Care Home: Rook Lodge

What the care home does well People are supported by a regular staff team that know them well. People living at Rook Lodge said: "I like it here, the staff are okay. My new keyworker helps me." "I am happy here. I can talk to the staff if I am anxious or upset." "I like it here, the staff help me." "Its okay here, the staff are okay." People are involved in developing their care plans. Care plans have been reviewed and updated and therefore contain the information needed for staff to give people the support that they need.Rook LodgeDS0000025921.V375513.R01.S.docVersion 5.2 What has improved since the last inspection? Regular one to one sessions have been introduced between keyworkers and people using the service. This gives people a regular opportunity to discuss how they are feeling, what they want to do or any concerns they might have. RCHL have introduced medication audits to monitor the administration of medication. Some improvements have been made to the building. For example there is new flooring in the conservatory and each person has got a new bed and new bedding. One person said that he had a new shower. The service has received a 5 star, excellent food safety rating from the local authority. What the care home could do better: Although health & safety checks are carried out they are not always as regular as they should be. A system needs to be in place to ensure that the required health & safety checks are carried within the prescribed timescales. For accountability any handwritten entries made on the MAR (Medication Administration Record) sheet must be endorsed with the date and the signed initials or signature of the person making the entry. It is recommended that the PRN (as required) guidelines are reviewed and made more detailed so that they contain all of the necessary information to minimise the risk of error and to enable these to be administered as safely as possible. The monitoring of medication administration and records needs to be more robust to ensure that medication administration is in line with good practice. Some areas of the building, in particular shower facilities, need attention to ensure that they are of an appropriate standard and as homely as possible. Key inspection report CARE HOME ADULTS 18-65 Rook Lodge 1-6 Wanstead Lane Ilford Essex IG1 3UB Lead Inspector Jackie Date Unannounced Inspection 28 August to 4 September 2009 9:45 th th Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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. Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rook Lodge Address 1-6 Wanstead Lane Ilford Essex IG1 3UB 020 8518 0740 0208 477 1801 rook.lodge@rchl.org.uk www.rchl.org.uk Redbridge Community Housing Limited [RCHL] Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Eric Charles Bateman Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 10 13th September 2007 Date of last inspection Brief Description of the Service: Rook Lodge is a home for ten people with mental health problems. It is one of a number of homes run by RCHL, Redbridge Community Housing Ltd. The house is in Ilford in the London Borough of Redbridge. The home is a large detached two-storey building with a garden. There are two TV lounges and a conservatory. Peoples’ rooms are located in five bed-sits and four self-contained flats, and one self-contained maisonette. The home is near to bus stops and the train station. There are shops close by. Rook Lodge aims to provide rehabilitation to enable service users to move on to less supported accommodation. The basic charge per week for each person is £827-58. This information was provided shortly after the visit by the manager. Information about the service provided is contained in the service users guide. Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was unannounced and took place over two separate days. This was to enable us to talk to the manager and also to access some records. There was a delay between the visits due to the manager being absent from the service and the inspector being on annual leave. This was a key inspection and all of the key inspection standards were tested. Staff were asked about the care that people using the service receive, and were also observed carrying out their duties. People using the service were asked to give their views on the service and their experience of living in the home. At the time of the inspection we were able to talk individually to all of the people living at Rook Lodge and also to four members of staff. All of the shared areas and some of the individual flats/bedsits were seen. Staff, care and other records were checked. Services are now required to complete an AQAA (Annual Quality Assurance Assessment) and the completed form was received in May 2009. Information provided in this document also formed part of the overall inspection We would like to thank the people living at Rook Lodge and staff for their input during the inspection. What the service does well: People are supported by a regular staff team that know them well. People living at Rook Lodge said: “I like it here, the staff are okay. My new keyworker helps me.” “I am happy here. I can talk to the staff if I am anxious or upset.” “I like it here, the staff help me.” “Its okay here, the staff are okay.” People are involved in developing their care plans. Care plans have been reviewed and updated and therefore contain the information needed for staff to give people the support that they need. Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 6 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. Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 & 5. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments completed by the home and information and reports received from health and social care professionals mean that staff have the necessary information available to enable them to determine whether or not the service can met a persons needs. People and their representatives have a written contract/statement of terms and conditions and will therefore be clear about what they are entitled to. EVIDENCE: The organisation has an admissions procedure that includes gathering of information and assessments. Prospective users of the service are given the opportunity to visit and to meet other people who live there before they make a decision about moving into the home. There has been one new admission since the last key inspection and an examination of this persons file showed that an initial referral had been made and all of the necessary reports and Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 9 information gathered from a variety of other professionals. The manager had attended a number of meetings to gather information and discuss the person’s needs. From this information a ‘moving in’ care plan was developed. This showed that the person had several visits to Rook Lodge ranging from a few hours to a weekend. Observations and evaluations had been made in regard to these visits and included comments from the person concerned. Therefore the staff team had the necessary information to decide whether they would be able to provide a service to this person and the individual was able to make a more informed decision about whether he wanted to live there. The accommodation at the home consists of a maisonette, flats and bed-sits. People living in the bed-sits prepare meals with the staff and eat in the communal dining area. They also receive more support than the people living in the flats and maisonette. Therefore a range of differing needs can be met and people can be supported to be as independent as possible and in the past this has enabled people to move on to more independent accommodation. Each person has a contract/statement of terms and conditions and these were available at the home. This means that there is clear information about the service that will be provided to each individual. Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Rook Lodge are involved in developing and reviewing their personal plans and these provide staff with the information they need to meet individual needs. The risk assessments are appropriate and reviewed and up to date. People are supported to take risks according to their needs and they have the opportunity to try things and to develop their skills as safely as possible. People can and do make their wishes known and make decisions about their lives. Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 11 EVIDENCE: Each person has a detailed care plan. Areas covered included health, self-care, communication, psychological needs, relationships and sexual needs, finance and cultural needs. People also have night care plans. Daily reports are made and these are linked to the care plans. Therefore there is a record of peoples’ care and well-being. A random sample of care plans were checked at the time of the visit and these were all relevant and up to date. In addition the person concerned had signed and commented on their plan. There was evidence that they had been reviewed regularly and that people living at Rook Lodge had been involved in developing and reviewing their plans. People also have six monthly reviews with other professionals as part of the Care Programme Approach (CPA). Copies of notes of the most recent CPA meetings were seen on peoples’ files. The service has now also introduced regular 1:1 meetings between users of the service and their keyworker. Therefore people have the opportunity to talk about what is happening in their lives, how they are feeling and what they want to do. Appropriate risk assessments were in place and again those seen had been reviewed and updated when needed. There were up-to-date risk assessments covering the necessary areas and these were relative to each individual, the activities that they do and their own specific behaviours. For example some people are ‘checked’ during the night but others only at the end of the evening and again in the morning. Overall sufficient detailed information is available so that staff can meet peoples’ needs. People living at Rook Lodge and staff talked about the choices that individuals made. For example, their menus, what they did, where they went and when they got up and went to bed. People had chosen where to go on holiday. One person said, “I have got a key and go out when I want to, I just let the staff know”. People using the service said that they could talk to staff if they had any concerns and that staff helped them. They also said that they could talk to the manager or deputy. Residents meetings are held each week and people take turns to chair the meeting. Independent advocacy is also available. People living at Rook Lodge can and do make their wishes known and make decisions about their lives. Personal records are stored securely in the office and staff are aware of issues confidentiality. Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 11, 12, 13, 14, 15, 16 & 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities for personal development and are supported to be as independent as possible. They are encouraged to engage in appropriate leisure activities within the local community. They go out when they want to and keep in contact with their friends and families. They choose their own food and some of them cook their own meals. EVIDENCE: People are encouraged and supported to develop their skills. Those living in the bedsits participate in household tasks on a rota basis. This includes the cooking as well as domestic chores. People that live in the flats cook their own meals, do their own washing, ironing and cleaning. The service has been Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 13 successful in supporting people and enabling them to move on to more independent