Care Home: Rosedale

What the care home does well There was evidence that the right of the resident to take control over their own life and make their own decisions and choices was supported. Person centred care planning meant residents were cared for as they wanted and needed. Staff who provided written comments considered the service did well in `Meets the needs of the clients. They all have 100% support in a very safe environment.` To ensure personal care and support was provided in a way, which maintained residents dignity and respected privacy and lifestyle, care plans took into account what residents wanted and what was important to them. Decision-making was encouraged and residents were given time to consider the individual choices they made. They had the benefit of regular one to one discussion with a registered Mental Nurse employed at the home, individual staff support, and weekly house meetings. Residents also benefited from additional specialist support where needed such as healthcare. Residents had a health action plan to support them with these needs, and their care needs was reviewed regularly. Risk management provided staff with information to know how to help keep people safe. Staff worked to a key worker system, and staff who provided written comments and those interviewed considered they were given enough information to care for residents properly. Comments included, `We have a communications book but also and more importantly, we have several handover meetings throughout the day which often includes the manager. All important information is discussed during these handovers, and we also complete day and night reports.` Residents right to confidentiality was respected. Residents lifestyle was centred on them and they did not have to conform to any institutional practice such as set times for getting up or going to bed. Daily living routines were also personal to them and they enjoyed various activities such as shopping, and socialising with friends. They went on holiday and they had kept good contact with relatives and friends. Friends were made welcome and could stay and enjoy a meal at the home. Meals provided met with residents tastes, needs and choice. Those residents spoken to during inspection said the food was `good`. They said they could have what they wanted. Records showed residents were helped to plan and prepare meals for themselves. Residents who were consulted, said they knew who to talk to if they were not happy. Staff working at the home had been trained in adult protection and knew their responsibility in this area. The home was warm, clean and comfortable and adequately maintained. Residents were satisfied with their bedrooms and living arrangements This meant residents were provided with accommodation they considered was suitable to their needs. The numbers of staff employed, training provided, and recruitment practices thatinvolved residents taking part, meant residents should be protected, and their needs properly met by staff they helped to choose. Staff interviewed said they enjoyed their work. They were supported by the manager and given good opportunities to attend relevant training. The number of staff trained to a National Vocational Qualification in care was very good. Written comments from staff included, `I am still relatively new in my employment and my training and induction file is still being updated. I am also regularly booked on training courses and feel very well prepared in my job.` And `To date I have attended seminars on Protection of Vulnerable Adults (POVA), epilepsy, and schizophrenia. The manager at Rosedale is both qualified and experienced to run the home. Changes have been made to improve service delivery, the environment, and skills of staff. Staff working in the home had confidence in the manager and one staff who provided written comments for this inspection said, `We have a very approachable manager who has regularly discussed my training file and also covered policies and procedures.` considered the manager to be The home was managed and run in the best interests of the people living and working there. What has improved since the last inspection? To make sure residents are not placed at risk of harm or abuse, safeguarding vulnerable adults policy, procedure, and practice is more robust in managing all circumstances. Improvements had been made to improve the environment. These included carpets cleaned and in some rooms replaced. Two new showers had been fitted and the bath panel repaired. To ensure residents are not at risk of accidental scalding whilst bathing, safety thermostats have been fitted to the bath and shower. Because residents do not always want windows opening in the designated smoking room, an extractor fan has been fitted, which has made the room more pleasant to sit in. An activity room has been created off the smoking room where residents can enjoy leisure pursuits. Staff training has improved to ensure residents individual and joint needs are met appropriately. Policies and procedures appeared to be up to date with current good practice to support staff to work effectively and safely. Regulatory requirements had been addressed within the timescales set by the Commission. What the care home could do better: People should be consulted properly, and their views considered before they move into the home. The assessment must be more thorough in determining whether the home can meet specific needs such as healthcare.What extra services covered in fees payable for resident care should be made clear to residents and the manager. This will help residents know they are being cared for as they need and the manager can plan their care better. Care plans should consider all areas of need completely for example in motivation, and the recording system used to monitor progress made, used better. This will help to ensure support provided is consistently maintained and evaluated. It is important that risk taking does not compromise staffs duty of care, and their skills and abilities are suitable to support residents to manage risks such as serious health problems and smoking combined. Where residents choices has an impact on their well being, how this is managed should be monitored better, and the right support provided