Care Home: Rosedene

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What the care home does well People have key workers who they get to know and are able to share their likes and dislikes.People are helped to look clean and dress in good clothes by staff.Staff help people to go to see their doctor and other people if they are unwell or need a check up.Staff help people who live in the home to do books with pictures that tell a story about their lives, interests, family and friends.Family and friends of people who live at the home are welcomed by staff.People are encouraged and supported to do things for themselves whenever it is safe for them to. Like taking a bath, putting clothes on and cleaning their rooms. Staff hold weekly meetings with people living at the home to discuss what works well, what needs to get better, changes in the home and choices of menus. The notes of the meeting are put into easy read and everyone gets a copy.Each person has their own bedroom which is decorated in their own styles with furniture that has been replaced where needed and is filled with personal items that people like, `making it their room`. Staff do not start work in the home unless proper checks have been done, to make it less likely that poor quality staff work there.The home is safe and all equipment that people are helped with is checked so that it works well.The new manager is experienced and wants to continue with the improvements needed so that the home is run in the best interests of people who live there. What has improved since the last inspection? A book that tells people about how the service works has pictures so people can see what it is like to live at Rosedene and has been updated.It tells us in the books about the home that people who may like to move into the home need to be able to get on with other people who live there.The care plans of the people who live in the home have more details to help the staff to give good support in ways that suit people best.People are able to choose whether a female or male member of staff supports them with their washing and dressing by using staff photographs as aids.The risks to people are written down in detail so that staff can support people properly to stay safe.Activity choices for people are being looked at so that people lead lives that hold meaning to them.The planning of meals is now done with people who live in the home with help from pictures of meals so that people are able to choose what meals they want each day.Staff are able to count people`s medications so that they can see if people are having their medications as they should be to stay well and healthy.People are being weighed regularly so that they can be supported to stay healthy.Staff are supporting people to raise any concerns they may have and know when people are unhappy.The new manager and staff make sure that the home is painted and any furniture replaced so that people live in a comfortable home that looks good.Staff have been given more training to help them meet people`s needs.Staff files are better organised so that we can see that staff who work at the homeThe new manager has started to make sure each staff member has meetings with a supervisor at least six times each year and this is written down.All staff are taking part in fire drills so that they will know what to do if there is a fire.The home checks what it is doing on a regular basis, to see how it can do things better for people living there.The new manager has worked hard to improve the way the home is run so people receive good services. What the care home could do better: The new manager is working to improve the care provided for people who live there. Involving people having more say in their care plans. Plans should be agreed by the person and their representatives with this written down in plans.Page 23 of 55Care Homes for Adults (18-65 years)All people who need communication passports should have these so staff know what aids people use to tell people what their likes and dislikes are.All communication plans should be signed by all staff so that we can be sure staff have read these and know how people like to communicate and what aids they need.Key consent forms should be checked with people regularly to see if they still do not want to have a key to their home.Staff are making sure that the books that have people`s health needs in are being reviewed so that staff have all the information. So that staff can follow this where there are any health worries or concerns.Staff should be trained in learning disabilities and mental health to make sure that they can meet the needs of people who live at Rosedene. Key inspection report Care homes for adults (18-65 years) Name: Address: Rosedene 128 Franche Road Kidderminster DY11 5BE 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: Sally Seel Date: 2 5 0 6 2 0 1 0 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 55 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 55 Information about the care home Name of care home: Address: Rosedene 128 Franche Road Kidderminster DY11 5BE 01562861917 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Minster Pathways Limited Name of registered manager (if applicable) Mrs Anita Homer Golden Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 5 0 0 care home 5 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 5. 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; Learning disability - Code LD. Date of last inspection 1 4 0 1 2 0 1 0 Care Homes for Adults (18-65 years) Page 4 of 55 A bit about the care home This is a small sized home for up to five people with a learning disability or mental health needs. At the moment four people live there, one woman and three men. The home is on a road near to some other houses, shops and bus routes. Care Homes for Adults (18-65 years) Page 5 of 55 Everybody who lives at the home has his or her own bedroom. There is a small kitchen and a small room, leading off with a dining table where people are able to sit with others to eat, enjoy a drink or just chat. There are toilets, bath and shower for people to choose. Care Homes for Adults (18-65 years) Page 6 of 55 The home also has a car, and the staff support the people that live there to go out in the car. There is a garden at the back of the house and this is going to be planted with plants that look and smell nice with some being vegetables for people to grow. Information about the home is provided in the statement of purpose and service user guide. Care Homes for Adults (18-65 years) Page 7 of 55 The monthly fees are in the service user guide and the manager of Rosedene will help you to work out how much it will cost you to live at the home. Care Homes for Adults (18-65 years) Page 8 of 55 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 9 of 55 How we did our inspection: This is what the inspector did when they were at the care home The inspection was carried out by one inspector who visited the home without telling anyone she was coming. An Expert by Experience and their supporter also visited the home to talk with some of the people who live in the home and staff. The Expert by Experience is a person who