Care Home: Rose Cottage

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What the care home does well Information about the home is now more user friendly as there are colour photographs, pictures and quotes from current service users. This means that prospective service users will have some up to date information about what the service has to offer. Service users have been involved in developing their care plans. Staff are talking to people about their personal goals for the future. Personal goals are being recorded and most have plans for staff to follow to help people achieve their goals. The manager is longstanding so knows people well. People have the support they need to keep in contact with family and friends. The home is clean and well maintained. People have access to all areas. People have the support they need to remain healthy and well. What has improved since the last inspection? They have made some information more user friendly. The quality assurance system has been improved. The company have also improved the assessment tool used to assess peoples needs. The manager can train staff in some subjects. What the care home could do better: The manager agreed that the review of care plans should be more regular so changes in needs and goals can be picked up and acted on. All staff, including the manager should have regular supervision. Key inspection report Care homes for adults (18-65 years) Name: Address: Rose Cottage Oak Lodge Road New Romney Kent TN28 8BG     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: Kim Rogers     Date: 2 4 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Rose Cottage Oak Lodge Road New Romney Kent TN28 8BG 01797362842 01797366237 rose.cottage@craegmoor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Lothlorien Community Ltd care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 7. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Rose Cottage is owned by Lothlorien Community Limited, which is a member of Craegmoor Group Limited. It is a large detached house located in New Romney that provides care for up to 7 people with a learning disability. All bedrooms are single and there is adequate w.c. and bathing facilities. The home is within walking distance of the high street, supermarket and the beach. A bus service to local towns is close by. Fees for Rose Cottage at 21/01/08 are in the range of £ 737.11 and £ 1068.87. There are additional charges for chiropody, hairdressing, massage, some toiletries and magazines. Please contact the provider for up to date information. 7 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced Key inspection of the service. This means that we assessed the Key Minimum Standards. The last Key inspection of this service was 21/01/08. We carried out an Annual Service Review on 26/11/08. Copies of these reports are available from the Provider or can be viewed on our website. We spoke to the people who use the service. We spoke to staff and the manager and sampled various records. We made observations and had a look around the home. We looked at the Annual Quality Assurance Assessment or AQAA. The manager completed this and it gives information about how the home has improved and how they intend to improve further. We looked at any notifications from the home about accidents and incidents. We looked at other information we have about the home including things like comments and Care Homes for Adults (18-65 years) Page 5 of 25 complaints. We sent surveys to the people who use the service and other stakeholders. People told us what they think about the home. We received 3 surveys back from service users and 4 from staff. All made positive comments about the service. Service users said in surveys that the home is always clean and fresh and they can decide what to do each day. Staff said, we are a good team who work together well and respect each other. It would be good to have more staff who drive. Care Homes for Adults (18-65 years) Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 25 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information available about the home to help decide about moving in. People know an assessment will be carried out before they move in. Evidence: There is information available about the home. This information is written with pictures, photographs and symbols. Since the last inspection the manager has updated this information and added colour photographs and pictures. This means that the information is more meaningful to people who may be thinking about moving in. One person has moved in to the home since the last inspection and we saw the assessment that the manager carried out. The provider company is in the process of improving the assessment tool so that it meets the Minimum Standard. This means that prospective service users will have their aspirations as well as their needs assessed before they move in so the manager can be sure the home can meet their needs. The manager said that people can have trial stays and visits so they can see what it is Care Homes for Adults (18-65 years) Page 9 of 25 Evidence: like to live at Rose Cottage. In surveys received two out of three people said they were asked about moving in. All said that they had enough information about the home. Care Homes for Adults (18-65 years) Page 10 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users know that their needs and goals will be supported. Risks are assessed and managed and people have the support they need to make choices and decisions. Evidence: Each person has a care plan that details the support they need. We sampled one care plan in detail and looked at a second. Since the last inspection service users have been involved in developing their care plans. People have been talking to their key workers about their aspirations and goals for the future. Plans of support are in place so staff know what to do to help people achieve their goals. Risks are identified and assessed with strategies in place to reduce risks. The manager agreed that regular, more effective review of care plans is needed so staff know if people are getting the right support or not. All plans are written with some pictures and symbols. The manager agreed that there is potential to produce care plans in a way that is more meaningful to the person and has ideas on how to do this. There is information in plans about how people prefer to Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: communicate. Staff have attended training in how to use alternative forms of communication. There are systems in place so the environment supports communication including a staff photo board showing who is on duty, a picture menu and signs on cupboard doors and room doors. This means that people can find things out for themselves rather than having to ask staff. We observed staff communicating respectfully and effectively with service users. Care Homes for Adults (18-65 years) Page 12 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to take part in leisure activities. Relationships are supported and people are involved in the running of the home including planning and preparing meals. Evidence: People have the opportunity to take part in a range of activities in the community and when at home. People told us that they like going to music sessions at a local community centre. There are a range of sessions on offer and this is run by the company who run the home. The manager said that staff who can drive support people to attend the sessions, otherwise public transport or a company mini bus service is used. In surveys, people told us they can choose how to spend their days. Each person has a weekly planner showing what they will be doing, the manager said that each person is different and therefore, where possible individual needs are supported. On the day of the visit two people went out for lunch with one staff Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: member and others went to a karaoke session. One person was visiting family and another person chose to stay at home. The manager said that no one has any form of employment at present. The manager said that everyone is involved in the day at day running of the home like the housework and cooking. People can access the kitchen and other areas so have control over their environment. People are involved in planning the meals and the menu is shown in pictures so people know what the choices are. Kitchen cupboards have pictures on them to show what is inside, giving people the extra support they need. Nutritional needs are recorded as well as needs relating to eating and drinking. The staff have worked with health professionals to ensure that there are guidelines