Care Home: Rosebank

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What the care home does well Rosebank presented as a welcoming and comfortable environment and the people using the service appeared relaxed and comfortable in their home environment. During the inspection the proprietors and staff were observed to communicate and engage with the people using the service in a respectful and dignified manner. Assessment and care planning systems have been developed to ensure the personal, health and social care needs of prospective and current service users are identified and planned for. Service users are encouraged to maintain contact with family members and to play an active role in the running of the home. Likewise, service users are supported to participate in a range of in-house and community based activities in order to lead fulfilling lifestyles. Staff have access to a range of training including induction, health and safety and service specific training and receive direct support and supervision from the senior staff to ensure the people using the service receive appropriate care. The proprietors continue to utilise the services of an external consultant to undertake a programme of quality assurance. Internal monitoring systems have also been developed and are in the process of being implemented to review and develop the service in the best interest of service users. Comments received from service users regarding the standard of care provided were generally positive and included: "It`s nice here." "I like living at Rosebank." "The home is good." "I like that I can help out." "We get looked after OK." "The staff are kind." "I like the food." "I`ve been living at Rosebank for six years and I`m happy." "I`m happy with my room." What has improved since the last inspection? Since the last inspection the service has introduced a new e-learning system to enable staff to complete a range of training including the common induction standards.Medication Administration Records had been signed by staff following the administration of medication to confirm medication had been administered in accordance with the prescribed instructions. A system had been established to periodically monitor and record the temperature of hot water at several outlets. The check should be extended to all outlets (see the section entitled `What they could do better`). A new fire alarm system had been installed and the alarm system had been tested on a weekly basis and drills in fire evacuation had taken place every six months. Advocacy services had been introduced for some of the people living at Rosebank. What the care home could do better: A copy of the Statement of Purpose and information pack should be on display in the home at all times to ensure people have access to key information on the service. A Service User Guide should be developed as a matter of priority in a format suitable for the needs of the people living at Rosebank. Care plans should be signed by residents or their representatives (where practicable) to confirm they are in agreement with the content and plan of care. The range of risk assessments in place should be expanded to also address any identified person centred risks. The menu should be developed in an easy read format using large print and identify alternative choices for each sitting to ensure best practice. Health care records should at all times be accessible and available for inspection to verify that the health care needs of the people using the service are being met. An audit trail for medication received into Rosebank should be maintained to safeguard the welfare of the people using the service and to ensure appropriate records are maintained. A copy of guidance issued by the Royal Pharmaceutical Society of Great Britain should be obtained for staff to reference. Handwritten entries on Medication Administration Records (MAR) should be signed and countersigned to verify that each entry is as per the prescribed instructions and has been checked by another suitably trained member of staff. A resident identification system and a record of staff designated to administer medication together with sample signatures / initials should be established to ensure best practice. The complaints procedure for Rosebank should be put on display and updated to include information on the timescales for investigating and responding to complaints The proprietors should locate or obtain a copy of the Local Authority`s adult protection procedures and update internal safeguarding procedures to help staff understand how to refer incidents of abuse to the local authority. The easy read complaints poster for service users should be updated with the correct name and contact details of the regulator (The Care Quality Commission) to ensure people have access to up-to-date information. The absence of water temperature valves and radiator covers in some areas of the home should be risk assessed to safeguard the health and safety of the people using the service. The minor maintenance tasks raised with the proprietors during the visit should be rectified. The proprietor should ensure that staff do not commence employment at Rosebank until all the information required under the Care Home Regulations 2001 is received. This will ensure the welfare of the people using the service is safeguarded. A minimum of 50% of the staff should complete a National Vocational Qualification in Care at level 2 or equivalent to ensure National Training Targets are met. Care staff employed at Rosebank should complete the Learning Disability Awards Framework to ensure staff have the necessary skills, knowledge and experience for their roles. The policies and procedures in use at Rosebank should be reviewed to ensure staff have access to up-to-date guidance to ensure best practice. Health and Safety records should at all times be available for inspection as required under the Care Home Regulations 2001. Relatives and advocates should assist service users to complete monthly quality assurance forms to ensure the system is objective and balanced. The temperature of all hot water outlets should be checked and recorded on a monthly basis, to minimise the risk of scalding. Day staff should receive fire instruction training every six months and night staff every three months and records of all training dates and