Care Home: Rosewood Lodge & Brook House

Similar services:

• 2 Perhaver Park
• The Vicarage
• St George`s
• 5 Seafield Road
• Radfords
• Honeybourne House
• 32 Beaumont Way

What the care home does well The people who live in the home we spoke with or who wrote to us said they feel they are treated well by staff, who listen to them and act on what they say. They are able to choose which staff support them and enjoy a wide range of activities of their choosing; some access the community without staff support. People know who to speak to if they are unhappy and know how to complain should they wish to. The staff members we spoke with or who wrote to us said they are provided with up to date information about the care needs of the people who live in the home. They are listened to, provided with appropriate training and are well supported in their roles. The health professionals spoken with or those who wrote to us said the home seeks their advice and acts upon this to manage and improve individuals’ health care and respects each person’s privacy and dignity. Each person has their own bedroom, which they are encouraged to personalise. They have a key to their rooms and lockable space for any items they wish to store securely. Thorough checks are carried out on new staff to ensure they are suitable to work in the home. The home is well run. Discussions with the people who live in home, staff members and with both Managers show that there is an open and inclusive management style. What has improved since the last inspection? Staffing levels are now being kept under review and the roles of staff are being changed. This will ensure staffing levels are sufficient to meet peoples’ needs. Staff training has been improved and the home is working closely with the local authority to ensure staff are offered appropriate ongoing training to enable them to meet the needs of the people who live in the home. The home’s electrical hardwiring has been re-inspected and a new safety certificate issued. This promotes the welfare and safety of individuals who live in the home and the staff team. The care planning approach is being improved. This helps each person to have more control over their own lives and supports them to make their own decisions. Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 The environment is being greatly improved. The Registered Persons should ensure that the refurbishment of the home is completed as this will ensure a homely and comfortable environment is provided to each person who lives in the home. What the care home could do better: The Registered Persons must ensure that unannounced auditing visits are carried out every month. This will ensure that the care and support each person receives is regularly checked and areas of improvement are noted and acted upon. The Registered Persons should ensure the Statement of Purpose is updated so it accurately reflects the services provided by the home. This would help people decide if the home can meet their needs. The Registered Persons should consider introducing more frequent medication audits. This may improve the safety of this system and better promote the welfare and safety of the people who live in the home. The Registered Persons should ensure each member of staff is familiar with the revised ‘abuse’ policy and that they complete the safeguarding training module. This would better promote the welfare and safety of the people who live in the home. The Registered Persons should consider improving the way staff supervision is recorded. This would provide better evidence of the frequency of supervision and a clearer record of what issues have been discussed. Key inspection report CARE HOME ADULTS 18-65 Rosewood Lodge & Brook House 11-13 Friarn Street Bridgwater Somerset TA6 3LH Lead Inspector David Smith Unannounced Inspection 1st July 2009 09:30 Rosewood Lodge & Brook House DS0000069127.V376090.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. Rosewood Lodge & Brook House DS0000069127.V376090.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 Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosewood Lodge & Brook House Address 11-13 Friarn Street Bridgwater Somerset TA6 3LH 01278 457676 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) rosewood@fsmail.net Rosewood & Brook House Ltd Mrs Tina Amanda Waterman Deborah Jane Smith Care Home 20 Category(ies) of Learning disability (20), Mental disorder, registration, with number excluding learning disability or dementia (20), of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (20) Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 20 persons in categories MD, MD(E) and LD including a maximum of two persons with a concurrent physical disability. 19th July 2007 Date of last inspection Brief Description of the Service: Rosewood and Brook House provides personal care for up to 20 people who have a mental disorder or a learning disability. The home is not registered to provide nursing care. Rosewood Lodge and Brook House consist of two mid-terraced Victorian houses next door to each other, located in a quiet street in the centre of Bridgwater. Both have large gardens which are well maintained. There are parking spaces at the rear of the home. The home is within easy walking distance of the town’s shops, educational and recreational facilities, and the train and bus stations. Accommodation in both houses is arranged over four floors; stairs provide access to the upper and lower floors. The home does not have any specialised equipment to help people with severe mobility problems, although there are two bedrooms on the ground floor available to people who may find stairs difficult to manage. The registered provider is Rosewood & Brook House Ltd. The responsible individual is Mr Biswanand Oozageer. The registered managers are Mrs Tina Waterman and Mrs Deborah Smith. The current weekly fee range is between £343.00 and £1400.00, although fees are currently being reviewed with the relevant Funding Authorities. Extra charges are met by each person for personal items, toiletries, chiropody. Further details regarding fees and extra charges should be obtained from the home. Rosewood Lodge & Brook House DS0000069127.V376090.