Care Home: Rowan Cottage

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What the care home does well The home provides good information to people who may want to live there to help them to decide whether the home will be right for them, including the needs of residents between sixteen and eighteen years of age. Residents are assessed properly before a place is offered, to establish whether their needs and wishes can be met. The home has good care plans which help staff to provide support to each resident according to their needs and wishes. Risk assessments are used to support residents to have a fulfilling lifestyle. Residents` physical and healthcare needs are met effectively by the home. The home manages residents` medication on their behalf but is considering working towards some residents managing this themselves. Residents can take part in a range of activities, educational and employment opportunities, and contact with family and friends is supported. Residents` rights and independence are promoted and they are encouraged to be involved in the planning and preparation of meals. Residents are able to raise any concerns through the complaints procedure and are protected by the home`s safeguarding policy.Rowan CottageDS0000073098.V376032.R01.S.docVersion 5.2The home provides a safe comfortable and homely environment and is equipped and decorated appropriately for the age group of the residents. Staff have had most of the training needed in order to meet the needs of the residents and staff recruitment systems help to safeguard the residents. The views of residents and others will soon be sought via a quality assurance survey, and the provider has undertaken regular monthly monitoring visits providing opportunities for residents to raise any concerns. The health, safety and welfare of residents are protected and promoted by the systems and checks in place What has improved since the last inspection? Not applicable as this was the home`s first inspection. What the care home could do better: The manager should set up a complaints log in which to record any complaints made about the service, so they can be monitored easily. The manager should ensure that any remaining shortfalls in mandatory training are addressed promptly, in order to ensure that all staff are equipped with the necessary training to meet the full range of needs of residents. Key inspection report CARE HOME ADULTS 18-65 Rowan Cottage Sulhampstead Road Burghfield Reading RG30 3SB Lead Inspector Stephen Webb Key Unannounced Inspection 16th June 2009 10:15 Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rowan Cottage Address Sulhampstead Road Burghfield Reading RG30 3SB 01189836003 01189836004 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) Choice Ltd Mrs Rebecca Alison Elizabeth Wardell Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (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 (LD). The maximum number of service users to be accommodated is 8. None. New service first registered in November 2008. Date of last inspection Brief Description of the Service: The home comprises two converted semi-detached bungalows which have been adapted to the needs of residents. All resident accommodation is on the ground floor, with single en-suite bedrooms provided for up to eight residents with a learning disability. The home currently accommodates seven men with ages ranging between sixteen and thirty-five years of age. Appropriate considerations are in place to safeguard the interests of residents under eighteen years of age. Staff receive training in safeguarding of both adults and children. A variety of communal spaces are provided, including living and dining areas, a conservatory and a separate day-care room which is being converted to a gym and games room at the request of residents. At the time of this inspection, fees ranged from one thousand and seven hundred pounds per week, dependent on the assessed needs of the individual. Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection included an unannounced site visit from 10.15am until 16.45pm on the 16th of June 2009. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with the manager. Residents also provided some verbal feedback and the inspector also observed the interactions between residents and staff at various points during the inspection. An inspection survey was completed by four of the residents, supported by staff. The majority of their feedback about the service was positive. One or two issues were noted which were discussed with the manager during the inspection. Verbal feedback during the inspection was positive. The inspector also examined the premises. What the service does well: The home provides good information to people who may want to live there to help them to decide whether the home will be right for them, including the needs of residents between sixteen and eighteen years of age. Residents are assessed properly before a place is offered, to establish whether their needs and wishes can be met. The home has good care plans which help staff to provide support to each resident according to their needs and wishes. Risk assessments are used to support residents to have a fulfilling lifestyle. Residents’ physical and healthcare needs are met effectively by the home. The home manages residents’ medication on their behalf but is considering working towards some residents managing this themselves. Residents can take part in a range of activities, educational and employment opportunities, and contact with family and friends is supported. Residents’ rights and independence are promoted and they are encouraged to be involved in the planning and preparation of meals. Residents are able to raise any concerns through the complaints procedure and are protected by the home’s safeguarding policy. Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 6 The home provides a safe comfortable and homely environment and is equipped and decorated appropriately for the age group of the residents. Staff have had most of the training needed in order to meet the needs of the residents and staff recruitment systems help to safeguard the residents. The views of residents and others will soon be sought via a quality assurance survey, and the provider has undertaken regular monthly monitoring visits providing opportunities for residents to raise any concerns. The health, safety and welfare of residents are protected and promoted by the systems and checks in place What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 7 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 Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 2: 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. Prospective residents and their representatives are provided with the necessary information to enable them to decide whether the home will be able to meet their needs, including the needs of residents between sixteen and eighteen years of age. Residents are assessed prior to the offer of a place, to establish whether their needs and wishes can be met by the home, within the context of the existing resident group. EVIDENCE: The service has detailed and informative Statement of Purpose and Service User Guides in place, and both are provided to residents and their representatives. The documents include details of the homes admissions policy and preadmission assessment process and the complaints procedure; and also refer to core values including privacy, dignity, rights and inclusion, and identify ways in which the service addresses these. Both documents had been reviewed in 2008 and contained appropriate references to additional issues relating to accommodating residents who may Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 9 be between sixteen and eighteen years of age, such as alcohol consumption and 18 games and videos. However, when they are next updated, both need to have the references to the registration and regulatory body updated to refer to the Care Quality Commission and its contact details. The Service User Guide incorporated pictures, images and symbols as well as text to assist in conveying the information to residents, and a version in a specific symbol format was also available, having been devised for one resident who was familiar with the format. Copies of pre-admission assessments undertaken by the home and discharge reports from previous placements as well as individualised transition plans, were seen on the files examined in the course of the inspection. In one file an appropriate reassessment of needs had also been undertaken. Most residents indicated they had been to visit the home and been asked their views prior to being placed there. Assessments addressed specialist needs where applicable including those relating to physical and emotional health and wellbeing and identified individual support needs within the community. The home was also able to recognise where it could not meet the emerging needs of a resident following their admission, and had supported the resident to make a positive move to a more appropriate placement. Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs, wishes and goals of individuals are identified within their care plan documents to support individualised care, and residents are actively encouraged and supported to make decisions about their daily lives. They are supported to take appropriate risks in order to develop and enrich their lifestyle and independence. EVIDENCE: The home provides a “home for life” where appropriate but care plans/essential lifestyle plans indicate that individual residents may also be working towards a long-term goal of moving on to placements offering them greater independence. Care plans reflected this with relevant targets/goals being set and worked towards, and there was periodic evaluation of progress towards these through regular reviews. Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 11 Both of the care plans examined included targets and were focused on developing residents’ skills and increasing their presence within the local community. The care plans included information on individual’s needs and also any identified preferences about how they are supported, as well as providing detailed information to staff on how the identified needs should be met. They also identify areas where the resident can meet their own needs in particular aspects and whether supervision or prompting may be necessary. The care plans identify where residents are able to give consent, and identify likes and dislikes around activities, hobbies, food, etc. The plans also identify the resident’s religion and whether they wish to attend places of worship. The plans address residents’ rights and dignity in various ways through recording their wishes and preferences and areas of independence. The level of support necessary when out in the community is also identified and plans are in place to develop community involvement. Inspection questionnaire and verbal feedback from residents indicates that residents are broadly satisfied with the way they are consulted and listened to. Within the care plan there are sections identifying what is important to the individual and the content has been taken from feedback from the resident. The care plans also identify how individuals communicate their moods and feelings, where this may be via a range of non-verbal cues supplementing their verbal communication, and also provide staff with guidance about how to respond, in order to support consistency. A range of communication tools is used to support residents, including Makaton, objects of reference and social story cards, and some residents who do not actually use it, have developed an interest in learning Makaton. The home is also using a traffic light system to support and develop healthy eating awareness. One of the care plans examined was not dated and it is suggested that all care plan documents are checked to ensure each is appropriately dated and signed. Residents are encouraged to take part in the daily routines of the home, though they can choose whether they wish to do this; and are encouraged to make choices, ask questions and raise any concerns they may have. This was observed to happen in practice during the inspection. Residents have decided they want the day-care room to be converted into a gym and games room and this had been done. Residents have also been involved in the recruitment process for prospective new staff, both within interviews and via informal group contact before and after the interviews, after which their views have been sought. Copies of a new screening tool to meet the Deprivation of Liberty guidelines from the Mental Capacity Act were also on file. The home is working towards the residents each having their own bank account and cash-point card, and having direct access to their personal allowance for the week. Some residents already have responsibility for Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 12 managing elements of their own money. One budgets and shops for his own meals a week at a time with staff support and prepares his own individual menu. Financial records in the form of individual cashbooks are maintained where the home handles residents’ monies and individuals