participants maintained to safeguard health and safety. Key inspection report Care homes for adults (18-65 years) Name: Address: Rosebank 52 Leyland Road Southport Merseyside PR9 9JQ     The quality rating for this care home is:   one star adequate 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: Daniel Hamilton     Date: 2 8 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 35 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Rosebank 52 Leyland Road Southport Merseyside PR9 9JQ 01704535548 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): info@leylandhouse.com Mr Gerard Cunningham Name of registered manager (if applicable) Miss Louise Dorman Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only: Code PC, to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Learning disability: Code LD The maximum number of service users who can be accommodated is: 17. To include up to 3 named service users with Mental Health needs. Date of last inspection Brief description of the care home Rosebank, also known as Leyland House is a privately owned care home situated on Leyland Road in Southport, close to the coast road. It offers care and accommodation for up to 17 residents who have a learning disability. The home is a three-storey property in a residential area and has good access to local transport links, with buses to Southport town centre. Transport to Lancashire & Liverpool is also accessible. The service has its own accessible minibus and a static caravan in Morecambe for residents Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 17 2 8 0 4 2 0 0 9 Brief description of the care home to use. Parking is available at the front of the building. There is a large garden to the rear of the home. The weekly fees for the service range from £351.00 to £540.00 per week. Care Homes for Adults (18-65 years) Page 5 of 35 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: one star adequate 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: The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. This unannounced inspection took place over one day and lasted approximately 10 hours. 14 residents were living in Rosebank at the time of the visit. A site visit took place as part of the unannounced inspection and a tour of the premises was completed. Two of the residents care files were case tracked (their care files were examined and views of the service obtained). This process was not carried out to the detriment of the other residents who were encouraged to join in the inspection process using their preferred methods of communication and engagement. A selection of staff and service records were also looked at and the two proprietors deputy manager, two staff, twelve residents and one visitor (a social worker) were spoken with during the inspection. Care Homes for Adults (18-65 years) Page 6 of 35 Reference was made to an Annual Quality Assurance Assessment (AQAA) which was completed by the proprietor before the visit. This document enables a person to undertake a self-assessment of a service, prior to an inspection. Survey forms were also distributed to the home prior to the inspection. None were received prior to the inspection so additional surveys were distributed during the inspection and feedback received was generally positive. Comments included in the report are taken from the survey forms and / or from feedback received from residents during the inspection All the key standards were checked as part of the inspection process. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? Since the last inspection the service has introduced a new e-learning system to enable staff to complete a range of training including the common induction standards. Care Homes for Adults (18-65 years) Page 8 of 35 Medication Administration Records had been signed by staff following the administration of medication to confirm medication had been administered in accordance with the prescribed instructions. A system had been established to periodically monitor and record the temperature of hot water at several outlets. The check should be extended to all outlets (see the section entitled What they could do better). A new fire alarm system had been installed and the alarm system had been tested on a weekly basis and drills in fire evacuation had taken place every six months. Advocacy services had been introduced for some of the people living at Rosebank. What they could do better: A copy of the Statement of Purpose and information pack should be on display in the home at all times to ensure people have access to key information on the service. A Service User Guide should be developed as a matter of priority in a format suitable for the needs of the people living at Rosebank. Care plans should be signed by residents or their representatives (where practicable) to confirm they are in agreement with the content and plan of care. The range of risk assessments in place should be expanded to also address any identified person centred risks. The menu should be developed in an easy read format using large print and identify alternative choices for each sitting to ensure best practice. Health care records should at all times be accessible and available for inspection to verify that the health care needs of the people using the service are being met. An audit trail for medication received into Rosebank should be maintained to safeguard the welfare of the people using the service and to ensure appropriate records are maintained. A copy of guidance issued by the Royal Pharmaceutical Society of Great Britain should be obtained for staff to reference. Handwritten entries on Medication Administration Records (MAR) should be signed and countersigned to verify that each entry is as per the prescribed instructions and has been checked by another suitably trained member of staff. A resident identification system and a record of staff designated to administer medication together with sample signatures / initials should be established to ensure best practice. The complaints procedure for Rosebank should be put on display and updated to include information on the timescales for investigating and responding to complaints The proprietors should locate or obtain a copy of the Local Authoritys adult protection Care Homes for Adults (18-65 years) Page 9 of 35 procedures and update internal safeguarding