Care Home: Rosedale Care Home Ltd

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What the care home does well .People can make choices about their lives.Staff support people to do the things that they like doing. They go to the cinema, shopping and go out for meals.They go on holidayPeople help to write their own support plans. They are easy to understand.The people who live in the home get on well with the staff.The people who live at the home and their relatives are asked what they think about the quality of the care and support. What has improved since the last inspection? All staff have two written references before they start work at Rosedale. This is to make sure that they are safe to work there. What the care home could do better: The people who own the home must make sure they keep the information about the home up to date and let us know about any changes to the service.The service should get special advice about how to improve the diet of one person living in the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Rosedale Care Home Ltd 4 Vicarage Street Whitwick Leicestershire LE67 5GZ The quality rating for this care home is: two star good 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: Ruth Wood Date: 0 2 0 6 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 31 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) 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 Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Rosedale Care Home Ltd 4 Vicarage Street Whitwick Leicestershire LE67 5GZ 01530455350 01530455350 office@Rosedalecarehome.com 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) : Rosedale Care Home Limited care home 6 Number of places (if applicable): Under 65 Over 65 6 0 learning disability Additional conditions: No one falling within category LD may be admitted into the home where there are 6 persons of category LD already accommodated within the home. The home may only admit persons falling with category LD. Date of last inspection 0 3 1 2 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 31 A bit about the care home Rosedale is a care home for people with learning disabilities. Up to six people can live at the home. The home is in Whitwick, and is close to shops, pubs and the health centre. There are bus stops nearby, for buses to Coalville and other local towns. Each person has their own bedroom. Some bedrooms are on the ground floor and some are on the first floor. There are two lounges and a big kitchen that people can eat in. The basic fee for staying in the home is £700 per week. Additional one-to-one support is charged at an hourly rate. Additional charges are made for day care. The service users guide gives full information about the service 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 Care Homes for Adults (18-65 years) Page 6 of 31 How we did our inspection: This is what the inspector did when they were at the care home Before we visited the home, we looked at the information that the owner had sent us about how the home is run and the kind of people who live and work there. We looked at information sent to us about things that had happened in the home since our last key inspection. This included information from social services about what the service had done to make sure people living in the home were safe. We looked at the information we had gathered at two visits to the service on 01/10/08 and 03/12/09 and if the service had made the improvements we asked them to make. Care Homes for Adults (18-65 years) Page 7 of 31 We visited the home on 02/06/09 for three and a half hours. We looked at some of the rooms in the house We spoke to one person living in the home about what they had done during the day. We looked at peoples support plans and how their needs are met. Care Homes for Adults (18-65 years) Page 8 of 31 We spoke to staff about how they supported people and about the training they had done. We looked at staff records that told us about the checks that had been done to make sure staff had the right skills and were safe to work in the home. What the care home does well . People can make choices about their lives. Staff support people to do the things that they like doing. They go to the cinema, shopping and go out for meals. They go on holiday Care Homes for Adults (18-65 years) Page 9 of 31 People help to write their own support plans. They are easy to understand. The people who live in the home get on well with the staff. The people who live at the home and their relatives are asked what they think about the quality of the care and support. What has got better from the last inspection Care Homes for Adults (18-65 years) Page 10 of 31 All staff have two written references before they start work at Rosedale. This is to make sure that they are safe to work there. What the care home could do better The people who own the home must make sure they keep the information about the home up to date and let us know about any changes to the service. The service should get special advice about how to improve the diet of one person living in the home. Care Homes for Adults (18-65 years) Page 11 of 31 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Ruth Wood CPC1 Capital Park Fulbourn Cambridge Cambridgeshire CB21 5XE 01223771300 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 12 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 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Thorough assessment procedures help to ensure that the service can meet peoples needs. Evidence: We made a random visit to the service on 01/10/08. This followed an incident that was referred to the Local Authoritys safeguarding team, where a newly admitted service user left the premises without staffs knowledge. At this visit we found that a full assessment procedure had not been followed, before the person moved in. We made a further visit to the service on 03/12/08. The assessment process had been reviewed, to ensure that comprehensive information is gathered about people, before they move into the home, and a system of trial visits is encouraged to help people make up their minds about the home, before they move in. At todays inspection visit we looked at the assessment procedure and documents for a person who is currently making respite visits to the service. In-house assessment documents were completed by the responsible individual before the persons first visit; these included a communication passport which outlines how staff should communicate Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: with the person. The person themselves had also completed a Who am I document, which gives staff a range of information about how they liked to be supported. Assessments from the placing social worker and from a Clinical Psychologist had also been obtained as part of the homes assessment process. The Statement of Purpose needed some updating to reflect that the home now offers a respite service. Discussions with one of the Directors and with one service user confirmed that people living in the home had been consulted about this. Changes were also required to reflect changes in staff. We received an updated version of the Statement from the responsible individual on 04/06/09. As we also had to require the Statement and the service user guide be updated at the previous inspection, a requirement has been made for the responsible individual to keep these documents under review and ensure that they reflect any changes made to the service. Care Homes for Adults (18-65 years) Page 15 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. People can make choices about their day to day lives Clear support plans help staff to meet peoples needs and take responsible risks. Evidence: At the visit we made to the service on 01/10/09, we noted that there were no clear risk assessments in place for the service user whose placement had subsequently broken down. A requirement was made that a support plan be in place for each person so that staff know how to meet their needs. At this visit we looked at the plans of the two people who live permanently at the home and the person who has recently made respite visits. There is a support plan in place for all three people and the permanent service users plans have recently been updated. Staff have signed to say that they have read and understood peoples support plans. Support plans contain information about how each person likes to communicate and they cover all aspects of the persons lives. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: A risk analysis has been completed for each person; this helps to identify the key risks for each individual. Risk assessments are in place for each identified risk although advice to staff about how to manage the behaviour of one person could be improved. Currently the plan states, try to reduce the risk of X becoming angry but it does not state what may trigger the persons anger and what action staff could take to contain this. People are asked what they want to do during the day and in the evening and current staffing levels allow service users to undertake their chosen activity with staff support. People are also encouraged to attend residents and staff meetings to have a more formal input into decision making and how the home is run, but sometimes they are reluctant to do this. One person that we spoke with confirmed that they had chosen to go into town that day and had also chosen what and where to eat. Each person living at Rosedale has their own bank account and staff support them to manage this. All transactions are recorded and receipts are kept. Care Homes for Adults (18-65 years) Page 17 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. People are supported in their chosen lifestyles and to take part in appropriate leisure activities. Evidence: Each person in the home has an individual, weekly activity plan. This includes doing things in the home like cooking, craftwork, working on the computer as well as activities outside of the home such as swimming, shopping and going to the leisure centre. On the day of the inspection, one person had gone out for the day with their brother, another person had gone shopping and out to lunch. When this person returned they said they had enjoyed their day. One person also likes to attend car boot sales, to go cycling and go to the gym. Staffing levels allow people to pursue individual activities and interests. Rosedale has its own transport and people use this for day trips to places such as Drayton Manor and the local garden centre. People have the opportunity to go on short breaks to Skegness, and the two people living permanently in the home have decided that they would like to go on holiday to Spain this year; this is currently being arranged. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: People are supported to have regular contact with their families by visiting, making telephone calls or writing letters. Menu records show that a varied diet is on offer within the home, which includes fresh vegetables and fruit. People go shopping to the market (with staff support) to buy fresh food. One person does choose a very restricted diet, despite other foods being available. People can choose to eat together or by themselves. Care Homes for Adults (18-65 years) Page 19 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. Peoples health, medication and personal care needs are well met. Evidence: Only one person living in the home takes prescribed medication. This is stored appropriately and Medication Administration Records (MAR) are completed accurately and up to date. Suitable storage is in place should any service users require controlled medication. Staff administering medication have received suitable training in this area and their competence has been reviewed, following one medication error made last year. All staff are to update their medication training on 11/06/09. One new staff member confirmed that they did not administer medication as they had not yet received the appropriate training. Peoples support plans contain evidence of dental, optical and GP appointments and regular monitoring of longstanding, chronic health conditions. People who live in the home have health action plans and a My Health booklet, which details the support that they would need if they were admitted to hospital. Support plans also outline how people wish to be supported in their personal care and discussion with staff members and one person living in the home confirmed that this guidance is followed. One person still eats a very restricted diet (although plenty of different food choices are Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: available). Staff expressed concern about this and it is strongly recommended that a formal referral to a dietician be made, to gain additional support in addressing this. Care Homes for Adults (18-65 years) Page 21 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. People are listened to and current procedures and practice in the home help to ensure their