has experience of using services. Care Homes for Adults (18-65 years) Page 10 of 55 Two managers and other staff helped the inspector on the day of the visit to the home. The Expert by Experience talked to some of the staff working at the home and watched how they helped people who live at Rosedene. The inspector was shown around some of the home and said hello to some people who live there. Care Homes for Adults (18-65 years) Page 11 of 55 We looked at some care support plans and plans to help make sure someone keeps healthy. Papers in the office were shown to the inspector to tell them how the home is run. Six surveys were returned from staff who work at the home. Care Homes for Adults (18-65 years) Page 12 of 55 The inspector would like to say thank you to people who live in the home, managers and staff for helping and making the inspector, expert by experience and their supporter feel welcome. What the care home does well People have key workers who they get to know and are able to share their likes and dislikes. Care Homes for Adults (18-65 years) Page 13 of 55 People are helped to look clean and dress in good clothes by staff. Staff help people to go to see their doctor and other people if they are unwell or need a check up. Staff help people who live in the home to do books with pictures that tell a story about their lives, interests, family and friends. Care Homes for Adults (18-65 years) Page 14 of 55 Family and friends of people who live at the home are welcomed by staff. People are encouraged and supported to do things for themselves whenever it is safe for them to. Like taking a bath, putting clothes on and cleaning their rooms. Staff hold weekly meetings with people living at the home to discuss what works well, what needs to get better, changes in the home and choices of menus. The notes of the meeting are put into easy read and everyone gets a copy. Care Homes for Adults (18-65 years) Page 15 of 55 Each person has their own bedroom which is decorated in their own styles with furniture that has been replaced where needed and is filled with personal items that people like, making it their room. Staff do not start work in the home unless proper checks have been done, to make it less likely that poor quality staff work there. The home is safe and all equipment that people are helped with is checked so that it works well. Care Homes for Adults (18-65 years) Page 16 of 55 The new manager is experienced and wants to continue with the improvements needed so that the home is run in the best interests of people who live there. What has got better from the last inspection A book that tells people about how the service works has pictures so people can see what it is like to live at Rosedene and has been updated. Care Homes for Adults (18-65 years) Page 17 of 55 It tells us in the books about the home that people who may like to move into the home need to be able to get on with other people who live there. The care plans of the people who live in the home have more details to help the staff to give good support in ways that suit people best. People are able to choose whether a female or male member of staff supports them with their washing and dressing by using staff photographs as aids. Care Homes for Adults (18-65 years) Page 18 of 55 The risks to people are written down in detail so that staff can support people properly to stay safe. Activity choices for people are being looked at so that people lead lives that hold meaning to them. The planning of meals is now done with people who live in the home with help from pictures of meals so that people are able to choose what meals they want each day. Care Homes for Adults (18-65 years) Page 19 of 55 Staff are able to count peoples medications so that they can see if people are having their medications as they should be to stay well and healthy. People are being weighed regularly so that they can be supported to stay healthy. Staff are supporting people to raise any concerns they may have and know when people are unhappy. Care Homes for Adults (18-65 years) Page 20 of 55 The new manager and staff make sure that the home is painted and any furniture replaced so that people live in a comfortable home that looks good. Staff have been given more training to help them meet peoples needs. Staff files are better organised so that we can see that staff who work at the home Care Homes for Adults (18-65 years) Page 21 of 55 The new manager has started to make sure each staff member has meetings with a supervisor at least six times each year and this is written down. All staff are taking part in fire drills so that they will know what to do if there is a fire. The home checks what it is doing on a regular basis, to see how it can do things better for people living there. Care Homes for Adults (18-65 years) Page 22 of 55 The new manager has worked hard to improve the way the home is run so people receive good services. What the care home could do better The new manager is working to improve the care provided for people who live there. Involving people having more say in their care plans. Plans should be agreed by the person and their representatives with this written down in plans. Page 23 of 55 Care Homes for Adults (18-65 years) All people who need communication passports should have these so staff know what aids people use to tell people what their likes and dislikes are. All communication plans should be signed by all staff so that we can be sure staff have read these and know how people like to communicate and what aids they need. Key consent forms should be checked with people regularly to see if they still do not want to have a key to their home. Care Homes for Adults (18-65 years) Page 24 of 55 Staff are making sure that the books that have peoples health needs in are being reviewed so that staff have all the information. So that staff can follow this where there are any health worries or concerns. Staff should be trained in learning disabilities and mental health to make sure that they can meet the needs of people who live at Rosedene. Care Homes for Adults (18-65 years) Page 25 of 55 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 Sally Seel CQC (West Midlands) Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 03000 616161 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 26 of 55 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 27 of 55 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. Prospective and existing people or their representatives have access to the information they need to help them make an informed choice about the suitability of the home for the individuals needs. The manager demonstrated their awareness of making sure that any prospective people who may be considering living at Rosedene are able to fit in with people who already live there. Evidence: Information is provided to people who may be considering moving into the home together with their relatives/advocates and also external professionals. This information is provided in the statement of purpose and the service users guide. We saw that these documents provided a range of information about what a person can expect from the service and a copy of the