Care Home: Rosswood Gardens (4-10)

Similar services:

• Ashlong House
• Norbury Crescent (30)
• Edenvale
• Wadham Avenue
• Chatsworth Care - Dawson House
• Cowden Road, 52 - 54
• Chatsworth Care - Tudor Lodge
• Foxley Lane (121a)

What the care home does well A number of residents told us that they liked living at the home; typical comments included "I like the staff they are nice to us" and "I like the home and the food". Staff told us "it`s a good place to work and we get support from the managers, training is getting better" and "I got a good induction when I started working at the home". Good information is available to people about the home. The needs of residents planning to use the service are fully assessed to make sure that they can be met. Support plans generally give good information about the support needs of the residents. Risk plans are completed to help people live as independently as they can. Residents are able to take part in activities and be part of the local community. Residents are able to keep in touch with family and friends and the home supports them to have appropriate personal and family relationships. Residents have healthy, well-presented meals and snacks, at a time and place to suit them. The health care needs of the residents are addressed and people have access to appropriate healthcare professionals. Medication is well managed by the service.The home has a clear complaints procedure that is accessible to the residents. Policies are in place for the protection of vulnerable adults and staff complete training in this important area. People live in a clean, comfortable and homely environment. Residents are encouraged to personalise their rooms. The home is well run. Good Health and Safety arrangements are in place. What has improved since the last inspection? The resident`s contracts have been made easier to understand however these could be developed further. All of the residents have had their placements reviewed however a copy of the reviews should be kept in the resident`s personal files. Residents risk assessments are now being kept under regular review. The home has fitted door guards to fire doors to reduce the risk of fire at the home. Chemicals hazardous to people`s health are now kept locked away at all times. What the care home could do better: No requirements were set as a result of this inspection however a number of recommendations for good working practices have been made. The home could be careful about displaying confidential information about residents in communal areas of the home. The resident`s computer could be repaired or replaced. Staff supervision sessions need to take place more often. Staff training needs should be assessed and staff should attend refresher training if needed. Staff files should be available in the home for inspection and include all of the information as required in Schedule 2 of the Care Home Regulations. Regulation 26 visits could include more information about how the visit was conducted. The homes fire risk assessment should be reviewed.The inspector would like to thank the resident`s, staff and the deputy manager for their comments and support during the inspection process. CARE HOME ADULTS 18-65 Rosswood Gardens (4-10) 4-10 Rosswood Gardens Wallington Surrey SM6 8QZ Lead Inspector James O`Hara Key Unannounced Inspection 7th July 2008 09:30 Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosswood Gardens (4-10) Address 4-10 Rosswood Gardens Wallington Surrey SM6 8QZ 020 8647 8193 020 8647 6671 Helen.Jackman@mst-online.org.uk www.stepforward.org.uk Metropolitan Support Trust 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) Helen Marie Jackman Care Home 22 Category(ies) of Learning disability (22) registration, with number of places Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories 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: 2. Learning Disability - Code LD The maximum number of service users who can be accommodated is: 22 25th May 2007 Date of last inspection Brief Description of the Service: Rosswood Gardens is within a short distance of Wallington town centre, with shops, library, pubs and post office all near by. There are good transport links with British Rail station and a number of bus routes within walking distance. There is only limited parking available at the home. Rosswood Gardens provides a home for up to 17 people with a learning difficulty. The home is divided into three separate units. There is a smaller home for 5 people who come to the home for a break, this is known as respite care. All rooms within the home are single, with their own sink, bed and wardrobe. Service users have their own key to their room and are free to home and go as they wish. Some of the downstairs rooms have their own bathroom, these are for people who are wheelchairs or need a lot of care. The current fee for a placement at the home is £715.34 per week. Rosswood Gardens (4-10) DS0000007189.V364123.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. We spent three hours at the home and talked with six residents, three members of staff and the deputy manager at the time we visited. Records and documents looked at included care plans, staff files, training records and health and safety records. The home completed an Annual Quality Assurance Assessment (AQAA) to tell us about the service provided, how it makes sure of good outcomes for the people using it and any planned developments. What the service does well: A number of residents told us that they liked living at the home; typical comments included “I like the staff they are nice to us” and “I like the home and the food”. Staff told us “it’s a good place to work and we get support from the managers, training is getting better” and “I got a good induction when I started working at the home”. Good information is available to people about the home. The needs of residents planning to use the service are fully assessed to make sure that they can be met. Support plans generally give good information about the support needs of the residents. Risk plans are completed to help people live as independently as they can. Residents are able to take part in activities and be part of the local community. Residents are able to keep in touch with family and friends and the home supports them to have appropriate personal and family relationships. Residents have healthy, well-presented meals and snacks, at a time and place to suit them. The health care needs of the residents are addressed and people have access to appropriate healthcare professionals. Medication is well managed by the service. Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 6 The home has a clear complaints procedure that is accessible to the residents. Policies are in place for the protection of vulnerable adults and staff complete training in this important area. People live in a clean, comfortable and homely environment. Residents are encouraged to personalise their rooms. The home is well run. Good Health and Safety arrangements are in place. What has improved since the last inspection? What they could do better: No requirements were set as a result of this inspection however a number of recommendations for good working practices have been made. The home could be careful about displaying confidential information about residents in communal areas of the home. The resident’s computer could be repaired or replaced. Staff supervision sessions need to take place more often. Staff training needs should be assessed and staff should attend refresher training if needed. Staff files should be available in the home for inspection and include all of the information as required in Schedule 2 of the Care Home Regulations. Regulation 26 visits could include more information about how the visit was conducted. The homes fire risk assessment should be reviewed. Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 7 The inspector would like to thank the resident’s, staff and the deputy manager for their comments and support during the inspection process. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rosswood Gardens (4-10) DS0000007189.V364123.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 Rosswood Gardens (4-10) DS0000007189.V364123.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Good information is available to people about the home. The needs of people using the service are fully assessed to make sure that they can be met. EVIDENCE: The home has a Statement of Purpose and Service Users Guide. The Service Users Guide is given to residents when they arrive at the home. The Service Users Guide has been completed using words and pictures for the benefit of some of the residents. The registered manager told us in the Annual Quality Assurance Assessment (AQAA) that the home is in the process of producing a video brochure to show potential tenants so that they can see what it would be like to live at Rosswood Gardens. No new residents have moved into the home since the last inspection. The registered manager told us in the Annual Quality Assurance Assessment (AQAA) that prospective residents are encouraged to try out living at Rosswood Gardens by coming for dinner and staying over for a night and then for a weekend. This way they can assess if the resident would like to live there. A significant amount of time is spent making the admission to the home personal and involving family and the new resident can choose furniture and Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 10 the décor for their room. They often invite family to attend Sunday lunch so that they feel included and welcome at the home too. New residents are designated a key worker who helps them to settle in and show them around the local area. A requirement was set at an inspection in July 2005 and at subsequent inspections that home must provide each resident with a contract that is in a format that is suitable to each individual. The contracts had been complicated and written using jargon. The deputy manager told us that the registered manager had reviewed the contracts and removed the complicated jargon to make them easier for residents to understand. However the deputy manager agreed that not all of the residents would understand the contract. She told us that a number of documents including the Service Users Guide, supports plan and goals and activities had been recently been developed using words and pictures and that the residents contracts would also be developed in the same way. It is recommended that resident’s contracts be developed in ways that the residents would understand for example CD, DVD or in Makaton Sign Language. The current fee for a placement at the home is £715.34 per week. Rosswood Gardens (4-10) DS0000007189.V364123.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Support plans generally give good information about the support needs of the residents. Risk plans are completed to help people live as independently as they can. The home should be careful about displaying confidential information about residents in communal areas of the home as they may lose confidence that personal information about is handled appropriately. EVIDENCE: A requirement was set at the last key inspection that statutory reviews must be held within an appropriate timescale. The deputy manager told us that all of the residents have had their placement reviewed by care managers from the London Borough of Sutton. The meetings had been attended by the residents, relatives, key workers, advocates and care managers however the minutes of these had yet to be received at the home. It is recommended that the Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 12 registered manager request a copy of the individual placement review from the London Borough of Sutton to keep in the resident’s personal files. The deputy manager told us that some staff had attended training with the London Borough of Sutton to become person centred plan facilitators. The deputy manager told us that some residents have person centred plans and that these would be developed for all of the residents. A number of resident’s personal files were examined; all had support plans that identified their needs in relation to such issues as, for example, the environment, communication, social interaction, hobbies