procedures to help staff understand how to refer incidents of abuse to the local authority. The easy read complaints poster for service users should be updated with the correct name and contact details of the regulator (The Care Quality Commission) to ensure people have access to up-to-date information. The absence of water temperature valves and radiator covers in some areas of the home should be risk assessed to safeguard the health and safety of the people using the service. The minor maintenance tasks raised with the proprietors during the visit should be rectified. The proprietor should ensure that staff do not commence employment at Rosebank until all the information required under the Care Home Regulations 2001 is received. This will ensure the welfare of the people using the service is safeguarded. A minimum of 50 of the staff should complete a National Vocational Qualification in Care at level 2 or equivalent to ensure National Training Targets are met. Care staff employed at Rosebank should complete the Learning Disability Awards Framework to ensure staff have the necessary skills, knowledge and experience for their roles. The policies and procedures in use at Rosebank should be reviewed to ensure staff have access to up-to-date guidance to ensure best practice. Health and Safety records should at all times be available for inspection as required under the Care Home Regulations 2001. Relatives and advocates should assist service users to complete monthly quality assurance forms to ensure the system is objective and balanced. The temperature of all hot water outlets should be checked and recorded on a monthly basis, to minimise the risk of scalding. Day staff should receive fire instruction training every six months and night staff every three months and records of all training dates and participants maintained to safeguard health and safety. 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 10 of 35 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 35 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. Admission and assessment procedures are in place to ensure the care needs of people are met. Evidence: At the time of the visit a copy of the Statement of Purpose for Rosebank was not on display in the home. A copy dated April 2010 was located in the proprietors registration application pack however there was no Service User Guide in place. The inspector was informed that one of the proprietors was in the process of developing a service user guide in a format suitable for people with a learning disability. The whereabouts of an information pack referred to in the Annual Quality Assurance Assessment for the service could not be located on the day of the visit. Examination of the Annual Quality Assurance Assessment (AQAA) for the service confirmed that prior to a prospective service user being admitted, home visits and trial stays would be undertaken, together with an assessment of needs. Two of the residents files were selected to view during the visit. One was for a service Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: user who had recently moved into Rosebank for a period of respite care and the other was for a service user who had lived in the home for approximately 2.5 years. Both files contained a copy of a Residents Needs Assessment that covered a range of areas including general health, physical needs, personal care, occupation, education, social and other significant needs. A copy of an assessment undertaken by a social worker had also been obtained for one service user. Care Homes for Adults (18-65 years) Page 13 of 35 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. The needs of the people living at Rosebank are identified and planned for to promote independence and wellbeing. Evidence: The Annual Quality Assurance Assessment (AQAA) for Rosebank confirmed that the service had developed a policy on Individual Planning and Review. Two of the residents files were selected to view during the visit. One was for a service user who had recently moved into Rosebank for a period of respite care and the other was for a service user who had lived in the home for approximately 2.5 years. Both files were well organised and contained a copy of a care plan that was linked to the initial assessment of need. Care plans outlined the health, personal and social care needs of service users and the action required from staff. Plans viewed had been kept under review but had not been signed by residents or their representatives as noted at the last visit. It is recommended that this is done so that service users and / or their Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: representatives are fully involved in their support. Separate person centred plans based upon the essential lifestyle planning model had also been developed and there was evidence on file that the needs of service users were also being kept under review by social workers. A range of supporting documentation including; background information, nutritional and medication risk assessments, personal hygiene records, daily schedule and activity information, personal weight records and daily report information was also available on files viewed. Only a limited amount of medical appointment information was available as recent information had been archived. Service users were encouraged to participate in the inspection process using their preferred methods of communication and the proprietors, deputy manager and staff were observed to communicate and engage with the people they cared for in a positive, respectful and dignified manner. Likewise, staff were observed to be responsive to the needs of the people using the service and residents spoke highly of the care provided by staff. Comments received regarding the standard of care provided were generally positive and included: Its nice here. I like living at Rosebank. The home is good. I like that I can help out. We get looked after OK. The staff are kind. I like the food. Ive been living at Rosebank for six years and Im happy. Im happy with my room. The proprietors confirmed that the people using the service are supported to take Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: responsible risks. Risk assessments had been completed for key areas such as nutrition and medication and reviewed periodically. The proprietors