in place to keep people safe when eating. People can eat at a small table in the kitchen or in the conservatory used as a dining room, which overlooks the garden. People have the support they need to keep in touch with family and friends. Relatives details are recorded and visits to and from family are supported. Care Homes for Adults (18-65 years) Page 14 of 25 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know their personal care and health needs will be supported. Medication practice is safe protecting service users. Evidence: The support people need with their personal care is recorded in individual care plans. Additional information has been added so staff have more detail about how people prefer to be supported. We observed people being supported with their personal care discreetly and respectfully. Health needs are recorded so staff know what support people need to remain healthy. There are guidelines for staff to follow about individual health needs. Staff monitor peoples weight and nutrition so they can act if anything changes. The manager agreed that the records of the monitoring of peoples general health could be more detailed and recorded more frequently. People have support to attend health appointments. For one person a decision was made in the persons best interests not to attend an important health check appointment. The manager said that staff will be making checks with the person instead. This is not recorded anywhere so staff may not be aware of it and may not know how to support the self checks. The manager agreed to Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: address this. People have booklets in their care plans about being healthy. The manager said staff are in the process of completing the booklets with individual service users. There will be an action plan of what support people need to remain well and healthy. Staff have training related to health including epilepsy. The manager ensures that staff watch videos from the Epilepsy Society to give them a general awareness about epilepsy during their induction period. Staff then attend more detailed training. Medication is stored safely in individual rooms giving more privacy and some control to service users. The manager said that staff have training in how to administer medication safely. They then have a yearly competency assessment by the manager which includes an observation. We sampled medication administration records and found these to be in order with no gaps. There is a record to show the receipt of medication into the home. There are systems in place to check what stocks of medication the home has. Care Homes for Adults (18-65 years) Page 16 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know who to complain to and are confident their complaints will be acted on. People are protected from harm and abuse. Evidence: There is a written complaints procedure displayed in the home. This is also produced with text, photographs and symbols. The manager said that there have been no complaints about the service since the last inspection. The Commission has received no complaints about the service since the last inspection. People meet up regularly to talk about things like activities and menus. The manager said this also gives opportunity for people to raise any concerns or complaints. Service users told us in surveys that they know who to talk to if they have a complaint. There is a safeguarding vulnerable adults and whistle blowing policy and procedure. The manager said that staff attend training in safeguarding vulnerable adults so are aware of the procedures. The policies and procedures are displayed in the office for staff to refer to. The manager is aware of the procedures to follow if abuse or harm is suspected. Care Homes for Adults (18-65 years) Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and well maintained. Evidence: The home is well maintained with adequate furniture and fittings. The manager said some new sofas have been ordered. There are communal areas like lounge and conservatory and each bedroom is single with a wash hand basin. This means that people can have some private space if they need it. There are enough bathrooms and showers that meet peoples needs. Service users have support to take part in keeping the house clean. The home was clean and smelled fresh on the day of our visit. People told us in surveys that the home is always clean and smells fresh. There is a schedule for decorating and maintenance. The garden is private and can be accessed from the conservatory. There is a decked area with seating and a lawned area. The manager said they make full use of the garden in the warmer weather. Care Homes for Adults (18-65 years) Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff to meet service users needs. Staff have access to mandatory and other training. Recruitment checks are carried out before people start working at the home. Evidence: There is usually up to three staff on duty with the manager. The manager said that the rota is planned around service users appointments and activities and that extra staff come in when needed. In surveys from staff, one staff said that there is never enough staff, two said there is usually enough staff and one said there is sometimes enough staff. The manager said that some staff have left since the last inspection and the home will be fully staffed again once a waking night staff is recruited. One staff survey said, We are a good team of workers who get on well and respect each other. Staff have access to mandatory training courses. The manager said that staff are up to date with this training and more courses are planned to ensure people have the updates they need. The manager also uses videos on subjects like epilepsy to give staff an awareness while they wait for a training date. The manager said that all staff have attended a one day course about person centred thinking since the last inspection. Staff told us that they have the training and support they need. The induction of new staff meets the Minimum Standard. Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: Recruitment checks are carried out before a person starts working at the home. Staff told us in surveys that they had recruitment checks and an induction. Staff have the opportunity to attend staff meetings and have one to one meetings or supervision with a line manager. This means that staff get some coaching, mentoring and support. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an experienced longstanding manager in post. There are quality assurance systems in place and peoples health and safety is protected. Evidence: The same manager is in post as at the last inspection. She has managed the home for over four years. The manager is registered with us so she has passed the fit person process. The manager has had several years experience in working with people with a learning disability and has the qualifications required by the Minimum Standard. The manager said she would like to gain a qualification relating to learning disabilities in the future. The manager spoke with knowledge and understanding of peoples needs and has plans to improve outcomes for people. All four staff surveyed said they get enough support from the manager, they can attend staff meetings and they get the training they need. There are quality assurance systems in place. The company carries out audits of the service including a financial audit and health and safety audit. The manager completes weekly and monthly returns for head office which are monitored. Surveys are sent out Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: to stakeholders by head office to gain peoples views about the service and service users meetings are held so people get to air their views. The manager said the manager of another company home or the area manager makes monthly visits to the home. These visits monitor practice and reports are completed that show that service users and staff are spoken to. The manager does not currently have enough recorded formal supervision or one to one meetings. The AQAA shows that health and safety checks are carried out on the premises and equipment. Staff attend training related to health and safety including food safety and first aid. Regular fire drills are held and fire equipment is checked regularly. Care Homes for Adults (18-65 years) Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 25 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 Care Homes for Adults (18-65 years) Page 24 of 25 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. Copyright © (2009) Care Quality Commission (CQC). 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