Care Home: Rosemere

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What the care home does well The homes admission and assessment procedures ensure that a prospective residents needs are appropriately identified and met. Residents benefit from being supported to maintain control in their lives and have a say in how they receive support and care from staff. The monitoring of risk assessments are robustly managed to ensure the residents safety and well being and promotes their rights to make informed decsions and take risks in their daily lives. Residents are able to maintain bonds with family and friends and take part in social, cultural, religious and recreational activities. Residents are encouraged to be involved in the running of the home and maintaining their daily living skills and their rights to choice and dignity is promoted. A choice of a healthy diet is provided. Residents physical, emotional and health care needs are monitored and met. The homes medication procedures ensure that medication is administered to all residents in a safe and appropriate way. Residents right to dignity and respect is consistently promoted. The homes complaints procedure is an accurate document for residents or people associated with the home to express any concerns or complaints. Procedures are in place to protect residents from abuse and harm staff receive safeguarding vulnerable adults training to ensure that residents are safeguarded from abuse or harm. The physical layout and indoor and outdoor communal areas of the home enable residents to live in a safe and well maintained environment and all areas of the home are clean and safe. The homes recruitment practices, induction and mandatory training of staff is consistent to ensure that residents needs are appropriately and safely met and staff have equal opportunities with regard to their own professional development. The management and administration of the home is consistent and robust. The home continues to be run in the best interests of the residents and their views and opinions and those of others associated with the home are sought. Residents welfare is promoted through the robust monitoring of health and safety in the home. What has improved since the last inspection? Some new carpets and flooring in residents rooms have been replaced and new furnishings which residents helped to choose have been purchased. A new bath and shower has been fitted. New staff have been appointed and several more staff have achieved their National Vocational Qualification in Care level 2 or above. What the care home could do better: It has been recommended that due to the future changing needs of the residents group that additional bathing facilities and sluice facilities be considered by Welmede in order to ensure that residents needs can continue to be met, their choices promoted and infection control maintained. Key inspection report Care homes for adults (18-65 years) Name: Address: Rosemere Rosemere Brookfield Close Ottershaw Surrey KT16 0JL     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Suzanne Magnier     Date: 2 3 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Rosemere Rosemere Brookfield Close Ottershaw Surrey KT16 0JL 01932872361 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): RBeedasee@nsurreypctnhs.uk Welmede Housing Association Ltd The registered provider is responsible for running the service care home 6 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Dementia - DE Date of last inspection Brief description of the care home Rosemere is a home for six adults who have learning disabilities and dementia. The home is a purpose built bungalow, situated in a residential area of Ottershaw. Each person has their own bedroom which includes furnishings and a wash basin. Communal areas of the home include a large spacious combined lounge dining room and a Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 0 6 6 Brief description of the care home separate kitchen which people can access. A small separate quiet room is also available where people can meet with friends or family members in private. The home has a bathroom which contains an adapted bath and shower. An enclosed garden is available and accessible for people to use for leisure activities and local amenities include a variety of shops and pubs. The home have their own seven seater transport to support people to leisure activities and health care facilities. Parking and public transport are available near the home. Welmede Housing Association, own and manage the home and employ all the staff. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. This inspection of the care home was an unannounced Key Inspection carried out by Ms S Magnier Regulation Inspector. The registered manager and a senior care worker represented the service throughout the inspection. For the purpose of the report the individuals using the service are referred to as residents. The inspector arrived at the service at 07.30 and was in the home for six hours. It was a thorough look at how well the home is doing and took into account detailed information provided by the home and any information that the commission had received about the service since the last inspection on the 13th September 2007. Care Homes for Adults (18-65 years) Page 6 of 33 The commission received four resident survey cards which had been completed on behalf of the residents, four completed survey from health care professionals and four surveys completed by staff at the home. The comments of which have been included within the report. The inspector spent time being, talking and observing the body language of the residents living at the home and with staff members in order to gain their views and opinions about the service. The inspector looked at how well the service was meeting the key national minimum standards and some additional standards have been assessed. This report contains judgments about the standard of the service. Documents sampled prior and during the inspection included the homes Annual Quality Assurance Assessment AQAA, care/person centred plans, risk assessments, medication procedures, a variety of training records, staff recruitment files and several of the services policies and procedures including complaints and safeguarding. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection and no safeguarding referrals have been made since the last inspection. The home had submitted the Annual Quality Assurance Assessment (AQAA) prior to the inspection, which was very well written to inform the commission about the service and some details of the document have been added to the report. From the evidence seen by the inspector and comments received, the inspector considers that the home continues to be able to provide a service that meets the needs of people who have diverse religious, racial or cultural needs. