of staff is good practise and means that service users can recommend appointing staff that they feel comfortable with or have similar interests. There is a structured induction process for newly appointed staff, which was confirmed during discussion with a newly appointed member of staff and the viewing of his induction records. Staff complete an induction to the service and then work through the Skills for Care (national training organisation) induction standards, with each element being signed off by a senior member of staff. During this period the member of staff works alongside a more experienced member of the team. The training matrix for the team shows that all staff complete a programme of core training which includes health and safety topics and also topics such as mental health, challenging behaviour, autism, sexual health, dual diagnosis and mental capacity. Senior staff complete management training relevant to their role. As well as day to day management support, regular staff meetings are held and the minutes of recent meetings were viewed. Supervision and appraisal records show that most staff have an annual appraisal and the format used includes a self appraisal by the staff member concerned. There are also formal, recorded supervision sessions with staff, which give good opportunity to discuss work practise and training needs. The manager is advised to monitor the frequency of supervision and appraisal meetings, to make sure that each member of staff receives this formal support at least six times a year. Information from the CQC surveys confirms that service users feel well supported by staff and that staff listen and act upon what service users say. Feedback from staff surveys was extremely positive regarding the support and training they receive. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience 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 well managed with good quality assurance systems in place. Staff training and good practise promote the health and safety of service users and staff. Evidence: The manager of Rockmount is a Registered Nurse (Learning Disabilities) and has experience in working in services for both mental health and learning disabilities, in the community and in hospital settings. The manager works hard to keep updated regarding best practise initiatives and undergoes training to update and increase her skills and knowledge and is an accredited East Lancashire person centred planning coach and trained in behavioural management techniques. The manager is supported by senior staff at the home, who carry out certain delegated management duties. Senior staff also have access to management training. The owners of the home are both experienced mental health social workers who carry out some on call duties in cases of emergencies and have some working input in relation to key working and administration. Rockmount has recently undergone a review by Investors in People and had their Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: accreditation renewed. The Investors in People (IIP) Standard is a national quality standard which sets a level of good practise for improving an organisations performance through its people. Monthly, minuted staff meetings take place, giving staff good opportunity to make suggestions regarding improvements to the service. Weekly staff meetings also take place and these include discussions regarding, best practise and ways of working with individual service users. This helps to promote high standards and consistency of approach. A member of staff explained that there are also de briefing meetings following any incident, where staff are supported to reflect upon the incident and if necessary look at how the situation could have been better managed. Service user meetings also take place. Feedback surveys are sent to service users, relatives and health and social care professionals with links to Rockmount and the responses are collated and acted upon. Ways of getting feedback from service users is currently being reviewed by a group of staff and service users, showing that new approaches to quality monitoring continue to be explored. Regular audits and checks take place, which help to ensure that good standards of service provision are being maintained. The manager has completed accredited health and safety training. The training matrix for the home shows that staff undergo health and safety training, such as infection control and food hygiene. New staff also complete the Skills for Care (national training organisation) induction standards, which address maintaining safety at work. These training programmes help to ensure that staff have a good knowledge of health and safety issues and work in ways which promote the safety of all those at the home. Records were viewed regarding the checking of fire equipment and fire drills take place. There is a fire risk assessment for the home and specific fire risk assessments for certain service users who may not be able to respond quickly in an emergency, such as an individual who has hearing problems. Records of water, fridge and freezer temperatures were also seen. The environmental health agency had recently visited the home and the subsequent report shows that no issues were identified. There is a cleaning schedule for the kitchen and records regarding cleaning of the kitchen were viewed. Care Homes for Adults (18-65 years) Page 28 of 31 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 Adults (18-65 years) Page 29 of 31 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 6 All care plans should be reviewed at least every six months. This will provide staff with current guidance regarding how identified needs are to be met. All records should be dated and signed by the staff member concerned. This helps to build up a chronological record and ensures professional ownership of the record. The content of service users files should be reviewed to make information easier to find. Handwritten entries on medication records should be checked and signed by two members of staff. This will help to prevent errors being made. Medication should be dated when first used. This will help to prevent medication being used when past its use by date and will also allow for thorough auditing. 2 19 3 4 19 20 5 20 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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