Care Home: Rose House

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What the care home does well People who used the service and their relatives stated that they were satisfied with care and support that was provided. They said that staff were `kind and caring`. There was a good and committed staff team, which was working well to ensure the health and wellbeing of people who used the service. Staff were provided with good training and development opportunities to make sure they had the necessary skills and competency to carry out their responsibilities. The home was well managed and relatives of people who used the service, said that they felt reassured that the safety and wellbeing of their loved ones were well promoted. They stated that staff were `good at listening to people and taking their views into account`. What has improved since the last inspection? Since our last inspection, an activities co-ordinator has been appointed to ensure the organisation and provision of appropriate social and recreational activities for people who use the service. This has helped to ensure that there is appropriate social stimulation and social inclusion of people who live at the home. The physical environment has continually been upgraded. Both the communal and private accommodation have been well decorated and furnished. Commendably, the vegetable garden has been redesigned to provide raised boxes, which enable people to tend to the plants with more ease. Staff training and development has progressed well and more staff were accessing distance learning courses to equip themselves with good care practices. What the care home could do better: Although the care planning and the management of care was satisfactory, there is a need for staff to ensure that actions to be taken to meet identified care needs are clearly set out. This will help care staff to take all relevant actions to meet specific needs in a consistent manner. Senior staff should also make sure that medicines administration records are appropriately maintained at all times. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rose House Rose Grove, Church Street Armthorpe Doncaster South Yorkshire DN3 3AJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ramchand Samachetty     Date: 1 1 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 25 Information about the care home Name of care home: Address: Rose House Rose Grove, Church Street Armthorpe Doncaster South Yorkshire DN3 3AJ 01302831450 01302834275 NONE Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Doncaster Metropolitan Borough Council care home 30 Number of places (if applicable): Under 65 Over 65 20 10 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 0 Rose House is a Care Home providing accommodation and care for up to thirty people in the category of older people. The Home is divided in two units. Twenty of the thirty places are registered for Dementia. The other ten places are for older people, not falling in any other category. Rose House is owned by the Doncaster Metropolitan Borough Council and managed by its Social services Department. There is a registered manager who is responsible for the day- to- day running of the Home. Rose House is a two-storey building, situated in the Armthorpe area of Doncaster. It is close to local amenities and is accessible by public transport. Accommodation for residents is provided on both floors, and there is a passenger lift to facilitate access between the floors. All bedrooms are single. The Home also provides day care for up to six people a day. Care Homes for Older People Page 4 of 25 Brief description of the care home The communal areas comprise of two dining areas and four smaller television lounges. The kitchen and laundry facilities are located on the ground floor. There is a secure internal garden for use by people with dementia. Information gained on the 11th June 2009 indicated the current fees are from £375.00 to £410.00 per week, with additional charges being made for newspapers, hairdressing and toiletries. Further information can be obtained from the home. Care Homes for Older People Page 5 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 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 unannounced inspection took place on 11 June 2009, starting at 09.45 hours and finished at 17.00 hours. The manager, Mrs Pam Castle was present during our visit. The last inspection of this service was carried out on 15 June 2007. The service is registered to provide accommodation and care for up to thirty older people. Twenty places are available for people who have dementia and they are accommodated in a separate unit. There were 28 people living at the home at the time of this inspection. Prior to our visit, the manager had submitted an Annual Quality Assurance Assessment (AQAA), which gave us information about how the service was addressing Care Homes for Older People Page 6 of 25 the relevant National Minimum Standards for older people in residential care, the progress made since our last inspection and the work planned for the next twelve months. We used some of this information in our assessment of the service. We spoke to people who used the service and relatives and also to members of staff. All the key national minimum standards for Care Homes for Older People were assessed at this inspection. The inspection included a tour of the premises, examination of care documents and other records, including those pertaining to complaints, staff employment, medicines management, maintenance of equipment and quality assurance methods. We gave feedback about our initial findings to the manager and other senior staff, during the course of our inspection. We would like to thank all the people living at the home, relatives and staff who helped with this inspection. 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 set out 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 25 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 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 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. The care needs of people were appropriately assessed before their admission to the home. This ensured that their identified needs could be met at the home. Evidence: The care files of two people who had been admitted to the home in the last six months were checked. They showed that full assessments of their care needs had been carried out before their admission. These assessments were carried out by placing social workers and by the staff at the home. This helped to make sure that their identified needs could be catered for by the home. The home does not provide an intermediate care service. Care Homes for Older People Page 10 of 25 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. People who used the service and their relatives were satisfied with the care being provided. The health care of people who lived at the home was well catered for and this promoted their continued wellbeing. However, there was a lack of clarity about the actions to be taken to meet some identified needs. This may affect the overall quality of care provided. Evidence: People who used the service and their relatives told that they were satisfied with the care and support that was provided. They said that staff were friendly and caring. They said that care was always provided in a way that protected their privacy and dignity. Staff explained that personal care was provided in private in peoples own bedrooms or in bathrooms. We noted that staff interactions with people in their