protection. Evidence: Since the previous key inspection there have been two safeguarding referrals made to the local authority. Both of these have been investigated and resolved. The second referral prompted the Commission to make two additional visits to the service to address issues relating to assessment, care planning, medication and environmental safety. The service addressed all of these issues within the given timescales. Staff have received training in safeguarding vulnerable adults and contact numbers for the local authority safeguarding team are clearly displayed in the home. Staff have also received training in the implications of the Mental Capacity Act and have reserved places on the implementation of the Deprivation of Liberty Standards. The complaints procedure is written in plain English with supporting pictures so that it is easy to understand. People living in the home have regular meetings to express their views and the relationship observed between the person who was at home during the inspection and the staff was very open and friendly. The person said they were very happy living at Rosedale. Arrangements for managing peoples finances and for staff recruitment also help to ensure that people are protected. Care Homes for Adults (18-65 years) Page 22 of 31 Care Homes for Adults (18-65 years) Page 23 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. People live in a comfortable, clean home, which meets their needs Evidence: We looked at some of the homes communal areas. These were clean and tidy and discussion with staff confirmed that they had received training in infection control. The home is spacious with a large kitchen diner, a lounge and a separate activities room. This means that people do not always have to sit together or stay in their rooms if they wish to be by themselves. The kitchen cupboards and drawers have pictures of what is inside them, on their fronts; this helps people to find what they are looking for. Following an incident where one new service user left the building unnoticed, security alarms have been fitted to all external doors, which when set, alert staff to any person entering or leaving the building. Care Homes for Adults (18-65 years) Page 24 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. People are well supported by competent staff. Evidence: All staff recruitment information was inspected during the random visits to the service on 01/10/09 and 03/12/09. Requirements made in relation to written references and full employment history of people working in the home have been met. We looked at the recruitment information of the one person employed since our last visit. Two written references had been obtained together with a check to see if the person appeared on the vulnerable adults register, before they started to work in the home. All staff working at the home have had a full, enhanced Criminal Records Bureau check. Staff records also contain details of any disciplinary warnings issued and information about peoples training. Three staff have completed National Vocational Qualifications in health and social care at level 2 and four more are currently studying to achieve this qualification. Staff have also received training in effective communication and working with people with autism and with epilepsy. 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 service takes account of peoples opinions and views to ensure that it is run in their best interests. Evidence: Since the previous key inspection, the service has employed and subsequently dismissed an acting manager. The homes responsible individual, Karen Ferrie is currently working as acting manager, together with her son who is a Director of the company. Karen Ferrie is currently completing her registered managers award and assured us that a new acting manager is being sought for the service. The service has made a prompt response to requirements issued at the random inspections made on 01/10/08 and 03/12/08. The Director of the company showed us the information we requested and we also spoke with Karen Ferrie by telephone to clarify particular issues. People living in the home are encouraged to take part in residents meetings and to also attend staff meetings. They also fill in service user questionnaires. These forms ask for Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: peoples opinions on the quality of food, the attitude of staff and if they have enough privacy at Rosedale. The service also asks visiting professionals and relatives to comment on the quality of the service and we saw some of the responses the service has received; these were positive. We suggested that the form for visiting professionals asked people why they were visiting; this question was added to the form immediately following the inspection. The Annual Quality Assurance Assessment completed by the responsible individual gave us information about maintenance checks that had taken place, including the fire alarm system, which was last serviced in August 2008. Staff have received statutory training in moving and handling, fire safety and first aid. This training was undertaken in-house by using videos and workbooks. We recommended that first aid training be delivered by an external agency and this has been arranged to take place later this month with St Johns Ambulance. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes  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 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 Description 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 Description Timescale for action 1 1 6 The registered person must 19/06/2009 ensure that the statement of purpose and service user guide is kept under review and updated when there is any change in the service. The Commission must be notified of any such revision within 28 days. This is to ensure that people living at or wishing to live at Rosedale have accurate information about the service so they can make an informed decision about whether the service can meet their needs. 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 Adults (18-65 years) Page 29 of 31 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 9 Some risk assessments require more detail so that staff have clear guidance on how to manage and respond to identified risks. A formal referral to a dietician should be sought to work with the person who has a restricted diet. 2 19 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. 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