service users guide is in each persons bedroom. We were told that the manager and or staff have looked through the service user guide with each person who lives at the home to ensure they are aware of the information that tells people of what they can expect from the facilities and services offered. This is positive as Care Homes for Adults (18-65 years) Page 28 of 55 Evidence: people are able to be reminded about the home, its staff, house rules, fees and contractual information particularly as there have been some changes in staffing and management of the home. We also saw that efforts have been made to create an attractive and user-friendly document involving the use of pictures. We were also told that a leaflet has also been devised for people who want to see brief information about the home at a glance. We looked at a copy of the homes statement of purpose which we had been told had been revised since our last visit. We saw that the statement of purpose has been reviewed with a date of January 2010. This document had sufficient details about the home, facilities, services, management and staffing details. Within the statement of purpose there are also details about the homes aims and objectives with one of the aims being:Within this home we aim to provide long-term residential accommodation for Five (5) adults aged from 18-65 who have a learning disability and additional mental health needs. Importantly the statement of purpose confirms prospective people of how their needs will be met and the processes in place to make certain any new person coming to live at the home will be compatible with the other people who already live there as follows:The assessment process helps the homes staff to be sure that the home can meet a potential residents requirements and to make an initial plan of the care we will provide. We will provide prospective service users with as much information as possible about the home to help them make a decision about whether or not they want to live here. People can visit the home to join people for a meal and to stay overnight on a trial basis to see what it feels like to live in the home and meet the other people who already live there. It was positive to see that an, assessment of a new service users compatibility with existing service users will also be considered at this stage. This is an area where we made a recommendation for the home to review its practices at the last inspection when making an assessment of how new people will fit in with others who already live there. We discussed this with the manager and they demonstrated to us that they recognise that any new person who comes to live at the home will need to be compatible with others who already live which should include individuals gender, age and behaviour. This practice should reduce the risk of negative outcomes for the person or those already receiving a service. All of the existing people have lived in the home since before the last inspection so there were no recent pre-admission assessments to examine. The home met this standard at the last inspection in January 2010. Care Homes for Adults (18-65 years) Page 29 of 55 Evidence: Seven members of staff who completed a survey said that they were always given up-todate information about the needs of the people they cared for. A survey we received from a person who lives at the home told us what the home does well:Look after me well. Care Homes for Adults (18-65 years) Page 30 of 55 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is developing a person centred approach to care planning and risk assessment which promotes peoples participation, enables their independence and ensures their needs and choices are respected. Evidence: At the last inspection we made one requirement and three recommendations that the home reviews their care planning and risk assessment processes in order to fully meet the national minimum standards and promote a person centred approach. At this inspection we looked at a sample of support plans and risk assessments to see if this had been implemented. In the support plans we looked at there was some excellent details about individuals needs and preferences which had been written in a person centred style. Efforts had been made to ensure that the plans had been reviewed since we last inspected the home, were more organised, easy to read, contained clear information and were respectful in the way personal details were presented. Plans were also seen to have been updated to take account of changes in individuals lives. Care Homes for Adults (18-65 years) Page 31 of 55 Evidence: Each person has an up to date support plan showing their preferences and all their needs in relation to relevant areas. They include physical care, mobility and exercise, continence, education and occupation, communication, domestic skills, behaviours and finances. Their individual short and long term goals are also being identified with any action needed to meet them specified. The manager and staff are implementing an appropriately person centred (PC) approach to care planning. This aims to involve each person in planning their own care and making choices to the extent they are capable. The PC plans had been drawn up with their input as much as possible by their key worker who is allocated to them from the care staff team. Significant other people in their lives, such as relatives, other staff and professionals are also consulted if they want them to be, or when they are unable to specify their needs and goals themselves. A recommendation that was made at the last inspectionnto ensure that people who live in the home and or their relatives and representatives sign the support plans to ensure that what is written about them is an accurate reflection of their needs and wishes. It is suggested that if people and or their representatives do not want to do this then it should be documented. An important aspect of PC planning is that staff know people living at the home well so they understand their needs and what they like and dislike. Also to enable people to express their views and make choices and decisions about their lives. For example, the manager told us that following the last inspection a person now has photographs of staff and is able to make their choice about who they want to support them with their personal care tasks. This shows that the manager is now actively promoting peoples involvement in their plans and finding creative ways to do this so that people who have limited communication are able to still choose how they receive the support and by whom. However, we do recommend that all staff sign individuals communication books/plans to confirm they have read these so that it can be seen that staff are able to put into practice the best methods of communication for each person in a consistent way. In each plan we noted that attention had been paid to individuals rights to make choices about the way they live their life and respect for their ability to be independent where appropriate. For example, key consent forms were in place for each person that confirmed that people were asked whether they would like to hold a key or not. It is now