and the deputy manager were advised to further develop and expand the range of risk assessments, to also address any actual / potential person centred risks. Care Homes for Adults (18-65 years) Page 16 of 35 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. Meals, activities and routines remain flexible and varied to enable service users to follow their preferred routines. Evidence: At the time of the inspection, none of the people using the service had an occupation or attended college as service users had previously completed available courses. Records highlighted that nine of the service users continued to participate in a range of community based activities including; 1:1 community based support, day centre activities, community groups, focus team activities, mens and womens groups and / or coffee clubs. A range of in-house and community based activities were also provided by the service and records of activities were maintained. A timetable of activities and interests pursued by the people living in the home was also on display in the home and a number of people were observed to be enjoying participating in group activities with staff during the visit. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: As noted at the last inspection, many of the service users have lived at Rosebank for a number of years and are familiar with the Southport area and its amenities. Public transport routes are located close to the home and the service has its own transport in the form of a new accessible mini-bus and a static caravan in Morecambe which the proprietors reported will soon be used on a regular basis by the service users for holiday breaks. The deputy manager advised that service users were encouraged and supported to maintain different levels of contact with family members and this was confirmed in discussion with service users. No relatives were observed to visit the home on the day of the inspection however a social worker was seen to visit the home and was complimentary of the service provided. People are also able to maintain relationships with others within Rosebank as they wish. Three of the service users had access to support from independent advocates. Service users spoken with confirmed the routines in the home were flexible and person centred and the people using the service were observed to participate in household tasks during the visit. The environment was warm and friendly and residents were seen to spend time chatting with staff and their friends in the communal parts of the home. The lounge areas in Rosebank provide sufficient communal space for the people using the service to interact together or enjoy their own company. A four week rolling menu in a standard format had been developed which was on display in the dining room. It was noted that the alternative options for the tea-time meals had not been included and records of the dietary intake for each service user had not been maintained. These issues should be addressed. A mealtime was discreetly observed during the visit. A dining area is available for residents to use and it was clear that residents viewed their meal times as a social occasion. Staff were available to offer support and assistance as required. At the time of the visit none of the service users had any special dietary needs and feedback on the standard of catering was good. Care Homes for Adults (18-65 years) Page 18 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of records relating to healthcare and medication are in need of review to ensure the wellbeing of service users is safeguarded. Evidence: Discussion with the proprietors, deputy manager, staff and service users highlighted that the people using the service required different levels of care and support with their personal care. Key information on the health, personal and social care needs of service users had been outlined in care plan records and staff spoken with during the visit demonstrated a satisfactory understanding of the principles of good care practice and the need to promote privacy, dignity and independence when providing care to service users. Staff were observed to be attentive to the support requirements of service users during the inspection process and were seen to communicate and engage with the people using the service in a dignified and respectful manner. As noted at the last inspection, service users were able to express their own sexuality and personal appearance. Again this was outlined in care plans with an emphasis on Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: individuals being able to choose their own clothes, hairstyle and make up as appropriate. All individuals have keyworkers who offer individualised support as necessary. The majority of service users spoken with reported that they were reliant on staff to arrange appointments with medical practitioners, to ensure their health care needs were met. Some service users spoken with were able to confirm that they had accessed routine health care services however this could not be verified for some health care appointments as some medical appointment records had been archived and were not accessible on the day of the visit. This issue was raised with the proprietors and deputy manager for action. Examination of the Annual Quality Assurance Assessment (AQAA) for Rosebank confirmed policies and procedures were in place for the Control, Storage, disposal, recording and administration of medicines. The proprietors were advised to obtain a copy of guidance issued by the Royal Pharmaceutical Society of Great Britain for staff to reference and to establish a resident identification system and a record of staff designated to administer medication together with sample signatures / initials. The deputy manager reported that senior staff members were responsible for administering medication and that staff who administer medication had completed elearning training in medication, advanced medication training from an external provider and in-house training. Competency assessments for staff were not in use and advice was given to introduce these records to ensure best practice. Medication was dispensed by a local pharmacist using a blister pack system and stored in a locked cabinet. The deputy manager and proprietor were advised to secure the cabinet to the wall when not in use. A sample