to help them improve their quality of life. The home must be maintained to a satisfactory standard. The rippled carpet is a potential risk to residents tripping on the landing. Remedial work is needed to the hallway floor where the tiling remained cracked, and cement used for repair crumbling. Floor coverings in the bathing areas should be replaced to provide a more pleasant area for residents. Verbal references should only be accepted as an interim measure. At least one reference should be from the applicants last employer. It is important to make sure management out of hours emergency contact cover is formalised on the rota so staff can always be sure of an immediate response if dealing with an emergency. Mrs Healey Registered Provider must also visit the home once a month and make a report of the visit, forwarding a copy of the report made to the Commission. This will help to ensure the home is run in the best interests of the residents. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Rosedale 42a Manchester Road Haslingden Lancashire BB4 5ST     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marie Dickinson     Date: 2 7 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Rosedale 42a Manchester Road Haslingden Lancashire BB4 5ST 01706222066 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Bridget Mary Healy care home 6 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 6 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: Mental Disorder, excluding Learning Disability or Dementia - Code MD The maximum number of Service Users who can be accommodated is: 6 Date of last inspection Brief description of the care home Rosedale is registered to provide accommodation and social care for 6 adults with a mental illness. The house is a Victorian building and offers spacious accommodation with small garden areas to the front and rear. It is situated in the centre of Haslingden town centre, close to all local amenities. Accommodation is provided on two floors in six single bedrooms. There is a lounge, a games room, and dining room on the ground floor. There are designated smoking areas for residents. Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home Fees at Rosedale range from £550.00 - £1253.50 per week, according to assessed need. There was some information available to potential service users advising them of the home and about the type of service they could expect. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: A key unannounced inspection was conducted in respect of Rosedale on the 27th April 2009. An annual quality assurance assessment (AQAA) was sent to us by the manager prior to this inspection. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service, such as number of staff trained, and of essential maintenance to keep the home safe being carried out. Written comments were also received prior to the inspection from staff employed at the home who gave their views as to how well the home performed in supporting them Care Homes for Adults (18-65 years) Page 6 of 31 in meeting needs of residents. There were no written comments from residents or relatives. Discussion took place with the manager, staff and residents during inspection. Documents including policies, procedures, and staff and residents records were looked at. The premises were inspected as part of the process. Areas that had been required to improve were looked at for progress made. The home was assessed against the National Minimum Standards for Younger Adults. What the care home does well: There was evidence that the right of the resident to take control over their own life and make their own decisions and choices was supported. Person centred care planning meant residents were cared for as they wanted and needed. Staff who provided written comments considered the service did well in Meets the needs of the clients. They all have 100 support in a very safe environment. To ensure personal care and support was provided in a way, which maintained residents dignity and respected privacy and lifestyle, care plans took into account what residents wanted and what was important to them. Decision-making was encouraged and residents were given time to consider the individual choices they made. They had the benefit of regular one to one discussion with a registered Mental Nurse employed at the home, individual staff support, and weekly house meetings. Residents also benefited from additional specialist support where needed such as healthcare. Residents had a health action plan to support them with these needs, and their care needs was reviewed regularly. Risk management provided staff with information to know how to help keep people safe. Staff worked to a key worker system, and staff who provided written comments and those interviewed considered they were given enough information to care for residents properly. Comments included, We have a communications book but also and more importantly, we have several handover meetings throughout the day which often includes the manager. All important information is discussed during these handovers, and we also complete day and night reports. Residents right to confidentiality was respected. Residents lifestyle was centred on them and they did not have to conform to any institutional practice such as set times for getting up or going to bed. Daily living routines were also personal to them and they enjoyed various activities such as shopping, and socialising with friends. They went on holiday and they had kept good contact with relatives and friends. Friends were made welcome and could stay and enjoy a meal at the home. Meals provided met with residents tastes, needs and choice. Those residents spoken to during inspection said the food was good. They said they could have what they wanted. Records showed residents were helped to plan and prepare meals for themselves. Residents who were consulted, said they knew who to talk to if they were not happy. Staff working at the home had been trained in adult protection and knew their responsibility in this area. The home was warm, clean and comfortable and adequately maintained. Residents were satisfied with their bedrooms and living arrangements This meant residents were provided with accommodation they considered was