recommended that key consent forms are reviewed periodically to ensure that the person has not changed their mind. The managers present told us how they have given one person a key to their bedroom as the first step to then holding a key to the homes front door to further promote their independence. Risks are involved which have been acknowledged about how the person may lose their key but the managers are looking at other strategies to help the person to remember their key whilst they are out. Another person has more of their personal items on display in their bedroom with the acknowledgement that they may throw these at times. We also saw risk assessments in place with regards to the use of kitchen facilities, individuals behaviour and vulnerability, Care Homes for Adults (18-65 years) Page 32 of 55 Evidence: road safety, community activities, use of public transport and maintaining a safe environment. All contained clear and relevant information about the action to be taken by staff in the event of them being concerned about individuals safety. It was clear from our discussions that people who use the service are treated very much as individuals and the support that is delivered to them is tailored to their individual needs rather than the needs of the group. For example in one persons support plan we noted, My routine is to have hair mousse applied to my hair and dried using a hairdryer. Once dry I prefer to have my hair curled with my curling tongs, once completed curling of my hair a small amount of hairspray. Make-up applied, eye shadow, mascara, lipstick and will choose colours I want to wear. I also enjoy having my finger nails painted, choose colour. Our observations showed each of the people living in the home following a different routine during the day. From our discussions on the day it was clear that peoples views about their care are being listened to and the home is working hard to adapt the care they provide to individuals needs. For example, we were told that forward planning in relation to activities does not work for one person who lives in the home so staff have to adapt to what suits this person best. The Expert commented upon how effective communication is between people who live in the home and staff to suggest areas which could be further improved upon:3 of the people in the home can verbally communicate, one lady uses some words but mostly she uses pictures to communicate what she wants to do. Staff showed me a communication book with photos of different things the lady would like to do in the day. Each day the lady chooses what she wants to do using the photos. There were also photos of members of staff and the lady chooses which member of staff she would like to support her that day. The book is very good and it does help the lady choose but I would like to see her have a communication passport as well. I observed staff asking the lady what she wanted for lunch, the lady was verbally given lots of choices from 3 different members of staff and I got the feeling she was a little confused. It may be better for staff to show the lady photos of her choices to make sure she is choosing properly and not just saying yes to whatever she is being asked. We were told that residents meetings are held on a regular basis as a means of promoting peoples participation in decision-making. We looked at a sample of minutes from meetings that had been held and saw that individuals had been supported to contribute ideas and make choices. For example, people had been supported to choose colours and items in relation to the redecoration of the home. It was evident from our conversations with people who use the service and staff who support them that individuals have different levels of independence and this is recognised and respected. We saw that following the last inspection the manager and staff have worked hard in ensuring that short and long term goals are all in place. Staff are working hard to try to support one person with their motivation to access holidays, meet their spiritual needs, varied activities and other celebrations. However, this person has chosen not to attend Care Homes for Adults (18-65 years) Page 33 of 55 Evidence: church but it has been established that they like birds so this interest is being pursued. Their support plans showed some good information about how they would achieve their goals with clear risk assessments in place which identifies measures to reduce risks. We also saw noted that this person may need support of an advocate at times when some big decisions are to be made to ensure that these are made in the interests of the person concerned. We also saw risk assessments in place with regards to fire and evacuation, financial exploitation, challenging behaviour, bathing, life skills, medications and personal hygiene. All contained clear and relevant information about the action to be taken by staff in the event of them being concerned about individuals safety. Care Homes for Adults (18-65 years) Page 34 of 55 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. Improvements are now taking place and are ongoing to make certain people are supported and encouraged to lead full and active lives based on their individual needs and capabilities. Meals provided are balanced and healthy and improvements have been made so that people are fully involved in choosing their meals each day. Evidence: Positively activity planning within the home is improving and the manager is making sure that this is ongoing and being followed through in practice for people who live at Rosedene. It is good therefore that key workers are actively involved in care planning and can spend some individual time supporting people. We also saw that key workers are helping a person with their life story book which has photographs that are important to the person and reflect their life history. We were told that a memory box is also to be utilised to put items in both now and in the future. Another person was looking forward to planning their birthday party and sending out invitations. The Expert commented upon some of the activities people are experiencing within the Care Homes for Adults (18-65 years) Page 35 of 55 Evidence: home:I spoke to one resident about the sorts of things he does in the week. He told me that normally he goes to college on a Monday, Tuesday and Wednesday but he has now finished for the summer. He was going to the Beacon Centre for Employment in a couple of weeks. I think it would be really good if this man could be supported to get a paid job in the future. The man told me that his friend was visiting that night and that they might go out for something to eat. He told me that recently he had been to West Midlands Safari Park and Drayton Manor. He was going out shopping the following day and had chosen the member of staff he wanted to support him Another resident came home whilst I was there; this man is able to access the community by himself and has a voluntary job at an Age Concern centre. He told me he enjoys this and that he is always out and about. This resident had also helped to do work in the garden, which is good. The Expert also commented upon two people who