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 star. This means the people who use this service experience good quality outcomes. This was an unannounced visit to the home to allow us to carry out a Key Inspection. We spent approximately 9 hours in the home on the day of our visit. The inspection was carried out by one inspector, but the term we is used in this report. This is because the report, and the judgements within it, are on behalf of the Care Quality Commission (CQC). The pre-inspection planning involved reviewing the report of the last Key Inspection carried out in July 2007, the report of the Random Inspection in February 2008, the Annual Service Review completed in July 2008, the reports of significant events which have happened in the home and the service history, which details all other contact with, or relating to, this service. We sent surveys to people who live in the home, staff members and health professionals prior to the last Annual Service Review; nine were returned. We sent surveys to these groups again prior to this inspection visit and six have been returned. The views of each person who wrote to us have been included within this report. During our visit we spoke with six people who live in the home and time was spent informally observing interaction and communication between staff members and a number of people who live here. The inspection was fully supported by both Registered Managers, Mrs Deborah Smith and Mrs Tina Waterman (who very kindly came in on her day off). We also spoke with one Care Co-ordinator from the Local Authority who visited and six staff members who were working in the home on the day of our visit. We gathered additional information for this report by looking at a number of records within the home including: care plans, daily records, risk assessments, medication administration, staffing records, menus and some health and safety procedures. We also viewed all communal areas of the home and a number of bedrooms used by the people who live here. It should be noted that this inspection visit took place during a time of significant change for the home in respect care planning and care approaches. Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Staffing levels are now being kept under review and the roles of staff are being changed. This will ensure staffing levels are sufficient to meet peoples’ needs. Staff training has been improved and the home is working closely with the local authority to ensure staff are offered appropriate ongoing training to enable them to meet the needs of the people who live in the home. The home’s electrical hardwiring has been re-inspected and a new safety certificate issued. This promotes the welfare and safety of individuals who live in the home and the staff team. The care planning approach is being improved. This helps each person to have more control over their own lives and supports them to make their own decisions. Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 7 The environment is being greatly improved. The Registered Persons should ensure that the refurbishment of the home is completed as this will ensure a homely and comfortable environment is provided to each person who lives in the home. 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. Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 8 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 Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 9 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. Individuals are given the information they need about the home to enable them to make an informed choice about where to live. People are confident the home can support them as their needs are thoroughly assessed before they are given the opportunity to move in. They know about their rights and responsibilities because there is an easy to understand statement of terms and conditions between the person and the home. EVIDENCE: The home has both a Statement of Purpose and Service Users Guide. These provide clear information regarding the range of services and support the home is able to offer. We did note that the Statement of Purpose does require updating; the home have recently started supporting one person who has moved from the home Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 10 into a new home of their own in the community and this type of detail needs to be reflected. This was discussed with both Managers who agreed to update the Statement of Purpose as soon as they can. Each person who lives in the home we spoke with or who wrote to us said they were asked if they wished to move to the home and that they did receive enough information to decide if this was the right home for them to live in. We looked at the records for one person who has recently moved into the home. These contain lots of information about them, such as care plans or assessments from their Funding Authority, together with a number of other reports which describe their history and their support needs in detail. We also spoke with this person during our visit. They told us ‘It’s nice here. I wanted to move home and I wanted a big room to house all my things. I have a big room, I asked for one’. Each person who lives in the home is provided with their own guide to the service and a statement of ‘Terms and Conditions’ which describe the home’s aims, objectives, level of fees and who is responsible for payment, complaints procedure and each person’s rights and responsibilities whilst living in the home. We discussed the current Terms and Conditions with both Managers who agreed this may be a good time to review them to make sure they are in line with the new care planning approach. They may wish to add details of any expectations placed upon people who may wish to move into the home. Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 11 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, 8 and 9. 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. Individual’s needs and goals are met and each person has a plan that they, and people close to them, have been involved in making. Each person is supported to make decisions about their lives and to take risks to enable them to live as independently as possible. EVIDENCE: We looked at the care records for three of the people who live in the home. Each person has a detailed plan which describes the care and support they require and how staff should provide it; information is also included about their life history, who the important people in their life are, how they communicate and what daily routines they may have. Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 12 The care planning system and the approaches staff use in providing care and support in the home are currently being improved; each care plan is being rewritten using the new ‘recovery’ approach and this process is almost complete. The new care planning format is much clearer and still contains all the information staff need to know to enable them to support people in a safe and consistent way. Each person who wrote to us or those spoken with said they are fully involved in the care planning process, both at the initial assessment and during the regular reviews; they said their care plan is up-to-date and fully reflects their needs. They sign each section of their care plan to say that they agree with its content; this is good practice. The staff members we spoke with or who wrote to us said they are provided with up to date information about the care needs of the people who live in the home. Each person is provided with a Keyworker; this is a named member of staff who plays a key role in co-ordinating the care and support each person receives. They meet regularly with each person and go through the plan of care; any changes to the care needs or risk assessments are recorded and agreed. The people who live in the home we spoke with said they made decisions about their lives. Staff support them, and sometimes help by explaining options or possible consequences, but let them choose. Those who wrote to us said they make decisions about what they wish to do during the week and at weekends and staff listen to them and act on what they say. They are encouraged to become involved in all aspects of home life such as attending the regular house meetings, cooking, cleaning and deciding what courses or activities inside or outside of the home they would like to take part in. Interaction between staff and people who live in the home was observed informally during our visit. These show that staff have a good knowledge of each person’s support needs and how to communicate with them effectively. Both the people who live here and staff appear relaxed in each others company and at no time did staff appear rushed or unable to give people their attention. Care and support is provided within a risk assessment framework. Healthy risk taking continues to be encouraged and supported, as evidenced within the wide range of opportunities and activities people are able to enjoy. Each of the person centred risk assessments examined are detailed and have been regularly reviewed. Rosewood Lodge & Brook House DS0000069127.V376090.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. Each person is treated as an individual and has opportunities and appropriate support to develop and access leisure and educational facilities. Each persons rights are respected. Individuals are able to keep in touch with families and friends. People have healthy, well presented meals which they are involved in choosing. EVIDENCE: The home encourages and supports people to pursue their hobbies or leisure interests as well as offering support with daily living tasks. Some of the people Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 14 who currently live in the home are older people who said they prefer not to become involved with these tasks, such as washing, cleaning or cooking. Other people who live here are involved in them and some people wish to be able to move to less supported accommodation when they chose and feel ready to do so. The people we spoke with said they enjoy going out on shopping trips, cooking some of their own meals, going swimming and going to the theatre. One person said they enjoy helping at a local home for older people, where they assist with bingo. One person told us ‘I have lived in lots of different places; this is the best place I have lived in’. Other comments include ‘I have lived here for two years the staff are nice and they always help me’ and ‘it’s very nice here’. Each person has the opportunity to go out individually or with a small group. They make use of the many facilities available locally and also go out on longer trips to coastal resorts, such as Weston-Super-Mare and Burnham-on-Sea. Some people who live in the home are able to go out without staff support and, for some individuals, they are only able to do this due to the progress they have made since living at the home. Many individuals are funded for activities and previously allocated ‘access workers’. This has changed recently as all staff now support people both inside and out of the home. The issue of appropriate funding is currently being addressed by both Managers as they wish to ensure each person’s fee reflects the support they need to pursue their hobbies and interests, although this process will take some time to complete. Each person is supported to maintain links with their family and friends. Visitors to the home are welcome and people can meet with relatives in private if they wish. Each person we spoke with has a key to their bedroom and they know they can choose to lock their room if they wish to. Some people offered us or used their own key when we asked if they would be happy to show us their own room. The health professional we spoke with and those who wrote to us said the home supports people to live the life they choose, responds well to their different needs and respects each persons privacy and dignity. One professional said the home is good at ‘promoting independence’. They told us ‘the home is keen for residents to maximise their potential and looks for residents to move on to more independence’. Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 15 Individual’s rights and responsibilities are also confirmed in their terms and conditions; this includes guidance on violent behaviour, smoking, privacy, visiting and health and safety. The home continues to provide a variety of meals and snacks, which are healthy and nutritious. Each person is given a choice but the staff we spoke with said they sometimes help people choose. They are confident doing this as each persons likes and dislikes are recorded and they know each person well. We joined a small group of people at lunchtime in one of the dining rooms, which has been recently redecorated. The people we spoke with said they are always given a choice of meals; these are cooked freshly in the home. One individual said ‘the food here is the best I have ever had’ and another said ‘the food is excellent’. One person said they did not wish to cook their own lunch today as they had planned and decided to buy lunch while they were out; it is clear this was this person’s choice. Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 16 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 receive personal support in they way they prefer and their healthcare needs are well met. The home supports each person with their medicines in a safe way. EVIDENCE: Care plans provide clear guidance for staff on how they should support those living at the home with their personal and healthcare. Each person is registered with a local G.P., dentist and optician. Other specialist services are accessed when an identified need arises. Clear records are kept of each appointment with health professionals; these note the reason for the appointment and the outcome. Staff support some people to make and attend appointments; others attend their appointments independently. Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 17 The healthcare professionals who responded by survey said the home does meet each person’s health care needs, seeks their advice and acts upon this to manage and improve individual’s health care. The home uses a monitored dosage system of medication administration, which is well managed. Each person has their own medicine profile as part of their care records; these give staff clear instructions to follow, such as how and when people prefer to take their medicines and also explain what the medicines are for. Each individual has their medication reviewed regularly and we did note that some people have been able to change or reduce their medication since they moved into the home. One person is currently on a staged programme to enable them to take responsibility for their own medicines. Each week they will be given a greater supply to manage; should there be any problems or errors made, they have the option to go back to the previous week’s programme. This is clearly recorded in this individual’s care plan and has had each of the risks assessed. Staff assist other people with their medicines; each member of staff must complete training before they are able to do this. Medication audits are carried out, however the records we looked at show that these have become irregular this year. An audit was carried out in June 2009, which resulted in a large amount of medicines being returned to the pharmacy. This was discussed with both Managers who will try to ensure these are more regular. Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 18 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. If individuals who live in the home, or people close to them, have concerns about their care they know how to complain; their views would be listened to and acted on. People are safeguarded from abuse, neglect and self harm and the home would take action to follow up any allegations. EVIDENCE: The home has a formal Complaints Policy, a revised Abuse Policy and a Whistle Blowing Policy, which staff can use in confidence to raise any issue or concern they have regarding the service. Each person who lives here has the complaints procedure in their ‘terms and conditions’. There have been no complaints since our last visit and we have not had any complaints or concerns direct regarding the services provided by the home. The people who live in the home we spoke with and those who wrote to us said they know they are able to complain if they are unhappy about any aspect of the home. Most people said they would speak with staff; two people said they were not sure who they would speak with, but they would tell someone about any concerns they had. Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 19 Health professionals who wrote to us said they do know who to speak to if they have any concerns regarding the care and support provided at the home; they feel their views would be listened to and taken seriously. The staff we spoke with and those who wrote to us are clear about the important role they have to ensure people are happy with their service and remain safe; they know what to do if an individual, family member or a friend is concerned about any aspect of the care and support they provide. The home has clear guidelines and risk assessments in place for supporting individuals who are distressed or presenting behaviours which may be perceived as challenging the service provided, such as being verbally or physically aggressive or self-harming. One health professional said the home works well with individuals who may display these types of behaviours. ‘Other homes people have lived in have not met their needs or managed their behaviours this well’. The home’s ‘terms and conditions’ state that ‘violent behaviour is not acceptable within the home. Any serious incidents will be reported to the Police’. We note that the Police have been notified of such incidents and these have been dealt with appropriately. Staff are provided with training in relation to Safeguarding Vulnerable Adults (although some staff still need to complete this training module) and are subject to enhanced Criminal Record Bureau disclosures (CRB’s), before they start work in the home. The home maintains thorough records of each accident, incident or other significant event which occurs in the home. We are always notified of significant events together with any other concerns regarding individuals who live in the home. Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 20 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, 25, 27, 28 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. Rosewood Lodge and Brook House generally provide a homely and comfortable environment for people to live in. EVIDENCE: Rosewood Lodge and Brook House consist of two mid-terraced Victorian houses next door to each other, located in a quiet street in the centre of Bridgwater. Both have large gardens which are well maintained. There are parking spaces at the rear of the home. The home is within easy walking distance of the town’s shops, educational and recreational facilities, the train and bus stations. Accommodation in both houses is arranged over four floors; stairs provide access to the upper and lower floors. The home does not have any specialised Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 21 equipment to help people with severe mobility problems, although there are two bedrooms on the ground floor available to people who may find stairs difficult to manage. Each house has 10 single bedrooms; each has a lock and people are given a key to their room. Each bedroom has a wash hand basin, 10 have an en-suite shower and one has and en-suite shower and toilet. They are fitted with a lockable space to enable people to store private items or medicines securely. The communal areas consist of three lounges, one smoking lounge, two dining rooms, two laundry rooms and two kitchens. There are three rooms used as office space. There are a number of toilets and two bathrooms which people share. The home is currently being refurbished; they employ maintenance staff who complete this work. Many areas have already been tastefully redecorated, with new furniture and other decorative features added. One room, previously used as a smoking lounge, is now an attractive dining area. Some areas of the home still require redecoration and some furniture needs to be replaced. The Managers provided us with a copy of the home’s maintenance and refurbishment schedule which shows that out of the 36 jobs identified, 17 have already been completed. The outstanding work is scheduled for completion by December 2009 at the latest. The people who live in the home we spoke with and those who wrote to us said they liked the environment and it was kept ‘fresh and clean’. Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 22 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): 31, 32, 33, 34, 35 and 36. 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. Each persons needs are met and they are provided with safe and appropriate support by a competent and trained staff team. Thorough checks are carried out on new staff to ensure they are suitable to work in the home. EVIDENCE: Staff are provided with job descriptions which clearly identify their roles and responsibilities. Staff we spoke with and those who wrote to us said they are clear about their own and others’ responsibilities. The home has 2 Team Leaders, 5 Senior Care staff, 7 Care Assistants, 3 Bank Staff (who provide cover for sickness and holidays) and 2 Maintenance Officers. There are always at least 5 care staff in addition to the Managers during the day; 3 staff work at night. Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 23 The staff we spoke with said they are happy working in the home and told us they are always given up to date information about the people they support. They feel there is nice atmosphere in the home, they feel listened to and that their views are taken seriously and acted upon wherever possible. Comments from staff include: ‘we have good training, all the staff are pleasant and all of the residents are treated equally’, ‘there is really good communication between all staff and management and good training available’ and ‘I enjoy my work very much. It gives me great satisfaction.’ The health professional spoken with and those who wrote to us said the staff team do generally have the right skills and experience to support people’s social and health care needs. Some staff are a little uncomfortable with the new way of working, in line with the ‘recovery model’. They did say they are very committed to working in this way but sometimes feel they would like to help individuals more. One member of staff said ‘you have to stand back, but sometimes I just want to get in there and help them. I am doing it though and I suppose nobody really likes change’. Health professionals told us the staff team is working closely with them using the recovery model and recovery care planning. One professional said ‘I feel the home has taken on the ethos of ‘recovery’ with its residents and works closely with partnership staff in reviewing and improving residents’ care needs’. The home operates a robust recruitment process. The personnel records of staff who have recently joined the team contain copies of their application form, documents proving their identity and eligibility to work in the