Care Home: Rose Mount

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What the care home does well The home is good at obtaining assessments from social workers before deciding if a place can be offered to individuals. In addition to this the home also undertakes its own assessment and carefully considers whether Rosemount can meet the needs of people looking to live there due to the home only providing minimal supervision to individuals. People have access to a range of health and social care professionals and this ensures that health care needs are met. People are able to express their own choices in relation to leading fulfilled lifestyles with activities that suit them and are meaningful. The registered manager has got to know the two people who live at the home and spends quality time with them. For example, on a `one to one` basis, one person who lives at the home goes out every morning with the registered manager to walk the dog. This provides both exercise and good social interaction time. The home maintains consistency in their staff group which benefits the people who use the service in receiving care from people who are familiar with, and have knowledge of, their personal preferences. The registered manager is striving to make improvements that meet people`s individual needs and ensure that people are part of this process. This ethos can only enhance the quality of life for people who use the service. People are provided with a homely and comfortable environment in which to live where privacy is maintained. What has improved since the last inspection? The home has worked towards meeting the majority of previous requirements, which suggests that the registered manager is keen to ensure that people live in a home that complies with regulations. The registered manager has been in contact with the local authority and the two people living in the home were allocated a social worker who has recently undertaken a review of each persons needs to ensure that these are being met. The registered manager has now obtained a copy of the procedure produced by the local authority for the protection of vulnerable adults. A cleaning schedule is now in place to make sure the tasks are always completed to a satisfactory standard and individuals live in a well maintained environment. The home has undertaken risk assessments in relation to all first floor windows within the home. Following this the registered manager has made the decision that first floor windows do not require window restrictors and the full length landing window nowremains locked at all times to safeguard the people living at Rosemount. The registered manager has acknowledged and showed they are proactive in relation to ensuring that the homes decor is updated to provide an enhanced environment for the people who live there. In view of this there are plans to redecorate all of the home and fit a new kitchen in April/May of this year. What the care home could do better: The statement of purpose and service user guide could be improved so that people who live in the home can understand this more easily. Contracts of residency require some updating to ensure that people`s rights are protected. To obtain further guidance information in relation to the changing needs of individuals as they go through the ageing process. This will provide knowledge around age related illnesses and the changing physical needs of people. Records should clearly show the amount of fruit and vegetables that people eat to make sure they have a healthy diet. To sensitively progress with obtaining individuals last wishes so that their preferences and needs can be upheld at this important time in their lives. To record the annual holidays or alternatives that are chosen within each persons care records. To consider introducing a complaints/compliments display book or suggestion box for people living in the home to use and also visitors to the home as these can be used to measure the acheivements in ensuring the home is run in the best interests of the individuals who live there. Formal training in adult protection must be progressed so that people living at Rosemount are fully reassured that they will be protected from harm by knowledgeable staff. Surveys to be sent to family members where appropriate together with stakeholders and used towards the development of the home`s quality assurance systems. The registered manager must progress the staffing files of the two named family members who are available to provide cover if needed. The required information must then be forwarded to the Commission for Social Care and Inspection, (CSCI). The quality assurance system now needs to be progressed and shared with the people who live in the home together with CSCI. There is a list of requirements and recommendations at the end of this report should the reader wish to look at these. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Rose Mount 138 Stourbridge Road Holly Hall Dudley West Midlands DY1 2ER     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: Sally Seel     Date: 1 3 0 1 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 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 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 Adults (18-65 years) Page 2 of 32 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Rose Mount 138 Stourbridge Road Holly Hall Dudley West Midlands DY1 2ER 01384457855 01384457855 nigeldhillon@blueyonder.