live in the home who could possibly complete more activities both in the home and community. The Expert reported:He told me he likes to watch the football and that he goes to the pub in the evenings with another resident. Apart from this the man did not seem to be doing very much. Staff told me he likes to sit around the house and relax, this is ok but he should have the option of doing more. I was told that this man used to have a job and live independently; he should be supported to do more meaningful things in his day. We did have a discussion about this person and the manager told us that they are currently receiving support from external professionals to improve this persons motivation so that their quality of life in the areas of activities both in the home and community increase. It was good to hear that staff have discovered that this person has an interest in birds as already mentioned earlier in this report which is being considered for future activities. The Expert also commented about an activity planner which they looked at for another person who lives in the home and noticed there were not doing very much with their time. On the day we visited this person did some drawing in the garden and made some cakes. The Expert commented, It was great that she made the cakes with the staff member but I feel she could do a lot more with her time. When I looked at all of the activity planners I noticed that everyone had days where they cleaned their rooms. It is great that everyone is taking responsibility for cleaning the house as everyone has to do this in their own home. I asked about holidays and was told that everyone goes on holiday together. The younger resident wants to go on a city break so he may do this on his own with support. The rest Care Homes for Adults (18-65 years) Page 36 of 55 Evidence: of the residents are thinking of going to Breen this year. Staff told me that everyone likes to go together and they have always gone on holiday together. We are confident that the manager will now be ensuring that activities are personalised. Also that key workers are actively involved in developing life books, which show peoples social histories and the people and things in their lives that are important to them. These books are also useful in supporting people with following their individual interests so that people are leading fulfilled lives. The homes service User guide indicates that friends and family are welcome to visit at reasonable times. Discussions on the day indicated a sound awareness and sensitivity towards individuals personal circumstances. It was evident from examples given that the home has taken a proactive approach to supporting individuals with making contact with their family and overcome any barriers in relation to this. At the last inspection a recommendation was made:Consideration should be given to the planning of meals and how to help people who live in the home to be involved in this through using pictures, photographs and symbols so that individuals are able to influence all meals offered. Part of the PC process is facilitating communication and the staff have started to use pictures and objects of reference to promote choice making. The Expert commented upon how choices are made in relation to meals:- There is a photo menu board in the kitchen, which is good. It gave people 2 choices for every meal however, whilst I was there I observed everyone having different meals for lunch that were not on the menu. This is good as it means people can be flexible and have what they want to eat on the day. I was told that everyone has different things for breakfast; one man likes to have kippers so he has those. I observed one young man making his own breakfast, which is good. I was told that 2 of the male residents like to go to the pub together most evenings and they make their own supper when they get home. I was also told that everyone has chance to go food shopping, which is good. Care Homes for Adults (18-65 years) Page 37 of 55 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. Improvements have been made and are continuing to make certain people receive personal care in the way they prefer and their health needs are met with reviewed health action plans in place. People are protected by the homes policies and procedures for dealing with medicines. Evidence: The support plans we looked at contained sufficient information about individuals personal care needs to ensure that it is clear to the reader where people are able to be independent and where support is required. All had been reviewed and rewritten where necessary since our last inspection visit to ensure that peoples choices and goals were known so that these could be achieved to suit each person. There was clear consideration of individuals preferences and we observed examples where care was taken by staff to meet them. For example one person showed us how staff had assisted them with their make up to begin their day and as mentioned earlier they have photographs of the staff for the person to choose who they wish to assist them on they day. This is an improvement from the last inspection where we were concerned that peoples choices were not being upheld in gender specific care. We looked at information in support plans about individuals behaviour and mental health. There was clear information about how Care Homes for Adults (18-65 years) Page 38 of 55 Evidence: staff should respond to issues that arise and who should be contacted in an emergency. We saw evidence of appropriate liaison with health care professionals where specific concerns had arisen and how staff training is now been done in a planned and timely way when needed to ensure safe working practices. For example, it is also positive to hear that the management team are researching mental health training and courses in relation to the learning disability qualification. This was a requirement made at the last inspection and we will be reviewing whether staff are receiving these training courses when we next inspect the home so that the needs of people who live in this home are effectively met by knowledgeable and skilled staff. We looked at some peoples Health Action Plans (HAPs) which assist staff in helping people to stay healthy and well. We saw that these are being reviewed and updated. We looked at the appointment records for one person and saw evidence that they had been supported to access various health care services to meet their needs. This included health promotion services, such as, well persons checks. We saw in the files we looked at that peoples weights are now being recorded regularly so that early detection of any underlying health condition can be seen and action taken. Record keeping was generally satisfactory and more organised than at our last inspection visit. We will review HAPs when we next inspect the home as staff should have made further progress with these and have therefore repeated our recommendation made at our previous key inspection in relation to ensuring each person who lives in the home as a reviewed HAP in place. We also looked at feedback from a person who uses the service through the surveys that were