Care Home: Rowallan House

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What the care home does well What has improved since the last inspection? All the requirements made at the previous inspection have been addressed and are now met. Lounges and corridors have been redecorated. Activities continue to improve, as do the opportunities for residents to go out. Staff receive ongoing training and are knowledgeable and able to meet the needs of the residents. What the care home could do better: The manager and staff team continue to work hard to provide a good service for the residents and to meet each person`s needs. The requirements in the previous inspection have been met. Two requirements have been made from this visit, the registered manager must ensure that all staff adhere to the procedures for the receipt, recording, storage, handling, administration and disposal of medicines. The registered person must carry out his/her function (visits required to be carried out under Regulation 26) once a month in a robust and thorough manner, in order to assess whether the home operates with in its stated aims and objectives and form an opinion of the standard of care provided in the care home. The reports of these visits must be made available for inspection upon request. Daily and night recordings should also be more meaningful, detailed and correlate to events that happen as well as relate to the desired outcomes in each part of the resident`s care plan. This will help to identify any changes required with regard to outcomes, at the monthly review or more frequently if the need is identified.It was suggested to the manager that he uses the Key Lines of Regulatory Assessment (KLORA) to assist and continue to identify and evidence the excellent quality of the service provided. CARE HOMES FOR OLDER PEOPLE Rowallan House 17 Little Heath Chadwell Heath Romford Essex RM6 4XX Lead Inspector Ms Harina Morzeria Unannounced Inspection 22nd July 2008 8:15 X10015.doc Version 1.40 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 Rowallan House DS0000025922.V368468.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 Older People. 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. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rowallan House Address 17 Little Heath Chadwell Heath Romford Essex RM6 4XX 020 8597 4175 020 8597 1118 rowallenhouse@btconnect.com 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) Mrs Marina Stack Mr Laurie George Taylor Justice Care Home 41 Category(ies) of Dementia (41), Old age, not falling within any registration, with number other category (41) of places Rowallan House DS0000025922.V368468.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: Old Age, not falling within any other category - Code OP 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 41 11th July 2006 Date of last inspection Brief Description of the Service: Rowallan house is located in a residential area in Chadwell Heath, in the London Borough of Redbridge, close to public transport links. The home provides residential care to people over the age of 65 who have physical illnesses and/or dementia. It is registered to provide care for 41 residents, offering personal care and assistance in a homely environment. The bedrooms are situated on the ground and first floor, which are served by a lift and stairs. There are three lounges, plus a separate dining area. There are 37 single bedrooms, of which 13 rooms have en-suite facilities. The home also has two double bedrooms. Adequate bathing and toilet facilities are provided. Various activities are planned such as listening to music, board games, exercise classes and bingo as well as outings during fine weather, which are actively enjoyed by the residents. Staff also take some of the more able residents out individually and those residents who are able and willing to go out independently are encouraged to do so. The residents are offered a varied, nutritious and culturally appropriate diet. They are able to have their meals flexibly at different times or in their rooms if the wish. Personal care is provided on a 24 hour basis, with health needs being met by visiting professionals, or by staff/relatives accompanying residents to hospital appointments. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 5 The home provides a Statement of Purpose that clearly sets out the objectives and philosophy of the service. A Service User’s Guide is also available to prospective residents which includes information about the accommodation, qualifications and experience of staff and how to make a complaint. This information can be made available in different formats (picture format) and languages upon request. The inspection report, statement of purpose and service user guide are also available in the reception area of the home, and copies can be obtained on request from the home. The fees range from £450.00 - £525.00 per week. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means that people who use the service experience good quality outcomes. This inspection was unannounced and took place over approximately seven hours. The manager was present and assisted with the inspection. The inspector looked around the home, spoke to the residents, staff and relatives. The inspector was accompanied to this inspection by an “Expert by Experience” who looked around the home with a member of staff. He spoke to the residents and staff, observed the lunchtime routines at the home and provided a report of his findings to the inspector, part of which have been incorporated in this report. Care staff were asked about the care that residents receive and were also observed carrying out their duties. Staff, care and other records were checked. Feedback questionnaires were sent to residents, relatives and staff and a good response was received. Additional information relevant to this inspection has been gained from the Annual Quality Assurance Assessment and Regulation 37 notifications. The inspector spoke to the contracts team for the London Borough of Redbridge to get feedback about the quality of the service, who stated that they do