accommodation. All of the people living at Rook Lodge can and do go out without support from the staff team. One person said, “I have got a key and go out when I want to”. People said that they go to college and to various support groups and clubs. One person goes to a Jewish club and another to a Caribbean club. Another said that he goes out with his friend. At the time of the visit some people were making preparation for their holiday to Pontins. They said that this was where they wanted to go. Some people have a lot of contact with their families; others do not have any close family that they are in regular touch with. People talked about how staff support them to be as independent as possible. For example supporting them with menu planning, shopping and cooking meals. One person said, “the staff help when you need them”. Another said that he would like to “move to his own place” and that he had discussed this with staff. Although none of the people living at Rook Lodge have any ongoing employment they are encouraged in this area. For example one person does some work for RCHL at their head office and another said that he had completed some retail training at Tesco. Four people have completed interview training and have been participating in staff interviews. They have also been taking courses in food hygiene, catering and self defence. There is now a computer, linked to the internet, in the lounge and some people enjoy using this. Staff said that the people living at Rook lodge are now doing more and involved in more things. Overall people have opportunities for personal development and are supported to be as independent as possible. They are encouraged to engage in appropriate leisure activities within the local community. As stated previously some people cook their own meals and do their own shopping. Staff help them with menu planning and advise on healthy eating. People that eat in the communal areas choose the menu, which includes a variety of dishes with healthy and homemade options, and take turns to cook with the staff. Nobody has any specific dietary requirements. Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service receive personal care that meets their needs and preferences and staff support them to get the health care that they need. The monitoring and recording of medication needs to be more robust to ensure that people are receiving their prescribed medication as safely as possible and in line with best practice. EVIDENCE: Most people are very independent in terms of personal care; some just need reminders and prompting. Should more support be required female staff support the female living at Rook Lodge and males can be supported by male staff. The level of support that each person needs is documented in their care plan. Each person is registered with a local GP practice and receives specialist input as and when required. This includes the dentist, optician, community psychiatric nurse and psychiatrist. Staff remind people about their Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 15 appointments and accompany individuals for major issues. Details are kept of medical appointments and outcomes. People have regular blood tests to monitor their medication levels. Individual’s mental health needs are reviewed 6 monthly as part of the Care Programme Approach (CPA). Each person has a “breakdown footprint”. This indicates the symptoms of a possible deterioration in their mental health. People are supported by a regular staff team who know them well and who are able to identify when an individual is unwell both physically and mentally. There are policies and procedures for the handling and recording of medication. The staff administer medication to those people who are unable to self medicate. One person said, “the staff give me my medication. I don’t feel ready to do it myself yet.” Medication is securely and safely stored in an appropriate locked facility in the main office. Most of the medication is in a monitored dosage system dispensed by a local pharmacist. The remainder is collected, by individuals, directly from the hospital. The service is in the process of changing to another medication supplier and staff are scheduled to have training on the new system in the near future. There is a medication file and this contains photographs of each individual, a list of staff that are able to administer medication and their signatures and MAR (Medication Administration Record) sheets. Examination of the medicines administration record (MAR) chart found that there were a lot of handwritten entries. The manager explained that this was due to some difficulties with the MAR (Medication Administration Record) sheets supplied by the pharmacy. In some cases the handwritten sheets had been initialled by a member of staff. For accountability any handwritten entries made by staff must be endorsed with the date and the signed initials or signature of that person. Some people are prescribed PRN (as required) medication and a PRN medication policy and procedure has been developed. This gives general guidance and individual protocols/guidelines are also in place. However these do not always contain sufficient detail to ensure that all staff know when and why to administer PRN medication to each individual. For example they did not confirm the required gap between doses. It is recommended that the PRN (as required) guidelines are reviewed and made more detailed so that they contain all of the necessary information to minimise the risk of error and to enable these to be administered as safely as possible. As part of the monthly monitoring carried out by RCHL a medication audit was carried out two months before this inspection. This was thorough and made a number of recommendations. Medication training has been arranged for all staff as a result of the audit. We were told that these had all been addressed but found that out of date medication was still stored in the medication cabinet even though this had been identified as part of the audit and highlighted on the first day of the inspection. The monitoring of medication needs to be more robust to ensure that people are receiving their required medication as safely as possible and in line with good practice guidance. Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Rook Lodge are safeguarded by the working practices and support of the staff team. EVIDENCE: There is an organisational complaints procedure and each person has a copy of this. People said that they could talk to the manager or deputy if they werent happy about anything. They also meet with the housing officer and discuss problems. In addition they have access to an independent advocate, regular residents meetings and regular one to one meetings with their keyworker. RCHL have monthly meetings with users of their services and people can ‘have their say’ at these. Two people from Rook Lodge go to these meetings with a member of staff and then feedback to the others. Therefore people have the opportunity to raise and discuss any issues or concerns. There was one recorded complaint since the last inspection. Staff had recently helped one individual to make a complaint about repairs carried out by the Housing Association. He had been assisted to complete this on line and it was passed to the Housing Officer. The Commission has not received any complaints or allegations about this service. The organisation has produced a detailed adult protection policy that tells staff the actions to take in the event of abuse/suspected abuse being discovered. All staff have attended training on POVA (Protection of Vulnerable Adults) Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 17 training and staff spoken to were aware of the issues of abuse and aware of their responsibilities. All staff have received MCA (Mental Capacity Act) and DOL (Deprivation of Liberty) information and training has been arranged on this. The section on staffing later in this report gives information that confirms that there is an appropriate recruitment procedure and this also helps to safeguard people living in the home. Some of the people living at Rook Lodge manage their own finances others receive differing levels of support from the staff team. Each person has a financial risk assessment and details of the support that they require is documented. Each person collects their own money from the building society or bank. Those requiring support from the staff team take this to the office and staff record the details and put money into individual wallets, which are kept in the safe. People are helped to budget and given money when required. They sign to say they have received their money The records of three people were examined and cash counted. Records are kept of financial transactions and weekly checks are made. Cash is also checked as part of the monthly monitoring visits made by RCHL and the organisation carries out annual financial audits. Systems are in place to ensure that people are protected from financial abuse as far as possible and that their finances are appropriately managed and monitored. Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 & 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean home that is suitable for their needs. EVIDENCE: Rook Lodge was a nurse’s home and was converted to a registered care home. Accommodation consists of 5 bed-sits, 4 flats and 1 maisonette. There is a communal lounge, dining area, smoking area, laundry and kitchen. Each person either has a bed-sit, a flat or a maisonette. The bed-sits consist of a bedroom and en-suite facility. The flats have a combined kitchen/lounge/dining area, a bedroom and a bathroom. The maisonette has a kitchen, a lounge/dining area, a bedroom and a bathroom. None of the people currently living at Rook Lodge require adaptations or disability equipment. There is a call system within the home and they are all able to use this to summon assistance or to speak to staff. Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 19 Communal areas are appropriately decorated and furnished and new flooring has been fitted in the conservatory. Each person has got a new bed, duvet and bedding. People clean their own personal areas and the cleaning of the communal areas is shared. To support this there are periodical deep cleans in the kitchen and to carpets. The building is owned by a Housing Association and there is a five year decoration and renewal cycle. The downstairs shower room has had some work completed to replace tiles but is still not in a good state. Also the ensuite shower room in one of the flats needs attention. This was discussed with the manager and he is putting these areas on the cycle for next year. Therefore at this stage a requirement has not been made. At the time of the visit the communal areas appeared to be clean and hygienic. The service has had a food safety inspection and received an excellent 5 star rating. Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported and protected by the recruitment practices of the service. Staffing levels are sufficient, and staff receive the necessary training, supervision and support, in order to meet peoples’ current needs and provide an appropriate service for them. People are supported by a staff team that know them well and who are committed to providing a service that supports people to be as independent as possible and where possible to move on to more independent accommodation. EVIDENCE: From the rota and from discussions with staff it was evident that people are supported by a regular staff team that knows them well. Any absences are covered by the staff team and regular relief staff. There are usually three staff on duty during the daytime shifts and at night one waking and one sleep in staff. Feedback from staff was that there were sufficient staff on duty to meet Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 21 people’s needs. They also said that there was a good supportive staff team and it was a good place to work. All staff have job descriptions, contracts and staff handbooks and were clear about their roles, responsibilities and duties. They attend an organisational induction programme and also have access to a range of training courses. In 2007 RCHL received a National Training Award in recognition of how their training and development programme has supported organisational success and individual staff development. Records are kept of staff training and show that staff receive the training needed to meet the needs of the people using the service. This includes POVA (Protection of Vulnerable Adults), food hygiene and managing challenging behaviour. As previously stated staff training for the MCA (Mental Capacity Act) and medication has been arranged. In addition 9 of the 11 permanent staff have obtained NVQ level 2 or above. Some staff have completed NVQ in Mental health in addition to NVQ in care. Therefore staff receive the training that they need to provide a good service to the people living there. The organisation has a robust recruitment and selection procedure that includes application forms and interviews. Two references are obtained and POVA (Protection of Vulnerable Adults) and CRB (Criminal Records Bureau) checks are undertaken. People who use the service are involved in interviews. The files of the two newest members of were inspected. They contained all of the necessary information, including proof of identity. Therefore people are protected by the organisations recruitment procedure. Staff spoken to confirmed are receiving supervision regularly and also that staff meetings are being held regularly. Staff therefore have an opportunity individually and together to discuss issues, concerns and the development of the service. Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Rook Lodge benefit from a service that is well managed and where their opinions are sought and acted upon. They live in a safe home. EVIDENCE: The manager is a qualified psychiatric nurse and has extensive experience of managing services for people with mental health difficulties. Staff spoken to said that they get good support from the manager and that they can talk to him if there are difficulties or concerns. The staff team carries all of the necessary health and safety checks out and records are kept of these checks. For example fire call points are tested and Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 23 appropriate servicing is carried out on the fire system and fire equipment. However the fire call points are not always checked every week. The records show that frequency has varied from once per month to four times per month. Two fire drills have taken place recently including a night time fire drill but the last drill prior to this was a year ago. Systems need to be in place to ensure that the required health & safety checks are carried within the prescribed timescales. The service received an excellent 5 star food hygiene assessment from the Local Authority. Staff also carry out monthly health and safety audits and every three months a ‘housing officer’ from the head office carries out a more in depth audit. Therefore the organisation also monitors health & safety. A safe environment is provided. The quality of the service provided is monitored by the manager and by the organisation. The service manager carries out monthly monitoring visits to check the quality of the service provided. These indicate the action to be taken if deficiencies are identified. Copies of these reports were available in the home. In addition to this the organisation carries out a quality audit each year and also a financial audit. RCHL have held five service user participation days in the last year. These were: ‘The Service User Survey Day’, ‘The Annual Report Day’, ‘The Business Plan Day’, ‘A Speak Up Day’ and ‘A Day on what is Important in Services’. In October 2008 RCHL held a service user consultation day facilitated by independent drama and advocacy consultants. In addition to people giving RCHL their views there was also an opportunity to try activities and have lunch. Therefore people using any of the RCHL services have the opportunity to feedback on services and to help shape future services. A newsletter is published every three months and this contains information about what is happening in the organisation. It also gives information about planned events. Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X X 3 X Version 5.2 Page 25 Rook Lodge DS0000025921.V375513.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 (2) Requirement For accountability any handwritten entries made on the MAR (Medication Administration Record) sheet must be endorsed with the date and the signed initials or signature of the person making the entry The monitoring of medication practices and systems must be more robust to ensure that people are receiving their required medication as safely as possible and in line with good practice guidance. Timescale for action 31/10/09 2 YA20 13 (2) 30/11/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations It is recommended that the PRN (as required) guidelines are reviewed and made more detailed so that they contain all of the necessary information to minimise the risk of error and to enable these to be administered as safely as DS0000025921.V375513.R01.S.doc Version 5.2 Page 26 Rook Lodge 2 YA42 possible. It is recommended that a system is put in place to ensure that the required health & safety checks are carried within the prescribed timescales. Rook Lodge DS0000025921.V375513.R01.S.doc Version 5.2 Page 27 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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