Care Home: Rosewood

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Rosewood Church Lane Grangetown Middlesbrough TS6 6TP two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Bassett Date: 2 1 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. 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 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20092008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Information about the care home Name of care home: Address: Rosewood Church Lane Grangetown Middlesbrough TS6 6TP 01642463306 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Bridgings Limited care home 8 Number of places (if applicable): Under 65 Over 65 8 8 0 0 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 8 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: Learning disability - Code LD, maximum number of places: 8 Physical disability - Code PD, maximum number of places: 8 Date of last inspection A bit about the care home Rosewood, Bridgings Limited, is a care home for 8 service users with a learning disability, some of who have associated physical disabilities. The home is a detached bungalow, set in its own grounds and is on one level, which is suited to the needs of highly physically dependent people. Each service user has their own room, which is personalised according to taste and preference and which is equipped to meet the needs of each individual. There is land surrounding the property, which can be used for outdoor activity when weather permits. The home has its own transport which has been adapted for the use of service users with a physical disability. The home currently charges fees from #462.96 to #1054.70 per week. 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 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was a key inspection. As a key inspection, all of the key standards were looked at or discussed. This was to check that the home meets the standards that the Care Quality Commission ( CQC) say are the most important for the people who use services, and that it does what the Care Standards regulations say it must. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. During the inspection the inspector carried out an unannounced visit to the home. The inspection visit lasted four hours. During this time the inspector looked at a range of documentation including, service user and staff files. The inspector spoke to one service users, two staff members and the manager. Three service user and seven staff surveys were returned to CQC. The manager of the home completed an Annual Quality Assurance Assessment (AQAA). At the time of the inspection the home was providing services to 8 service users. What the care home does well The facilities, equipment, furniture and staffing levels at Rosewood, were of a good standard and provided the residents with good facilities and levels of staff support. Due to the nature of the service users disabilities, communication between service users and the Inspector was not always possible, however all appeared settled and comfortable. The inspector observed good interaction between service users and staff. Staff were seen to meet peoples needs in a relaxed, friendly and respectful manner. One service user told the inspector he was happy at the home and liked living there. Responses in surveys returned to CQC indicated people were satisfied with the care they receive at the home. What has got better from the last inspection What the care home could do better 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 Jane Bassett Care Quality Commission St Nicholas Building St Nicholas Street Newcastle upon Tyne NE1 1BR 01912333300 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 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 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. The home has procedures that should ensure that prospective service users have their needs assessed. Evidence: During discussion with the manager she was able to describe the process that is followed to obtain information about a prospective service users needs including an assessment by staff from the home, visits to the care home by the prospective service user and an assessment from the care manager if that person is funded by a local authority. The manager stated the information would be used to ensure the home could meet that persons needs and preferences. The inspector examined the file of one person recently admitted this was found to contain information from other professionals involved in the persons care. A member of staff at the home is developing a DVD welcome pack to assist prospective service users. 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. Individuals are involved where able in decisions about their lives and play a role in planning the care and support they receive. Evidence: During the visit the inspector examined the files for three service users. Each was found to contain plans of care in relation to that persons activities of daily living. Plans were seen to contain information relating to that persons abilities, preferences likes and dislikes. Files seen also contained assessments for risks identified in the care plans. The manager told the inspector that plans of care are discussed with the service users and/or their family where appropriate. One file seen contained signatures of the service users representative. Both plans of care and risk assessments were seen to be reviewed on a regular basis, however reviews were limited and contained little or no evidence of evaluation. The inspector observed a good rapport between service users and staff. Staff who spent time with the inspector had a good knowledge of service users needs, likes and dislikes. Seven staff returned surveys to CQC, two people commented on the need to develope individuality for service users. One service user who spent time with the inspector confirmed people were able to make choices about their lifestyle. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported to make choices about their lifestyles. Social, educational and recreational activities meet individuals expectations. Evidence: Plans of care seen by the inspector included a brief life history and reflected that persons abilities, preferences, likes and dislikes. Staff who spoke to the inspector had a good knowledge of individuals needs and how these are met. Daily records for all service users included details of activities that had taken place. The home has a weekly activities plan that reflects services users preferences. A number of service users attend day placements which enables them to maintain contact and engage in activities with their peer groups outside the home. Staff spoke of outings, visits to resturants, public houses, parties, shopping, bingo, aromatherapy,and music. Residents are currently planning holidays for later in the year. The inspector was told there is an open door policy and families can visit when they wish. Service users are encouraged and enabled to visit families in their own homes. Service users are involved in decisions within the home e.g. choice of menus and choice of activity. One service user who spent time with the inspector confirmed this, he said he was happy at the home and liked living there. Information in surveys returned to CQC indicated people were happy with their lifestyles within the home. The inspector observed a good interation between service users and staff. 