and interests, medication and sexuality. Further assessments had been carried out that identified their strengths and needs in relation to physical needs, social needs and their skills. As a result of the support plan and assessment each resident had set achievable long-term and short-term goals that are being monitored by staff on a regular basis. As required at the last key inspection risk assessments are being reviewed on a regular basis. The home has a policy on confidentially which also outlines what should be done if there is a breach of confidentiality. Staff have signed and dated the document as an indication that they have read and understood it. It was observed that information relating to residents bathing preferences was located on the fridge in one of the kitchens. This is an area of the home were residents receive visits from family and friends. The deputy manager agreed that this information was confidential and should not be available to visitors to the home or to other residents. The deputy manager removed this information and placed it in the resident’s personal files. Resident’s files are kept in the main office, which is locked when not in use. Rosswood Gardens (4-10) DS0000007189.V364123.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): 12, 13, 15, 16 and 17. People who use this service receive excellent quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Residents are able to take part in activities and be part of the local community. Residents are able to keep in touch with family and friends and the home supports them to have appropriate personal and family relationships. People have healthy, well-presented meals and snacks, at a time and place to suit them. EVIDENCE: A number of residents told us that they liked living at the home; typical comments included “I like the staff they are nice to us” and “I like the home and the food”. Two residents told us that they had just returned from a holiday in Spain and another told us that she was going to Malta the day following the Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 14 inspection. Another resident who owned a cat called George told us he was very happy at the home and liked to watch television. Staff told us “the residents get a good choice of what they want to do”. All of the residents appeared well dressed, confident and comfortable in their surroundings. One resident told us that he helps with cooking, the deputy manager told us that residents are encouraged to be involved in the preparation and serving of meals. Residents attend a variety of activities depending upon their wishes and needs. Many attend day centres, although none attend on a five-day basis, instead having at least one day off a week. The deputy manager told us that some of the residents go horse riding, swimming and to play football and golf supported by staff from by the day centre. Some residents attend college and some have jobs the deputy manager told us that one resident is currently seeking employment. One resident has ‘retired’ from day centres however visits an older peoples group once a week. On the day of the inspection three residents told us that they were going off to the day centre. They waited from 9am for the bus to arrive however they had a call from the transport at 10.15am saying that they were going to be late but could give a time when they would arrive. The residents were given the choice of waiting or spending the rest of the day relaxing at home and chose the latter. The deputy manager told us that one of the residents was going to raise a complaint about the transport with the London Borough of Sutton. The deputy manager produced a monthly activities plan drawn up by residents at residents meetings. Activities for July included lunch clubs, cinema, holidays, Tuesday club, residents meeting, keep fit and arts and crafts. On the day of the inspection two residents were due to attend the London Borough of Suttons Civic Office to receive Awards for Excellence. Residents regularly check the local newspaper to find out what events are taking place in the area. The deputy manager told us that two residents have expressed a wish to live together and the home with support from care managers have enabled this to happen. Each of the houses compiles a weekly menu, usually on a Sunday. However, if residents decide that they do not want a particular thing to eat an alternative is always available. The home is able to cater for people on special diets; currently this includes someone who is a diabetic. The deputy manager told us that the home is developing picture menus so that some of the residents can have a clear understanding of what they can choose to eat and what meals are on offer that day. Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 15 Various snacks and drinks were available and residents were observed moving freely around the kitchen areas. The registered manager told us in the (AQAA) that the home holds regular parties and gatherings which celebrate different cultures and religions. They recently celebrated Buddha’s Birthday and had a party to celebrate St George’s day. The residents are supported to try new foods and flavours and to celebrate different cultures through food. They recently enjoyed a Caribbean night with foods of Caribbean influence. Staff are trained in the use of makaton and work with other residents to teach them Makaton so that they may communicate with those who use makaton. It was evident that residents are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The home had sought the views of the residents and considered their varied interests when planning the routines of daily living and arranging activities both in the home and the community. Routines are flexible and residents can make choices in major areas of their life. Rosswood Gardens (4-10) DS0000007189.V364123.