completed:All the staff are very good. We looked at staff survey comments which told us:We work very well as a team and our main goal is to ensure that people whom we are supporting got everything they need. The home always puts clients needs above all. Looks after our service users keep service users happy. We asked if there were any difficulties with practices around administration and management of medicines. We were told that there was not and this was also confirmed in the visit undertaken by a representative for the provider who also focuses upon medications kept in the home. The home has a medication management policy that covers arrangements for collecting and receiving medication, storage, ordering of medicines, medication errors, and administration. We looked at facilities in place to store medication. There is a metal cabinet that is fixed to the wall of the office that contains individuals medication. At the time of the inspection, there were no controlled drugs being stored in the home. Care Homes for Adults (18-65 years) Page 39 of 55 Evidence: Medication is currently supplied to the home by a local pharmacy. We observed a member of staff in the office administering medications with the manager checking these. We were told that regular medication checks are completed so that any errors and or oversights can be resolved in a timely way. As at the previous inspection senior staff administer medications and there is always a senior member of staff on shift to enable this to happen in practice as the rota indicates. We looked at a copy of the homes training matrix to see if staff had attended training in medication administration. This showed that four staff have completed training with two staff having confirmed training dates in place and or awaiting their training certificates and two staff have requested training. Care Homes for Adults (18-65 years) Page 40 of 55 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. There are clear complaints procedures that people are able to access in formats that meet peoples reading needs which encourage and support people to raise issues and concerns. Staff are able to access information and receive training so that people should be protected from harm. Evidence: We saw that there is a complaints procedure and this is in suitable formats so that people living in the home are able to understand, such as, using pictures to illustrate the written word. It is also important for people who live at Rosedene to have access to advocates where required and key workers help in this process to ensure each person who lives at this home has the support which they need to be able to make their complaints and or concerns known. For example it is important that staff are able to recognise if a person is unhappy and in the survey responses we received from staff we were told that staff do notice if a person seems unhappy and or has some concerns. Both surveys we received from people who live in the home informed us that people know who to speak to if they are unhappy and how to make complaints. The Expert focused upon how people are able to understand the homes complaints procedures:I also saw an accessible complaints leaflet; this was good as it showed residents how to Care Homes for Adults (18-65 years) Page 41 of 55 Evidence: complain if they are not happy about something. People can also talk about any issues they have in their residents meetings and the Manager told me that sometimes people go to talk to her. We saw that there has been one informal verbal complaint made but this was resolved appropriately. The Care Quality Commission (CQC) have not received any recent complaints about the home since we last completed a key inspection. However, if the home should receive any complaints they have a specific book to log these to ensure action is taken together with the required monitoring and reviewing of each complaint received. This should make certain there is a culture of openness within the home and a proactive approach to identifying and addressing concerns. At the last key inspection we saw that residents meetings were not always happening on a regular basis and the minutes could not be found. Therefore we could be certain that people are having opportunities of influencing what happens in their home and how it is run. However, the Expert looked at some resident meetings and commented:I looked at some minutes of the residents meetings. I was pleased to see they were in easy read and used photographs. I could see that they had talked about the decor in the home, holidays and the menu in their meetings, which is good to see. I also saw an accessible complaints leaflet; this was good as it showed residents how to complain if they are not happy about something. People can also talk about any issues they have in their residents meetings and the Manager told me that sometimes people go to talk to her. The updated training matrix told us that staff are receiving training in adult protection and positively the matrix reflects when training has been completed with a date to ensure that refreshers are undertaken appropriately. This should ensure staff able to describe and recognise the actions that they would take if they witnessed any form of abuse. There is a safeguarding adults and the prevention of abuse policy in place. We were told that staff have access to Worcestershires safeguard and protect policy. This is the policy that must be followed if abuse is suspected. There have been no recent safeguarding referrals since we last inspected the home in January 2010. Following the last inspection we saw that four staff have now received training in the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS) in March and April 2010. This is positive as it is important for staff practices as this legislation examines how risk assessments and decisions to restrict someones liberty such as movement, leaving the home or making decisions for themselves should be done to ensure that their liberty is not denied. We did not examine the financial records for monies held on behalf of people who live at the home on this occasion but no concerns were expressed to us and therefore we shall inspect these records when we next inspect the home. However, we did observe that Care Homes for Adults (18-65 years) Page 42 of 55 Evidence: staff are ensuring that people have their money as they require it with staff and individuals signing for their monies on the day we visited the home. We sampled two staff records and found that appropriate recruitment and selection checks have been followed. This means that the systems in place for the recruitment of staff are satisfactory which is discussed further in the staffing standards of this report. Care Homes for Adults (18-65 years) Page 43 of 55 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. Improvements have been made which have resulted in people living in a comfortable home with lots of homely touches which hold meaning to people who live at Rosedene. The home is clean and tidy and generally infection control practices promote good hygiene. Evidence: Improvements in the home have been made since we last inspected, such as, the