not have any issues of concern to report. The inspector had a discussion with the manager on the broad spectrum of equality & diversity issues and he was able to demonstrate an understanding of the varied needs of the service users around religion, sexuality, culture, disability and gender. What the service does well: The manager and his staff were able to demonstrate a good understanding of equality and diversity issues around sexuality, religion, culture, ethnicity and disability. Examples of some residents who are Jewish and one person who is Muslim, were discussed and the manager was very aware of the resident’s needs around the their cultural and religious as well as dietary needs. Rowallan House presented as very homely and there were no unpleasant odours. Both residents and staff interacted very well and several of the residents said “the home was nice and the staff very kind.” The home is well furnished and the décor is generally in a good condition. There is a planned programme of structural alteration and redecoration for the home with some work already completed. One resident told the inspector “I really like my room and the staff are kind.” The home is fully staffed and there is a stable staff team that residents say are kind and caring. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 7 More than half of the staff team have got NVQ qualifications and have had the training needed to help them to provide a good service for the residents. There is a relaxed atmosphere in the home and relatives are welcomed. Families are invited to any celebrations or events organised at the home. Activities are organised daily. Relatives state, “I have no complaints with Rowallan House. My mother has been at the home 41/2 years and always been well cared for, considering she has dementia and there have been difficult times with personality change. I feel I can speak freely to management and staff very easily.” Another relative states, “Rowallan House make my father feel very comfortable and welcome.” The expert by experience states that “with the exception of the incident in the dining room, the establishment is well-run and any problems would be referred to the manager without hesitation”. What has improved since the last inspection? What they could do better: The manager and staff team continue to work hard to provide a good service for the residents and to meet each person’s needs. The requirements in the previous inspection have been met. Two requirements have been made from this visit, the registered manager must ensure that all staff adhere to the procedures for the receipt, recording, storage, handling, administration and disposal of medicines. The registered person must carry out his/her function (visits required to be carried out under Regulation 26) once a month in a robust and thorough manner, in order to assess whether the home operates with in its stated aims and objectives and form an opinion of the standard of care provided in the care home. The reports of these visits must be made available for inspection upon request. Daily and night recordings should also be more meaningful, detailed and correlate to events that happen as well as relate to the desired outcomes in each part of the resident’s care plan. This will help to identify any changes required with regard to outcomes, at the monthly review or more frequently if the need is identified. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 8 It was suggested to the manager that he uses the Key Lines of Regulatory Assessment (KLORA) to assist and continue to identify and evidence the excellent quality of the service provided. 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. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 (standard 6 is not applicable to this service) 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 the service. People who use the service can be assured that their needs will be properly identified and that the service that the home provides is acceptable to them. Information is available in different formats upon request and residents are provided with a written contract or statement of terms and conditions. EVIDENCE: There is a Statement of Purpose & Service Users guide. These are reviewed and updated annually and can be made available in different formats and languages upon request. The service user guide informs prospective residents that information is available in different formats upon request. Relatives of the residents spoken to said that they had been given of copy of the guide. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 11 Each resident has a contract with the provider and a copy of these were seen in residents’ files. Admissions are not made to the home until a full needs assessment has been undertaken. For people who are self funding and without a care management assessment, a skilled and experienced member of staff always undertakes an assessment. The assessment is conducted professionally and sensitively and involves the individual and their family or representative, where appropriate. Where the assessment has been undertaken through care management arrangements the service insists on receiving a summary of the assessment and copy of the care plan. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. The files of two new residents were viewed and both showed evidence of a comprehensive pre-admission assessment and a statement of terms and conditions or contract. Evidence showed that the prospective residents had an individual needs assessment and were given the opportunity to visit the home prior to making a decision to live there. Referrals are made by Social Services department and they provide initial assessment information. This may be from information that they have gathered or from assessments made by hospital staff. Assessments are then carried out by the manager before an individual moves into the home. At this time the prospective residents and/or their relatives are provided with information about the home and encouraged to visit. The assessments cover all of the required areas and include health, mobility, nutrition, religious, cultural and spiritual needs. Examples of this were seen on residents’ files. From this assessment information, an initial basic care plan is drawn up to enable staff to provide appropriate care for an individual when they first move into the home. Evidence was seen on new residents’ files that they can visit the home and enter the home for a trial period of stay before deciding to move in permanently. A review of each placement is carried out prior to deciding upon permanency. The home does not provide intermediate care. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10,11 People who use 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 receive personal care that meets their individual needs and preferences. The healthcare needs of all of the residents are met and clearly recorded in each person’s care plan which is drawn up with the involvement of the resident and/or relatives. Personal support is responsive to the varied and individual needs and preferences of the residents. Residents can be sure that they are protected by the home’s policies and procedures for dealing with medication. The manager must ensure that all staff adhere to the medication administration procedure at all times. The staff team are able to meet the needs of residents and support them in a way that they prefer, through gathering detailed information and good care planning arrangements. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 13 EVIDENCE: People receive personal and health care support using a person centered approach and support would be provided based upon the right dignity, equality, fairness, autonomy and respect. Personal health care needs including specialist health, nursing and dietary requirements are clearly recorded in each person centered plan. Personal support is responsive to the varied and individual needs and preferences. The files of four residents were viewed and all had a person centred care plan. There was evidence that residents and/or their family are involved in drawing up the care plans. Reviews take place on a monthly basis, or more frequently if necessary. All of the residents have care plans, which give details of their needs and how to maintain their independence as far as possible. Individual plans clearly record people’s personal and healthcare needs and detail how they will be delivered. The care plans identify residents’ strengths and capabilities and how their needs should be met. For example, for one resident who suffers from Parkinson’s disease his care plan says staff to liase with him daily and assess his co-ordination, balance and mobility on that day related to each particular task and to assist and encourage him as necessary. The care plans also contain information about residents’ likes and preferences. For example, “likes to rise late in the morning”. Whilst viewing the home, the inspector noted that whilst many residents were served breakfast in the dining room, a number of them were also served breakfast in their rooms either through choice or because they were feeling unwell and wanted to stay in bed. Each resident has a nominated key worker. The care plans are used as working tools and are reviewed and updated when a person’s needs change. They therefore contained up to date information to enable staff to meet residents’ current needs. There was some evidence of life histories and this needs to be developed further. Obviously, the successful development of life stories will need the involvement of relatives because some residents who are living with dementia may not be able to remember some significant events in their lives. Residents have access to healthcare and remedial services. The health care needs of residents unable to leave the home are managed by visits from local health care services. Residents have the aids and equipment they need and these are well maintained to support them and the staff in daily living. Residents are registered with local GPs. The optician and dentist make regular checks. The district nurse visits as and when required to provide nursing support. Residents’ weight is monitored and dietary needs addressed. Manual handling assessments are in place and reviewed monthly. Aids and equipment are provided to encourage maximum independence for people using services, These are regularly reviewed and are replaced to accommodate changing needs. Specialist advice is sought by the home to ensure the effective use of equipment. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 14 Medical information is recorded and the outcome of visits to the doctor or hospital and any follow up action is recorded. Residents are supported, either by their families or care staff to attend doctors and hospital appointments. The manager arranges training on health care topics that are related to the health care needs of the residents to make sure that staff are trained and competent in health care matters relevant to the needs of the people who use the service. The home is registered as a service for people with dementia and staff assist residents appropriately as they have all received dementia care training. It was evident that residents living with dementia are enabled to maintain their independence with support and assistance from the care support staff, and the care plans for these residents were detailed around personal care, communication needs and behavioural needs. One relative said “ I have no complaints with Rowallan house care home my mother has been at the home for four and a half years and always been well cared for considering she has dementia and there have been difficult times with a personality change”. Many of the staff working with residents living with dementia have received adequate and appropriate training, and this was evident in their care practices. However, daily and night recordings could be more meaningful, detailed and correlate to events that happen as well as relate to the desired outcomes in each part of the resident’s care plan. This will help to identify any changes required with regard to outcomes, at the monthly review or more frequently if the need is identified. None of the