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? Care Homes for Adults (18-65 years) Page 8 of 33 Some new carpets and flooring in residents rooms have been replaced and new furnishings which residents helped to choose have been purchased. A new bath and shower has been fitted. New staff have been appointed and several more staff have achieved their National Vocational Qualification in Care level 2 or above. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 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 10 of 33 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 residents and their representatives have up to date information regarding the home so they can make an informed choice about using the homes services and facilities. The admission and assessment procedures ensure that residents needs are appropriately identified. Evidence: The homes Statement of Purpose and Service user Guide include large print and up to date photographs of the home and the local community. Both documents detailed the current facilities and services offered by the home in order that any prospective residents or their representatives are informed of what services and facilities the home offers. Welmede have a pre admission and assessment policy and procedure which enables any prospective resident and their representative the time to meet and get to know the home and the other residents prior to moving in and to ensure that their needs are fully assessed in order that staff can meet the persons needs. There have been no Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: admissions to the home since the previous inspection. Care Homes for Adults (18-65 years) Page 12 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from being supported to maintain control in their lives and have a say in how they receive support and care from staff. The support and personal care that residents receive is based on their individual needs set out in their care plans and associated documents which are robustly managed and maintained. The monitoring of risk assessments is robustly managed to ensure the residents safety and well being and promotes their rights to make informed decisions and take risks in their daily lives. Evidence: The two care plans sampled contained up to date, clear and well written guidelines for the homes staff to read which enabled them to provide care and support in the way the resident preferred. There was evidence that residents lifestyle choices were clearly recorded and throughout the inspection it was observed that the residents preferences were respected by staff for example one resident not wishing to engage having just got up and wanting to be alone and residents getting up when they chose to. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: There was evidence to support through sampling two residents care and person centred plans, individual life plans and the daily report note books that the way residents preferred to live their daily life was clearly recorded. There was well documented evidence which detailed the residents individual preferences, their equality and diversity, how they chose to communicate and use objects of reference, what their needs were with regard to support from staff with personal care, support and encouragement with maintaining their independent living skills for example house keeping chores, washing up, laying the dining tables. The documentation also included agreed working practises and guidelines for staff to support residents should they become distressed. It was noted that the care plans were referred to each day by staff who then documented the care and support the resident had received and reflected upon the residents general demeanour throughout the twenty four hour period. The senior staff member confirmed that the staff group who support the residents remained stable which is a benefit for the residents to feel comfortable and for staff to be aware of any subtle changes in the residents well being. There was robust evidence to support that an effective key working system was in operation and several residents told the inspector who their key worker was and when they would be next on duty. The care plans were well managed, kept under a monthly key worker review and reflected the current support needs of the resident in order to ensure their welfare and being. The registered manager confirmed that three residents reviews had been undertaken by the local authority and a further three would be undertaken by the end of the year in order to ensure that the local authority maintains their responsibility for the wellbeing and welfare of the residents. Whilst sampling the two person centred plans it was evident that the resident had assisted and been part of the development of the plan which included a variety of aspects of their life for example their dreams and aspirations which included getting married, going to the horse races having another holiday, their likes and dislikes, social and cultural history and family and friends. The documents seen were thoughtfully presented and included pictures and photographs which offered the reader an insight into the residents personality and life. Written comments received by the commission on behalf of the residents concerning their views about the home include They keep me busy with lots of activities, Im very happy living here and they have good home cooked meals. I like my key worker, Id like more marshmallows, chocolate and cigarettes and like the quiet room best. Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: It was observed that residents were free to move around their home and have access to all areas. Two residents were seen to prepare and choose their breakfast, choose what to wear, have a cigarette and decide if they wished to go out or stay at home. The registered manager demonstrated that the principles of the home are for each resident to maintain control in their lives and have a say in how they receive support and care from staff. It was confirmed that advocacy arrangements are in place for residents if they would like or need to have an independent advocate and links with other health care professionals and agencies to support the needs of residents are maintained. Within the individual life plans thorough and reviewed risk assessments were available to demonstrate that the homes staff continue to be aware of the hazards in the residents daily life and the ways in which to reduce harm to the resident. The risk assessments included aspects of the residents daily living both within their home and in the community and included leisure activities. The general recording and management of the files was robust and well managed to reflect that residents make their own informed decisions and have a right to take risks in their daily lives. Care Homes for Adults (18-65 years) Page 15 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to exercise choice in their daily lives, maintain bonds with family and friends and take part in social, cultural, religious and recreational activities. Residents are encouraged to be involved in the running of the home and maintaining their daily living skills. A choice of a healthy diet is provided. Evidence: Throughout the inspection it was observed that residents were comfortable and settled in their home and the staff on duty were attentive to the needs of each individual. There was evidence in the home that residents are encouraged to take part in meaningful and purposeful engagements which include aromatherapy, going on holidays, attending the local church, visits to places of interest, going to the pub, spending time with relatives and friends, taking part in planned day service activities, using the local sensory suite and hydrotherapy facilities, using the homes own Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: transport and continuing to be present within the local community. Several staff employed by Welmede arrived at the home during the inspection to support individuals on a one to one basis which included attending the local Bingo session, hydrotherapy pool and going to the local pub for a pint. It was observed that residents culture and ethnicity was promoted and staff supported residents to have a good sense about their own individuality and esteem. The registered manager confirmed and the AQAA detailed that residents can have keys to their rooms in order to protect their belongings and promote their rights to privacy and one resident chooses to exercise this right. There was evidence that family and friends are involved in the lives of residents. Staff work alongside residents friends and family to promote the best interests of the residents. Staff support residents to take part in celebrating specific family related occasions such as mothers day and birthdays and anniversaries and correspondence from family members regarding gifts and cards sent were sampled. Residents bedrooms contained family photos and personal items which involved their inclusion in family life. Records confirmed that regular one to one support is provided by the residents key worker and during this time residents views about their home and how they are are taken into account. Although residents supported at Rosemere have a variety of complex communication styles it was observed that staff understood and had knowledge of the residents way of communicating and responded accordingly. The home promotes healthy eating and it was evident through looking at documents that dietitians and speech and language therapists were involved in the dietary and special needs of residents to promote their safety and welfare at meal times. Nutritional, eating and drinking risk assessments and regular body weight records were kept within the residents care plans in order to ensure their well being and safety at mealtimes. The homes fridge and freezer did not contain very much food yet the commission were assured that the day of the inspection was the day that the general food shopping for the home was undertaken. This was also confirmed by a member of staff who was observed detailing the shopping list. The home have a variety of menus which include pictures to assist residents in choosing what they would like to eat. The current menu contained residents initials to reflect that they had chosen the meal which was one of their favourites. The AQAA advises that the home keeps the British tradition of having Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: fish and chips on Friday and a roast dinner on a Sunday which were reported to be greatly enjoyed by residents. The breakfast and midday meals were observed during the inspection and residents were relaxed and comfortable in their surroundings at the mealtimes. Staff were at hand to support residents if they needed assistance and where individual preferences were expressed for example a resident choosing to eat on their own these preferences were accommodated by staff. Care Homes for Adults (18-65 years) Page 18 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents care plans were up to date and the provision of personal care and support were robustly documented. Residents physical, emotional and health care needs are monitored and met. Choice and dignity is promoted and the homes medication procedures ensure that medication is administered to all residents in a safe and appropriate way. Residents right to dignity and respect is consistently promoted. Evidence: The staff team consist of a multi racial mixed gender staff group. Gender specific care and support is provided and staff demonstrated awareness of residents preferences regarding receiving support and personal care. It was observed that staff supported residents in a sensitive way ensuring their privacy is respected when providing assistance with personal care and residents were observed to respond favourably and at ease with staff. Throughout the inspection it was observed that the general ethos of the home supports residents rights to dignity and respect which is consistently promoted. The care plans sampled documented clearly how the resident liked to receive care and support from staff and it was noted that staff were sensitive and aware with regard to residents needs for example offering reassurance and Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: encouragement and using objects of reference in order to promote the residents sense of ease and have control over their life and decrease any anxiety. The home have developed health action plans which have been well maintained and included records of attended health care appointments for example visits to the residents general practitioner, appointments with the dietitian, continence advisors, mobility specialists, speech and language therapists, occupational therapists, dentists, support when admitted to hospital, visits by care managers and other specialist health care personnel. The daily note books records completed by staff, over a twenty four hour period, were well