UK, two satisfactory references and Enhanced Criminal Record Bureau Disclosure. New staff complete a thorough induction training programme; all staff are then provided with mandatory courses such as first aid, food hygiene, how to move and handle people safely, health and safety and infection control. Staff are also given training in specific areas such as medication administration, how to manage difficult or aggressive behaviour and abuse (currently known as ‘safeguarding vulnerable adults’). Staff are provided with regular supervision; informal discussions which could be considered supervision also take place although these are not generally recorded. We looked at the formal supervision records; these contain very little detail of what was discussed, some only contain one sentence. We discussed supervision records with both Managers who agreed to look at better ways of recording supervision meetings and the more informal discussions. Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 24 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, 38, 39, 40, 41, 42 and 43. 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 is well run and each individual benefits from how it is managed. The views of the people who live in the home, or those close them, are sought to help the home review their practice. Each person is safeguarded as the home keeps clear records, staff understand the ways things should be done and health and safety practices are carried out. EVIDENCE: Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 25 Rosewood Lodge and Brook House has two experienced Registered Managers, Mrs Deborah Smith and Mrs Tina Waterman; both have worked at the home for a number of years. Discussions with the people who live in home, staff members and with both Managers show that there is an open and inclusive management style. People said they are happy to discuss any issues with either manager and they feel they are always listened to; people said communication is very good. The views of the people who live in the home are sought as much as possible. Regular house meetings are arranged, although it seems that attendance does vary. One person who lives in the home said ‘I do go to these meetings, they are very good’ and another person said ‘I will be going to the next one’. Regular quality assurance surveys are given to people involved with the home to complete; comments are looked at and an action plan is drawn up to address any areas which can be improved. The management systems and structures are efficient; the record keeping is of a good standard. Files and documentation remain well organised, easy to access and stored securely. Some of the record keeping has been improved since our last visit and some changes are still in the process of being completed, such as care plans. The home has a number of policies and procedures, which are designed to ensure that both the people who live in the home and the staff team are safe, the service complies with the law and remains aware of best practice or new ways of working. A monthly audit should be carried out by a Director each month to monitor the quality of care and support provided at the home. These audits have not been completed for several months due to the Director dealing with issues in another of the organisation’s homes. These audits must be re-instated. There are recording systems in place to support health and safety in the home, which are used consistently. The home’s electrical hardwiring has been reinspected and a new safety certificate issued. There is adequate insurance cover in place and there are a number of general Risk Assessments to promote the welfare and safety of people who live in or work at the home, which are clearly written and subject to regular review. Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 26 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 2 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X 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 3 3 3 3 3 2 Version 5.2 Page 27 Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Are there any outstanding requirements from the last inspection? NO 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 YA43 Regulation 26 Requirement The Registered Persons must ensure that unannounced auditing visits are carried out every month. This will ensure that the care and support each person receives is regularly checked and areas of improvement are noted and 01/09/09 acted upon. Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The Registered Persons should ensure the Statement of Purpose is updated so it accurately reflects the services provided by the home. This would help people decide if the home can meet their needs. The Registered Persons should consider introducing more frequent medication audits. This may improve the safety of this system and better promote the welfare and safety of the people who live in the home. DS0000069127.V376090.R01.S.doc Version 5.2 Page 28 2. YA20 Rosewood Lodge & Brook House 3. YA23 4. YA24 5. YA36 The Registered Persons should ensure each member of staff is familiar with the revised ‘abuse’ policy and that they complete the safeguarding training module. This would better promote the welfare and safety of the people who live in the home. The environment is being greatly improved. The Registered Persons should ensure that the refurbishment of the home is completed as this will ensure a homely and comfortable environment is provided to each person who lives in the home. The Registered Persons should consider improving the way staff supervision is recorded. This would provide better evidence of the frequency of supervision and a clearer record of what issues have been discussed. Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 29 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. Rosewood Lodge & Brook House DS0000069127.V376090.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!