Care Home: Rowan House

What the care home does well The people living in the home benefit from a service that has experience in supporting people who have enduring mental health issues and offers a professional and supportive environment for them to live. One relative said in the survey, "this is a very good home and my son is very happy and well looked after". Another relative said, "the home is kept very clean and tidy. My relative is well cared for, the food is healthy and social activities are organised". The residents all benefit from a comprehensive assessment and individual care plans that are regularly reviewed. These enable each persons individual needs to be met. Each resident is supported by a key worker. One member of staff said in the survey, "we have good information about the needs of the residents through effective communication" within the service.The home has good working links with health care professionals including the mental health service that enables the people living in the home to be supported with their healthcare issues. The home welcomes relatives and other friends and supports residents to maintain relationships. The people living in the home all feel able and comfortable to express their views on how the home is working and anything they need or want to happen. The residents are very satisfied with the home and one resident said in his survey, "the staff are very co-operative and encouraging". The home operates professional policies and procedures including those relating to staff recruitment and management, health and safety and medication. These help to safeguard the residents. The homes are well located to enable the people living in the service to access local shops and other amenities. What has improved since the last inspection? Since the last key inspection in June 2007 the home has made significant progress in a number of areas. A new statement of purpose has been prepared providing essential information about the homes. New residents moving into the home have all had comprehensive assessments and the staff are well informed about their individual needs. Each resident now has a contract between themselves and the home, so they know what the home will provide. The residents now sign their care plans and understand their content. They also all have individual risk assessments. The residents are encouraged to develop their independent living skills and to maintain good standards of personal care. The people living in the home have also been encouraged to access a range of community-based activities. The residents have been supported to access healthcare input to ensure their health needs were met. A proper record of medication being administered in the home has been kept so there is a full audit trail for all the medication to ensure it is all accounted for. The residents are being supported appropriately with their personal monies. The physical environment in both homes has improved. A new games room with a pool table and other games has been provided at Rowan House. In terms of staffing, all staff have full recruitment checks in place to safeguard the residents. They have all completed a full induction and are having regular supervision. An ongoing programme of staff training is in place.To ensure safety in the homes, fire safety risk assessments are in place and weekly fire alarm checks are taking place. In order to maintain standards the home has also developed systems of quality assurance that include seeking the views of residents and other stakeholders. CARE HOME ADULTS 18-65 Rowan House 23 Galliard Road & 56 Bury Street Edmonton London N9 7NY Lead Inspector Jane Ray Unannounced Inspection 17th June 2008 9:45 Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rowan House Address 23 Galliard Road & 56 Bury Street Edmonton London N9 7NY 020 8804 4398 020 8350 4213 sanjeev@conniferscare.co.uk 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) Connifers Care Limited Tahen Seechurn Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users. Limited to 9 adults of either gender with a mental disorder not to exceed 6 accommodated at 23 Galliard Road, Edmonton, London, N9 7NY and 3 accommodated at 56 Bury Street, Edmonton, London, N9 7JY. 27th November 2007 Date of last inspection Brief Description of the Service: Rowan House is a privately owned care home for adults who have continuing mental health problems. The home is registered to provide care for nine adults between 18 and 65 years. The care provider is Conifers Care Ltd, which is a limited company. The company also manages four other registered homes in the locality. The responsible person is Mr Sanjeev Soobdhan and the registered manager is Mr Tahen Seechurn. The company has three partners who are all qualified mental health nurses and have extensive management experience. The service comprises of two separate houses that are a few minutes walk apart. The main home is located at Galliard Road and is called Rowan House. This service accommodates five residents. Bury Street is where four other people reside and this home is called Beech House. This arrangement was approved when the home was originally registered. The home is situated in Edmonton, North London and is near to shops and other amenities. There are good public transport links to the home. The stated aim of the service is to offer care and rehabilitation in a supportive and friendly environment for people recovering from mental health problems. To work towards meeting service user needs by encouraging user involvement in exercising choice and independence whilst building on key daily skills in enabling progress towards independent living in the community. At the time of the inspection there were nine people living in the service. The current range of fees in the home is from £600 - £1600 a week. A copy of this report can be obtained direct from the provider or via the CSCI website (web address can be found at page two of this report). Rowan House DS0000069134.V365903.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. The inspection took place on the 17 June 2008 and was unannounced. The inspection lasted for six hours and was the key annual inspection. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. The inspector was able to observe the support given to eight of the current residents and also spend time talking to them. The inspector was also able to spend time talking to the manager, the two deputy managers as well as the two care staff who were working. The inspector did a tour of the premises and also looked at a range of records including resident records, staff files and health and safety documentation. The home had provided the inspector with a completed self-assessment questionnaire (AQAA) prior to the inspection. The inspector also received seventeen completed surveys completed by 7 residents, 8 staff members, 1 relative and 1 care professional. The service also had a random inspection that took place on the 27th November 2007 and the outcome of this inspection are referred to in this report. What the service does well: The people living in the home benefit from a service that has experience in supporting people who have enduring mental health issues and offers a professional and supportive environment for them to live. One relative said in the survey, “this is a very good home and my son is very happy and well looked after”. Another relative said, “the home is kept very clean and tidy. My relative is well cared for, the food is healthy and social activities are organised”. The residents all benefit from a comprehensive assessment and individual care plans that are regularly reviewed. These enable each persons individual needs to be met. Each resident is supported by a key worker. One member of staff said in the survey, “we have good information about the needs of the residents through effective communication” within the service. Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 6 The home has good working links with health care professionals including the mental health service that enables the people living in the home to be supported with their healthcare issues. The home welcomes relatives and other friends and supports residents to maintain relationships. The people living in the home all feel able and comfortable to express their views on how the home is working and anything they need or want to happen. The residents are very satisfied with the home and one resident said in his survey, “the staff are very co-operative and encouraging”. The home operates professional policies and procedures including those relating to staff recruitment and management, health and safety and medication. These help to safeguard the residents. The homes are well located to enable the people living in the service to access local shops and other amenities. What has improved since the last inspection? Since the last key inspection in June 2007 the home has made significant progress in a number of areas. A new statement of purpose has been prepared providing essential information about the homes. New residents moving into the home have all had comprehensive assessments and the staff are well informed about their individual needs. Each resident now has a contract between themselves and the home, so they know what the home will provide. The residents now sign their care plans and understand their content. They also all have individual risk assessments. The residents are encouraged to develop their independent living skills and to maintain good standards of personal care. The people living in the home have also been encouraged to access a range of community-based activities. The residents have been supported to access healthcare input to ensure their health needs were met. A proper record of medication being administered in the home has been kept so there is a full audit trail for all the medication to ensure it is all accounted for. The residents are being supported appropriately with their personal monies. The physical environment in both homes has improved. A new games room with a pool table and other games has been provided at Rowan House. In terms of staffing, all staff have full recruitment checks in place to safeguard the residents. They have all completed a full induction and are having regular supervision. An ongoing programme of staff training is in place. Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 7 To ensure safety in the homes, fire safety risk assessments are in place and weekly fire alarm checks are taking place. In order to maintain standards the home has also developed systems of quality assurance that include seeking the views of residents and other stakeholders. What they could do better: 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. Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3,4 and 5 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that their individual needs will be assessed and that the staff have the skills and ability to meet these needs. New people moving to the service will have access to information in an appropriate format to tell them about the home. Contracts between the home and the resident are in place and so there is clarity about what the homes will provide. EVIDENCE: The service has now prepared an updated statement of purpose and this was inspected. This document is accurate but rather lengthy and it would benefit from being made easier to read. The home provides prospective and new residents with a “welcome pack” to give them information about the service. This includes information on their terms and conditions, the drug and alcohol policy, the smoking policy, the complaints procedure, equal opportunities procedure, health and safety information and information about local Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 10 resources. Residents mentioned this pack in their survey responses. It was also observed that each resident has a copy of the pack in their bedroom. We looked at the assessments for two residents at Bury Street and two residents at Galliard Road. The residents at Galliard Road have assessments provided by care professionals as part of their admission and an assessment has been prepared by the home. The residents at Bury Street who have been in the service for many years have more up to date information provided by care professionals through review meetings as well as an assessment provided by the home. The care provider has prepared a contract document between the home and the resident stating what the home will provide. Four contracts were read and included a fee as well as being appropriately signed. The AQAA prepared by the home refers to the admission process and says, “we will facilitate an overnight stay if necessary and a phased admission process if needed. Relatives are also encouraged to visit as part of the decision making process”. No new residents have moved into the home since the random inspection and the home is fully occupied. The current needs of the people who live in the home were discussed with the manager and care staff. They have very specific individual needs linked to their mental health and in some cases issues of substance abuse. The staff spoken to had a very good understanding of the individual needs of the residents. In addition it was observed that the staff were supporting the residents with great skill and sensitivity. The staff were observed encouraging and supporting the residents to access the specialist services available to them. The residents also feel very much at home and have a positive relationship with the staff team. Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7,8 and 9 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home can be confident that they will be supported to have an individual care plan and risk assessments. This will facilitate the residents to make choices in their daily lives. EVIDENCE: We inspected care plans for four people currently living in the service. We also spoke to the manager and care staff about the care plans. All of the people whose records were inspected had comprehensive care plans in place. These were clearly laid out and covered all aspects of each persons needs and were written using appropriate language. The care plans had all been reviewed on a six monthly basis by the key-worker. All of the residents had been supported to have a CPA meeting or an annual care plan review meeting with their care Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 12 manager. All of the residents had signed their care plans and one person said that he knew he had a care plan and had discussed it with his key-worker. From discussions with residents it was observed that residents knew of their care plans but did not look at them regularly. There is scope for the care plans to gradually become more accessible and meaningful for the residents. Each resident had a named key worker. The staff were asked about their role as a key-worker and this showed that the support they provided was very comprehensive including helping to organise activities, attending healthcare appointments, ensuring all the residents needs were met, meeting on a monthly basis for a key-worker session and updating care plans. The staff spoken to said, that they felt they were well matched as key-workers and had a good relationship with the resident. We read the risk assessments for the same four people who live in the service. It was possible to see that an effort had been made to identify areas of personal risk and look at how this can be managed without placing unnecessary restrictions on people. The risk assessments had been prepared using one main format that was clear and easy to follow. Each person living in the home had individual behavioural guidelines as part of their assessment, care plan and risk assessments and these were clearly written and gave appropriate guidance to the staff. One member of staff was able to discuss how she would diffuse a situation where a resident becomes upset and potentially aggressive. We observed the people living in the home and their interaction with each other and the staff. It was positive to note that they felt very comfortable making decisions about what they wanted to do and able to ask the staff for support where this was needed. The staff were also very aware of consulting the residents about all aspects of their daily lives. One resident was able to talk about how he had been encouraged to decide how he wanted to celebrate his birthday. The arrangements to support the people living in the home to manage their own finances were recorded in all of the care plans that were viewed. Since the last key inspection the manager has ensured all the residents have received their outstanding DSS benefits. The manager told the inspector that none of the residents has an advocate but a number have relatives who help them to express their views. The records of residents meetings were viewed and these had taken place each month in both homes. The people we spoke to in both homes said they found the staff very helpful and one person said that if anything is agreed at the residents meeting, the staff try hard to implement the suggestions. He said Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 13 that at the moment they are arranging a football game in the park opposite the home. Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 14 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): Standards 11,12,13,14,15,16 and 17 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the homes are supported to develop their daily living skills and are also enabled to follow their own routine. The home has made progress in supporting the residents to enjoy a range of activities based on their individual interests. Residents are offered a healthy, varied and culturally appropriate diet. EVIDENCE: The people living in the homes were observed to be continuing to assist with domestic activities in the home such as cooking and cleaning. The staff and the residents all talked about how the residents were developing their independent living skills. Everyone is encouraged to help with cleaning their bedrooms. Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 15 Several enjoy assisting with the food preparation and there are cooking rotas in place to encourage everyone to participate. The residents were observed preparing themselves drinks, snacks and breakfast. The residents do different things during the day. One person attends a supported employment service and a day service. Others enjoy shopping and seeing friends. One person at Galliard Road said that he had bought a bike and goes cycling. He also said he is looking into going for music lessons. Another resident wrote in his survey about how the staff encouraged him to keep up his writing and offered him access to the computer in the home. It was observed that all the residents were leading an active lifestyle. Six of the nine people living in the services are Afro-Caribbean and choose to enjoy their culture in a number of ways. The staff said that two of the men occasionally like to go to church. Their dietary preferences are reflected in the menu choices. Their choice of hair care and music also reflects their culture. The current service users all have regular contact with their relatives and have arrangements in place to see them. Relatives are welcome to visit the home and residents also go to see them. Relationships are also respected. At the time of the inspection one of the residents had gone to visit his partner for four days. It was also observed that some of the residents had formed friendships with each other and socialize together. Since the last inspection a pool table and other games have been provided at Rowan House. One evening a week the residents from the other homes in the organisation are invited to the home for a social event. Several residents commented on how much they enjoy these evenings. The staff also explained that they are planning a day trip out during the summer. One resident is going to Spain with his relatives for a holiday. The people living in both homes said that whilst staff ensured they took their medication at the correct time and maintained a routine, they did have flexibility around the times they went to bed or got up. At Rowan House we were able to observe people getting up at different times and spending time in their rooms if they wanted to do so. One resident talked about how they have a key to their rooms and the front door. The staff explained that only two residents need staff support to go out and everyone else is independent. The staff in both homes explained that each week the people living in the homes choose the food for the week ahead from a list of healthy meals. It was observed that there was fresh food available in the homes. One resident said that he was vegetarian and cooks for himself. He said there is always suitable food available to ensure he eats a healthy diet. One resident who has been very reluctant to eat meals is offered regular healthy snacks and is managing to maintain a healthy weight. Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported in a manner that protects their privacy and dignity. Each person is supported to access professional healthcare input based on their individual needs. The medication administration records are accurate and this ensures the residents take the correct medication. EVIDENCE: We observed during the inspection that the residents attend to their own personal care, but where some prompting is needed this takes place in a sensitive and encouraging manner. I also observed that the residents were all dressed in an appropriate manner. We looked at the healthcare records for four of the people living in the homes. Everyone was registered with the GP and had regular health checks. Everyone Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 17 had been encouraged to visit the dentist and optician and where the resident had refused this was recorded. All the residents had input from the local mental health care professionals. The staff understand the importance of monitoring each persons mental health and contacting the care professionals if there are any issues to address. The residents have been supported to check their weight and blood pressure on a monthly basis. We looked at the medication, administration records and staff training records. The home uses a blister pack system. The medication is stored in a medication cupboard in the office in both the homes. Air coolers have been introduced in both these rooms to ensure the medication is kept at a suitable temperature. The medication administration records record when all the medication is delivered to the home and returned to the pharmacy so a clear audit trail is available. Each resident had a profile and these appeared accurate and reflected the medication on the medication administration record. It was however noted that one resident had run out of a nasal spray prescribed for hay fever. None of the residents self-administers their medication. None of the residents has been prescribed a controlled drug. Each resident also has a list of homely remedies they can take and this has been approved with the GP. Where “as required” medication is used there are guidelines stating when this should be administered. The training records were inspected and all of the staff had completed the medication training. Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home have access to an appropriate complaints procedure. Procedures and training on safeguarding vulnerable adults are in place to protect the residents. Systems have been implemented to ensure residents personal monies are being managed appropriately. EVIDENCE: I looked at the complaints procedure and this was clearly displayed in both houses. The complaints procedure is also available in the information pack given to each of the residents. The AQAA stated that there have been no written complaints since the last inspection. The surveys completed by the residents and relatives said they would know how to make a complaint. One resident in the survey said, “I know how to make a complaint but I don’t need to”. Another resident said, “I would speak to the manager and my keyworker”. A member of staff spoken to during the inspection was familiar with the complaints procedure. There have been no adult protection issues since the last inspection. Copies of the organisations procedures and social service procedures are available in the home. We looked at the staff training records and these show that all of the staff had received safeguarding vulnerable adult training and further dates are booked for refresher training. Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 19 We spoke to the care staff about the safeguarding adults procedure and they all displayed a good knowledge of the procedures and the importance of speaking to the manager about issues that arise. We also looked at the training records to see if the staff had been trained on how to appropriately support people who have complex challenging behaviours. These show that all of the staff have received this training and from discussions with staff and reading the risk assessments they feel prepared to cope appropriately with challenging situations as they arise. We saw the record for two of the people living in each of the homes relating to their personal finances. The residents have a number of different arrangements in place according to their ability to manage their own finances and agreements reached with placing authorities about the management of monies. The residents all have their own building society or post office account. Most of the residents place their cash with the home for safekeeping and then take their money on a weekly or daily basis. The records show their cash deposited with the home and they sign when they take their money. One resident at Rowan House needs more support from the staff and receipts are kept of individual purchases. It was hard to link up the receipts with this persons’ record of expenditure and it is recommended that the receipts are numbered. Another resident at Rowan House is not receiving his income support and his balance is reducing. The manager explained that this has been discussed with his care manager who is resolving the matter. Progress with this issue needs to be chased up. Rowan House DS0000069134.V365903.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24,28 and 30 were inspected. Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. People living in the home benefit from a comfortable and homely environment, which is maintained to a high standard. EVIDENCE: The service consists of two houses at Galliard Road and Bury Street. The provider has refurbished both homes and this has included new furnishings and fittings. Both environments are clean, bright, safe and comfortable. The shopping centre at Edmonton is a short distance away and there are corner shops available very close to the homes. The bedrooms in both homes are single and appropriately furnished. We were shown one bedroom by a resident and this had been personalized to reflect his individual taste. Bathrooms and shower rooms are easily accessible from all Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 21 the bedrooms. Each home has adequate communal space consisting of a kitchen, dining area and lounge. Designated smoking areas are provided. Each home also has a small, enclosed garden. The homes were both clean and tidy. Both were also well maintained and we saw a record of items for repair and that these were addressed in a timely manner. Rowan House DS0000069134.V365903.