written and contained good evidence of the care and emotional support provided by staff, detailed in the residents care plans. Records of the monitoring of any health related concerns were well recorded and through sampling care plans and observation it was evident that the home maintains good working partnerships with health care professionals in order to promote the health and well being of the residents. Written comments received by the commission from healthcare professionals stated they provide good care for my patients, they respond appropriately to enquiries, I do not have any concerns about my clients at Rosemere. They offer and provide personalised diets. The home carers have shown evidence that they adopt a holistic approach to the way they care for the clients and offer both physical and social support. The medication cupboard continues to be located in a safe and secure area within the home. The medication procedures regarding the safe handling, administration and disposal of medicines have been maintained. The homes medication policy and procedure, medication administration charts were well recorded and evidence was available within the residents care plans of the way they preferred to take their medicines. The residents photo and any known allergies were available within the records sampled. No controlled medicines are currently prescribed or stored within the home. Up to date and well documented guidelines were sampled regarding the use of medication to be given when necessary if a resident should be distressed. Additionally written homely remedies authorisation from the residents general practitioner were up to date if the resident needed to have this type of medication. The inspector observed two staff members administering medicines. The procedures were unrushed and methodical to ensure the safety of the residents receiving their prescribed medicines. Staff confirmed that residents have the right to refuse to take their medicines and policies and procedures are documented for reporting of the Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: event. Care Homes for Adults (18-65 years) Page 21 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes complaints procedure is an accurate document for residents or people associated with the home to express any concerns or complaints. Procedures are in place to protect residents from abuse and harm staff receive safeguarding vulnerable adults training to ensure that residents are safeguarded from abuse or harm. Evidence: The home has a clear complaints policy and procedure, which is also available in pictorial form and available within the home for residents or any person associated with the home to see in order that their views, opinions and complaints are recognised and acted upon. It was evident during the inspection that the best interests of residents are strongly promoted by the staff in order that ensure that residents have a voice and that their views and opinions are considered. The registered manager confirmed that no complaints have been received by the home and no complainant has contacted the commission with information concerning a complaint made to the service since the last inspection. The registered manager and senior staff member demonstrated that they were aware of the local authorities multi agency procedures for safeguarding vulnerable adults and confirmed that no referrals had been made to the local authority safeguarding team. The home has a whistle blowing policy and procedure, which is available to staff to inform them of their duty of care to report any suspected harm or abuse in order to Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: safeguard residents in their care. The home have the current local authority multi agency safeguarding procedures within the home. Records confirmed that care staff receive safeguarding vulnerable adults training and where staff need to attend training there was documented evidence to support that the training had been booked for staff to attend in order to ensure that residents are protected from harm and abuse. There was evidence to support that the homes manager was promoting staff awareness regarding the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards in order to ensure that all staff were aware of the promotion of residents rights. Care Homes for Adults (18-65 years) Page 23 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical layout and indoor and outdoor communal areas of the home enable residents to live in a safe and well maintained environment and all areas of the home are clean and safe. Evidence: During the tour of the premises the inspector observed that the home had a homely atmosphere and all residents bedrooms had been decorated to reflect the persons personality and ethnicity and contained a variety of personalised details and leisure items. Specialist equipment, where necessary was available including a profiling bed to support the resident in a safe way with regard to their mobility needs. Communal areas were observed to be spacious and clean and residents were observed to be comfortable and relaxed in their surroundings and the home was well maintained and clean and orderly throughout and no malodour was detected. Improvements to residents rooms have been made which have included the replacement of carpets and flooring in several rooms, and the purchase of framed pictures, new bed linen, and a residents wardrobe. There are plans for a new kitchen to be fitted which will also include a larger cooker and oven. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: It was observed that the home has met the previous requirement regarding the refurbishment of the bathroom and have installed a specialist bath and a walk in shower within the bathroom. It was noted and discussed with staff that the home has only one bathroom and during the inspection it was observed that two residents were waiting to use the bathroom in order to have a bath. Staff advised that they generally manage well to provide a bath, on a daily basis, to each resident as they like to have a bath each day and that the bath is available for use throughout the day. The laundry area was sampled and observed to be orderly. The staff confirmed that the washing machine does not have a sluice facility and any soiled linen would be soaked prior to being put into the washing machine. The home have provided suitable equipment including hand washing facilities throughout the home. It was observed that the disposal of general and clinical waste was well managed and the control the spread of infection in the home was well managed. The