Care Home: Roselea

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What the care home does well People said that they enjoy helping to cook and bake in the kitchen. Some people are supported to go to college, go swimming and horse riding. One person said they have a work placement and another helps out at the local church. Relatives said, "staff do a great job. He is well cared for." Staff are having access to a training programme which should provide them with the skills and knowledge they need to support people. A quality assurance system is in place which involves people living in the home. Improvements were seen to be taking place as a result of this annual audit. What has improved since the last inspection? Fourteen requirements issued at the last inspection have been complied with. Of these five had been repeated from previous inspections. Improvements include, providing each person with an assessment and care plan. Personal information is stored securely. Bathrooms and a kitchen have been refurbished. Each person has an inventory in place. Staffing levels have improved providing greater access for people to a range of activities. TrainingRoseleaDS0000044230.V375350.R01.S.docVersion 5.2in epilepsy, autism and learning disability has been provided for staff. A fire risk assessment has been put in place. What the care home could do better: Ways of communicating with people should be promoted to include use of sign language, symbols and photographs. Restrictions must be recorded and where appropriate agreed with people. Consent to have medication administered by staff should be recorded. When new staff are appointed gaps in employment history must be examined. The manager should complete training in the Mental Capacity Act and Deprivation of Liberty Safeguards. Key inspection report CARE HOME ADULTS 18-65 Roselea Churchend Slimbridge Glos GL2 7BL Lead Inspector Ms Lynne Bennett Key Unannounced Inspection 14th May 2009 09:30 Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 1 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. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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. Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 2 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 Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roselea Address Churchend Slimbridge Glos GL2 7BL 01453 890444 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Voyagecare.com Voyage Limited Manager post vacant Care Home 12 Category(ies) of Learning disability (12), Physical disability (3) registration, with number of places Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd May 2008 Brief Description of the Service: Roselea is a residential care home registered for twelve people, including three adults who may also have a physical disability. People living at the home may demonstrate verbally and physically challenging behaviour. Roselea is situated in the village of Slimbridge, close to local amenities. The accommodation is divided into four separate living areas, with separate staffing for each area. The ground floor accommodates six residents, and the first floor is divided into three self-contained flats accommodating six people. Fee levels for the home range from £1239 - £1929 per week. The Statement of Purpose and Service User Guides are available from the main office. People have a copy of this on their personal files. Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection took place in May 2009 and included two visits to the home on 14th and 15th May by one inspector. The manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). Surveys were returned from 2 members of staff and 4 relatives. The manager was interviewed by us (the Care Quality Commission) after this inspection and was confirmed as the registered manager for the home. We talked to 3 people using the service, and asked staff about those peoples needs. We also looked at their care plans, medical records and daily notes. This is called case tracking. We looked at a selection of other records including staff files, health and safety systems and quality assurance audits. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Fourteen requirements issued at the last inspection have been complied with. Of these five had been repeated from previous inspections. Improvements include, providing each person with an assessment and care plan. Personal information is stored securely. Bathrooms and a kitchen have been refurbished. Each person has an inventory in place. Staffing levels have improved providing greater access for people to a range of activities. Training Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 6 in epilepsy, autism and learning disability has been provided for staff. A fire risk assessment has been put in place. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to the information they need enabling them to make a decision about whether they wish to live at the home. An assessment of the person’s wishes and needs would be taken into consideration before offering them a place. EVIDENCE: The Statement of Purpose and Service User Guide had been reviewed in 2009 to reflect changes in the service provided and to the management of the home. The Service User Guide had been produced in a format using pictures and symbols. Each person had a copy of this on their personal file. A copy was also displayed in the reception area. There had been no new admissions to the home since the last key inspection. An assessment of need would be completed and copies of assessments and care plans from placing authorities obtained prior to inviting people for visits. One person was being helped to explore supported living options locally. Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 9 Each person had a copy of the terms and conditions dated March 2009 providing them with a summary of the service they receive and any additional costs. Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans reflect people’s assessed needs and there is some evidence that people are being supported to make choices about their lifestyles. Ways of communicating with people could be improved to enable them to be involved in decision making process. More robust recording is required of restrictions that are in place to safeguard people from harm. EVIDENCE: Considerable work had been completed since the last inspection to review people’s needs and produce new support plans. These were in place for a range of holistic needs including physical, intellectual, emotional and social. Each person had an assessment of need followed by the relevant support plan and other documentation such as risk assessments. Support plans clearly referenced any additional records which should be read alongside them Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 11 including behaviour management plans. Staff spoken with appeared to have a good understanding of people’s needs. There was evidence that people were having annual reviews at the home and where placing authorities had attended they had supplied a copy of their new assessment and care plan. Needs identified in these documents were then reflected in their support plans provided by the home. The latter plans were being monitored monthly or sooner where changes in people’s circumstances had occurred. There was a range of supporting documentation including daily notes, monitoring forms for epilepsy, diet, weight and incidents. Daily notes clearly referenced where these forms had been used and all were kept together to provide a picture of the person’s experiences and lifestyle for any particular month. The quality of some recording in the notes was poor and the manager said that she was supporting staff through supervision to monitor this. Each person had a communication profile which described how they communicated and how to interpret their non verbal behaviour. Profiles indicated that some people used Makaton sign language, objects of reference or photographs to help them to express themselves. Staff were not observed using sign language and those spoken with indicated that not all staff had accessed this training. Staff said that they were developing a new range of photographs to use around the home. One relative commented that “although ….. has problems communicating, carers who know him can usually understand what he wants.” There were a number of restrictions in place affecting people living in the home such as the use of keypads to the front door and kitchen and access to the telephone. Whilst these were noted in care plans and risk assessments the rationale for these needs to be clearly recorded and where appropriate evidence provided of discussion in a multi disciplinary forum in line with the Mental Capacity Act and Deprivation of Liberty Safeguards. One risk assessment noted that the ‘lounge door should be locked’. When questioned staff said this was done for a short period of time to prevent harm to others and that people had access by other means out of this area. The rationale for this needs to be clear including timing, support to the person and others and that other people by default are not being locked into the lounge and have freedom to leave if they wish. Risk assessments had recently been reviewed and amended where needed to reflect incidents which had occurred. Risk assessments identified hazards and ways in which staff could support people to minimise these enabling them to take risks in a measured and as far as possible safe way. A missing person’s policy and procedure was in place and each person had an individual pen picture. Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 12 Throughout our visits to the home records were kept securely in lockable cabinets either in the office or at the staff work station. Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 11, 12, 13, 14, 15, 16 and 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to participate in social, educational, cultural and recreational activities that reflect their personal expectations. People living at the home are offered a range of freshly produced meals giving them choice about their diet. EVIDENCE: Each person had a pictorial activity schedule in place and daily notes provided evidence of their lifestyles and the opportunities they had chosen to participate in. Where people had refused activities this was recorded. We looked at daily records for two weeks in May 2009. Since the last inspection staffing levels had been maintained at a minimum of 5 staff per shift rising to 8 or 9 as indicated by the activities people had arranged for that day. Some people have an active lifestyle reflecting their wishes and aspirations. People go to the local church, Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 14 have the opportunity to do voluntary work, attend college and go on annual holidays. Some people through ill health or from choice spend a considerable amount of time in the home. One such person was supported to go to the Opera and Ballet, which their relative said they really enjoyed. Arts and craft sessions, massage, cooking or baking, bingo and music were being provided for people at home. Staff said they would be helping people to do some gardening and growing their own vegetables. Some people have regular access to horse riding, swimming, trampolining and a sensory room/Jacuzzi. People liked to pop out to the local shop to buy magazines or newspapers and to go for