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The health care needs of the residents are addressed and people have access to appropriate healthcare professionals. Medication is well managed by the service. EVIDENCE: All of the residents are registered at a local General Practitioners Surgery. Good medication procedures and practices are in place. Medication is labelled and stored correctly. Administration records examined were up to date at the time of the inspection. As recommended at the last key inspection records contain a photograph of the resident and any allergies that they may have. There are no controlled drugs used at the home. A number of the resident’s personal files were examined and there was evidence that they had visited General Practitioners, dentists, opticians and chiropodists were appropriate. Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 17 One of the respite care resident has diabetes. The deputy manager told us that the community nurse had trained a number of staff on diabetes and the administration of insulin. Another resident suffers from epilepsy; the deputy manager told us that the community nurse had trained staff on the condition. Some residents have health action plans that are kept in their personal files. The deputy manager told us that a number of staff recently attended training on health action planning and that there were plans to set these in place for all of the residents. Rosswood Gardens (4-10) DS0000007189.V364123.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear complaints procedure that is accessible to the residents. Policies are in place for the protection of vulnerable adults and staff complete training in this important area. EVIDENCE: The deputy manager told us that nine members of staff had recently attended training on Safeguarding Adults and three staff were due to attend training the day after this inspection. Procedures on Safeguarding Adults are available for staff to follow if required. The home has a complaints policy, which is in a user-friendly format, copies of which are displayed throughout the home and in resident’s files. The home maintains a complaints log. The log contained a number of concern/complaints from residents and their relatives; these were usually about issues relating to maintenance at the home. The log indicated what actions the home had taken to deal with the concerns/complaints. The log also contained a number of compliments from relatives about the support afforded by the staff team to their loved ones. Residents told us that us that they would talk to staff if they had any concerns or complaints about the service. Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27 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. People live in a clean, comfortable and homely environment. Residents are encouraged to personalise their rooms. EVIDENCE: There are three separate units at Rosswood Gardens and another smaller unit that offers respite care. Each unit has its own front door, kitchen/dining room, and lounge and laundry room. The main hallway links all of the units together. There is a large shared garden to the rear of the building. Each unit has a television, DVD player and books and puzzles. One unit had a computer that was used by the residents however the deputy manager told us that the computer didn’t work. It is recommended that the resident’s computer is repaired or replaced. Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 20 A tour of the building was conducted and a number of bedrooms were viewed The home is generally well furnished with domestic style furniture that is of a reasonable quality. There is a pleasing degree of personalisation in the bedrooms, with residents choosing their colour for the room and decorating them how they wish. Bedrooms are well equipped with a single bed, wardrobe, chest of drawers and a wash hand basin. Some of the ground floor bedrooms have en-suite facilities. Each unit has a laundry room with hand washing facilities. All of the units were clean and free from offensive odour on the day of the inspection. Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 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. Residents have safe and appropriate support as there are enough competent 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 to care for them. Staff supervision sessions need to take place more often. EVIDENCE: Staff told us “it’s a good place to work and we get support from the managers, training is getting better” and “I got a good induction when I started working at the home”. The home currently employs twenty permanent staff and three regular agency staff as cover when required. The deputy manager told us that thirteen members of staff hold NVQ level 2 in Care or above and two members of staff Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 22 are working towards this qualification. One agency member of staff holds an NVQ level 2 in Care. Staff’s training records were examined. These indicated that most staff had attended training on health and safety, infection control, makaton, moving and handling, first aid, food hygiene and fire safety however much of this had been completed between 2003-2005, the deputy manager told us that the changeover between organisations had affected the availability of training but that things were improving and staff were again being offered training relevant to the needs of the residents. Some staff recently attended training on Safeguarding Adults, moving and handling and the community nurse has trained a number of staff on diabetes and epilepsy. Fire safety training is planned for all staff to attend on the 23rd of July 2008. It is recommended that the registered manager assess the training needs of all members of staff and arranges for training or refresher training if needed on health and safety, infection control, moving and handling, first aid, food hygiene, fire safety and any training relevant to the needs of the residents. The deputy manager told us that six new members of staff had started work at the home since the last inspection. The new staff files were examined. Each file except one included a Criminal Record Check and two written references. None of the files held proof of identification, copies of passports, a medical statement or a recent photograph. The deputy manager told us that this information was held at the human resources department at head