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Valerie Dhillon,Mr Paul S Dhillon Name of registered manager (if applicable) Mr Nigel Dhillon Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Rose Mount is a small private Residential Care Home, providing accommodation for up to three adults under the age of 65 years who have learning disabilities. The Home is situated on a busy main road, with easily accessible bus routes to a number of nearby towns and shopping centres, Merry Hill, Dudley, Wolverhampton, Brierley Hill, Stourbridge etc. There are numerous local amenities within walking distance from the Home, Post Office, library, church, health centre, parks and pubs. There is limited car parking, two cars at the frontage to the property, with limited on road parking nearby. The accommodation provided consists of three good size single bedrooms, one on the ground floor and two on the first floor. There is a lounge/dining area, toilets, and bathing facilities. The office is located in the cellar. There is a garden and patio to rear of the Home, accessible to residents. The Registered Manager and Joint Proprietors and Care Homes for Adults (18-65 years) Page 4 of 32 care home 3 Over 65 0 3 Brief description of the care home family provide staffing. The level of fees for this home can be obtained by contacting the registered manager, Mr Nigel Dhillon. Care Homes for Adults (18-65 years) Page 5 of 32 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: One inspector undertook this announced fieldwork visit to the home, over a weekday. The registered manager assisted us throughout. There were two people living at the home on the day of the visit and when the inspector arrived one person had already left to begin their day but the other person was at the home. Information was gathered from speaking to one person who lives at the home. We case tracked both of the people who live at the home and this involved discovering their experiences of living at the home. This was achieved by looking at care records and reviewing areas of the home relevant to these people, in order to focus upon outcomes. Case tracking helps us to understand the experiences of people who use the service. Health and safety records were also reviewed. Care Homes for Adults (18-65 years) Page 6 of 32 The atmosphere within the home is inviting and warm and we would like to thank the registered manager and people living at the home for their assistance and cooperation. What the care home does well: What has improved since the last inspection? The home has worked towards meeting the majority of previous requirements, which suggests that the registered manager is keen to ensure that people live in a home that complies with regulations. The registered manager has been in contact with the local authority and the two people living in the home were allocated a social worker who has recently undertaken a review of each persons needs to ensure that these are being met. The registered manager has now obtained a copy of the procedure produced by the local authority for the protection of vulnerable adults. A cleaning schedule is now in place to make sure the tasks are always completed to a satisfactory standard and individuals live in a well maintained environment. The home has undertaken risk assessments in relation to all first floor windows within the home. Following this the registered manager has made the decision that first floor windows do not require window restrictors and the full length landing window now Care Homes for Adults (18-65 years) Page 8 of 32 remains locked at all times to safeguard the people living at Rosemount. The registered manager has acknowledged and showed they are proactive in relation to ensuring that the homes decor is updated to provide an enhanced environment for the people who live there. In view of this there are plans to redecorate all of the home and fit a new kitchen in April/May of this year. What they could do better: The statement of purpose and service user guide could be improved so that people who live in the home can understand this more easily. Contracts of residency require some updating to ensure that peoples rights are protected. To obtain further guidance information in relation to the changing needs of individuals as they go through the ageing process. This will provide knowledge around age related illnesses and the changing physical needs of people. Records should clearly show the amount of fruit and vegetables that people eat to make sure they have a healthy diet. To sensitively progress with obtaining individuals last wishes so that their preferences and needs can be upheld at this important time in their lives. To record the annual holidays or alternatives that are chosen within each persons care records. To consider introducing a complaints/compliments display book or suggestion box for people living in the home to use and also visitors to the home as these can be used to measure the acheivements in ensuring the home is run in the best interests of the individuals who live there. Formal training in adult protection must be progressed so that people living at Rosemount are fully reassured that they will be protected from harm by knowledgeable staff. Surveys to be sent to family members where appropriate together with stakeholders and used towards the development of the homes quality assurance systems. The registered manager must progress the staffing files of the two named family members who are available to provide cover if needed. The required information must then be forwarded to the Commission for Social Care and Inspection, (CSCI). The quality assurance system now needs to be progressed and shared with the people who live in the home together with CSCI. There is a list of requirements and recommendations at the end of this report should the reader wish to look at these. Care Homes for Adults (18-65 years) Page 9 of 32 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 32 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 11 of 32 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. The home have had no new admissions for many years but people who do wish to consider living there can be provided with information telling them about the home. People who have lived in the home for some years have had multi-agency reviews to ensure that support is provided. Consideration needs to be given in providing pictorial information about the home and updating contracts of residency. Evidence: As at the previous inspection there have been no new admissions to the home and so the outcomes in this area could not be fully assessed. However, the home has a statement of purpose and service user guide that provides individuals with a variety of information about the services the home offers. It is stated within this information that the home can offer an independent lifestyle for people with learning disabilities where care and guidance is available when required. There was no evidence that the statement of purpose and service user guide are available in other formats, such as, larger print, audiotape and/or using pictures as aids to communication for individuals who may not understand the written word. Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: The care records of the two people living at the home were viewed, each had a contract specifying the terms and conditions of residency and the fees to be paid. However, the fees stated have now increased and these require updating. Contracts are important to inform individuals or their representatives of the terms and conditions of the persons stay and the cost of that stay. Positively, we found all contracts were signed and in place. The registered manager told us that Rosemount is the residents home first and foremost. We certainly found this to be the case as the registered manager considers carefully the needs of any individuals considering living at Rosemount and takes into account how they would fit into the lifestyle of the home. Individuals can spend time at the home prior to moving in, with the opportunity of meeting the other two people who live there and looking at what Rosemount can offer. This ensures that peoples needs and aspirations are able to be met before they move into the home. We looked at the care records of the two people who live in the home and found that their care plans had been reviewed within multi-agency forums. A social worker has now been allocated to both people as was recommended at the homes last inspection and a recent review of both individuals care plans have been completed to ensure that their needs are still being met appropriately. One person told us, I like living here. Care Homes for Adults (18-65 years) Page 13 of 32 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. People can be confident that care plans do reflect their current care needs. Risk assessments are in place which are managed and reviewed responsibly to ensure peoples personal safety but still enabling individuals to participate in the wider community thereby not restricting choice of freedom, independence and dignity. Evidence: We looked at the care plans of the two people who live at the home and found examples of individual care plans which reflected the persons aims and goals in relation to varying aspects of their daily lives. For example, family, relationships, healthcare, personal and social care needs. Each care plan includes risk assessments and how these are able to be managed whilst ensuring that individuals aspirations are met. We found that each person living at the home are included in decision making processes which affect their lives. Individuals living at the home are consulted in respect to all aspects of the running of Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: the home. In the main this is done by care planning reviews and informal discussions. During our inspection we were able to speak with one of the people living at the home who informed us that they are able to tell the registered manager their likes and dislikes quite openly. The registered manager told us that the home does not hold any monies for the people who live at the home at this time. Each individual holds their own monies and family members act as power of attorney for one person who lives at Rosemount. However, the home does hold the passbook of one individual which is by their choice to prevent them spending their whole weekly allowance all in one go. Care Homes for Adults (18-65 years) Page 15 of 32 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 are encouraged to choose the activities that they participate in which is a reflection of their individuality and independence. Individuals are able to flexibly choose their own meals and where able peoples independence to actively cook their own meals is celebrated. Evidence: On the day of our visit one person had already left the home to go to their voluntary work. Positively, this individual has made the break from visiting their day centre to undertaking voluntary work. They also go to Tai Chi and cookery during the week. The other person was waiting for the registered manager so that they could walk the dog. It was recommended at the homes last inspection that one individual living at the home was enabled to look at options of voluntary work with animals as this was their wish. This recommendation has now been met as the individual has decided that they Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: do not want to participate in voluntary work now that they have retired from working in a foundry but wants to enjoy their retirement as their job was physically hard work. In view of this individuals choices have been upheld and a daily social programme has been implemented. This is based around the homes dog, Switch, and the person living at the home and registered manager take Switch for daily walks in the mornings to different places, such as, Kinver, Himley, local parks and woods. This means that this individual is gaining a good exercise regime and quality one to one social interaction time. People living at the home are encouraged to lead active lives both in the home and surrounding community. For example, we were told individuals go to local churches, libraries, the cinema, theatre and music concerts. The registered manager also told us that both people who live in the home have been on holiday, last year, for a week at Butlins and another holiday is planned for April of this year. However, it is now recommended that the registered manager keeps documentary evidence within each persons care records detailing planned holidays and/or alternatives that each