Care Home: Rodney House

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What the care home does well Residents at the home told us that they were being cared for and supported properly by staff at the home. They were confident their privacy and dignity were respected and that there were sufficient social and leisure activities available to them. Comments made to us included; "There`s enough going on (socially) if you want to join in. "I go out to the shops when I want, no one stops you". "There`s always something going on, but I like to do my own thing". "Staff have a nice manner and always speak to me properly", "they ask me what I think about things", "the staff always knock on my door and wait for me to let them in", "I don`t need a lot of help, but when I do the staff help me in a way that doesn`t make me feel awkward". The health and personal care needs of residents were being properly met and suitable procedures were in place to keep residents safe and they were being supported by sufficient numbers of appropriately qualified and experienced staff. Policies and procedures for the operation of the home were in place and worked in the best interests of residents. An active programme of refurbishment and redecoration was also in place to improve the environment for the benefit of residents. Throughout the day of this inspection staff were observed to interact positively and appropriately with residents, talk to them properly and with respect, and to maintain their privacy and dignity particularly when supporting them with personal care and support. What has improved since the last inspection? Since the last published key inspection report a wide range of improvements have been noted and are addressed in more detail in the various sections of this report. However a summary of those improvements include; discussions with residents, visiting health care professionals, care staff and senior staff at the home indicated that the ways in which residents health and personal care needs were being met has significantly improved. This view was also supported by the improvements that have been made to the way residents care records are written and maintained. Positive changes to the daily life of residents and the social activities available to them are reflected in some of the comments quoted above. Improvements have been made to the environment and staff have been provided with a wide range of training to meet residents support needs (including their specialist needs). Throughout the inspection process there was lots of evidence to show that great efforts had been made to provide staff with a clear sense of direction by the new management team. What the care home could do better: It is recommended that a copy of the complaints procedure should be displayed around the home to ensure all residents, relatives and visitors have direct access to this information. Also daily entries in the care records should be timed and signed (not just initialed) to ensure the staff making those entries can be readily identified. It is also noted that in the AQAA (referred to above) that the management of the home have identified areas that they wish to improve the quality of and have introduced checks to ensure improvements made are sustained. Key inspection report Care homes for older people Name: Address: Rodney House 4-6 Canning Street Liverpool Merseyside L8 7NP     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: Michael Murphy     Date: 1 7 0 2 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 Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Rodney House 4-6 Canning Street Liverpool Merseyside L8 7NP 01517093883 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): EBS Services Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 56 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability 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: Old age, not falling within any other category - Code OP (Maximum number of places 53), Mental disorder, excluding learning disability or dementia - Code MD (Maximum number of places 28), Physical disability - Code PD (Maximum number of places 2). The maximum number of service users who can be accomodated is: 56 Date of last inspection Brief description of the care home Rodney House is a large former hotel, situated in a conservation area close to Liverpool city centre. Both of Liverpools cathedrals, shops, libraries and museums are Care Homes for Older People Page 4 of 30 1 3 0 8 2 0 0 9 28 0 2 Over 65 0 53 0 Brief description of the care home within walking distance of the home. Accommodation is provided in single rooms (56), on three floors with lift and stair access. There are three lounges and a designated smoking area on the ground floor with dining rooms situated on the ground floor and the basement area. On street parking is limited. Rodney House is registered to provide care and support to older people. Many of the service users are self-caring, though they need support and reminding to maintain personal standards of health and hygiene. A copy of the most recent inspection report by the Care Quality Commission is available from the registered provider. Fees at the time of this inspection ranged from 330.00 pounds to 420 pounds per week. Please contact the home for further details. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was conducted by two inspectors on the 17th of February 2010. During the visit we talked to numerous residents, all the staff on duty, the new home manager, the director of care, the home owner and visiting community health care professionals who regularly support residents at the home. We also looked at documents and records the home have to keep such as residents care records, medicine records, written policies and other records. Before the inspection, we also asked the management of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home sees the service they provide the same way that we see the service. We felt this form had been completed in sufficient detail and provided useful information. Care Homes for Older People Page 6 of 30 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 Care Homes for Older People Page 7 of 30 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 Older People Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitable written information was being provided to prospective residents (and others) to make choices about the suitability of the home for them. And before being admitted to the home prospective residents have their care and support needs assessed to ensure the home is able to meet their needs. Evidence: Over the last six months the written information provided to prospective residents (and others) has been reviewed. This document was prominently displayed in the home and contained the information required to help prospective residents (and their supporters) in determining their choice of home. The policy of the home is that all prospective residents undergo a pre-admission assessment before a decision is made about them entering the home. This assessment is conducted by the appropriately qualified and experienced director of care or home manager (both are registered nurses). The purpose of this assessment is to decide if the home will be able to meet potential residents care and support needs properly. It also helps prospective Care Homes for Older People Page 10 of 30 Evidence: residents (and their supporters) in their decision of how appropriate the home would be for them. A record of the pre-admission assessment is kept in residents care records and identifies what care and support they will need. Other pre-admission assessments conducted by social workers and health care workers were also kept in the care records. One resident had been admitted to the home since the last inspection. A detailed pre-admission assessment had been made and recorded by the director of care. Prospective residents are given the opportunity to visit the home before they are admitted - and it was evident this had been the case in case of the admission referred to above. The home policy is that a formal review is undertaken around six weeks after admission to determine if the new resident has settled well, is happy at the home and decide if the home is suitably meeting their care and support needs. Discussion with staff working at the home revealed they were of the view that they have received appropriate training to properly meet the care and support needs of residents (including their specialist needs) and said the training and support provided by the director of care and the home manager had significantly increased over the last 6 months or so and that the home is manged in a much more organised, supportive and structured way - which has benefited both residents and staff. The director of care and home manager are registered nurses with a background in mental health and support staff to develop the skills and experience to deliver the care and support residents at the home require. Also see the staffing section of this report for further evidence relating to staff being provided with the appropriate skills to meet residents care and support needs. Discussion with residents demonstrated that they were satisfied their care and support needs were being properly met. This view was also supported through our discussions with health care professionals visiting the home on the day of inspection and who have regular contact with residents at Rodney House. Staff and residents at the home have been actively engaged with the local irish community to address the social/cultural needs of residents of Irish origin. Residents (with the support of staff) have attended a range of social and other events held by the Irish community. Similar engagement had been made with the local Caribbean community. The home does not provide intermediate care. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at the home were being addressed properly and appropriately documented. Evidence: The director of care has reviewed and re-written the care plans and re-organised the care records for all residents since the last published inspection. Consequently care records have significantly improved. The director of care and the home manager check (audit) residents care records regularly to ensure this improvement is maintained. And care staff were being provided with training and support to improve their skills in relation to residents care records. The care records of four residents were looked at on this occasion. These were organised and contained care plans that set out the action that needed to be taken by the care staff to ensure the health (including mental health needs) and the personal and social care needs of residents are properly met. The care records also contained risk assessments that identified possible threats to a residents health and safety and described things that needed to be done to keep them safe at the same time as maintaining their freedom and independence. Care records had been evaluated regularly and kept up to date. However Daily entries in the care records Care Homes for Older People Page 12 of 30 Evidence: should be timed and signed by staff (not initialed). The need for this was discussed with the director of care and home manager. Arrangements had been made to register all residents with a local GP. Information in the care records and discussion with residents and staff indicated residents were able to access health care services appropriately. A record of all such access was kept. For example access to specialist nursing, dental, pharmaceutical, chiropody and therapeutic services and care from hospitals and community health services (including psychiatric support) according to need. Residents were also supported to access hearing and sight tests according to need. Discussion with residents and inspection of their care records indicated that their wishes are respected, that their views are taken into account and that they are consulted regarding matters concerning their own care and that they are treated as individuals. Discussion with healthcare professionals who visit the home regularly indicated that the quality of healthcare support that residents require has improved significantly over the last six to eight months. We were informed that the new management structure at the home has resulted in better communication and quicker referral of issues to the health care professionals who support the home. It was also stated that the care staff are much more confident and effective in the way they support residents with their health and personal care and support needs. Residents medicines were being looked after safely and securely. The senior staff manage and administer residents medicines. These