of Medication Administration Records (MAR) were checked during the visit. Overall, MAR had been correctly completed to account for medication administered although there were no audit trail records for medication received into Rosebank. Furthermore, a handwritten entry for one type of medication had not been signed or countersigned to verify that the entry was in accordance with the prescribed instructions and had been checked by another suitably trained member of staff. No controlled medication was being stored in the home at the time of the visit. Separate storage facilities and a controlled drugs register were in place should a service user be prescribed this type of medication. Advice was given to the proprietor regarding the correct method of fixing to be used for the controlled drugs cabinet to Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: ensure compliance with the Misuse of Drugs (Safe Custody) Regulations 1973. Care Homes for Adults (18-65 years) Page 21 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures for complaints and safeguarding are in need of review to ensure people understand how to complain and an appropriate response to suspicion or evidence of abuse. Evidence: A copy of the Complaints procedure for Rosebank was not on display at the time of the visit however each service user had a poster in their bedrooms, which had been developed in a symbolic form and outlined who they could speak to if they were unhappy. The poster developed for service users was in need of review as they did not have the correct name or contact details of the current regulator (The Care Quality Commission). Similar issues were noted at the last visit. A copy of an up-to-date complaints procedure was located in the proprietors application pack for the proposed partnership and manager application for the Care Quality Commission. The proprietors were recommended to update the policy to include details of the timescales for investigating and responding to complaints. The Annual Quality Assurance Assessment (AQAA) detailed that the service had received once complaint in the last 12 months. No record of any complaint(s) had been recorded in the complaint log and the proprietor reported that the entry in the AQAA was made in error. Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: The AQAA confirmed that procedures for the Disclosure of abuse and bad practice (Whistle blowing) and Safeguarding Adults and the Prevention of Abuse policy were in place. Upon examination of the homes internal Adult Protection Investigation policy dated 2002, it was again noted that the policy was in need of review as the name and contact details of the regulator were not correct. It was also noted that the Whistle blowing policy was brief and also dated 2002. During the inspection the proprietor collected a more comprehensive Whistle blowing policy for reference. A copy of the local authority adult protection procedures could not be located. Discussion with staff and examination of the training matrix for the service confirmed staff had completed e-learning Safeguarding of Vulnerable Adults training. Senior staff spoken with during the visit demonstrated a satisfactory understanding of the different types of abuse, their duty of care to protect vulnerable adults and alerting procedures. Conversely, some care staff spoken with did not understand external alerting procedures and this should be reviewed. No concerns, complaints or allegations were brought to the attention of the inspector during the visit and service users spoken with confirmed they felt safe at Rosebank. Care Homes for Adults (18-65 years) Page 23 of 35 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. Rosebank is generally well maintained and provides the people living in the home with a safe, clean and comfortable environment. Evidence: Rosebank Care Home is a privately owned three-storey property situated on Leyland Road in a residential area of Southport, close to the coast road. The premises are in keeping with the local community and cannot be distinguished as a registered care home. Local transport links are available and the service has its own new minibus. The premises is able to accommodate up to 17 residents who have a learning disability. Parking is available at the front of the building and there is a large garden to the rear of the home. The proprietors reported that the property receives ongoing investment, refurbishment and maintenance as required. A full-time handyman was employed to undertake minor maintenance tasks within the home and to maintain the grounds. Contractors were hired for specialised work as and when necessary. The annual quality assurance assessment (AQAA) for Rosebank detailed that in the last 12 months the home had received ongoing maintenance and benefited from an Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: internal decor plan. A new fire alarm system had also been installed. A partial tour of the premises was undertaken during the visit and areas viewed appeared generally well maintained and furnishings throughout the home were of a good standard. Service users reported that they were happy with the standard of accommodation provided and confirmed they were able to personalise their bedrooms with pictures, photographs and other memorabilia. Some minor maintenance tasks were noted and raised with the proprietors during the visit. For example, a shower bar was broken in an upstairs shower room and a radiator had become detached from a bracket in a downstairs bathroom. The proprietor was also requested to risk assess the absence of thermostatic valves in some parts of the home and to remove the key code lock on an upstairs bathroom to make the environment more homely. A part-time domestic member of staff was on duty and areas viewed were clean and hygienic. A laundry is located in the basement area separate from food preparation and storage areas and this contains industrial appliances and is an organised facility. Soap and towels were provided at all hand wash basins in the building. Care Homes for Adults (18-65 years) Page 25 of 35 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. Recruitment practice and key areas of training remain in need of review to ensure the welfare of service users is fully safeguarded. Evidence: Since the last inspection, the