individual living in the home decides to go on. Each person living at the home completes domestic tasks around the home and takes responsibility for their own room, choosing daily meals and assisting to prepare and cook these. In the main the registered manager cooks the daily main meal in the evenings for both of the people who live in the home. We were told both individuals enjoy plain food and this was confirmed by one person living in the home on the day of our inspection visit. They also confirmed some food that they would like the registered manager to prepare for them, such as, chicken legs, cucumber sandwiches and more dessert choices instead of rice pudding. We were told that the two people living in the home are offered fruit and we saw the fruit bowl in the lounge area of the home so that individuals can help themselves. However, fruit and vegetable portions of both people are not recorded. In view of this it is now recommended that the registered manager maintains individual fruit and vegetable records for both people who live in the home together with when these are declined. This will ensure that people living at Rosemount are offered a balanced and healthy diet particularly as one person needs to do this for their own health reasons. People have keys to their rooms which were all locked when people went out into the community ensuring that peoples privacy is maintained. Care Homes for Adults (18-65 years) Page 17 of 32 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. Peoples care plans show that people are seen by their doctors when they are ill and by other health care professionals when needed. Care records that were sampled had good information in respect of peoples social and health needs. This now needs to be extended to include further information about the ageing process and sensitively addressing individuals last wishes with them. The home has policies/procedures for the administration of medication but currently the individuals who live at the home have no need for any medication to be administered by the home. Evidence: Each person living at Rosemount are very independent and are capable of completing their own personal care tasks at their preferred times of the day. One individual requires some verbal prompting to ensure that their personal care rountines are completed appropriately. We found evidence within each care record that we sampled of health appointments attended with individuals own doctors together with when they had received their influenza vaccine. One person living at the home has been trying to stop smoking and Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: encouragement is provided. It is now recommended that the registered manager obtains further information in relation to meeting peoples changing needs as they grow older. This will help individuals with the issues of growing older and age related illnesses together with the changing physical needs of people who live at Rosemount. As at the homes last inspection the two people living at the home do not require any prescribed medication. However, if they did then both individuals would be able to administer their own medications. In relation to the use of homely remedies the registered manager showed us that they have the protocol for this devised by CSCI,(Commission for Social Care and Inspection), pharmacists. The registered manager is recommended to pursue the last wishes of people living in the home in a sensitive manner with assistance from advocates or social workers. This will ensure that individuals choices and needs will be met at this important time in their lives. Care Homes for Adults (18-65 years) Page 19 of 32 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. Generally, the home promotes an open culture where individuals feel safe and supported to share any concerns in relation to their protection and safety. This could be further improved by completion of formal adult protection training. Also the introduction of a complaints/compliments book or suggestion box for people to add their views as they choose would be helpful in monitoring the homes aims and acheivements. Evidence: We were told by the registered manager that the home have received no complaints since the last inspection visit. We were told by one person who lives at the home that they are able to discuss any concerns and/or complaints with the registered manager. However, it is recommended that the home put some consideration into devising a complaints/compliments book or suggestion box where people living in the home and/or visitors are able to record any comments as they wish. We found a copy of the local authorities, (Dudley), multi-agency protection of vulnerable adults procedures, Safeguard and Protect which as satisfied a requirement made at the homes last inspection. The registered manager told us that they are going to attend a training course, Deprivation of Liberty Safeguards , (DOLS), which is to be implemented in April 2009 and is linked to the Mental Capacity Act and provides knowledge around the protection of individuals rights. This is a positive move forward Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: in gaining knowledge in protecting vulnerable people but it is further recommended that formal training in relation to safeguarding vulnerable adults is now sought. This will ensure that individuals living at Rosemount can be reassured that they will be protected from harm by people who are able to recognise forms of abuse, know how to react and how to report it. This also needs to be appropriately discussed with the people living at Rosemount and documentary evidence provided to confirm this action. Care Homes for Adults (18-65 years) Page 21 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. It is a pleasant, safe place to live. Further improvements in terms of redecoration will enhance this home further and fully meet the needs of the people living there. Evidence: Rosemount is a traditional semi-detached house which provides comfortable