staff have been provided with appropriate training in this area. A medicine record was kept in respect of each resident. These had been completed properly. Regular checks (audits) were being made to make sure the way residents medicines were being looked after continued to be safe. Residents spoken to said staff spoke to them respectfully and maintained their dignity, particularly when individual support and/or personal care was being given. Comments made included; Staff have a nice manner and always speak to me properly, they ask me what I think about things, the staff always knock on my door and wait for me to let them in, I dont need a lot of help, but when I do the staff help me in a way that doesnt make me feel awkward. They [the staff] have all been very nice and polite to me, you never feel you are being left out of anything, I feel that my privacy is respected and that the staff give me space when I need it, I am feel able to talk to the carers about private things, I see the nurse in private when she comes to see me, I have my own room, and the staff do not open my post before they give it to me. I think that all the staff treat me well and I have not had any problems with any of them, they help me and I am grateful for that, you are allowed to have your own Care Homes for Older People Page 13 of 30 Evidence: space and I feel the staff respect that, there is a telephone you can use in private, I dont feel embarrassed when the staff help me, they have a nice manner. I have no complaints, I have lived here for a long time and its the best place I have been, the staff are good and talk to me a lot especially when I get upset, they help me to sort things out when I get mixed up. Throughout the day of this inspection staff were observed to interact positively and appropriately with residents, talk to them properly and with respect, and to maintain their privacy and dignity particularly when supporting them with personal care and support. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported to make choices and maintain control over their own daily routines and activities within the boundaries of their assessed capabilities. Evidence: During the past six months the management team have carried out a full review of the social activities that are made available to residents living in Rodney House. From this review activities have been made available that residents have asked for or have indicated that they would like to be involved in. Discussion with the director of care and the home manager confirmed that further work was taking place to ensure that every resident living in the home would have their individual social needs fully assessed and we saw evidence that this work had already started. In the new care plan system recently adopted there was a social care plan, a social assessment and a life history booklet. It is intended that the social care plan will give staff guidance on how to meet residents social needs, the assessment will give details of everything social in the life of the individual, including likes and dislikes and the life history booklet will be completed with the resident by the key worker. It is hoped that this booklet will provide valuable information about the family, friends, and past working life of the person. Care Homes for Older People Page 15 of 30 Evidence: We saw evidence that where these assessments had already been started and completed for a number of residents, important information had been found out about the persons background that has resulted in various external contacts being made on behalf of the resident (with their permission). To further aid the development of social and leisure activities an activities organiser has recently been employed by the manager of the home. Once pre-employment checks have been completed it is intended that the activities organiser will take a significant role in making sure each resident has been assessed and that all relevant paperwork has been fully completed and information acted upon. Information about activities and other interesting articles about the local community were displayed on a Community Notice Board in the main reception area of the home. Details on this board advertised Keep Fit classes that were held daily between 11:15am - 3:30pm using one of the latest types of games consoles. It also displayed the Rodney House Newsletter for January 2010 giving residents information about things happening in the home and wider community. Residents spoken to told us that they were aware that if they looked at the notice board they would find out what was going on in the home as information was updated regularly. A recent Valentines day dance had been very successful and provided the residents opportunity to socialise with each other in a more informal setting. Cultural needs had also been reviewed, following which contact had been made with the local Irish community and residents had been invited, supported by staff, to attend a range of social events. We observed that a number of residents could, at times, have some challenging and difficult behaviours. We asked the director of care what strategies were in place to deal with such situations should they arise and to prevent such behaviours having a negative impact on the quality of life of the other residents living in Rodney House. All senior staff had received training in Mental Health Awareness and Challenging Behaviours and the director of care is a non crisis prevention trainer. Discussion with a senior carer on duty confirmed that this training had taken place and they also told us, We use distraction techniques, the way we talk and the tone of our voice and the use of positive body language. The carer also told us that no physical restraint was used and that there was a No Hands On Policy. Comments from residents about the availability of social activities in/out of the home included, Theres enough going on (socially) if you want to join in. I go out to the Care Homes for Older People Page 16 of 30 Evidence: shops when I want, no one stops you. Theres always something going on, but I like to do my own thing and We had a smashing time on Sunday at the Valentines party and the food was brilliant. The management team from the home have recently spoken with a local minister in the hope of developing a drop in centre outside of Rodney House, where people from all