dining area now has blinds to the windows and looks like a place where people would enjoy sitting to have their meals. The lounge no longer looks bare as there are homely features, such as, new furniture, pictures and other items that hold meaning to people who live in the home. Much more is being created in the garden and people are taking an interest in gardening to ensure improvements continue to evolve over time. The Expert reported:The Manager showed us around the home. The garden was very nice and had lots of flowers in pots and hanging baskets, there was a smoking area where the residents smoke with a patio table and chairs. I was pleased to see that the staff office was in the garden, this means it does not take up any space in the peoples home. There was a nice dining area and the living room had recently been decorated, the residents told me later that they had chosen the decor in the living room and dining room, which is good. The Care Homes for Adults (18-65 years) Page 44 of 55 Evidence: Manager showed me the ladys bedroom, I was pleased to see that she asked the ladys permission first. The bedroom was very personal to the lady and she had an en-suite toilet and sink. There is a bathroom downstairs for the 2 residents on the ground floor to use and another one upstairs for the other residents to use. The Expert also commented that there were locks on one persons wardrobe because this person tears their clothes which then need to be replaced which the manager told us could become costly to the person. It is suggested that this situation is reviewed with this persons representatives to ascertain whether any other recommendations can be put in place so that the wardrobe does not have locks on it. This review should be documented to show that the human rights of this person are not being breached and or restricted unnecessarily. We were shown one of the bathrooms and noticed that the manager was making certain that homely touches are also placed in these areas which makes them nice places for people to be in. The home presented as clean and tidy at the time of the inspection. This was confirmed by people who responded to our survey who told us they were satisfied with the homes cleanliness. Discussion with people who use the service and observation of them in their home indicated that they are supported to participate in household tasks to promote an ordinary living environment. We also saw from looking at the staff training matrix that three staff have received training in the prevention and control of infection with confirmation that other staff have requested this. There is also a policy about infection control in place in the home about this. Care Homes for Adults (18-65 years) Page 45 of 55 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. The homes procedures for recruiting care workers are generally satisfactory and therefore protect people who use the service. Some gaps in staff training have been identified where further development is required to ensure care workers have the specialist knowledge and skills to work with people who use the service. Evidence: On the day we visited the home there was a female senior support worker and a male support worker on duty together with the manager and a manager from one of the providers other homes who was continuing to provide some support. We looked at the staffing rota which confirmed that there are at least two members of staff on duty with the aim being three together with the manager. There is also a member of staff that provides overnight support if required so they complete waking night duties at the home. It was good to see that there is now nearly a full compliment of permanent staff so that people can be confident that they will be supported by staff that are familiar with them and also consistency is applied to all staff practices. We looked at the records for two members of staff who had been employed in the home since the last inspection. Records were seen to be in good order with information including an application form, full employment history, photograph, appropriate references, proof of identity and a check with the Criminal Records Bureau (CRB). All seven surveys that we received from staff told us that checks had been carried out on Care Homes for Adults (18-65 years) Page 46 of 55 Evidence: them before they started working in the home. Following the last inspection in January 2010 the management team have developed a training matrix. This is colour coded so that the manager and staff can see at a glance what training has been achieved, what courses staff have been booked on and or requested together with identification of where refreshers are required. The manager has supplied us with a copy of the homes training matrix. We saw from this information that systems are now in place to provide care workers with mandatory training so we are confident that all staff will now receive this training and refreshers where required in a timely way. This was not the case at the previous key inspection in January 2010. Some care workers have also undertaken, or are working towards, National Vocational Qualifications (NVQ) Level 2 in Care although the number does not meet the minimum standard. For example the training matrix informs us that, two staff have NVQ Level 2, three staff have commenced this training with two staff having requested the training. The manager told us that she is working to increase the uptake of NVQ Level 2 in the home with the aim that all staff will have completed this particular training so that have the required knowledge and skills to meet peoples needs. We will inspect how many staff have completed their NVQ Level 2 when we next inspect the home. We noted that staff have not as yet been able to undertake a relevant course in learning disabilities qualification and mental health training. As illustrated throughout this report and in the statement of purpose these training course are important as the home is registered to provide care and support to people who have a learning disability and or mental health needs. The management team told us that they are researching courses in mental health as they were looking for a course that holds substance so that staff gain value in doing the course. We were also told that specific training in learning disabilities qualification is now underway. We are confident with the new management approach that staff will receive the training they require. This will ensure that all staff have the specialist skills to understand and meet the needs of people who use the service and that it is important that the training offered to care workers reflects the needs of people who use the service. We are therefore repeating a requirement for the home to review their training programme to increase access to specialist training relevant to the needs of people who use the service for all care workers. We will be inspecting whether staff are receiving this training when we next inspect the home. We saw that a supervision planner is now in place which shows that regular supervision sessions are now taking place which is an improvement as at the previous key inspection this