domestic style accommodation for up to three adults with learning disabilities. On entering the hallway leads you through to the three rooms downstairs. The front room is not used, the lounge area has a small table positioned in it and two chairs to enable the people to have their meals as they choose. The lounge also has a television in it together with comfortable seating. A small kitchen area is used by the peole who live in the home and the registered manager. At the homes previous inspection a requirement was made to ensure that a cleaning schedule is implemented so that the grouting in the kitchen is cleaned and/or replaced. Also the bathroom washbasin taps and skirting needed to be thoroughly cleaned. The registered manager told us that these areas have now been cleaned and a schedule is now in place to ensure the environment is well maintained. We observed that grouting did appear to have been cleaned. The registered manager said the home is to be redecorated in April/May this year and a Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: completely new kitchen put in. In the main the home looked clean and once all decoration had been completed it would be freshened up so that people live in an environment that enhances their lives. Individuals bedrooms are located on the first floor of the home and with permission we looked in one which was arranged to the individuals preferences with their personal items. The registered manager told us that individuals have complete control over how their bedrooms are arranged and cleaned. The main bathroom is also located on this floor which is shared by both people. In the main the rear garden area looked tidy and the registered manager told us that they cut the grass. The people living in the home have no particular interest in gardening but enjoy going out for walks in the local community. At the front of the property by the drive area there is a large tree which is now touching the telegraph poles and one person who lives in the home shared with us their concerns about the safety of this tree. The registered manager has reported the tree to the local authority who have been and placed sand around the trees roots. The registered manager is unclear as to the purpose of this action but does intend to contact the local authority again to ascertain whether the tree will be removed on the grounds of health and safety reasons. Care Homes for Adults (18-65 years) Page 23 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The two people living at this home are well supported by the registered manager. However, the home needs to adopt an improved robust system in relation to the staffing files of bank staff with all documentation in place to ensure vulnerable people are fully protected. Formal training courses in adult protection must be pursued. Evidence: As at the previous inspection the two people living at the home continue to demonstrate a high level of independence and only need minimal support. Therefore the home continues to be staffed by the registered manager and joint proprietor who provides cover in the mornings for three hours and then again later in the afternoon/evening for four hours. On the day of our visit we observed interaction between the registered manager and one of the people who live in the home, and this clearly showed that they have formed friendly and respectful relationships. At the homes last inspection in January 2007 a requirement was made for the registered manager to complete staffing files for his two brothers who provide bank cover as the need arises. However, we only found the names, dates of birth and Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: addresses of these two people. The registered manager stated that they had misunderstood what CSCI required in relation to the staff files. Therefore the registered manager must now complete the two staff files by obtaining the relevant documentation, such as, Criminal Records Bureau checks, (CRB), work histories, qualifications and training. It is then the registered managers responsibility to submit copies of these to CSCI. As mentioned in the complaints and protection section of this report the registered manager must ensure that formal training is progressed in relation to adult protection. This will ensure that abuse is able to be recognised and reported appropriately. Care Homes for Adults (18-65 years) Page 25 of 32 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. Systems for consultation with people are good to ensure a service that is run in their best interests. However, there is room for improvement in relation to providing formal documentation of stakeholders views, resident meetings and ensuring that staffing files are completed. The safety of people who live in the home is generally promoted and protected. Evidence: The joint proprietor and registered manager of Rosemount is Mr. Nigel Dhillon and he has been in this role since Rosemount opened. The registered manager told us that they are still completing a Certificate in Management and estimated that this should be completed by April 2009. However, there is evidence that the registered manager does keep up to date with mandatory training which includes first aid. As mentioned in the section on complaints and protection the manager must now ensure that they attend formal training in protecting vulnerable adults from abuse. The homes quality assurance system now needs to be fully developed. A requirement Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: was made at the homes last inspection to gain completed surveys from the people who live at the home. However, we were told the two individuals who live at the home prefer to verbally communicate any issues and/or complaints that they have in relation to the services they receive within the home. In view of this we had a discussion with the registered manager who will now obtain the views of any relatives and other visitors to the home, such as, social workers, doctors and district/practice nurses. Also there