walks of life may go for a cup of tea/coffee and a chat. Funding will hopefully be raised from charitable organisations and this would then enable the centre to be used by the residents of Rodney House and members of the local community. No restrictions were placed on visiting the home and a number of visitors were seen visiting during our time at Rodney House. Meal times were seen as an important part of the day and were used to encourage residents to engage in social interaction with each other and the staff. Two dining rooms were available and residents were encouraged to use them where it was thought it would benefit them. Dining rooms had recently been refurbished to a good standard and tables were set appropriately for the meals expected. Menus were on the tables indicating a choice of meals for the day. Also displayed on the menus were the planned social events for the month and residents birthdays. On the day of our visit the usual cook was not on duty. The head housekeeper was covering this role. Discussion with her confirmed that she had lots of experience of cooking for a large number of people and also held the certificate in basic food handling and hygiene. Menus were planned using a four week rota and on examination the menu for the day was the menu displayed on dining tables. Observation of breakfast time in the lower ground floor dining room took place at the invitation of residents having their breakfast. Tables were set appropriately and the placing of knives and forks on the tables demonstrated that cooked breakfast was the norm. As reach resident arrived in the dining room a fresh teapot of tea or coffee was provided to them whilst they waited to be served breakfast. Choice of cereals were offered, followed by a cooked breakfast. People chose various things including, egg & bacon, sausage & egg, egg & tomatoes and egg, bacon & beans. All cooked breakfasts were freshly made and people did not wait more that two or three minutes to be served their meal. Residents spoken to about meals in the home were extremely positive and their comments included, You can have anything you want at breakfast and dinner, the cooking is fantastic and the staff are very nice, it is a very good home Care Homes for Older People Page 17 of 30 Evidence: and I like living here, I am very happy here, it is a fantastic place. Staff will do anything for you, even little things. We have really good food. I have nothing really bad to say about the place, the staff treat us with respect and dignity and we have good one to one relationships with staff, what I like is they dont look down on you and We had a lovely chicken casserole last night. There is quite a variety at dinner time and the best thing is, it is all made fresh. The atmosphere in the dining room was relaxed, informal and unhurried. People came down to breakfast in their dressing gowns and where people wanted to take their meals in their rooms, trays were taken up to them. Where residents had a poorer diet, food supplements were supplied. Staff had received training in this subject from the supplier of one particular brand of food supplement and we saw that further training was planned for more staff in the following weeks. Staff spoken to were aware of those residents with this need and care plans were in place for those with extra nutritional needs. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The policies, procedures and staff practices were present to protect vulnerable people from abuse and protect their wellbeing. Evidence: There was a complaints procedure that was in an easy to read format and was available in the statement of purpose and service user guide and the manager told us that all residents had received a copy of these documents. No information was displayed around the home for residents/relatives to access should they wish to raise a concern or complaint and it was suggested to the manager that a copy of the complaints procedure be placed on the community notice board. We spoke to a number of residents who told us that they knew how to make complaints and who they would go to if they were unhappy about anything. Comments included, I would go to....(staff) or see....(senior carer), I have nothing to complain about but if I did I would see Carol (manager) or ......(staff), I would see the boss and I could speak to any of the staff, they are all very good. We looked at the complaints records and saw that two complaints had been recorded and both had been responded to in writing and within line of the homes complaints policy and procedure. There were clear policies and procedures about safeguarding adults and they were Care Homes for Older People Page 19 of 30 Evidence: readily available to the staff team. The Suspicion of Abuse Policy clearly directed staff to notify the local Adult Protection Unit and a copy of the Liverpool Inter-agency Policy, Procedures and Guidance was in place. There had been 12 safeguarding referrals made within the last twelve months and many of these related to incidents of aggressive behaviour taking place between some of the residents living in Rodney House. The director of care confirmed that all had been satisfactorily dealt with. One particular resident spoken to knew that if he was unhappy about the potential aggressive behaviour of residents that he could complain and he told us, Staff deal with difficult situations very well. They try to distract people who are worked up and this seems to work most times. Things have improved a lot, with a lot less shouting and swearing (from residents). The manager told us that two senior staff and one carer had completed Mental Capacity Act training (MCA) and it was being arranged for more staff to attend this training including Deprivation of Liberty training. All staff had completed Protection of Vulnerable Adults (POVA) training and we were told that 7 had completed this training with Liverpool County Council and the remainder in-house. Staff spoken to were clear about what action to take should an allegation of abuse be made. Discussion with the home manager confirmed that she was clear about what action to take in the event of an allegation of abuse being made and evidence was available to show how a safeguarding referral had been made to the Safeguarding Adults team on 10/02/2010. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were provided with a clean, warm and comfortable environment to live in. there have been a number of improvements to the home since the last inspection and a refurbishment programme was in operation to further improve the facilities offered. Evidence: The home has introduced a new system by which people gain access and leave the home. The purpose of this system is to maintain security and maximize residents freedom of movement safely. The home has a large foyer/reception area. This area was clean, free of malodour and adequately furnished and decorated. A wide range of information was displayed in this area for the benefit of residents and visitors. For example information about how the home is run, the programme of social and leisure activities, how to access advocacy and health promotion support and whats on in the local area (including educational and training opportunities locally). There were also photographic displays featuring recent social events held at the home. The space provided in lounge and dining areas has been reviewed and improved since the last inspection. There are now three lounge areas and two dining room available to residents. The lounges, situated on the ground floor adjacent to the reception/foyer area, were adequately and comfortably furnished, adequately decorated, clean, warm, adequately lit and ventilated and free of malodour. They also contained adequate leisure equipment including televisions, board games, music centres, well stocked bookcases, an aquarium, computerized games console and a hot/cold drinks machine Care Homes for Older People Page 21 of 30 Evidence: available to residents at all times. A separate designated smoking area has been provided for residents. Residents spoken to said that the lounge areas were kept clean and comfortable and that they were able to access them at all times. There are two dining rooms, one on the ground floor that has been completely re-furbished since the last inspection and one on the lower ground floor. Both dining rooms are easily accessible to all residents. These rooms were found to be adequately and appropriately furnished (including the provision of suitable table settings), adequately decorated, clean, warm, adequately lit and ventilated and free of malodour. Residents spoken to were of the view that these areas provided a pleasant and suitable areas in which to take their meals. There was adequate provision of bathing/shower and toilet areas (including provision for disabled residents). These were clean, warm, adequately equipped/adapted and afforded privacy. We were informed that a programme of refurbishment has began to transform bathrooms into more up to date wet rooms. Nine residents bedrooms currently have an en-suite bathroom. A passenger lift enables all residents to access all parts of the home designated for their use. There are general aids and adaptations provided to maximize residents independence. Individual residents specialist aids/adaptation needs are met by assessment by an appropriate health care professional. Corridors were clean, uncluttered, had adequate floor covering, were adequately decorated and adequately lit, pictures and paintings were hung on the walls. However a staircase to rear of building was seen to be in need of new floor covering and decor. The provider informed us that it is planned to re-furbish this area in the near future. Residents bedrooms are situated on all floors of the home. Those bedrooms seen were clean, warm, well lit and adequately ventilated. It was evident some of the rooms had been recently been re-decorated and refurnished. Others were in need of such improvement. We note that a number of other rooms were in the process of being upgraded at the time of this inspection. The director of care also informed us that all residents have been written to to say a programme of bedroom refurbishment us underway and detailing the temporary arrangements that will be made when their room is being improved. Residents spoken to said they were happy with their rooms, that their privacy was respected and that they had keys to their rooms and to the lockable space within. They also told us that their rooms were cleaned daily and that their bedding was regularly changed. Some had chosen to highly personalize their bedrooms. The laundry arrangements at the home were adequately meeting residents needs. The laundry area was appropriately equipped and was staffed every day. This area was found to be clean and organized. The home was found to be clean throughout on the day of inspection and free of malodour. The home provided housekeeping staff each day and their duties include cleaning residents bedrooms. Adequate arrangements were in place in respect of preventing the spread of infection. For example suitable hand washing facilities were provided, staff were provided with disposable aprons and gloves when providing Care Homes for Older People Page 22 of 30 Evidence: personal care for residents, suitable arrangements were in place for disposing of infected material and adequate cleaning materials/equipment were provided for the use of housekeeping staff. Care Homes for Older People Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were being supported by sufficient numbers of appropriately qualified and experienced staff. Evidence: Examination of the staffing rotas for the home demonstrated that enough management and care staff were on duty at any one time to meet the current identified needs of the individual residents. Domestic and catering staff appeared to be employed in sufficient numbers and the cleanliness of the home and high standard of meals prepared at the time of our visit demonstrated this. Improvements had been made to the availability of training for all staff teams and an up to date training matrix was in place and available for examination. This clearly indicated that a lot of training had taken place, particularly in the last six months, some of which included, Alcohol Awareness, Nutrition, Health & Safety, Food Hygiene, Fire Awareness, Infection Control, Protection of Vulnerable Adults, First Aid, Mental Health Awareness, Challenging Behaviour, Epilepsy Awareness and Mental Capacity Act training. A number of staff had also completed specialised training in Practical Strategies to communicate with older people with neurological conditions. This training had been carried out by the Royal College of