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. The health and personal care that people receive is based on their individual needs. The principles of respect dignity and privacy are put into practice. Evidence: During the visit the inspector examined the files of three service users. Each was seen to contain evidence of involvement of health care professional such as GPs, district nurses, speech and language therapists. Two of the three files contained a regime of passive movements and exercise devised by a physiotherapist in 2005. There was no evidence that these had been reviewed since. Daily records for each service user included detail of the care given. The service user who spoke to the inspector and responses in surveys returned to CQC indicated people were happy with the care and support they receive. Staff members were seen to communicate effectively with service users. Staff were seen to meet peoples needs in a relaxed, friendly and respectful manner. Staff who spoke to the inspector were able to demonstrate a good knowledge of individuals needs and how these are met. Staff spoke of promoting individuals privacy, dignity and independence. Information contained in the AQAA returned to CQC indicated the home has policies and procedures in relation to the safe handling of medication. The inspector was told staff involved in the administration of medication had undergone an appropriate training. A sample audit of medication systems found no major concerns with ordering, storage and recording. Information is kept in relation to each medication administered. The manager carries out a monthly audit of medication. A sample audit of Medication Administration Records (MAR) examined were seen to be completed with no gaps in entries. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to a complaints procedure, are protected from abuse and have their rights protected. Evidence: Information in the AQAA returned to CSCI indicated the home has policies and procedures in relation to handling complaints and safeguarding people from abuse. These were seen to be available. The manager told the home a pictorial, user friendly version of the complaints procedure is to be developed. Responses in surveys returned to CQC indicated people were aware of how to raise any concerns. Further information in the AQAA indicated the home received no complaints in the previous twelve months. Staff confirmed they had received training on how to deal with the Protection of Vulnerable Adults. Staff who spoke to the inspector were able to demonstrate through response to questions the action they would take if they became aware of a concern. All demonstrated a commitment to protecting service users from abuse. 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 design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: During the visit the inspector walked around the building. It was seen that the home provides a clean, odour free & homely environment. The home offers a range of communal areas for people to use. These include lounges and dining room. A number of areas have recently been redecorated including the main corridor, lounge and a bathroom. Service users bedrooms were seen to be recently decorated and personalised to the individuals taste. Garden areas are well maintained and accessible. Information contained in the AQAA returned to CQC indicated the home and equipment are maintained as required. 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. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. The home has a recruitment procedure that promotes the safety and wellbeing of service users Evidence: The Registered Manager had the required qualifications and experience to run the home. A service user and staff who spoke to the inspector, and the majority of people who returned surveys indicated there were sufficient staff on duty to meet current care and social needs. Comments in two surveys returned by staff members indicated that at times the service users would benefit from additional staff. Information in the AQAA indicated the home has a policy and procedure in relation to recruitment, and all appropriate checks are carried out. The inspector examined the file for a staff member most recently recruited. This was found to contain evidence of application, two written references and CRB (Criminal Record Bureau) check. Staff training records seen by the inspector contained evidence that staff have received training including moving & handling, first aid, protection of vulnerable adults, fire safety, and food hygiene. A number of staff have also completed training in safe handling of medication, challenging behavior, diabetes, peg feeding and epilepsy. A number of staff are currently undertaking training in nutrition, and further training in relation to medication is planned. Staff who spoke to the inspector confirmed this. Information given to the inspector indicated 8 staff had successfully completed NVQ at level 2 or above and the remaining staff member is undertaking the training. Staff with NVQ level 2 are undertaking level 3 training, one staff member is completing level 4. Records seen by the inspector indicated staff receive regular formal supervision. Staff who spoke to the inspector confirmed this, and spoke of the support they receive from Evidence: the manager. 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 management and administration of the home is based on openness and respect, has quality assurance systems that should promote the safety and well being of service users Evidence: People who spoke to the inspector and those who returned surveys indicated communication is good. There is an open door policy and regular meetings are held for both service users and staff. Staff who spoke to the inspector told her the team work well together and supported each other. The inspector saw evidence of monthly Regulation 26 visits and reports. Responses in surveys returned to CQC indicated people were satisfied with the care and support they receive at the home. Accidents were seen to be recorded appropriately, fire alarms are checked weekly. Records of service users personal monies held by the home included details of all transactions and receipts. A sample audit of service users monies held by the home found no discrepancies between the amount held and the amount recorded. Information contained in the AQAA returned to CQC indicated the home has a range of policies and procedures that should promote the safety and well being of service users, and these were reviewed in September 2008. 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 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 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 Records of reviews of both care planning and risks assessments should be developed further and include details of evaluation. The passive movement and exercise regimes should be reviewed and evaluated by a physiotherapist on a regular basis. 2 19 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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