Care Home: Roslin

What the care home does well The home continues to provide personalised care and support and works closely with other professionals to make sure people`s health needs are met. People are encouraged to take part in a range of social activities and maintain contact with the community. There are clear systems for making complaints and safeguarding vulnerable people from harm. Health and safety is promoted through staff training and safe working practices to ensure people`s welfare. What has improved since the last inspection? The standard of recording about people`s support and health needs has improved and is more person centred. Information to help people make choices and decisions and manage risks has been enhanced with communication aids. The home has had lots of redecoration and upgrade to the facilities to make it attractive and comfortable. There is now a full staff team who were properly recruited and are provided with plenty of training to meet people`s needs. The provider is making sure that the home is visited every month and a report is written on the conduct of the service. What the care home could do better: Individual support plans should continue to be developed and these plans are to be evaluated in greater detail. Staff need to make sure they always complete the medication records properly. Medication storage is still to be relocated and hand washing facilities provided for staff dealing with medication. Key inspection report Care homes for adults (18-65 years) Name: Address: Roslin 1 The Chesters Low Fell Gateshead Tyne & Wear NE9 5PB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Elaine Malloy     Date: 0 4 0 3 2 0 1 0 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 25 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Roslin 1 The Chesters Low Fell Gateshead Tyne & Wear NE9 5PB 01914873191 01914873191 ntawnt.roslin@nhs.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Northumberland, Tyne & Wear NHS Trust Name of registered manager (if applicable) Peter Richardson Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia physical disability Additional conditions: The maximum number of service users who can be accommodated is 5 The registered peson may provide the following categories of service only: 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 5 Mental Disorder, excluding learning disability or dementia - Code MD, maximum number of places 2 Physical Disability - Code PD, maximum number of places 1 Date of last inspection 2 8 0 7 2 0 0 9 5 2 1 Over 65 0 0 0 Care Homes for Adults (18-65 years) Page 4 of 25 Brief description of the care home Roslin is a detached house in a quiet area of Low Fell in Gateshead. It is close to local amenities including a shopping area, GP surgeries and local public transport. The local college is within walking distance of the home. Roslin provides personal care for five people with a learning disability. Nursing care is not provided. There are four bedrooms on the first floor and one on the ground floor that is suitable for people with physical disabilities. The home comprises a large entrance hall, a sitting room, conservatory and a combined kitchen/breakfast room. Assisted bathing facilities are also provided. There are gardens to all sides of the house. Roslin has its own transport. Details of fees and copies of inspection reports are available by contacting the home. Care Homes for Adults (18-65 years) Page 5 of 25 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 health care 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 2 star. This means that people who use this service experience good quality outcomes. The inspection was carried out by: Looking at information received since the last key inspection on 6 April 2009. Getting the providers view of the service and how well they care for people. An inspector visiting the home on 4 March 2010. Talking to the management about the service. Looking at records about the people who live at the home and how well their needs are Care Homes for Adults (18-65 years) Page 6 of 25 met. Looking at a range of other records that must be kept. Checking that staff have the knowledge, skills and training to meet the needs of the people they care for and support. Looking at the resources that the home has to operate the service. Getting the views of people living at the home and staff by talking to them. No completed surveys were returned to the Commission. Checking if improvements required at the last inspection had been made. The inspection was carried out over five hours. A random inspection was previously carried out on 28 July 2009 to check how the home had complied with the requirements of a warning letter the Commission sent to the provider concerning improvements needed to the environment and staff training. 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. Care Homes for Adults (18-65 years) Page 7 of 25 What the care home does well: What has improved since the last inspection? 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 8 of 25 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care 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 9 of 25 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 demonstrates good capacity in providing support to meet peoples assessed needs. Evidence: There have been no new people admitted to the home in the period since the last inspection. Records showed that people have their care and support needs regularly assessed and reviewed. The manager reported that people living at the home have continued to be consulted about proposed changes to the care provision. They have been involved in meetings and supported by relatives, advocates and care managers. He said there has been a recent decision that Gateshead Council will take over as the care provider in the future and the service will continue to operate as a care home with the same staff team. One person living at the home is having their needs reassessed with a view to moving onto a supported living arrangement. Care Homes for Adults (18-65 years) Page 10 of 25 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. Person centred planning is to an improved standard and people are well supported to make decisions and take responsible risks. Evidence: Each person living at the home now has a central person centred support plan, individual support plans covering a wide range of needs and corresponding assessments. The central support plans and assessments were well recorded and showed clearly what the person can do independently, the support they need and how they want this to be provided. The individual support plans lacked specific detail and were not being properly evaluated, though separate monthly summary records provided a better overview of the persons progress. People also have a communication dictionary that shows their individual methods and goals to develop communication and details of how to recognise and understand individuals non-verbal communication. Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: People living at the home have been involved in choosing their new key worker. The manager said this has worked out well in terms of compatibility, shared interests and staff skills. Meetings with keyworkers have started to take place and these have lead to new ideas and activities. Staff have received training on equality and diversity and the Mental Capacity Act to help them have greater understanding of peoples diverse needs and rights and how legislation affects their practice. A meeting has been held for the person who is looking towards moving out of the home, to ensure the decision is in their best interests. External advocates provide support with decision making to three people living at the home. One person takes part in a weekly advocacy group. Assessments are recorded to identify and manage risks according to individual vulnerabilities. Communication aids such as checklists and charts are used where necessary to help people keep to routines that minimise risks. This was verified by one gentleman who showed the inspector the aids, laminated sheets with pictures and numbers, that he uses. Care Homes for Adults (18-65 years) Page 12 of 25 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 receive flexible support that gives them good opportunities to meet their social and dietary needs and live their preferred lifestyles. Evidence: Each person uses external day services during the week where they take part in a variety of activities. People have support plans addressing their social needs and weekly plans with details of regular activities. Flexible staff support is provided to accompany people to activities on a one to one and small group basis in the evenings and at weekends. The home has a house car for transport and half of the staff team are drivers. People also use public transport and make good use of amenities in the local and wider community. The manager said one person has had restricted activities due to a health related difficulty but this has now been resolved following input from health professionals and Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: an aid to use when going out and on holiday. Visitors are welcomed and people are supported to maintain links with family through telephone contact and visits to relatives homes. Staff provide support with reading and managing personal mail. Routines are flexible and staff are guided to provide support with the person as opposed to doing things for them. The inspector observed staff giving good encouragement and praise to one person with their appearance and household tasks. People are encouraged to retain independent skills and help out in the home. This includes keeping bedrooms tidy, going food shopping, help with food and drink preparation, making packed lunches, laundry and ironing. An assessment by an occupational therapist was being arranged for one person to look at obtaining suitable kitchen equipment to aid independence. People have unrestricted access within the home, all have keys to their bedrooms and some people choose to have a key to the front door. Personal care and any treatment are provided in the privacy of the persons bedroom. There is a four week cycle of menus in place. The manager was looking towards having the menus reviewed by a dietitian. People living at the home choose, and help themselves where possible to breakfast, lunch, supper, snacks and drinks. The main meal is served in the evening and people can have various alternatives if they do not want what is on the menu. A healthy diet is promoted with plenty of vegetables and fruit. A book of menu symbols has been introduced with photographs and pictures of foods and meals to help peoples understanding and choices. Weights are monitored and healthy eating is built into support plans. No one currently requires a special diet, though food is adapted for person who does not have teeth and another person has a lipped plate to keep food secure. Care Homes for Adults (18-65 years) Page 14 of 25 Personal and health care 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. People are provided with well planned support that is responsive to their health care needs. Evidence: People living at the home are supported to access a range of physical and mental health care services and have regular health checks. There is choice of General Practitioner, regular visits from District Nurses and links with a Community Nurse who works with people with learning disabilities. Records showed that referrals are made for specialist health care support for individuals such as speech and language therapy, occupational therapy and psychiatric services. Health action plans are now in place and these were well recorded with a good level of detail. Staff also maintain good records on health care and input from professionals. Each person has a form completed in the event of being admitted to hospital that provides details of contacts, medication, a brief medical history and a pen picture. No one currently self administers their prescribed medication. The home uses a monitored dosage medication system and the supplying chemist provides pre-printed Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: administration records. Administration records were examined and whilst these were generally satisfactory it was noted that there were a few gaps where staff had not signed to verify medication given or entered a code to confirm the reason why not given. A signature checklist is kept of staff who take responsibility for administering medication and there were recorded details of each persons medications, the reasons why these are prescribed and side effects. All staff undertake medication training and have their competency individually assessed. Protocols are in place to guide staff on administering medication when people have epileptic seizures. The relocation of medication storage and provision of hand washing facilities for staff administering medication were still to be done. Care Homes for Adults (18-65 years) Page 16 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are appropriate systems to protect people from harm and