sign for their funds when given to them. The six month action plans within the care plans have yet to be completed but the manager was intending to address this in the near future as residents attended their first six-monthly reviews which were beginning to take place. The Looked After Children (LAC) review for one resident under eighteen, took place on the day of the inspection, and he was supported to take a full part and contribute his views. Reviews had taken place after the initial six and twelve weeks of placement for the two residents whose files were examined and the resulting minutes were on file. Where necessary specific behaviour management plans are in place devised in consultation with in-house clinical psychology support, to provide a consistent response to particular behaviours or situations. Appropriate risk assessments were also in place, which also included specific guidelines for staff on how to address identified hazards to support and enable the activity to take place. Staff have received appropriate accredited training in managing behaviours, and specific minimal interventions are identified where relevant, to guide and support individuals and prevent injury. These and other relevant documents have signature sheets where staff sign to confirm they have read and understood the guidance. Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: Standards 12, 13, 15, 16 and 17: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have access to an appropriate range of social, educational and employment opportunities within and outside the home, to enable them to have a fulfilling lifestyle. Contact with friends and family is actively supported to maintain social and family networks. The rights and responsibilities of residents are respected and promoted in developing their skills and independence. Residents are provided with an appropriate and varied diet with an emphasis on healthy eating, and are encouraged to be involved in the planning and preparation of meals. Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 14 EVIDENCE: The care plans identify residents’ preferences with regard to activities and hobbies, and each has an individual weekly activity planner which is posted in the office. Some are regular and others more individual or occasional activities. Current activities include a lot of active pursuits, reflecting the younger age group of residents, such as swimming, gym, cycling, trampoline sessions, various clubs, day-trips to places such as Thorpe Park, as well as computer sessions and bible reading. The home has a computer available to residents with internet access, and some also have their own computers as well as TV and hi-fi in their bedroom. A small gym and games room with a pool table has also been set up in the day-care room at the request of the residents. One resident under eighteen years of age, attends school regularly, but for other under 18’s this will begin in September as new places are not available till then. The possibilities of supported employment are being explored for one resident who had a similar opportunity at a previous placement. As already noted each resident’s religion is noted within their care plan together with details of whether they wish to pursue worship. None of the current residents has expressed a wish to attend church, though one likes to read the bible, which is enabled as noted above. The home currently has one vehicle to support residents in accessing the community, but a second one will reportedly be available later in June. Some of the residents already have travel cards for the local buses and these will also be obtained for the newer residents. Work is under way to increase the level of community access by individuals, some with staff support and others possibly working towards unsupervised time in the community. A skills assessment is planned for one resident to support this. Three of the residents were away on a holiday at the time of inspection at Centre-parks, which they had chosen themselves. The home has a policy of not taking new residents away on holiday for the first six months of placement to ensure that staff know the resident well and how they may respond to being away from the home. Other residents have yet to reach this milestone but will be asked about holidays once they have settled in. The home has an open door visiting policy though visitors are encouraged to telephone first to ensure that the resident they are visiting will be in. All of the residents are able to use the telephone to make contact with friends and family, and each also has their own mobile phone. Staff support the residents to maintain contact with family and friends including ex-residents where appropriate. Some contact is also maintained with previous schools and placements. Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 15 Residents’ visits to family are supported and transport can be provided, where relatives may live remotely or have difficulty travelling to the home. Some relatives visit regularly and take residents out or collect them for home visits. Some residents will also write letters and staff also maintain regular contact with residents’ families. One resident uses an internet social networking site to contact friends and family. Residents are encouraged to take part in the daily routines and tasks in the home as part of developing their skills and independence, though some may be reluctant at times. Residents and staff are considering introducing a rota for domestic tasks to try to make sure each resident contributes appropriately. As noted above, one resident budgets his own weekly funds, prepares his menu and shops for this with support. He also prepares his own meals. The other residents become involved in breakfast and lunch on a daily basis and take turns to help with the evening meal. In the past the home had a shortage of drivers to support food shopping trips and had used online shopping, but now additional drivers have been recruited they have returned to bi-weekly food shopping to enable shopping skills to develop. The home has an open door policy for the kitchen and manages any issues through individual plans. A four week menu has been devised in consultation with the residents. The lunchtime meal observed during the inspection was healthy and well presented including salad which was popular with the residents present. Relationships between residents and staff were appropriate and relaxed with evidence of humour and banter. Residents were supported to make individual food and drink choices and also to eat together as a group. As mentioned earlier a traffic light system is operated to develop residents’ understanding of healthy eating with foods labelled according to their healthiness. The process is increasingly involving residents themselves in identifying and labelling appropriate items. Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported with due regard to their wishes and preferences so that their physical and healthcare needs are met. Though none of the residents is currently managing their own medication, the home has an appropriate system in place to do so on their behalf and the possibility of some residents taking on this responsibility in the future is under consideration. EVIDENCE: As noted already the individual care plans provide staff with information on residents’ needs and their preferences and wishes about how they are supported. Additional guidance is provided through risk assessments and behaviour management plans where appropriate; and the support of in-house psychologists and external professionals such as speech and language therapists has been sought where necessary to develop understanding of Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 17 individuals’ communication methods and enable certain behaviours to be managed consistently in an individualised way. Staff receive appropriate approved training on managing behaviours and specific approaches are agreed by the psychologist and written into management plans. Instances of identified behaviours and the use of approved intervention techniques are noted within critical incident forms which are analysed by the in-house psychologist, and also monitored by an external learning disability organisation. There are clear individual goals set and evidence of work towards these was seen on files and within reviews. The creative use of a social story cards to challenge inappropriate, and reinforce appropriate behaviours, is also noteworthy. Where it became clear that one resident’s emerging needs could not be met by the home, appropriate plans were made for a constructive move to an appropriate alternative placement. Any healthcare or dietary needs are recorded within the care plan, including a nut/dairy allergy. Records of healthcare appointments are maintained and where necessary there was individual guidance for staff on managing individual’s attendance at healthcare appointments. The Health Action Plans on individual files identify relevant healthcare issues and how these are being addressed. The home uses a proprietary monitored dosage system and maintains appropriate records of the medication it manages on behalf of residents, which provide an audit trail for the medication. A double signatory system is used wherever possible within staffing limits. Staff who administer medication receive training from an accredited external trainer plus an in-house oral/written assessment of competence and observation of practice. This is further supported by six-monthly review. Separate stock control sheets are maintained for any non-blister-packed medication. At present none of the residents manages their own medication but this is a goal being considered for some residents in the future, (subject to risk assessment), consistent with the aim of developing their independence. Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. Residents have access to an appropriate complaints procedure and are able to raise any concerns they might have. The home has an appropriate procedure in place to safeguard residents from abuse and has responded appropriately to incidents that have arisen. EVIDENCE: The home has an appropriate complaints procedure but at the time of inspection there was no complaints log in place to enable an easy overview of complaints over a period for monitoring purposes. Instead separate records were being maintained of each complaint, of which there had been four recorded in the previous twelve months. Records and feedback from the manager indicated that each had been appropriately investigated, and one investigation was ongoing. The manager should establish a collective log for complaints to record brief details of each complaint, the action taken and outcome, cross-referenced where appropriate to the detailed confidential records already in place of each issue and its investigation. All of the residents would be able to raise a concern with the manager or another staff member. Verbal feedback from residents was positive about the home and one of them confirmed their awareness of the complaints procedure during the inspection. Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 19 No complaints have been notified to the Commission for referral to the service, in the past twelve months. The home has an appropriate procedure for safeguarding vulnerable adults and three incidents had been reported as required under the procedure, in the last twelve months, though in the event, none was taken up as a safeguarding issue and the home addressed each matter appropriately. Residents’ funds are also appropriately safeguarded by the system in place to manage them on behalf of residents. No additional safeguarding issues have been brought to the attention of the Commission in the past twelve months. Staff receive training on safeguarding both adults and children reflecting the fact that the home currently has two residents who are under eighteen. Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 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. The home provides a safe comfortable and homely environment for the residents and is equipped and decorated appropriately for the age group of the residents. EVIDENCE: The home comprises two converted semi-detached bungalows which have been adapted to meet the needs of residents. All resident accommodation is on the ground floor, with eight single en-suite bedrooms provided. A variety of communal spaces are provided, including living and dining areas, a conservatory and a separate day-care room. The corridors and rooms are light and airy and furnished in a modern homely style to suit the younger age group of the residents. Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 21 The conservatory was very hot in the sun on the day of inspection and would benefit from being fitted with blinds to make it possible to maintain a more comfortable temperature. The bedrooms are of good size and are very much personalised by each resident. Seven have en-suite showers and one its own bathroom. The rooms are pleasantly decorated and include TV’s, games consoles, DVD players etc. belonging to the residents. Residents hold a key to their bedroom and are able to lock their rooms. No adaptations for physical disability are currently required but the facilities are all spacious and on the ground floor. The garden is also level and is provided with areas of lawn and level pathways, a trampoline and a covered outdoor area with a table-tennis table. In the garden is a separate day-care room which residents have chosen to have set up with exercise equipment and a pool table. Appropriate laundry facilities are provided for the residents who undertake their own laundry with any necessary support, and observed standards of hygiene were good. Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35: 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 are supported by a team of permanent staff who are for the most part appropriately trained for their role in order to meet the needs of the residents. Staff recruitment systems help to safeguard the residents. EVIDENCE: The home is staffed by a team of permanent staff plus in-house bank staff. The manager indicated that no agency staff are used. The usual shift pattern was reported to be four support workers on the early shift, and five on the late shift with a further day-care worker working across the two shifts. Night staffing is two waking night staff. Levels of NVQ are improving. Two staff have attained NVQ level 3 with a further two staff currently working towards this award. One staff has level2 with a further three working towards it. New staff all complete an in-house induction followed by foundation training. Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 23 Examination of a sample of staff recruitment records indicated that an appropriate recruitment and selection process is followed and evidence retained within orderly bound files. One staff member has a POVA first check but is awaiting full CRB clearance, and as a result does not work unsupervised with residents. Appropriate action was taken in response to an unsatisfactory CRB check in one case, previously. Residents have been involved in the recruitment process both within the interviews and during informal supervised contact within the home before and after interviews, after which their views have been sought. The manager forwarded a current training matrix for the staff team following the site visit. The record indicates that the majority of staff have received the required mandatory training within the last couple of years, though a few might benefit from updates of some training and some shortfalls were evident, around fire safety and medication training in particular. The manager clarified that additional staff were booked on courses for fire awareness (4 staff in July), medication (four staff in July), and that others would be put onto courses on a rolling programme throughout the year to bring everyone’s training up to date. Two staff who have yet to have child protection training were reported not to work alone with the residents who are under eighteen at present. Some staff have yet to receive the full SCIPr behaviour management training, but have been trained in the physical intervention elements of this, to ensure they are able to maintain the safety of themselves and others in the event of incidents. The home’s assistant manager is an accredited SCIP trainer and a second accredited trainer, based at the local head office, also provides this training. The manager should ensure that any remaining shortfalls in mandatory training are addressed within an appropriate period. Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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 run by an appropriately qualified and experienced manager in the interests of residents. The views of residents and others will be sought via a quality assurance survey in due course and the provider has undertaken regular monthly monitoring visits providing opportunities for residents to raise any concerns. The health, safety and welfare of residents are protected and promoted by the systems and checks in place. EVIDENCE: The manager has attained NVQ level 4 and has enrolled on the NVQ management course. She also maintains her current knowledge through ongoing attendance on training courses including behaviour management, the Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 25 Mental Capacity Act and safeguarding for adults and children. The manager also has nine years relevant experience. The home has been open since November 2008 so a quality assurance survey has yet to be undertaken, but the manager indicated this was due to be done in August, and would include surveys to staff, residents, relatives, care managers and external healthcare professionals. A summary report will also be produced and made available to participants. In the interim, the home’s compliments book contains cards and letters expressing positive feedback about the home. Regular monthly monitoring visits have taken place monthly since the home opened, and the reports contain details of feedback from the residents. The manager confirmed that an annual development plan for the home would be produced following the quality assurance survey. Examination of a sample of health and safety-related service certification indicates that servicing and other checks have been undertaken regularly. The home’s fire risk assessment was revised in January 2009 and four fire drills had taken place in 2009. Accident forms are held collectively with monthly statistics provided to head office; and the manager plans to establish an individual log of accidents within residents’ files. Rowan Cottage DS0000073098.V376032.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 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 2 36 X 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 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Version 5.2 Page 27 Rowan Cottage DS0000073098.V376032.R01.S.doc Are there any outstanding requirements from the last inspection? N/A 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 Refer to Standard YA22 Good Practice Recommendations The manager should establish a complaints log in which to record brief details of any complaints made about the service, in order to enable the level of complaints to be readily monitored. The manager should ensure that any remaining shortfalls in mandatory training are addressed promptly, in order to ensure that all staff are equipped with the necessary training to meet the full range of needs of residents. 2 YA35 Rowan Cottage DS0000073098.V376032.R01.S.doc Version 5.2 Page 28 Care Quality Commission South East Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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