Nursing. Of the 21 care staff employed, 57 had successfully obtained a National Vocational Care Homes for Older People Page 24 of 30 Evidence: Qualification (NVQ) at Level 2 with more staff being registered to start NVQ Level 2 or Level 3 in the near future. On examining a number of personnel files for new staff we saw that a detailed induction programme and been carried out. The induction procedure was linked with Liverpool City Partnership and the Common Induction Standards promoted by Skills for Care. All new staff were placed on a three month probationary period during which supervision takes place once per month. We were also told that staff taking maternity leave or long term sickness leave would, on their return to work, be taken through an induction refresher day by the manager and would be put forward for any relevant training that might be identified. During our time at Rodney House we sought the views about staffing from visiting health care professionals such as the district nursing services. All were very positive and indicated that they way the home was managed and staffed had much improved. We were told that staff appeared to have received a lot of training in the past six months and, subsequently, have become much more skilled at recognising and understanding residents needs on an individual basis. It was also confirmed that staff made timely referrals when needed, for example, to the district nursing services. We looked at a selection of staff files for people newly employed and found all the necessary pre-employment checks including obtaining satisfactory written references and a Criminal Record Bureau (CRB) enhanced disclosure had been completed. However, on one particular file we saw that the applicants previous employment details had not been fully completed and that both references were from friends and colleagues, not the persons last employer. Following further details being received and disclosed at a later date, this person was suspended from duty and was subject to a disciplinary hearing. Discussion with the home manager demonstrated that she had learnt from this experience and safeguards had been put in place to ensure that policies and procedures relating to employing staff would be followed and adhered to at all times. It is important that robust recruitment and selection procedures are followed at all times to minimise the potential risk to people living in Rodney House from unsuitable people being employed in the home. Care Homes for Older People Page 25 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management, policies and procedures for the operation of the home were in place and worked in the best interests of people. Evidence: A new manager, Carol Nickeas, had been working at Rodney House since November 2009 and is a Registered Mental Health Nurse. Carol is managed and supported by a Director of Care, who is also a Registered Nurse with a Diploma in Management Studies. The manager told us that she was awaiting the receipt of her Criminal Record Bureau (CRB) enhanced disclosure and would then be applying to the Care Quality Commission (CQC) for registration. To further enhance the management team, a new care coordinator (deputy) had also been employed at the home. Throughout the inspection process there was lots of evidence to show that great efforts had been made to provide staff with a clear sense of direction by the new management team. The implementation of the new care planning system in particular had helped to identify that each resident was an individual, with individual needs and Care Homes for Older People Page 26 of 30 Evidence: aspirations and helped to focus staffs thinking and understanding of how to achieve a person centred service. During our visit we had the opportunity to speak with some visiting health care professionals about the management of the home and they told us, Things have improved significantly in the last 6 - 12 months. (There is now an) excellent management team in place. All staff are very good at supporting people with some differing, but difficult behaviours. Other comments about the management team came from residents and staff and included, Things have vastly improved. We now get plenty of training and there is always someone there to back you up. We get one to one supervision where we discuss things like training needs. I have not concerns at all, The managers and maintenance man are excellent and Our maintenance man.....can put his hand to anything, hes spot on. To monitor service delivery various auditing tools had been introduced. These included service user questionnaires and professional health care questionnaires. We looked at responses supplied from an audit carried out by Rodney House in October 2009. Feedback from residents demonstrated that they were happy with the service and the positive improvements made to the service over recent months. Feedback from other health care professionals was extremely positive and comments included, My patients are always well cared for at Rodney House. Six monthly service audits had also been introduced to highlight any shortfalls in service delivery and both the Director of Care and the home owner undertook unannounced Regulation 26 visits to the home and provided a written report. The homes administrator was day off and we could not have access to financial records on this occasion. Residents spoken to during the inspection told us that they always had access to monies and we observed people freely going to the shops for things such as newpapers and cigarettes. We looked at a random selection of maintenance and servicing records and found these to be in order. The fire alarm system was being tested by the maintenance person on a weekly basis and any faults were immediately reported to the relevant engineers. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 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 7 That daily entries in the care records should be timed and signed (not just initialed) to ensure the staff making those entries can be readily identified. A copy of the complaints procedure should be displayed around the home to ensure all residents, relatives and visitors have direct access to this information. 2 16 Care Homes for Older People Page 29 of 30 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. 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