was not happening. This should mean that staff are receiving the support they require in order to fulfil their duties, opportunities to improve their knowledge, any problems that need to be focused upon together with how staff are performing in their work. This can only benefit the people who live at Rosedene. The Expert commented on their observations of staff practices:I observed the staff whilst I was there. Staff appeared to speak to people with respect Care Homes for Adults (18-65 years) Page 47 of 55 Evidence: and were encouraging them to be independent. I was pleased to see that staff did not smoke in the residents smoking shelter and that they were spending time with the residents throughout the time I was there. This is positive and reflects the hard work that has taken place since we last inspected the home in relation to ensuring there is effective leadership and good quality supervision of staff which have all improved since our last inspection of the home in January 2010. Care Homes for Adults (18-65 years) Page 48 of 55 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 being run effectively and has demonstrated its capacity to improve and work in partnership with other agencies. Appropriate systems are in place to monitor aspects of health and safety and ensure suitable record keeping processes are in place. Evidence: Since the last inspection the organisation has appointed a new manager, Julie Lewis. The new manager is qualified and experienced in the field of learning disabilities and prior to taking up their position at Rosedene managed a day care service for people who have learning disabilities. The manager has achieved their NVQ Level 4 and managers award and are proactive in ensuring they maintain their training in all areas of meeting the needs of people who live at the home which compliment their management qualifications. Although the manager has yet to apply to the CQC to register we have been told that this is due to be submitted. We will monitor this. Examination of the fire logbook demonstrated that regular and thorough testing and servicing of the homes fire detection and fire fighting equipment and other appliances had been carried out as appropriate. Care Homes for Adults (18-65 years) Page 49 of 55 Evidence: We are satisfied that the majority of requirements made at previous inspections have now been met and this report provides evidence to support this. A staff member commented that there had been an improvement in the management of the home since the new manager came into post. Evidence seen during the visit substantiated this. Within the staff surveys that we received in February 2010 there were a number of issues that were reoccurring, such as, maintenance of the home, more staff, staff wages and holidays. However, we are satisfied that the majority of requirements made at previous inspections have now been met and this report provides evidence to support this. A staff member commented that there had been an improvement in the management of the home since the new manager came into post. Evidence seen during the visit substantiated this but as we cannot comment upon staff wages and holidays it is suggested that the manager may want to address this with staff in their supervision sessions if this has not been resolved. We were shown reports of the visits that are required under Regulation 26. These are completed by a person that is appointed by the provider to complete a number of quality audit checks including medication, health and safety, resident consultation and the environment. We will be repeating a recommendation for the home to review their evaluation of the quality of the services at the care home is fully implemented, and a written report of the outcomes made available to all interested parties. This is so that it can be seen that the views of people who use the service, staff, visitors and external professionals underpin the way in which it is reviewed and developed consistently which can be viewed. We will be examining the evaluation of quality of the services when we next inspect the home as we acknowledge that the manager is very new in their position of managing the home. The Expert reported upon the improvements that we saw and heard about on the day we inspected the home:It really pleased me to see that the new Manager had done a lot to improve the home for the people who live there. Care Homes for Adults (18-65 years) Page 50 of 55 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 51 of 55 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 35 12 Staff who work with people 24/09/2010 with specialist needs such as learning disabilities and mental health needs must have the appropriate training and be able to demonstrate their competence both in practice and through discussions. This will ensure that people receive specialist care that is based on current good practice and reflect relevant specialist and clinical guidance. 2 39 24 That greater care should be taken when completing the Annual Quality Assurance Assessment in order that it remains factual with clear practices and procedures examples provided in all sections. 24/09/2010 Care Homes for Adults (18-65 years) Page 52 of 55 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 This will ensure that the home is being run in the best interests of people living there. This was not inspected at the time of this inspection and therefore still remains in place. 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 7 To pursue and continue to develop communication passports appropriately for people who require these as aids in their everyday lives. All care plans should be signed by individuals whilst they are taking part in completing these and or their representative to confirm their agreement to how their needs will be met. If people decline this should also be recorded. All staff should sign to confirm that they have read individuals communication plans so that there is confidence that all staff are providing consistent support in meeting peoples needs with their abilities recognised and promoted. Key consent forms should be reviewed periodically so that if people change their minds this is recognised and appropriate action taken. Health Action Plans for all people who live in the home must continue to be reviewed and rewritten where appropriate to make certain these are all up to date. Included in this process should be an up to date record of peoples prescribed medications. This should ensure that people receive health care as required and monitoring takes place. 2 7 3 7 4 8 5 19 Care Homes for Adults (18-65 years) Page 53 of 55 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 6 7 32 39 NVQ Level 2 You should ensure that the system for evaluating the quality of the services at the care home is fully implemented, and a written report of the outcomes made available to all interested parties. This is so that it can be seen that the views of people who use the service underpin the way in which it is reviewed and developed. Care Homes for Adults (18-65 years) Page 54 of 55 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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