Care Home: Rosebank Care Home

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What the care home does well People who responded to our survey told us, among other comments about the home, that `the standard of care is excellent on a spiritual and emotional level`, `provides very good training`, `is exceptional in level of care and commitment`, and about what the home does well said `keeping relatives informed as to medical or other incidence` and `always there when I need them`. We found that people living in the home have their needs assessed before moving in and receive enough information about the home, so that they can feel confident that the home will meet their needs. People`s needs are understood and met by a staff team who understands them. They are supported to live as they want, to see their relatives easily, can take part in social activities of their choice and they and their representatives know how to make a complaint. People have a homely, comfortable and safe place to live in and are cared for by trained, caring and friendly staff. The home has strong leadership and works for the best interests of the people living in the home. What has improved since the last inspection? The home has appointed a new manager and she provides strong, caring leadership to the care team. An activity coordinator has also been appointed to strengthen the provision of activities. More staff training has been provided, including training about diversity, care planning and the implications of new legislation for the home. The home`s refurbishment and renewal programme has continued and includes improvements to the home`s plumbing, roof, garden, phone system and interior decor and furnishing. What the care home could do better: The home has identified in the AQAA how it intends to continue improving outcomes for people living in the home. Key inspection report Care homes for older people Name: Address: Rosebank Care Home High Street Bampton Oxfordshire OX18 2JR     The quality rating for this care home is:   three star excellent 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: Kate Harrison     Date: 2 1 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Rosebank Care Home High Street Bampton Oxfordshire OX18 2JR 01993850308 01993852411 rosebankcarehome@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Rosebank Nursing Homes Limited Name of registered manager (if applicable) Mrs Lynn Hughes Type of registration: Number of places registered: care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 28. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Rosebank is a care home registered for 28 older people and it is situated on the high street of the attractive village of Bampton. Accommodation is provided on two floors and the first floor can be accessed by a passenger lift. Both single and shared rooms are provided and many have en-suite facilities. There are three large lounge areas, two dining areas and communal assisted bathrooms. The home has large gardens, which Care Homes for Older People Page 4 of 25 Over 65 0 28 28 0 Brief description of the care home are accessible to the people living there. The home is managed by the homes manager, deputy manager and an administrator, supported by a team of care, housekeeping and maintenance staff. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the home was an unannounced Key Inspection, and was carried out by one inspector between 10.30hrs and 17.00hrs during the day. It was a thorough look at how well the service is doing. It took into account detailed information provided by the home through the homes self assessment document, the Annual Quality Assurance Assessment (the AQAA) and any other information we received about the home since the last inspection. The AQAA was completed and received by the expected date and information we needed to plan our visit. We looked at records and documents relating to the care of the people living there. We saw recruitment records and information about staff training and looked at how peoples medication was managed. We saw the communal areas of the home and some private rooms used by people living there. We asked the views of the people who live in the home, through questionnaires we had sent out. We also sent surveys to healthcare professionals involved with the home and to staff members. Altogether we received 14 completed surveys from staff, one Care Homes for Older People Page 6 of 25 healthcare professional and from people living in the home, and their views are reflected in this report. We spoke to several other people living in the home during our visit, to the deputy manager, some care and administrator staff members, and the responsible individual from the company, and discussed the running of the home with them. This inspection was a thorough look at how well the home is meeting the standards set by the government and in this report we make judgements about the outcomes for the people living in the home. The date of our last key inspection was 3rd October 2006. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before moving in and receive enough information about the home, so that they can feel confident that the home will meet their needs. Evidence: The home carries out a pre-admission assessment to make sure the home can meet individuals needs before admitting anyone to the home. Usually the registered manager goes to see the individual and completes the homes pre-admission form detailing all the needs of the individual. We saw the pre-admission process for one individual recently admitted, and noted that information was available from other healthcare professionals and family members involved with the individual, so that the home had all the information needed before a decision is made about admission. We saw that the individual had settled in well and that the home was meeting all the needs of the individual. People living in the home who responded to our survey said that they had received written information about the homes terms and conditions and had enough Care Homes for Older People Page 10 of 25 Evidence: information about the home to help them decide that the home was right for them. The home does not provide intermediate care. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have their needs understood and met, by a staff team who understands them. Evidence: All the people living at the home are registered with a GP and we saw that the district nurses attend individuals when necessary. We saw the care files of three individuals, and these showed that risk assessments had been carried out for key areas, such as safe moving and handling, nutrition and ability to swallow safely, falling and skin care. Care plans were in place to make sure that the staff team knew how to look after people properly, in the way they wanted to be looked after. Recently some staff training had taken place about how to improve the care planning process, with the intention of making sure that the individuals preferences and wishes were taken into account. We noted also that particular attention was given to individuals when they had difficulty in communicating, and the care plans gave clear directions to staff about how to make it easier for individuals to understand situations. The care plans were reviewed regularly and updated if necessary. We looked at how the home manages medication through checking medication for Care Homes for Older People Page 12 of 25 Evidence: three people. The homes medication is kept securely, administered as prescribed and properly recorded, and staff who manage the medication have training to do so. The home has carried out a review of medication in partnership with general practitioners, to make sure that the use of medication is minimised and this has benefited some individuals. New staff members receive information about dementia during their induction to the home so that they have an understanding about people with dementia. The majority of people who responded to our survey said that the staff always listen and act on what they said. We noted that the staff responded respectfully to individuals needs, and saw that they understood how individuals needed them to respond. We saw staff members behave in very caring understanding way to one distressed individual, and noted that their response eased the individuals anxiety. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to live as they want, to see their relatives easily and to take part in social activities of their choice. Evidence: A new activity organiser has recently been appointed and works part time to organise and provide the activities people chose in the home. She is due to have training about activities suitable for the home in the near future. The residents meetings are used to discuss what activities people would like and information about individuals social histories is also taken into account when planning activities. We saw that individual care plans are developed to help staff know what will interest individuals. The activity schedule is available and shows that the activities provided over the week are a mix of group and individual sessions, and people have opportunities to go outside. The majority of people who responded to our survey told us that there are always activities arranged that they can take part in, but there were comments too that more activities need to be available over the weekends. We understood that there is a recently introduced keep fit session some Saturday mornings, and that the activity schedule is continously under review to include peoples preferred activities. We saw that people are able to move about the home as they want and that they are supported to spend time as they want. The home is looking to continue improving the Care Homes for Older People Page 14 of 25 Evidence: homes environment to suit people with dementia, by the provision of rummage boxes, soft toys and visual clues, so that people feel at home and can be as independent as possible. The homes statement of purpose shows that local ministers come into the home so that people are helped to practice their religion if they want to and that visitors are welcome. Relatives are invited to social functions every year and have opportunities to discuss concerns at any time. People told us through our survey that one of the things the home does well is to keep in touch with relatives. We saw that mealtimes are well organised and that staff members help individuals who need prompts or help with eating. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home and their representatives know how to make a complaint, and the homes procedures help keep people safe. Evidence: The homes complaints procedure has recently been updated to show the Commissions current contact details, and includes a 28 day timescale to respond to any complaints made. All the people living in the home who responded to our survey said that they knew how to make a complaint if they wanted to. As some people may not be able to complain, the home makes sure that relatives and representatives are welcome and supported to make their views known. There is a form Letter of Concern to make it easy for people to report concerns and complaints, though no complaints have been recorded since our last inspection. There is also a Suggestions box for people to use if they have ideas to improve the home and the manager has an open door policy about talking to people living in the home and their representatives. The home has a policy and procedure to keep people living in the home safe from harm, and uses the local safeguarding guidelines to guide staff in responding to any concerns about abuse in the home. Staff receive training about safeguarding at induction and told us through our survey that they knew what to do if someone had concens about the home. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a homely, comfortable and safe place to live in. Evidence: The homes AQAA details the refurbishment, replacement and updating of the home since our last inspection, including repainting of communal areas, new furnishings and fittings in private bedrooms and replacement of kitchen goods. We saw that the refurbishment programme was continuing and that the home is well maintained. The homes management is looking to see how the homes environment can be better used to help people with dementia, for example by the use of colour, signage and memory prompts. During our inspection the home sought advice from a fire officer about the best type of lock to use for the boiler room door, and fitted an appropriate lock to make sure people living in the home were safe. There is a system in place to make sure that day to day maintenance issues are addressed, and a housekeeping team available to keep the home clean and hygienic. People told us through our survey that the home is always or usually fresh and clean. The recommendation made at the last inspection about replacing the flooring in the laundry with a suitable covering has been met. The homes laundry is managed by the care staff and they receive infection control training to make sure that the the risks of spreading infection are minimised during the management of the laundry. The requirement made at our last inspection about carrying out a risk assessment regarding a suitable place for the hairdresser to work has been met, and although she Care Homes for Older People Page 17 of 25 Evidence: works near a fire exit the home is satisfied that there is no risk of obstruction to people in the event of a fire. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are cared for by trained, caring and friendly staff. Evidence: The home has a staff rota showing the availability of staff in the home, and on our inspection visit we saw that there was enough staff available to make sure that all the needs of people living in the home were met. People who responded to our survey told us that there are staff members available when they are needed. The home supports care staff to attain their National Vocational Qualification (NVQ) Level 2 in Care and the home is meeting the national minimum standard of having 50 trained staff available in the home. We saw that the home has an appropriate induction training for new staff, including information about keeping people safe from harm. The homes booklet An Insight into Dementia is provided for new staff and discussed with new staff, so that they have an understanding about caring for people with dementia. The home has a staff development programme that includes key care training, such as moving and handling training, first aid, dementia and medication training and we saw the record of staff training for recent years. The home has arranged for staff to benefit soon from new training about dementia care, when two senior members of staff will be trained to train the staff team. Staff who responded to our survey said that they received induction that covered everything they needed to know when starting and that they receive ongoing training relevant to their jobs. We saw three staff files to check the homes recruitment procedures and noted that all Care Homes for Older People Page 19 of 25 Evidence: the necessary checks are made during the recruitment process on prospective new staff, including proof of identity and Criminal Records Bureau checks. We saw that all the necessary information was available about the three individuals but that a copy of one reference was not available for one individual. It is understood that a telephone reference was obtained but was not followed up with a written reference and the home is arranging for the written reference to be obtained. People commented about the positive qualities of the staff team saying: All the staff are very caring and nothing is too much trouble for them, and the staff are always friendly and welcoming. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can depend on the homes management to work in their best interests. Evidence: The registered manager has worked at the home for several years, including six as the deputy manager and since our last inspection has become the registered manager. She is experienced in caring for people with dementia, has the Registered Managers Award and also has had recent training about managing a team. She has support from the deputy manager and regular support and supervision from the homes responsible individual. We saw that the ethos of the home is open and transparent, by the homes policies and procedures, the approach of the staff team to visitors and by the acceptance and support of the staff team of the differing needs of the people in their care. Management meetings are held every six weeks where the homes performance is reviewed and planning takes place for improving performance. Other meetings are held with senior carers, carers and other staff meetings to make sure that all staff are supported and that any issues arising are quickly addressed. Staff have received Care Homes for Older People Page 21 of 25 Evidence: training in understanding the Mental Capacity Act 2005 and about the deprivation of liberty safeguards, and their implications for care planning and the daily lives of the people who live in the home. The homes quality assurance programme has several strands, including internal audits of cleanliness, medication and care planning. A quality assurance survey is carried out annually to get the views of people living in the home, their representatives and other stakeholders and their views are taken into account. As a result of this, additional reading lamps have been purchased for all sitting rooms, the suggestions box has been provided, activities have been prioritised, new garden furniture purchased andthe purchase of a larger television and two new CD players. This approach of listening and acting on peoples views shows respect for people and improves their daily lives in the home. The home does not manage monies for people living in the home and relatives and representatives manage it when individuals cannot manage alone. The home retains a specialist agency to manage health and safety in the home, and a risk assessment has recently been carried out to better understand and address the health and safety issues at the home. Staff receive regular training about health and safety issues, first aid and fire safety, and the home has a fire risk assessment in place. The home demonstrates a reflective approach to events in the home and works to use information meaningfully. Examples are the medication review undertaken recently and the end of life care audit, and these reviews have benefited people living in the home. People who responded to our survey made very positive comments about the homes management team, saying: Lynne is an excellent manager. She is approachable, knowledgeable and respectful of her clients. She has a very warm human approach; Rosebank is exceptional in level of care and commitment and Rosebank is a lovely care home that looks after us very well. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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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