needs to be some documentary evidence of resident meetings held and/or the informal discussions that take place with the two people who live at the home. This will ensure that the home are going some way to operating robust quality assurance systems and the home demonstrates that it is run in the best interests of the people who live there. The registered manager told us that they are awaiting further confirmation from the local authority in relation to plans whereby the home will become supported living accommodation as both individuals who live at the home may no longer need residential care. The management of health and safety appears appropriate in this home. Maintenance records show that portable electrical appliances, fire extinguishers, fire tests, emergency lighting, annual gas and electric tests have all been checked appropriately with reviews in place. Water temperatures are checked regularly and are all within the recommended guidelines to ensure people are protected from scolding and /or Legionella. Also at the homes last inspection a requirement was made in respect of risk assessments being undertaken for all of the windows in the home to ensure individuals safety. The registered manager told us that they had now completed risk assessments on all windows and no window restraints are necessary. However, the full length landing window is now kept locked and we did observe the registered manager unlocking this on the day we visited. These records show that individuals are protected from any risks to their health or care needs within their living environment. There have been no accidents recorded relating to the people living at the home since the last inspection in January 2007. At the homes last inspection it was noted that the status of the home had changed and had become a limited company with a change to shares held by each person and its registered address. However, the registered manager assured us that the home had always been registered as a limited company and this is now being looked into, ensuring that this is registered with the CSCI Central Registration Team, Regional Office, Birmingham. Care Homes for Adults (18-65 years) Page 27 of 32 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 28 of 32 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 1 23 13 That formal adult protection training is now pursued. This is to ensure that people living at Rosemount can feel reassured that they will be protected by people who recognise all forms of abuse, how to react to it and report abuse. 20/04/2009 2 34 19 The registered manager is required to gain the recruitment information needed for both relatives staffing files. It is then the registered managers responsibility to forward copies of this information to CSCI. To ensure that the people living in the home are fully protected by its recruitment procedures. 20/02/2009 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Adults (18-65 years) Page 29 of 32 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 1 The homes statement of purpose and service user guide is dated 2004 which does not reflect when these documents are reviewed by the home to show that all information is up to date. Therefore it is recommended that the registered provider ensures that these documents are dated accurately when reviewed, at least annually, and are in user friendly formats so that people can gain an understanding of their contents, thereby fully protecting individuals rights. The registered manager is recommended to review contracts of residency and ensure that the correct fees are documented for each person who lives at Rosemount so that individuals rights are fully protected. The registered manager is recommended to document within individuals care records, annual holidays and/or alternatives chosen by each person living at the home. The registered manager is recommended to record documentary evidence of daily intake of individuals vegetables and fruit intake together with when fruit or vegetables offered are declined with a reason stated. This is to ensure that people living in the home have a healthy balanced nutritional diet so that their health and wellbeing needs are not compromised. It is recommended that further information is gained and appropriate discussions take place which will help people living in the home with the issues surrounding growing older. This will provide knowledge around age related illnesses and the changing physical needs of people. The registered manager is recommended to pursue the last wishes of people living in the home in a sensitive manner with assistance from advocates or social workers. This will ensure that their individuals choices and needs will be met at this important time in their lives. It is recommended that the registered manager has a complaints/compliments book or suggestion box on display in the home so that people living in the home and visitors can write in this, as and when they choose. This will show that the home are proactive in relation to gaining the thoughts and views of people to ensure that the home is run in a transparent way with documentary evidence provided. The registered manager is recommended to ensure that Page 30 of 32 2 5 3 14 4 17 5 21 6 21 7 22 8 35 Care Homes for Adults (18-65 years) regular up to date training is provided for all bank staff as necessary specifically relating to the individual needs of the people who live at the home and this is documented. 9 39 The registered manager is recommended to progress gaining completed surveys from family members and stakeholders so that these can be included in the homes quality assurance process. This will ensure that the home is run in the best interests of the people living there. The formal quality assurance system should be implemented. This will ensure there is a consistent and thorough approach to measuring the success of the home in meeting aims and acheivements. 10 39 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. 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