office. A member of the human resources team confirmed over the telephone that proof of identification, copies of passports and a medical statement were held in their department and that staff would not be employed without this information. The deputy manager has arranged for this information to be sent to the home so that it can be held in staff files and available for inspection. The deputy manager told us that one new member of staff had been redeployed from another home in the organisation and that her Criminal Record Check and references had yet to be passed to the home. It is recommended that staff files are available in the home for inspection and that they include all of the information as required in Schedule 2 of the Care Home Regulations. All new staff employed by the home have a period of induction during which they shadow another of staff, read polices and procedures and undertake some basic training. The induction period then leads onto the Learning Disability Award Framework, and then finally onto the National Vocational Qualification (NVQ) Level 2 or 3. A number of staff supervision records were examined, these indicated that some staff had regular supervision but some staff supervision was less frequent. It is recommended that all staff receive regular supervision. Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 23 When supervision did occur, it was appropriately recorded and signed by both parties. Annual appraisals have taken place for all established members of staff, the deputy manager told us that new members of staff would have appraisal once they passed their probationary period. The home holds regular monthly staff meetings. Rosswood Gardens (4-10) DS0000007189.V364123.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run which should give confidence to the residents that they benefit from the ethos, leadership and management approach of the senior staff. Good Health and Safety arrangements are in place which benefits the residents health ,safety and welfare. EVIDENCE: The registered manager has worked at the home since September 2006; she has completed the Registered Managers Award and NVQ level 4 in Management. The deputy manager told us that she was also planning to complete NVQ level 4 in Management. The deputy manager and staff on shift spoke very highly about the registered managers management style and described her as approachable and very supportive. Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 25 A requirement was set at the last key inspection that all fire doors must kept closed at all times. The deputy manager told us that door guards had been fitted to all fire doors and release when the fire alarm system is operated. A requirement was set at the last key inspection that COSHH cupboards must be kept closes at all times. COSHH cupboards were locked on the day of the inspection. Regulation 26 visits are conducted on a monthly basis and copies of the reports from these visits were available for inspection. However the most report did not indicate how the visit was conducted and only indicated under actions “none” and was signed by the person conducting the visit. It is recommended that Regulation 26 visits be carried out as described in Regulation 26 of the Care Home Regulations. The deputy manager produced feedback forms from residents and their relatives that use the respite care unit. The feedback forms included positive comments and references to where the service could do better. The deputy manager told us that this information was used to improve the quality of the service. The deputy manager told us that there are monthly residents meetings and quarterly meetings were residents meet with senior managers to discuss quality issues in the home. Portable Appliance Testing was completed in February 2008; Legionella testing January 2008; Landlords Gas certificate August 2007. Certificates for various equipment showed regular servicing. The homes fire alarm system is checked on a weekly basis full fire evacuations take place every three months. Engineers check the homes fire equipment quarterly, the last check took place in June 2008. There is a fire risk assessment for the home that was completed in October 2006. This does not appear to have been reviewed since then however the registered manager had updated parts of the risk assessment in February and March 2007. It is recommended that the homes fire risk assessment be reviewed. Rosswood Gardens (4-10) DS0000007189.V364123.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 3 25 3 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement 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. 2. 3. 4. Refer to Standard YA5 YA6 YA24 YA32 Good Practice Recommendations It is recommended that resident’s contracts be developed in ways that the residents would understand for example CD, DVD or in Makaton Sign Language. It is recommended that the registered manager request a copy of the individual placement review from the London Borough of Sutton to keep in the resident’s personal files. It is recommended that the resident’s computer is repaired or replaced. It is recommended that the registered manager assess the training needs of all members of staff and arranges for training or refresher training if needed on health and safety, infection control, moving and handling, first aid, food hygiene, fire safety and any training relevant to the needs of the residents. It is recommended that staff files are available in the home for inspection and that they include all of the information as required in Schedule 2 of the Care Home Regulations. It is recommended that all staff receive regular DS0000007189.V364123.R01.S.doc Version 5.2 Page 28 5. 6. YA34 YA36 Rosswood Gardens (4-10) 7. 8. YA39 YA42 supervision. It is recommended that Regulation 26 visits be carried out as described in Regulation 26 of the Care Home Regulations. It is recommended that the homes fire risk assessment be reviewed. Rosswood Gardens (4-10) DS0000007189.V364123.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rosswood Gardens (4-10) DS0000007189.V364123.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!