enclosed garden was well maintained and secure and was observed to be accessible for residents to use if they choose. Care Homes for Adults (18-65 years) Page 25 of 33 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 staff provide twenty four hour support to the residents living at the home. The homes recruitment practises, induction and mandatory training of staff is consistent to ensure that residents needs are appropriately and safely met and staff have equal opportunities with regard to their own professional development. Evidence: The homes staff are currently supporting 6 people and have a stable staff team comprising of 9 staff. The registered manager confirmed that the deployment of staff had been reviewed which had been of benefit to the residents as staff were available at specific times of the day in order to support residents either in or outside of the home with meaningful activities. It was observed that the level of staffing was appropriate on the day of the inspection to meet the needs of the residents. As previously documented the homes staff were observed as skilled in supporting residents in their care and were knowledgeable regarding the specific needs of residents to ensure their safety, well being and offer reassurance. The home has a recruitment and selection policy, which incorporates equal opportunities. The inspector sampled two care staff files which were well recorded and contained application forms, with two references, evidence that face to face interviews Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: had taken place and the job description in order that the staff member was clear about their roles and responsibilities. There was documented evidence that a CRB clearance had been obtained. The care staff mandatory and induction training records were well presented and evidenced that staff had received updated training and some staff had also undertaken specialised training, for example in dementia, in order to support the needs of the residents in their care. The registered manager confirmed that discussions had been undertaken with Welmede regarding the training of all staff to support residents with dementia and this improvement will be monitored by the commission. The AQAA identifies that 85 per cent of staff have achieved their National Vocational Qualification in Care Level two or above. Care Homes for Adults (18-65 years) Page 27 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is consistent and robust. The home continues to be run in the best interests of the residents and their views and opinions and those of others associated with the home are sought. Residents welfare is promoted through the robust monitoring of health and safety in the home. Evidence: As documented within the report it was evident through observation that the pace of the home continues to be designed to meet the needs of the residents and the care staff present during the site visit demonstrated a good knowledge about residents to ensure their safety and well being. The registered manager has been in post for several years and has a nursing qualification, has completed his NVQ in management and holds a National Vocational Assessors and mentor ship qualification. Staff confirmed that the manager continues to conduct the home in the best interests of the residents and the management style is open and inclusive. Written comments from staff about the home included they keep me updated on staff and client issues, send me on all mandatory training. We Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: work well together as a team to meet the clients needs as best we can . I am very happy with my role at Rosemere. We work really well as a team we support the individual needs of the service users in a person centred approach and promote their independence, we treat the service users with respect and courtesy and maintain up to date care plans and other relevant paperwork. During the inspection it was observed that the registered manager undertook his duties in a professional and calm manner and was very knowledgeable about the running of the home to benefit the residents and the staff. Welmede have introduced a new filing system within the service and it was observed that the management of files and related documents was orderly. Some accident and incident records were sampled within residents files and the commission have confirmed following the inspection that the home continues to give notice to the commission without delay regarding any event, which affects the safety and welfare of the residents. Hand washing facilities remain available throughout the home. Records indicated that servicing of fire equipment had taken place and health and safety checks had been undertaken and recorded. A current insurance indemnity and certificate of registration of the home was displayed. A gas safety certificate was sampled yet the registered manager could not locate the current electrical certificate, despite efforts to obtain the certificate, and has advised that this will be further pursued and the commission informed when the certificate has been located. Confirmation was seen that the home continues to seek residents and their representatives views and opinions about the service through the Quality Assurance procedures and also the regular meetings held with residents about the running of their home and issues affecting their daily lives. The home have introduced a suggestion box where any people associated with the home can make comments and suggestions about the home and any improvements they would like to suggest. Regulation 26 records of an unannounced visits by the organisations area manager or other registered managers noted that the record was thorough in assessing the quality of the service and any issues identified would be noted by the owners in order that appropriate action would be taken to rectify the shortfalls. All substances which are hazardous were stored in compliance with the control of substances hazardous to health COSHH legislation in order to ensure the safety and welfare of residents. Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: Care Homes for Adults (18-65 years) Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 27 It has been recommended that due to the future changing needs of the residents group that additional bathing facilities and sluice facilities be considered by Welmede in order to ensure that residents needs can continue to be met, their choices promoted and infection control maintained. Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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