walks around the village. One person rides their bike to the nearby town. People use public transport as well as the home’s vehicles. The AQAA stated, “We have an open access policy for our visitors and service users have the choice of seeing them in their rooms or in the lounge.” Staff have supported people to visit their relatives overseas and to keep in contact via the telephone or by letter. One relative stated “when I visit or my brother visits me, the staff are excellent.” The home does not have internet access and staff felt that one person would benefit from keeping in contact via email. Records were being maintained of contact with relatives and friends. Several people were being supported in relationships with people from other homes. Some people had keys to their rooms and all had access to lockable facilities. Times for getting up and going to bed were flexible with daily records noting one person occasionally liked to stay up late going to bed in the early hours of the morning. People were having regular house meetings. Minutes of these meetings were available indicating that people chatted about activities they would like to have access to such as bingo and film nights. Both had been provided. People also requested pottery sessions and tennis which the manager said they had looked into but the cost had been too high for people to fund. The manager said that people had been involved in the choice of meals for the new menus which offered people a choice of main meal each day. People were observed choosing their lunch preferences and there was evidence that these were being recorded in the daily notes. Any special dietary requirements were highlighted in the kitchen. If people needed access to adapted crockery or cutlery this was being provided. Fresh fruit was provided and meals were freshly produced each day. Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using the 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’s health and personal care needs are being met helping them to stay well. Their health and wellbeing are promoted by satisfactory arrangements for the handling of medication and training of staff in specialised techniques. EVIDENCE: The way in which people wished to be supported was clearly detailed in their personal care support plans. Each person also had a list of likes and dislikes. Staff were observed supporting people discreetly and interacting with them positively. Surveys indicated, “staff have a good understanding of service users and have patience in dealing with them.” The AQAA stated “we support each individual to have access to physical and health care support in their preferred choice. Ensure that all support is in the service user’s best interest.” Health care professionals were being involved in the assessment and provision of equipment and adaptations. Listening devices had been replaced by sensory Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 16 mats in rooms to alert staff should be person have an epileptic seizure. These were less intrusive than the listening devices respecting people’s privacy. Support plans and risk assessments were in place for people with epilepsy and monitoring forms being used. People were having access to medication reviews and support from healthcare professionals in relation to their epilepsy. Each person had a Health Action Plan in place as well as a Health file containing evidence of appointments with a range of health care professionals including dentists, opticians and general practitioners. People had been supported with out patient appointments and to access emergency services. We had been informed of the latter under Regulation 37. People were having annual health checks at the well woman/man clinics. The home had a number of medication errors which they had informed us about at the time. The manager confirmed that staff had redone their training in the safe handling of medication and that competency audits were in place. Staff were also having access to training in the administration of rectal diazepam and midazolam. Each person had a support plan in place for medication. There were no documents recording that they had given staff consent to administer medication. The home had a monitored dosage system in place. Medication administration records were satisfactory. Stock controls were maintained on the medication administration record and in an additional stock book for ‘as necessary’ medication. Creams and liquids were labelled with the date of opening. It is advised that external and internal preparations are kept in separate sealed containers. Some homely remedies were kept and the general practitioner had provided permission that these could be used. The temperature of the cabinet was being recorded. A current copy of the British National Formula was in place. Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People using the 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 has an accessible complaints procedure which enables concerns to be raised by people living there or on their behalf. Systems are in place which should safeguard people from possible abuse. EVIDENCE: The home has a complaints policy and procedure which was displayed in the reception area. This was produced in a version using pictures, text and symbol. People also had access to Voyage’s “Letting us know what you think” which was available in a prepaid post card format. The home had a complaints folder which provided evidence of two complaints received in the last twelve months the responses and action taken. People spoken with indicated they would talk to staff or their key workers if they had concerns. Surveys confirmed that relatives would discuss their concerns directly with staff. The DataSet noted that there had been contact with the safeguarding team. This had been discussed with the manager and she was given information about training the local adult protection team provides for managers and for staff. Staff had completed an open learning course on the protection of adults and those spoken with had a good understanding of abuse and their responsibilities in reporting suspected abuse. Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 18 Staff also stated they had completed training Non Violent Crisis Intervention (NVCI) training which promotes a low arousal approach to supporting people who may be presenting with challenging behaviour. NVCI management plans were being reviewed and put in place for each person. Most indicated that physical intervention was not used and where it had been identified this was as a last resort only. Incident records within the home indicated that there had been no use of physical intervention for a considerable time. Staff again confirmed the effectiveness of the use of distraction and diversion. Financial records were examined and found to be satisfactory. Regular checks were in place. Bank records were cross referenced with withdrawals. The manager was advised to sign and date these as they were checked. A store loyalty card was observed to be in the name of a member of staff. This is not good practice and should be reregistered to the home. Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People using the 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 to Roselea are creating a homely environment which is safe and comfortable. The home is clean and well maintained. EVIDENCE: At the time of our visits considerable refurbishment of bathrooms and shower rooms was taking place. Facilities on the ground floor had new floors and fixtures and fittings installed to provide a wet room and bathroom. A wet room on the first floor had also been refurbished. People were being involved in choice of colour schemes for the redecoration of their rooms. Rooms were decorated to reflect people’s interests and lifestyles. One person who had previously not tolerated furniture or décor in their flat had personal possessions and furniture. The manager said that staff had been gradually reintroducing these and had found that by removing, for instance the mattress Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 20 during the day the person accepted this and did not destroy this item when it was returned. The manager said that long term plans for the home included refurbishment of the kitchen which would hopefully create more space for people who choose to eat their meals here. The communal areas were pleasantly decorated and had good fixtures and fittings. The gardens were well kept. The entrance to the home had been improved creating a small reception area and additional workspace had been created for staff and for the storage of confidential information. Day to day maintenance and repairs were being identified and records confirmed when they had been completed. The laundry was clean and tidy at the time of our visits and correct procedure was being followed. Staff were supplied with personal protective equipment. Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. People using the 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’ needs are met by a competent staff team, who have access to a training programme that provides staff with the opportunity to gain knowledge about the diverse needs of people living at the home. Greater consistency in the verification of recruitment and selection information will safeguard people from possible harm. EVIDENCE: The manager confirmed that there were currently no staff vacancies in the home. Staff levels were being maintained at a minimum of 5 per shift rising to 8 or 9 according to the activities or appointments people had arranged for the day. The rotas for April and May confirmed this. This is a significant improvement. Surveys said that “staff are excellent. Staff go the extra mile.” New staff confirmed they completed an induction programme and copies of their completed booklets were seen on their files. Voyage have stated that this is equivalent to the Skills for Care Common Induction Standards. There was Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 22 evidence that staff were also being registered for the Learning Disability Qualification before progressing on to a National Vocational Qualification (NVQ) award in Health and Social Care. The DataSet indicated that over 50 of staff had a National Vocational Qualification Award. Staff spoken with appeared to have a good understanding of the needs of the people they support. Surveys indicated that “staff seem capable of understanding their needs and wishes.” Records were examined for five new members of staff employed in 2008 and 2009. There was some inconsistency in the information being obtained prior to appointment. Two of the application forms had gaps in employment history or insufficient information was provided between leaving school and the first appointment being recorded. On one of the most recent applications gaps in employment history had been explored and evidence provided of the missing information. Copies of two references were on file which had been obtained prior to appointment. The front sheet to the files confirmed that Criminal Record Bureau (CRB) checks had been obtained and where people had been appointed prior to the receipt of these, a risk assessment and povafirst were in place. New staff confirmed they had shadowed staff and had reduced responsibilities until their CRB check had been returned. Proof of identity was in place and each person had an identity badge issued by Voyage. The