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,33,34,35 and 36 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents are supported by a committed and stable team of staff. Recruitment of staff has not yet been completed to ensure there are adequate numbers of staff available. The staff are receiving a range of training and are supported by regular supervision sessions. This enables them to work to a high standard and deliver good care. EVIDENCE: We checked the rota for the home and this showed that there is a team of seven staff working at Rowan House and three staff at Beech House. The organisation also operates an internal bank system. The staffing structure across the two homes consists of the manager, two deputies, two senior carers and a team of carers. During the day at Rowan House there are two staff on duty and at night there is one waking member of staff. At Beech House there are one or two staff working during the day and one waking night staff. The manager is shown as being supernumerary on the rota. The staff turnover has Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 23 been low and most of the staff spoken to during the inspection had worked in the service for over a year. The manager explained that recruitment has been taking place on an ongoing basis, but finding the correct staff remains a challenge. Looking at the staff rotas for Rowan and Beech House, it could be seen that some staff are working around 50 hours a week. This could result in staff becoming tired and not working effectively. It is recommended that ongoing recruitment should remain a high priority. The manager and care staff explained that staff team meetings take place on a monthly basis. The record of these meetings was inspected and it could be seen that they discuss a range of operational issues. The staff spoken to said, that the team felt it was getting clear direction from the manager and that communication was good. The AQAA prepared by the home stated that all the staff who do not have another qualification have completed an NVQ level 2 and some are now working towards a level 3 and one is studying towards a level 4. We looked at the recruitment records for staff who had started working at the home since the previous inspection. It was found that all the staff had two references, ID, POVA check and a CRB disclosure. The staff had completed and signed contracts of employment. We inspected the training records. We looked at the induction records for all the staff and they all had completed the skills for care induction programme and a record was available. Each member of staff had an individual training record. An ongoing programme of training had been booked till the end of the year covering mandatory training as well as specific training to support staff to work effectively with the residents they support. The staff said that the training they had received was a good standard and very useful for their work. A number of the surveys completed by the staff spoke very positively about the training they receive. We looked at the supervision records. All the staff had received regular individual supervision. The format used for supervision is appropriate and includes a record of any action agreed. Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39 and 42 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A residents benefit from a permanent manager who can provide effective leadership in the home. Health and safety measures are in place to safeguard the people living in the home. A comprehensive system of quality assurance helps to maintain and improve standards in the home. EVIDENCE: The service has a registered manager. The manager is a qualified nurse and has completed a BSc in Business Management and an MBA in strategic management. In line with advice from Skills for Care, the manager needs to contact an accredited NVQ training organisation to see if this previous training Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 25 covers all aspects of the RMA qualification. It was observed that there was very open communication between the manager, the residents and the staff team. One relative in the survey said, “I have always found the manager extremely helpful in terms of information concerning my relative and his needs”. The manager explained that a quality assurance system is in place including audits that take place where managers visit each other’s services. We looked at the records of both these audits and they are very comprehensive. The company has questionnaires to seek the views of residents, relatives and other care professionals as part of a quality improvement exercise and these have been completed. The feedback was inspected and was very positive. In terms of fire safety we looked at the fire safety risk assessment and emergency plan and this was complete. The fire alarm and fire extinguishers had been serviced. The fire alarm records show the alarm is checked weekly and the fire drills have been taking place monthly. The manager explained that fire safety training has been completed for the whole staff team. The AQAA showed that all the health and safety maintenance checks had taken place. Rowan House has had a new boiler fitted since the last inspection. The staff training records show that staff have completed all the health and safety training including food hygiene, first aid and infection control. Rowan House DS0000069134.V365903.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 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 x 26 x 27 x 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 4 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 4 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 2 x 3 x 4 x x 3 x Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement The registered person must ensure medication is managed effectively and that medication does not run out. Timescale for action 15/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA6 YA23 YA33 YA37 Good Practice Recommendations The registered person should continue to work towards making the care plans meaningful and accessible for the residents. The resident person should number receipts where they are kept for a resident to make the records well organised. The registered person should continue to keep recruitment as a high priority. The registered manager should contact a NVQ training provider to ensure that the previous management training covers all aspects of the registered managers award (RMA). Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 28 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 Rowan House DS0000069134.V365903.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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