suitable to their needs. The numbers of staff employed, training provided, and recruitment practices that Care Homes for Adults (18-65 years) Page 8 of 31 involved residents taking part, meant residents should be protected, and their needs properly met by staff they helped to choose. Staff interviewed said they enjoyed their work. They were supported by the manager and given good opportunities to attend relevant training. The number of staff trained to a National Vocational Qualification in care was very good. Written comments from staff included, I am still relatively new in my employment and my training and induction file is still being updated. I am also regularly booked on training courses and feel very well prepared in my job. And To date I have attended seminars on Protection of Vulnerable Adults (POVA), epilepsy, and schizophrenia. The manager at Rosedale is both qualified and experienced to run the home. Changes have been made to improve service delivery, the environment, and skills of staff. Staff working in the home had confidence in the manager and one staff who provided written comments for this inspection said, We have a very approachable manager who has regularly discussed my training file and also covered policies and procedures. considered the manager to be The home was managed and run in the best interests of the people living and working there. What has improved since the last inspection? What they could do better: People should be consulted properly, and their views considered before they move into the home. The assessment must be more thorough in determining whether the home can meet specific needs such as healthcare. Care Homes for Adults (18-65 years) Page 9 of 31 What extra services covered in fees payable for resident care should be made clear to residents and the manager. This will help residents know they are being cared for as they need and the manager can plan their care better. Care plans should consider all areas of need completely for example in motivation, and the recording system used to monitor progress made, used better. This will help to ensure support provided is consistently maintained and evaluated. It is important that risk taking does not compromise staffs duty of care, and their skills and abilities are suitable to support residents to manage risks such as serious health problems and smoking combined. Where residents choices has an impact on their well being, how this is managed should be monitored better, and the right support provided to help them improve their quality of life. The home must be maintained to a satisfactory standard. The rippled carpet is a potential risk to residents tripping on the landing. Remedial work is needed to the hallway floor where the tiling remained cracked, and cement used for repair crumbling. Floor coverings in the bathing areas should be replaced to provide a more pleasant area for residents. Verbal references should only be accepted as an interim measure. At least one reference should be from the applicants last employer. It is important to make sure management out of hours emergency contact cover is formalised on the rota so staff can always be sure of an immediate response if dealing with an emergency. Mrs Healey Registered Provider must also visit the home once a month and make a report of the visit, forwarding a copy of the report made to the Commission. This will help to ensure the home is run in the best interests of the residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 31 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 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process ensured peoples needs were properly assessed, however information known and received should be used to determine if moving into the home is the right decision to make. Contracts issued, protected individuals legal rights. Evidence: There had been one new admission to the home since the last key inspection. Records showed how this was managed. The assessment had been completed by the manager and was carried out over a period of stay in the home. This was because the resident was being admitted from another home in the scheme on the grounds of needing a ground floor bedroom and was having problems with other residents. The reason for the move was not sufficiently documented to support the admission being in the best interest of the resident. This was because assessed physical and mental health problems, and the support required from staff to manage this, was potentially above what could be reasonably provided without compromising the residents care. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: Records had been completed to show the usual process of admission. Pre assessment questionnaires were completed to ensure admission was planned and prepared for properly. For example on the first visit potential residents were asked, Were you introduced to the people within the home, shown around, seen your room, heard the fire alarm and had a fire drill explained. Were you made feel welcome and house rules explained. This is followed by a second visit, overnight stay, then a three week period of weekly evaluations prior to moving. Residents written statement of terms and conditions showed the amount of fee an individual paid. However there was no break down of costing to show what extra funding was for, as all fees were variable, according to individual needs. This information was not made available to the manager therefore there was no way of measuring if the personalised service commissioned was being provided. Training records showed staff was given training to help them to develop and know current good practice issues in mental health. Care Homes for Adults (18-65 years) Page 13 of 31 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. Good care planning meant residents were able to make good decisions and choices about their lives with the right support from staff who knew how to help them. Evidence: Information received at the Commission from the manager indicated the home did well as Staff promoted individuals to attend to their personal care and to follow advice from professionals. Written comments from staff included, The care plan, risk assessments and medical histories for each service user are available in