address any complaints about the service. Evidence: The home makes the complaints procedure available including an easy read version. The procedure is also being put into audio format to make it easier for people to understand. No complaints have been received about the service in the period since the last inspection. The manager is aware of his responsibilities to respond to complaints and any allegations of people being harmed. Policies and procedures are in place on safeguarding vulnerable adults from abuse and whistle blowing (informing on bad practice). An incident between two people living at the home had recently been reported to the local authority safeguarding team and the manager was awaiting further contact as to how this would be managed. Staff receive safeguarding training during induction and refresher training courses are also provided. There are guidelines on behaviour to minimise the risks of people living at the home harming themselves and others. Care Homes for Adults (18-65 years) Page 17 of 25 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. People living in the home benefit from a greatly improved environment that is comfortable and well maintained to meet their needs. Evidence: The home has had extensive redecoration and refurbishment over the past year. This has included upgrading bedrooms and communal areas, installing a new kitchen and bathroom and fitting radiator guards. Access to the home has been improved with external ramps. The home was fresh and clean. There are procedures for staff to follow to guide them on infection control and training is provided. Disposable gloves, aprons and anti bacterial hand gel are available for staff use. A sluice sink is fitted in an off shoot part of the kitchen however the manager confirmed that this is not used and laundry is not transported through the kitchen. The washing machine has a sluicing cycle and any soiled items are bagged before being taken to the laundry. Care Homes for Adults (18-65 years) Page 18 of 25 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. People are supported by trained staff in sufficient numbers to meet their diverse needs. Evidence: New staff have been appointed and there is now a stable staff team consisting of the manager, assistant, and five support workers. Additional staff hours were currently provided for the supervision of one person living at the home. Male and female staff are employed and staff have a multi-purpose role of providing care and support, cleaning and cooking meals. Staff rotas are planned in advance and are now more clearly recorded. Staffing levels are flexible according to the needs and activities of people living at the home. The usual staffing levels are two workers across the waking day and one worker sleeping in at night. The manager is clarifying with the provider the extent of his hours that are supernumerary to the rota to carry out management duties. Two staff have achieved National Vocational Qualifications (NVQ) in care at level 3 and two staff have level 2. The manager said another worker has enrolled to undertake this training. Potential new staff members meet with people living at the home during the Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: recruitment process. Staff recruitment files are held centrally within the provider organisation. All staff are employed subject to Criminal Records Bureau (CRB) checks being carried out. Confirmation has been received that staff identities are verified and two written references are obtained. All new staff have completed induction training. A range of core training and training specific to the needs of people living at the home has been provided over the past year. Details are kept of each staff members training and further training needs had been assessed and relevant courses were being arranged. An overview training plan is being developed for the staff team. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in peoples best interests and promotes their safety and welfare. Evidence: Alan Foster has managed the home since January 2009 and has submitted an application to the Care Quality Commission to be approved as the Registered Manager. He has twelve years of care experience and for the last five years has worked at a senior/management level. He has achieved National Vocational Qualifications (NVQ) in care and management at level 4. An annual quality development plan was in place and this was due to be updated in April 2010 to set out how the quality of the service will be improved and maintained. The manager reported that peoples views are obtained informally and through individuals reviews and that good feedback is received about the service. People living at the home are now having one to one meetings with their key workers. Improvements required and recommended by the Commission have been monitored Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: and actioned. Visits and reports on the conduct of the home by senior management were now confirmed as being carried out monthly. The home has a health and safety policy and associated procedures. Staff are provided with health and safety training and training on safe working practices such as fire safety, moving and handling, first aid and food hygiene. Risk assessments for safe systems of work and the environment were in place and had all been recently reviewed. Fire safety tests, checks and instructions to staff were not all recorded as being done at the correct intervals, however these were confirmed following the inspection visit as having been brought up to date. A system is in place for accident and incident reporting and these were appropriately recorded. Emergency evacuation plans are now in place for each person living at the home. Care Homes for Adults (18-65 years) Page 22 of 25 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 23 of 25 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 6 Individual support plans and evaluations of plans should continue to be developed with more specific recorded detail. Staff should ensure that medication administration records are always signed to verify that medication has been given or use codes to confirm the reason(s)for nonadministration. The medication storage cupboard should be relocated. Staff should be provided with appropriate access to hand washing facilities when administering medication. Outstanding Recommendation. 2 20 3 20 Care Homes for Adults (18-65 years) Page 24 of 25 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 25 of 25 - 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!