residents can self medicate and medication is administered by senior staff who have received medication administration training. There are policies and procedures for the handling and recording of medication. However, upon observing medication administration at breakfast time, the inspector noted that the medication for individuals was left in a container by their side for them to take after they had finished their breakfast. The home’s medication procedure states that the person administering medication must stay with the person and make sure it is swallowed before moving on. This was not the case. The manager must ensure that regular management checks are carried out to monitor compliance with procedures at all times. The manager needs to carry out an assessment to ensure each member of staff is competent to handle, record and administer medication properly. A requirement has been made for the manager to ensure that all staff follow the medication administration procedure. A random sample of Medication Administration Record (MAR) charts were examined and these were appropriately completed. The medication records include a photograph of the resident, a medical history and details of any allergies. The home has a detailed policy, procedure and practice guidance to help staff when caring for residents with degenerative conditions, terminal care and death. All staff receive in-house training and practical advice and have support and opportunities to discuss any areas of anxiety and concern. The manager is Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 15 in the process of drawing up end of life care plans for each individual. Some of the care plans contained some information with regard to end of life wishes, but the management team is further developing these in line with the recent Department of Health guidance. However, from discussions with staff the inspector was satisfied that residents who are dying are treated with sensitivity and respect and their wishes are complied with. Such care would also be extended to family members with support being given to staff and to other residents. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Residents have the opportunity to join in a range of activities and outings. Visiting times are flexible and visitors are welcomed in the home and residents can keep in contact with friends and relatives. Residents’ views and opinions are important and are used in planning and developing the service. The meals in the home are good and residents have a choice of what to eat. EVIDENCE: Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 17 Residents are involved in meaningful daytime activities of their choice and according to their interests, diverse needs and capabilities. A variety of activities are provided each day either by staff or an activities co-ordinator who visits the home three times a week. Some of these include gentle exercises, art & craft, bingo, musical entertainment and reminiscence. The care plans seen include information about preferred activities that residents may like to participate in including spiritual and cultural activities. The manager is in the process of developing an ‘activities of daily living planner for individuals’. He is also enrolling on the National Association for providers of activities for older people, exploring the provision of activities for people suffering from dementia. Residents spoken to said that they enjoy the activities. Outings for day trips are arranged for small groups of people who want to go out via the DABD. Staff take some of the residents out to the local shops or other activities subject to a risk assessment. A number of people go out with their relatives. There are photographs of the various activities and outings the residents have enjoyed over the year. These are displayed in the hallway. Some appropriate activities and stimulation are provided for people with dementia such as board games, reminiscense, photograph albums and music. However, more could be done to develop further relevant activities for people with dementia. Whilst there is some evidence, such as photographs of London areas as they used to be, and name/pictorial indicators on bedroom doors, more could be done around the environment to make the environment more amenable to residents living with dementia. Improvements, for example, could be through the use of ‘touch and feel’ materials, pictures/photographs which are more meaningful to the residents which could be used during activity time. A hairdresser visits once per week and ensures that the ladies have their hair done and the gentlemen have their haircuts. A religious service is conducted by a Reverend every month in the lounge and residents participate if they wish. People from other faiths will be supported by staff to attend places of worship for example, one person from the muslim faith was assisted to attend the mosque regularly but has been unable to do so recently due to deteriorating health. People who use the service have the opportunity to develop and maintain important personal and family relationships. Visitors are welcome at any reasonable time. The AQAA states that residents meetings are held and they talk about what they like, any complaints and where they to go for outings as well as menus. They put forward ideas and staff see what the can do. Residents’ opinions are sought and acted upon. The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 18 support being provided. Residents are encouraged to be as independent as possible and to be involved in choices about the home and about their lives. The menu is varied with a number of choices and special diets are catered for. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. Meals are served in the dining area and drinks and snacks are available. The night staff make a cup of tea or a drink for any residents who have difficulty sleeping during the night. They all said they enjoy their food. Care staff are sensitive to the needs of those residents who find it difficult to eat and give assistance with feeding. They are aware of the importance of feeding at the pace of the resident making them feel comfortable and unhurried. In his report the expert by experience states that, “I had an excellent lunch in the dining room. It was wholesome and very much “home cooking”. There were paper napkins and orange juice (diluted) at each place setting. There was good-natured banter and assistance when required between the residents and carers. One resident was assisted throughout the meal by a carer but I was unable to see if there was any conversation between them. I noticed that the meals were served one at a time from the servery. It would speed things up if a carer collected say four at a time on a large tray. One male resident, L--- was slumped with his head on his chest throughout my stay about 35 minutes. A meal was put in front of him but it was removed untouched after 20 minutes. The manager saw him just before I left and said to me hes got Parkinsons we will feed him later”. The above issue has been discussed with the manager who stated that when staff were assisting the person to the dining room he was fine but may have been unable to feed himself at the table. However, the inspector observed this person eating by himself during breakfast time. The manager agrees that prompt action should have been taken by staff to assist him with his meal at lunch time. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. There is a user-friendly complaints procedure that is followed in the event of any complaints being made so that people who use the service are able to express their concerns and dissatisfactions. People who use the service are adequately protected by a manager and staff who have received safeguarding adults training to ensure that they are clear about what constitutes abuse and what to do if abuse is seen or suspected. However, the manager must ensure that the procedures are adhered to, at all times when safeguarding issues occur. EVIDENCE: There is a complaints procedure and this is displayed in the home. Residents and relatives are encouraged to voice any problems so that they can be sorted out as soon as possible. Seniors are required to record any complaints after each shift and these are appropriately dealt with by the manager and the staff team and evidence of this was seen in the complaints book. Feedback from relatives states that any concerns raised are dealt with immediately by the manager or the staff team. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 20 There is a written policy and procedure for dealing with allegations of abuse and whistle blowing. Staff, as part of their induction are taken through the adult protection guidelines of the home and a copy of the all relevant Local Authority Adult Protection protocols is kept in the home for the guidance of staff. At the time of finalising this report, staff working in the home have received training in safeguarding adults and staff spoken to were aware of the action to be taken if there were concerns about the welfare and safety of the residents. However, prior to the inspection an alleged safeguarding incident had occurred at the home. Although the manager notified the placing authority and CSCI, other agencies (police and G.P) were not notified immediately. Appropriate support was provided to the resident and the family. Two case conferences were held as a result of this incident which was investigated and substantiated. The manager must ensure that links with external agencies are understood and safeguarding procedures followed at all times. Following discussion at the inspection the manager is now aware that this needs to be done and in future will ensure that all agencies are informed. Following this incident and to ensure that all staff have up to date training and awareness of safeguarding issues, the manager showed the inspector evidence of safeguarding training booked for all staff to attend in August 2008, which will include all ancillary staff. The manager stated that they do not handle any finances on the residents’ behalf. All staff understand what restraint is and alternatives to its use in any form are always looked for. Equipment which may be used to restrain individuals such as bedrails, keypads recliner chairs and wheelchair belts are only used when absolutely necessary with the home promoting independence and choice as much as possible. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The residents live in a clean and comfortable home that has suitable aids and adaptations for their needs. The staff team continue to work to improve the environment and to make it as homely as possible. EVIDENCE: The standard of decor, furnishings and fittings in the home are maintained to a good standard and there were no offensive odours. There is an ongoing programme of refurbishment and redecoration. A handyman has been employed to carry out any minor day-to-day maintenance to the home which ensures that the residents live in a comfortable and safe home. There is an Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 22 effective system in place for the staff to report items requiring repair or attention. The external areas of the home are well maintained and secure. The garden provides a safe and attractive area for the residents to enjoy during fine weather. At the time of the inspection visit, the inspector was shown a plan of further structural alteration to the building in order to expand the corridor space and the lounge area. The registered person must ensure the safety of residents at all times when this work is being carried out. Residents said that they are very pleased with their individual bedrooms and communal facilities. The inspector noted that bedrooms are personalised by the residents and contain family photographs, ornaments and small items of furnishings. On each floor there are sufficient bathrooms and toilets. Each bathroom has an assisted bath and all the toilets are wheelchair accessible. The standard of cleanliness in the home is high and there are sufficient numbers of ancillary staff employed to maintain it to this standard. Staff have attended training on infection control and take all the necessary precautions to ensure that there is no spread of infection within the home. There are adequate control systems in place to ensure that the home is free from any offensive odours. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Residents are supported and protected by the homes recruitment practice. Staffing levels are appropriate to meet the needs of people who use the service. Staff receive the necessary training, supervision and support in order to meet residents’ current needs and provide a good service for them. Residents are supported by a staff team that know them well and who are committed to providing a good quality service. EVIDENCE: At the time of the visit there were forty residents living at the home. There are three shifts for staffing the home and the usual staffing is five carers on the day shifts. At night there are three waking night carers. Domestics and kitchen staff support the care staff. There is generally a stable staff team and agency staff have not been used in the recent past. Hence, the home is fully staffed and any additional shifts are usually covered by the staff team. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 24 Therefore, residents receive a consistent service from a staff group that are aware of their needs and how to meet them and residents get continuity in their care. People have confidence in the staff who care for them. The staffing arrangements are sufficient and flexible to meet the changing needs of residents. However, the manager must keep staffing levels under review, especially during peak times in the morning and additional staffing must be provided if required. The views of residents who contributed to the inspection was that the staff were available to attend to them and meet their needs. Comments as stated in the expert by experience’s report from one resident is “ its very nice here, no complaints. They are good if you have problems at night. I read a lot and like my bingo.” From observation the staff showed a caring and helpful attitude towards the residents. Relatives feedback says, “the staff do a wonderful job.” “ This is one of the better homes. I took her out of the previous one. The staff here are very good. She had to go to hospital one night - no problems. I would always go to Laurie if there was a problem.” Staff members undertake external qualifications beyond basic requirements. Managers encourage and enable this and recognise the benefits of a skilled, trained workforce. In addition to short courses the staff team have also shown a commitment to achieving their National Vocational Qualifications. The AQAA shows that more than fifty percent of staff have obtained NVQ Level 2 & 3 qualifications. The home has internal developmental training as well as formal training for staff as part of an ongoing training plan. The training records checked of four members of staff confirmed that they have received training in dementia care, moving and handling, fire safety, infection control, safeguarding adults, oral care, medication and basic first aid. Hence, staff are receiving the necessary training to provide an appropriate and safe service to meet the needs of the residents and future training needs have been identified. Staff records seen and feedback from staff confirms that they receive the right support from the manager to meet the different needs of the people who use the service. The following staff comment states, “ I think all the services provided for residents and staff work very well. There is good communication from the domestic side up to the managerial department. Everyone works as a team to provide the best possible care”. The home puts a high level of importance on training and staff reported that they are supported through training to meet the individual needs of people in a person centred way. Staff meetings take place regularly. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the home recognising the importance of effective recruitment procedures and the delivery of good quality services and for the protection of individuals. Staff files checked evidence that the home has a thorough and appropriate recruitment procedure. There are application forms, interviews and the appropriate references and checks are Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 25 made. A random sample of staff records were checked during the inspection and were found to contain the required information. Staff recruited confirmed that the home was clear about what was involved at all stages and was robust in following its procedure. There are clear contingency plans for cover for vacancies and sickness and there is little use of agency or temporary staff. Staff have job descriptions and are clear as to their individual role in the home. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 & 38. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Residents live in a home that is run in their best interests by an experienced and qualified manager and deputy. Residents’ financial interests are safeguarded by the policy and procedures of the home. The staff team work well together to make sure that residents are safe and secure whilst living at Rowallan House. Staff receive supervision and this occurs on a regular basis and is evidenced. The residents’ rights and best interests are safeguarded by the home’s recordkeeping policies and procedures. Residents and staff health, safety and welfare are promoted and protected. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manager has the required qualifications and experience and is competent to run the home. The manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. He works to continuously improve services and provide an increased quality of life for residents with a strong focus on equality and diversity issues and promoting human rights. He is supported by a deputy who is in the process of completing her NVQ level 4 qualification. Feedback from both the residents and staff was positive about the way in which the home is run. The manager undertakes regular training and understands and values opportunities for continuing professional development. Therefore, the registered manager is competent to run the home and meets its stated aims and objectives. The atmosphere in the home is relaxed and friendly and there is a stable staff team. The manager communicates a clear sense of direction, is able to evidence a sound understanding and application of best practice operational systems particularly in relation to continuous improvement, customer satisfaction and quality assurance. Equality and diversity, human rights and person centred thinking are given priority by the manager aiming to continuously improve the service in order to meet the residents’ individual needs. The manager was aware of the recently introduced Mental Capacity Act 2005 and information relating to this has been cascaded to all staff. The further development of preferred place of care and end of life plans were discussed with the manager and he will be progressing this in line with the guidance from the Department of Health. Supervision sessions are regular and are conducted by an external person who previously worked in the home as a deputy. Staff find supervision helpful with a focus on improving outcomes for people using the service. Notes and action points are taken of meetings and sessions and progress is regularly review. The inspector was informed that the owner visits the home regularly. However there were no written reports of these visits available in the home for inspection. The proprietor is required to check the quality of care in the home through regular monthly Regulation 26 monitoring visits which must be carried out robustly and thoroughly in order to asses whether the home operates within its stated aims and objectives. Full reports of these visits must be made available to the Commission for inspection at any time upon request. See requirement. Residents are aware of safety arrangements and generally have confidence in the safe working practices of staff. Residents are confident that the manager Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 28 will take swift action when bad practice is identified. Although the inspector was concerned that a safeguarding issue was not appropriately dealt with by the manager at the time of the incident, lessons have been learnt from this issue and further training has been arranged for all staff, seniors and managers in order to ensure that any future allegations are handled by adhering to the safeguarding procedures. The home has an appropriate policy and procedures regarding safeguarding residents’ finances. If they wish and are able to, the residents are helped to take responsibility for managing their own money. They are provided with facilities to keep their valuables and money safe. The inspector was informed that most of the residents’ finances are handled by their family members. Quality monitoring takes place via feedback questionnaires. Residents are asked for their feedback about the service and improvements are made where gaps are identified. Record keeping is of a good standard. However, some improvements need to be made to daily recordings. Records are kept securely and staff are aware of the requirements of the Data Protection Act. Residents know they can access their records at any time. The AQAA contains clear, relevant information that is supported by appropriate evidence. The manager recognises the areas that they still need to improve and has detailed ways in which they are planning to do this. The home has a range of policies and procedures to promote and protect residents’ and employees’ health and safety. The manager is proactive with regards to health and safety to ensure that any potential risks are minimised as far as possible. Health and safety awareness issues are cascaded to staff to raise their awareness. Regular health and safety checks are carried out by appropriate professionals. The manager is aware that it is his responsibility to carry out all of the necessary health and safety checks and provide a safe environment for the residents and staff at all times. Staff meetings have been taking place regularly, providing staff with the opportunity to discuss problems and to be involved in the development of the service. Staff meetings have an agenda and are minuted. Staff spoken to said that there is very good communication and teamwork in the home. Training and development needs are identified as part of supervision. There are clear lines of accountability in the home. Appropriate insurance cover is in place. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 29 Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 3 3 3 3 3 Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 31 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 OP9 Regulation 13(2) Requirement Timescale for action 31/08/08 2 OP32 26 The registered manager must ensure that all staff adhere to the procedures for the receipt, recording, storage, handling, administration and disposal of medicines. The registered person must carry 31/08/08 out his/her function (visits required to be carried out under Regulation 26) once a month in a robust and thorough manner, in order to assess whether the home operates with in its stated aims and objectives and form an opinion of the standard of care provided in the care home. The proprietor and registered manager are required to forward full reports of these visits to the CSCI each month until further notice. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 32 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 OP17 Good Practice Recommendations Daily and night recordings should also be more meaningful, detailed and correlate to events that happen as well as relate to the desired outcomes in each part of the resident’s care plan. This will help to identify any changes required with regard to outcomes, at the monthly review or more frequently if the need is identified. Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 33 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 Rowallan House DS0000025922.V368468.R01.S.doc Version 5.2 Page 34 - 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. 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