the office and it is mandatory to keep up to date with this information on a regular basis. Two care plans for residents were looked at in detail. The plans outlined identified problems for residents and how they would be supported to improve their life. How identified needs were to be supported was generally clear and risk managed. By using Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: short term goal setting, this meant residents knew they were improving in what they could do for themselves with the help from staff. However care planning still required some work to make sure the plan is written in a way to address all areas of need completely for example in motivation, and the recording system used to monitor progress made used better. Individual plans had been reviewed. Staff worked to a key worker system that allowed them to work on a one to one basis with people. Records showed the service supported residents to take control over their own life and make their own decisions and choices. Risk assessments had been completed. These included, amongst others, for example personal physical neglect, self harm and depression. Management of risk was recorded, however where limitations were agreed, and decisions made in the interest of a residents well being, more consideration is required to ensure staff are able to safely manage any given situation. An example of this was for one resident a serious health risk due to smoking. Decision-making was said to be encouraged and residents were given time to consider the individual choices they made. Staff who provided written comments considered, Rosedale is a relaxed environment in which service users are encouraged to develope their independence. Records showed residents had the benefit of planned one to one discussions with staff, time allocated with a Registered Mental Nurse employed at the home, and weekly house meetings. As a result of this, mental health needs identified in assessment and central to residents well being were being addressed. There are procedures in place to ensure that residents are informed of their rights to confidentiality. Written into individual records is an agreement for the sharing of information and confidentiality, informing them of circumstances when staff may have to share personal information. Care Homes for Adults (18-65 years) Page 15 of 31 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. Residents were supported to be independent and given opportunity to take part in chosen activities, access community resources and keep in touch with families and friends. The meals provided were sufficient in providing for their tastes, choices, and diet. Evidence: Information received from the manger for this inspection indicated the home did well in promoting community inclusion for residents, and each resident has a daily activity plan. There was enough support network, activities planned, and weekly house meeting, encouraging residents to make choices. There was evidence seen in care planning, support was provided to enable residents to accomplish and develop skills for living that included, social, emotional, communication, and independence. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: Records showed how residents were supported to identify their goals, and work to achieve them. This was done through care planning and support from key workers. Care planning was used to help residents identify what their own goals were, and what they want and need to do. This was done by setting short term goals. There was sufficient evidence to show residents had opportunity to develop and maintain relationships. During inspection one resident made lunch for his visitors. Where residents were at risk or vulnerable in the community, this was managed through discussions with residents to help them make good choices and give support, for example managing money. However one resident would benefit more support in this area, particularly around shopping appropriately, as a need was identified during inspection. This would help prevent buying unwanted clothing and other items, the results of which meant a low self esteem and unorganised environment . Weekly planners were used to help residents have some order in their lives. For example they knew when they cooked a meal, cleaned their bedroom, and what day they usually met with their relatives or friends. They decided what they wanted to do and completed their planner themselves. To get out and about residents could walk to town, visit the library, parks, pubs, and clubs. Residents were taken out in the mini bus provided by the home. As part of the basic contract price, residents had the option of a minimum seven-day holiday outside the home they helped to choose. Family links were encouraged and residents could have visitors at any reasonable time. The home was managed in a manner to avoid any institutional routines. Observations of staff at work showed they treated individuals with respect. Residents preferred name was recorded on their plan. Residents had house rules they had agreed to follow. All bedrooms had locks on their doors and residents managed their own keys. Residents had access to a telephone. Residents planned their own menus, went shopping, and staff helped them with meal preparation and cooking as agreed in care planning. Mealtimes were flexible. Residents spoken to said they enjoyed their meals. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents preferred method of support allowed them to enjoy personal care in a non institutional and dignified way. Their healthcare needs were sufficiently monitored which supported them maintain their general well being. Medication procedures and staff training promoted good practice. Evidence: Records showed people using the service were registered with a General Practitioner and that appointments had been made and kept. Appointments had also been kept with care coordinators, consultants, and community health services as required. Healthcare was recorded and written with short term and long term planning, such as dental visits and routine medical checkups. Health action plans were written to support residents in identifying what their health needs were and how staff could help them. Help with personal care was given according to need and individuals wishes. Care planning for health was person centred and informed staff what residents could and could not do. For example, lacks motivation in attending to personal hygiene. Staff need to prompt and encourage to have a bath and change her clothes on a daily basis. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: Residents were encouraged to be independent and take responsibility for their personal care needs as much as possible. Residents in the home said staff did listen to them and helped them where needed. Comments from residents living in the home indicated staff treated them well. Staff had been trained in mental health care, to ensure they provided the right approach to care for people with mental health problems. They received guidance from other professionals supporting residents and from the support from a Registered Mental Nurse employed at the home. The home operated with a monitored dosage system for medication. Records of individuals medication was kept, and included information about the medication, and what staff should be aware of if someone was not well. Those staff responsible for administering medication had been trained. Residents were observed being given support to administer their own medication, by direct supervision. Residents could self medicate following an assessment to make sure this would be safe. Medication storage was secure, and required records were up to date. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure supported residents to raise any issue of concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues to support residents rights, safety, and welfare being promoted. Evidence: Information received from the manager for this inspection considered the service did well as The complaints procedure is discussed every week. It is a non-judgemental process. It is in both written and verbal formats. And It has been recently revised. It appeared the home had an open culture to allow residents to express their views, and concerns safely. All residents who were consulted were aware of the complaints procedure, and were confident to use it. It was displayed for them to look at and they had an individual copy. Records showed residents were able to express their views safely and comment on the service provision, for example during one to one sessions they had with staff. They were also invited to have their say during their house meetings. There had been no complaints received at the Commission since the last key inspection. Policies and procedures for Safeguarding Adults were available for staff to follow. Staff working at the home had received training regarding safeguarding issues, so they Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: knew their obligation and duty of care to use the procedure if necessary. Staff had formal agreements to abide by the homes code of conduct and practice that included protection issues such as financial protection. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was warm and comfortable and adequately maintained. This meant residents were provided with accommodation suitable to their needs. Evidence: The home is ideally located for all main shopping facilities and recreation. Parking is limited; however free parking is available near to the home. As a result of legislative requirements being made during the last key inspection in relation to improvements required to upgrade the home, an additional inspection was carried out to monitor progress made. Where improvements were made, these had been sustained. Following a tour of the premises the following observations were made. The home was being maintained satisfactorily. The front room was pleasant. Further remedial work is required to the hallway floor where the tiling remained cracked, and cement used for repair crumbling. The landing carpet was rippled and required straightening to ensure resident safety. The bathroom on the 1st floor bath panel had been repaired and all water outlets for resident bathing fitted with anti scalding devices. The shower and toilet facilities had been upgraded with two new shower Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: cubicles fitted, however floor coverings in bathing areas need to improve. Residents spoken to were generally satisfied with their bedrooms. They were arranged as they wished. Doors could be locked and residents held their own key. Some bedrooms had been painted to improve the appearance. Bedrooms would benefit further upgrading of bedroom furniture and floor coverings. Staff who provided written comments also considered some improvement was needed. The physical environment is in need of improvement. A recent fire and environmental health check had been carried out. The manager said there were no outstanding issues. The home was clean. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels maintained, and training provided helped to ensure residents had an effective, consistent, and person centred approach to their care. Evidence: Staff who provided written comments for this inspection said there was usually enough staff on duty to meet the needs of residents. Rotas seen showed how staff were deployed in the home day and night. The manager said staffing levels in the home allowed for staff to meet the needs of the residents, and supported a person centred approach to care. Changes made to the night staffing levels had been discussed with staff and residents. There was no domestic support provided. The home operated an equal opportunity policy. Since last inspection new staff had been employed. Records showed recruitment practice could be improved. Two staff applications were looked at. Application forms had been completed, and Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) register check had been applied for, prior to employment. References had also been requested. References in one staff file were verbal and no request had been made to a previous employer. Records seen showed staff had signed the employee handbook and safety handbook, and staff were given contracts of employment, and job specification. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: Applicants had attended for interview. The manager said residents were now involved in interviewing new staff. This is clearly good practice. However to develop this into a meaningful exercise for residents taking part, there is a need for some structure in the process. This will help residents to know their input is valuable to the recruitment process. Training for staff included comprehensive induction training for new staff, specific mental health training as routine for this specialist service, and other mandatory training as required. Written comments from staff and those spoken to during inspection indicated they were satisfied with the level of training they received, and were clear about their role and what was expected of them. Written comments from staff included, I am still relatively new in my employment and my training and induction file is still being updated. I am also regularly booked on training courses and feel very well prepared in my job. To date I have attended seminars on POVA, epilepsy, and schizophrenia. I am due to attend first aid training and I am enrolled on NVQ in housekeeping, food preparation. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed and run in the interests of the residents. Evidence: The manager of Rosedale is both qualified and experienced to run the Home. She is supported in her role on a daily basis by senior carers. The arrangements in place for emergency management out of hours contact must be recorded formally. This will prevent any delay in dealing with an emergency should this occur. Managers meetings are held every three months and Mrs Healey the registered provider is in contact. The manager was not involved in business planning, however she had a good understanding of the need to continue to improve the service. Unannounced visits from the provider were not as regular as they should be. The most recent visit was conducted very well with evidence residents were consulted and asked for their views on how well the service met with their needs. The home sent us their annual quality assurance assessment (AQAA), that gave us information we asked for. The information given was brief however it informed us of improvements made. For Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: example, the complaints procedure had been revised. Staff had further training specific to their role such as schizophrenia, approaches to mental health, drug awareness, and recent training in asthma care. Essential maintenance had been carried out. Rosedale holds Investors In People Award as part of the Healey scheme. Residents meetings were held every week enabling residents to discuss living at the home. Formal staff meetings were held in addition to regular informal meetings held to discuss resident care. Staff who provided written comments said The service provides a relaxed home, working with service users with a holistic approach. Does well by, Meets the needs of the clients. They all have 100 support in a very safe environment. We have a very approachable manager who has regularly discussed my training file and also covered policies and procedures. Staff considered communication was good. We have a communications book but also and more importantly, we have several handover meetings throughout the day which often includes the manager. All important information is discussed during these handovers, and we also complete day and night reports. To improve one comment stated, The physical environment is in need of improvement, which is the responsibility of not the manager, but the owner. Money is held for residents for safekeeping, and part of supporting people to manage their finances. Financial procedures included records kept of transactions made on behalf of people, to provide a clear audit trail. Secure storage was available for the safekeeping of money. Information received at the Commission showed regular maintenance of the homes fixtures, fitting and equipment. Staff training records showed essential mandatory training was being given to staff. The manager has notified the Commission of significant events in the home. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 43 26 Mrs Healey Registered 01/07/2008 Provider must visit the home once a month and make a report of the visit, forwarding a copy of the report made to the Commission. Previous timescale 31/05/08 not met. Care Homes for Adults (18-65 years) Page 28 of 31 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 1 43 26 The registered provider must 29/05/2009 visit the home once a month unannounced, and produce a report of the visit for the Commission. This will ensure the provider is aware of all issues in relation to resident care, protection, the environment, staffing and management, and arrange for any issue raised to be dealt with promptly and satisfactorily. 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 2 People should be consulted and their views considered before they move into the home. The assessment must be more thorough in determining whether the home can meet specific needs such as healthcare. What extra services covered in fees payable for resident care should be made clear to residents and the manager. This will help residents know they are being cared for as they need and the manager can plan their care better. 2 5 Care Homes for Adults (18-65 years) Page 29 of 31 3 6 Care plans should consider all areas of need completely for example in motivation, and the recording system used to monitor progress made, used better. This will help to ensure support provided is consistently maintained and evaluated. It is important that risk taking does not compramise staffs duty of care, and their skills and abilities right to support residents to manage risks such as serious health problems and smoking combined. Where residents right to make choices residents make that has an impact on their well being should be monitored better and the right support provided to help them improve their quality of life. Verbal references should only be accepted as an interim measure. At least one reference should be from the applicants last employer. Out of hours management cover should be indicated on the rota. This will ensure staff can be sure their contact is available. 4 9 5 16 6 34 7 37 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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