care were polite and respectful. Relatives commented that their loved ones were well looked after and that nothing was too much trouble for the staff to make people comfortable. Care Homes for Older People Page 11 of 25 Evidence: We looked at the care plans of three people who used the service. They were based on the assessments of identified needs, risks and preferences of the individuals concerned. They also included a section on personal profile and life history of the individual and we noted that some of this information was also used in planning their social care. The care plans outlined actions that were required to meet the care needs of individuals. However, in some instances, particularly in the area of mental wellbeing, these actions were not clearly stated and therefore staff had less guidance on how to effectively meet those needs. Risks were appropriately assessed and managed. The care plans that we checked were reviewed on a regular basis and changes in care needs were noted and addressed. People who used the service told us that they had good access to health care services. They said that staff were prompt in helping them with appointments to see their GPs, dentists and other health care professionals. The care plans included details and records of outcomes of such interventions. We noted that staff at the home had good communication and working relationships with health care professionals in the local area. This benefited people who used the service. We looked at the way medicines were handled and administered at the home. We checked a sample of medicines administration record (MAR) sheets. They were generally well maintained. However, we noted that in two instances, handwritten amendments on these sheets had not been signed and dated by the person who wrote them. There were therefore no recorded explanations for these changes. Medicines received at the home were appropriately recorded and administered. The manager confirmed that staff who administered medicines had received the relevant training to do so. None of the people living at the home were administering their own medicines. Care Homes for Older People Page 12 of 25 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 who lived at the home were able to benefit from the recreational and social facilities that were offered to them. This helped to maintain and improve their quality of life. Evidence: During our visit, we observed people living at the home, spending time in the lounges and in their rooms, listening to music and watching television. A small group of people chose to sit in the lounge near the entrance, which offered a view of the small garden and of the road. They said that they enjoyed the time by conversing with each other and by watching the activity on the road. Some people chose to spend their time quietly on their own. Staff we spoke to and the activities coordinator told us that both indoor and outdoor activities were offered to people who used the service. The activities coordinator, who had recently started working at the home, was planning weekly programmes of social and recreational activities for people living at the home. Records showed that social care needs and preferences of individuals were being considered in the planning of recreational activities. Records also showed that people living at the home had been Care Homes for Older People Page 13 of 25 Evidence: offered various activities and these included arts and craft sessions, one to one time, and nail care and hands massage, indoor board games and reminiscence. We noted that good efforts had been made to offer gardening activities at the home. A gardening group had been established and some people were keen to participate in this activity. People who lived at the home were also provided with appropriate information about the social and recreational activities and events taking place in local area. Relatives confirmed that they were always welcomed at the home. They felt that staff communicated well with them and with people in their care. This helped to ensure they could express their views and preferences about the way their care was provided. Staff would also help people who could not fully make decisions on their own, by working with relatives and relevant professionals, thus ensuring that their welfare was promoted. People who lived at the home and their relatives stated that meals served at the home were good and nutritious. People were offered adequate choices for breakfast, lunch and dinner each day. We observed lunch being served on the day of our visit. People who lived at the home told us that they had been well served and that they were happy with the meal. We noted that staff had carried out nutritional needs assessments of people in their care and had catered for them. We also observed staff helping a few people with eating their meals, in an unhurried and dignified manner. Care Homes for Older People Page 14 of 25 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. People who used the service were appropriately protected from harm and abuse. Staff were able to use existing policies and procedures to safeguard people in their care and to respond to their views and concerns. Evidence: There was a corporate complaints procedure in place. The procedure was produced by the Doncaster Council. Copies of the procedure had been made available to people who used the service and their relatives. The procedure was also included in the homes statement of purpose and service user guide. Relatives told us that they were aware of this procedure and would use it if they had to. They commented that if they had any concerns, they would make them known to senior staff. They felt confident that staff would address such matters appropriately. Staff confirmed that people who lived at the home and relatives would talk to them if they had comments to make about the service. Such comments were also made through the quality assurance questionnaires that were distributed to people who used the service and relatives. The manager had stated in the Annual Quality Assurance Assessment that was submitted to us, that the home had received no complaints in the previous twelve months. We checked the complaints record and it confirmed that no complaint had been received for the service for a long period of time. Care Homes for Older People Page 15 of 25 Evidence: The home had use of the Doncaster Councils adult safeguarding policy. This policy helped to guide staff on the prevention and management of abuse of vulnerable people in their care. In discussion, staff stated that they had received training and guidance on the protection of vulnerable people and showed good understanding of the procedures in place. The manager confirmed that there had not been any safeguarding concern at the home. Care Homes for Older People Page 16 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, 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 who lived at the home and their relatives were satisfied that the accommodation provided was safe, clean, comfortable and pleasant. This helped to maintain and promote the health and wellbeing of people who lived there. Evidence: We checked the premises in the company of the manager. The building comprised of two floors and there were a set of stairs and a passenger lift to facilitate access between the two floors. The communal areas included two dining areas and a few lounges and were located on both floors. the kitchen and laundry facilities were on the ground floor. All the residential accommodation