proprietors have purchased a new e-learning package to enable staff to undertake training from any location with internet access. A summary record of the training completed by staff was viewed during the visit and this confirmed that the majority of staff had completed induction, health and safety, food safety, infection prevention and control, control of substances hazardous to health, medication, safeguarding of vulnerable adults and dementia training. It was noted that staff had not completed the Learning Disability Awards Framework (LDAF) and advice was given to the proprietors on how to access information on this essential training from the skills for care website. The proprietor reported that first aid training was to be rolled out during May and June 2010 and the Annual Quality Assurance Assessment (AQAA) highlighted that staff had access to other training including palliative care and equal opportunity training etc. The (AQAA) detailed that the service employed 13 care staff of which four people had completed a national Vocational Qualification in Care at level 2 or above. Certificates for only three staff (23.07 ) were available on file at the time of the visit. The Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: proprietor reported that two other staff were awaiting the arrival of their certificates. Once the outstanding staff have received their certificates 5 staff (38.46 ) will have completed a National Vocational Qualification at level 2 or above in Care. Staff spoken with during the visit confirmed they had access to ongoing support and supervision and reported that they had enjoyed completing the e-learning training. Copies of documentary evidence of training completed had been stored on staff files to provide evidence of training completed. The AQAA for Rosebank detailed that a policy on Recruitment and employment including redundancy was in place for staff to reference and confirmed that satisfactory pre-employment checks had been completed for all new staff. The personnel files of three care staff employed at Rosebank were viewed during the visit. Each file contained the necessary records required under the Care Home Regulations 2001. For example, copies of application forms, two references, Independent Safeguarding Authority Adult first checks, Criminal Record Bureau certificates, declaration of health and proof of identity etc were stored on files. Likewise copies of periodic performance reviews and supervision records were available for reference. It was noted that some key records had been received after the dates staff had commenced employment in the home and this issue of concern was raised with the proprietor during the visit. Care Homes for Adults (18-65 years) Page 27 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and administration systems at Rosebank are in need of ongoing monitoring and review, to ensure the service is managed by a person endorsed by the Care Quality Commission and run in the best interest of the people using the service. Evidence: At the time of the inspection the service did not have a Registered Provider or a Registered Manager in place. The previous Registered Provider (Mr Gerard Cunningham) had passed away during February 2007 and the former Registered Manager (Louise Dorma) had resigned from post approximately six months after the death of the Registered Provider. The Care Quality Commission met with two relatives of the late Mr Cunningham during February 2010 to discuss the situation, as Rosebank was operating as an unregistered service. The Commission was informed that Mr Gerrard Cunninghams estate was not finalised until the last week in December and that Jonathan and Alistair Cunningham were now the legal owners. The Commission was also informed that Jonathan and Alistair Cunningham would submit a partnership application to take over the Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: ownership and operation of the business as a matter of priority, with Alistair also applying to become the Registered Manager. On the day of the visit, the inspector noted that the necessary application forms and cheques had been completed to enable Jonathan and Alistair to proceed with their application (pending receipt of Criminal Record Bureau checks) to register with the Care Quality Commission. A copy of a tracking status form from the Criminal Record Bureau (CRB) service was also viewed which confirmed that the CRB certificates had been applied for and that the check for Jonathan was in progress and the disclosure had been dispatched for Alistair. The progress in submitting and processing the applications will continue to be monitored by the Care Quality Commission. Both Jonathan Cunningham (Proprietor) and Alistair Cunningham (Proprietor / Acting Manager) were on-site during the visit. A deputy manager was also on duty providing care and support to the people using the service. Prior to the inspection, the proprietor completed an Annual Quality Assurance Assessment (AQAA). This document enables a person to undertake a self-assessment of the service and to provide statistical information. Overall, the AQAA was completed to a satisfactory standard, although there were some sections were more supporting evidence would have been useful to illustrate what the service does well, what it could do better and plans for the future. Records showed that the proprietors had commissioned an external consultant to undertake an annual quality assurance assessment during February 2010. The assessment involved distributing quality assurance questionnaires to residents /their relatives and staff each year, to find out their views on the service provided. Copies of monthly questionnaires, completed by the people using the service with assistance from staff, were also available for reference. The proprietors were advised to involve relatives or advocates in the process, to ensure the feedback received was completely impartial. The proprietors had also recently devised an in-house quality assurance audit which will require time to fully implement and evaluate. This covered a range of areas including; health and safety, activities, catering and food, laundry, planned maintenance and grounds, training, care planning and housekeeping. Evidence of recent resident, staff and resident and relatives meetings were also available for reference. Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: Information received via the Annual Quality Assurance Assessment (AQAA) for the service confirmed policies and procedures had been developed on Health and Safety. Likewise, the dataset section of the document confirmed that equipment / services in Rosebank had been routinely serviced and / or tested. Upon examination of a selection of policies and procedures for the service it became apparent that some policies and procedures used in Rosebank were in need of review and this issue was raised with the owner. Fire records were requested to view during the visit. The owner reported that the certificates for the new fire alarm installation and fire extinguisher servicing together with records for the weekly fire alarm tests, monthly emergency lighting tests, visual examination of fire extinguishers and routine fire drill records could not be checked as they had all been archived. Likewise the fire risk assessment was not available for inspection. Following completion of the inspection the owners forwarded the archived records to the Commission via faxination for review. Overall records viewed were found to be in satisfactory order. It was noted that the last fire instruction training was dated 16th March 2010 and prior to that 26th November 2009. Arrangements should be made to ensure day staff receive fire instruction training every six months and night staff every three months and records of all participants maintained to ensure best practice. Furthermore, the temperature of all hot water outlets should be checked and recorded on a monthly basis, to ensure the temperature of hot water in communal bathrooms, toilets and personal bedrooms is regulated to a maximum of 43 degrees centigrade. Discussion with staff and examination of the training matrix for the service confirmed staff had access to a range of mandatory training in health and safety topics. Systems were in place to record and monitor accidents / incidents. Care Homes for Adults (18-65 years) Page 30 of 35 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 31 of 35 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 1 A copy of the Statement of Purpose and information pack should be on display in the home at all times to ensure people have access to key information on the service. A Service User Guide should be developed as a matter of priority in a format suitable for the needs of the people living at Rosebank. Care plans should be signed by residents or their representatives (where practicable) to confirm they are in agreement with the content and plan of care. The range of risk assessments in place should be expanded to also address any identified person centred risks. The menu should be developed in an easy read format using large print and identify alternative choices for each sitting to ensure best practice. Health care records should at all times be accessible and available for inspection to verify that the health care needs of the people using the service are being met. A resident identification system and a record of staff designated to administer medication together with sample Page 32 of 35 2 1 3 6 4 5 9 17 6 19 7 20 Care Homes for Adults (18-65 years) 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 signatures / initials should be established to ensure best practice. 8 20 A copy of guidance issued by the Royal Pharmaceutical Society of Great Britain should be obtained for staff to reference. Handwritten entries on Medication Administration Records (MAR) should be signed and countersigned to verify that each entry is as per the prescribed instructions and has been checked by another suitably trained member of staff. An audit trail for medication received into Rosebank should be maintained to safeguard the welfare of the people using the service and to ensure appropriate records are maintained. The easy read complaints poster for service users should be updated with the correct name and contact details of the regulator (The Care Quality Commission) to ensure people have access to up-to-date information. The complaints procedure for Rosebank should be put on display and updated to include information on the timescales for investigating and responding to complaints. The proprietors should locate or obtain a copy of the Local Authoritys adult protection procedures and update internal safeguarding procedures to help staff understand how to refer incidents of abuse to the local authority. The absence of water temperature valves and radiator covers in some areas of the home should be risk assessed to safeguard the health and safety of the people using the service. The minor maintenance tasks raised with the proprietors during the visit should be rectified. A minimum of 50 of the staff should complete a National Vocational Qualification in Care at level 2 or equivalent to ensure National Training Targets are met. The proprietor should ensure that staff do not commence employment at Rosebank until all the information required under the Care Home Regulations 2001 is received. This will ensure the welfare of the people using the service is safeguarded. 9 20 10 20 11 22 12 22 13 23 14 24 15 16 24 32 17 34 Care Homes for Adults (18-65 years) Page 33 of 35 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 18 35 Care staff employed at Rosebank should complete the Learning Disability Awards framework to ensure staff have the necessary skills, knowledge and experience for their roles. Relatives and advocates should assist service users to complete monthly quality assurance forms to ensure the system is objective and balanced. The policies and procedures in use at Rosebank should be reviewed to ensure staff have access to up-to-date guidance to ensure best practice. The temperature of all hot water outlets should be checked and recorded on a monthly basis, to minimise the risk of scalding. Day staff should receive fire instruction training every six months and night staff every three months and records of all training dates and participants maintained to safeguard health and safety. Health and Safety records should at all times be available for inspection as required under the Care Home Regulations 2001. 19 39 20 41 21 42 22 42 23 42 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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