manager was advised not to keep copies of birth certificates in line with Data Protection Act recommendations. Evidence that this document had been seen can be recorded on the front sheet in staff files. The manager said that people living in the home had been involved either informally meeting or greeting applicants or in interviews. There was evidence that staff were having probationary supervisions/appraisals at six months to confirm their appointment. A training matrix was in place confirming that staff had access to a training programme which included refresher training. A mixture of open learning and taught courses were available for staff. They had accessed training in autism, learning disability and epilepsy as well as protection of adults and continence. Copies of certificates of completion as well as individual training profiles were on their files. Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are benefiting from a manager who has a dynamic and creative approach, and who will provide clearer direction and leadership. Effective quality assurance systems are in place involving people. Systems are in place which should maintain and monitor the health, safety and welfare of people. EVIDENCE: The manager had been in post almost twelve months and was due to be interviewed by us to be considered to be the registered manager for the home. (She was confirmed as the registered manager for the home at this interview). She had considerable experience in this area of care and had a NVQ Level 4 in Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 24 Health and Social Care and a Registered Managers Award. She was completing a Management Development Programme with Voyage. She said she was registering to complete Mental Capacity Act and Deprivation of Liberty Safeguards training with Gloucestershire County Council. There was information in the home about this legislation. She supplied the AQAA to us in time and it was completed satisfactorily. The home has a number of restrictions to liberty regarding the use of keypads to the front door, internal doors to flats and the kitchen. The home will need to discuss with placing authorities whether assessments require to be conducted in line with recommendations of the Deprivation of Liberty Safeguards (DOLS) or whether these are considered to fall short of deprivation of liberty – i.e. they are safeguards to prevent immediate harm. Voyage have robust quality assurance systems in place which involve people living in the home. They had taken part in a survey for the last annual audit completed in March 2009 and were being interviewed each month as part of the Regulation 26 visits to the home. The action plan for the home was examined and evidenced that issues were being completed by the manager and staff team. For example one action identified people should have greater involvement in menu planning and as noted earlier in the report this was being done in house meetings. The manager was in the process of producing a newsletter for people living in the home and their relatives. Systems for the monitoring of health and safety were in place. The AQAA indicated that equipment and utilities were being serviced regularly. Records in the home confirmed this. The fire risk assessment had been reviewed but individual fire risk assessments still referred to a ‘stay put procedure’. These were not in line with the Regulatory Reform (Fire Safety) Order 2005 or Voyage’s Fire policy and procedure. These documents were amended during our visits and staff informed of the change in procedure. This complied with an outstanding requirement from the previous inspection. Weekly and monthly checks for fire, water, fridge and freezer and hot food temperatures were being completed. Monthly health and safety audits were in place to confirm these were taking place. Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 4 X X 3 X Version 5.2 Page 26 Roselea DS0000044230.V375350.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA7 Regulation 17(1) Sch 3.3(q) Requirement The registered person must record any limitations or restrictions which are in place in the home such as keypads/use of telephone providing the rationale for these. People living in the home or others involved in their care need to be involved in these decisions. This is to make sure that any restrictions are in place to prevent harm to people. The registered person must obtain information about any gaps in employment history before new staff are appointed. This is to safeguard people from possible harm. Timescale for action 31/07/09 2. YA34 19 31/07/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Roselea Refer to Good Practice Recommendations DS0000044230.V375350.R01.S.doc Version 5.2 Page 27 1. 2. 3. 4. 5. 6. 7. 8. Standard YA6 YA7 YA20 YA20 YA23 YA23 YA37 YA37 Monitor the quality of recording in daily notes and other documents. Continue to develop Total Communication approaches around the home including access to training for staff. Consent to have medication administered should be in place. Internal and external preparations should be kept in separately in sealed containers. Bank records should be signed and dated as they are being checked. Store loyalty cards should be registered to the home and not in individual staff names. The manager should complete training in the Mental Capacity Act and Deprivation of Liberty Safeguards and cascade this information to staff. There should be consultation with placing authorities about whether DOLS assessments should be completed. Roselea DS0000044230.V375350.R01.S.doc Version 5.2 Page 28 Care Quality Commission South West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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