on the ground floor were for use by people who have dementia. This area of the home was kept secure by the use of electronic keypads. This helped to ensure the safety of people who have dementia. We noted that decoration work was in progress at the time of our visit. The manager confirmed that there was a refurbishment programme and it was being implemented to continually improve the homes environment. We noted that new and more domestic style lighting had been provided in the corridors. The manager also confirmed that new carpets would be installed in the home. The home was well furnished and had the appropriate equipment and facilities to help people who lived in it. Care Homes for Older People Page 17 of 25 Evidence: We viewed a few bedrooms with the permission of people who lived in them. The rooms were clean, tidy and well decorated. A few people had brought in some memorabilia and were therefore able to personalise their bedrooms. The communal areas were also clean and well maintained. The surrounding grounds were appropriately maintained. We noted that the secure garden had been improved by the installation of raised plant beds in order to allow people with limited mobility to participate in gardening. The patio area had been provided with an awning to help protect people from the effects of direct sun light and heat. People who lived at the home and their relatives said that they were satisfied with the accommodation provided. They felt that the home was very pleasant, safe and comfortable. Care Homes for Older People 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 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. Sufficient and adequately trained staff were employed to provide care and support to people who lived at the home. This helped to make sure care was delivered to consistently good standard. Evidence: At the time of our visit, there were 28 people in residence at the home and most had dementia. Besides the manager, there was a deputy manager and five care workers on duty during the day. Four care workers were scheduled to work at night. They were supported by an a senior carer who acted as a night manager. Other support staff during the day, included an administrator, two cooks, domestics and an activities coordinator. The manager confirmed that the care staffing level was calculated on the dependency level of people who were in residence and that this was regularly reviewed to ensure needs were effectively met. People who used the service and relatives stated that there were always sufficient staff on duty. They described the care staff, and in particular the key workers, as being very good at their job and very caring and committed. We looked at the employment files of three members of staff who had been recently recruited to work at the home. They satisfactorily included all the completed preemployment checks, including appropriate disclosures. There was also evidence of Care Homes for Older People Page 19 of 25 Evidence: induction and initial training provided to the staff concerned. In discussion, the manager stated that staff had been provided with a wide range of training. These included areas of mandatory training, like, moving and handling, fire safety, food hygiene and first aid.Staff have also been provided with training on various other topics, which included adult safeguarding, the mental capacity act, deprivation of liberty safeguards, medicines administration and dementia. The manager explained that all staff were being provided with a personal development review as forms of appraisals. In discussion, staff confirmed that they had received regular training. They also confirmed that they were receiving the required supervision and support to carry out their duties. Staff also showed that they had a good knowledge of the care issues and also the relevant skills to deliver care to people who lived at the home. We noted that on-going training, including refresher courses, had been planned and that some staff were undertaking e-learning. Information from the Annual Quality Assurance Assessment indicated that 23 out of 25 permanent care workers at the home had achieved their National Vocational Qualification (NVQ) level 2 in care. This also confirmed aspects of the competency of the care staff at the home. Care Homes for Older People Page 20 of 25 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 home was appropriately organised and managed and staff promoted the health, safety and welfare of people who lived in it. Evidence: The registered manager has experience of caring for older people in residential setting. She has a National Vocational Qualification level 4 in care and management. In discussion people who used the service, relatives and staff told us that the home was well managed. They commented that the manager and her senior staff were very approachable Staff stated that they felt supported in their work. They said that they were provided with good opportunities for training and development. They commented that they were receiving regular supervision. Records relating to staff training and supervision also confirmed good staff management practice. Care Homes for Older People Page 21 of 25 Evidence: The manager explained that staff had use of various quality monitoring tools to help improve the service. These included the use of regular satisfaction surveys and meetings with people who lived at the home and their relatives. People who lived at the home also commented that they found the homes newsletter a good way of receiving information and of feeding back their views. The manager and her senior staff were also using various audit tools. These included audits of care plans, medicine records and health and safety measures. The registered provider was also conducting appropriate monthly unannounced visits to the home. Reports of those visits showed that they were also used to improve the quality of the service. The manager informed us that the home had received an internal service award, The little Gem. This was a commendation for showing compassion and dedication in caring for people. The manager had submitted the homes Annual Quality Assurance Assessment document to us prior to this inspection. It showed that appliances, utilities and equipment used at the home were appropriately serviced and maintained. Appropriate risk assessments and health and safety measures, including infection control and fire precautions, were in place. These helped to maintain the health, safety and wellbeing of people who lived at the home. Arrangements were in place to support people living at the home with the management of their personal monies. All financial transactions undertaken on behalf of people concerned were recorded, witnessed and signed for and receipts were kept. We noted that people were satisfied that they could access their money outside office hours. Care Homes for Older People 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 Older People 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 1 7 Staff should ensure that actions, formulated in care plans, to be taken to meet identified needs are clearly expressed and are appropriate to meet such needs. This Will help improve the overall quality of care. Staff should sign and date all handwritten entries and amendments that they make on medicines administration record sheets. This will help to show authorisation received and will improve accountability. 2 9 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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