Care Home: Rowan House

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What the care home does well The home provides care and support to enable residents to live meaningful lives and staff supports them in their day-to-day lives and they are treated equally as individuals and with dignity and respect. There is a thorough needs assessment carried out before any resident moves into the home and there is an effective care planning system in place. Meals in the home are good and offer a choice at meal times and there is a varied diet with fresh fruit available at all times. Residents are offered choice as much as possible and are encouraged to make their own decisions about how they spend their time. What has improved since the last inspection? What the care home could do better: There were no requirements or recommendations made as a result of this visit, however some other points, which need to be addressed to help improve the service provided for service users are contained within the main body of the report, general observations were: Review notes in care plans did not always provide information on how the care plans were working. Review notes seen had very little information and they would benefit from more information and evaluation on how the care plan has been working and should provide information on progress or lack of it as the case may be. Whilst touring the home we observed that the home was clean and tidy, however one bedroom had a slight odour that the home needs to address quickly to avoid this becoming a problem. CARE HOMES FOR OLDER PEOPLE Rowan House 9 Darwin Road Shirley Southampton Hampshire SO15 5BS Lead Inspector Mick Gough Unannounced Inspection 23rd June 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rowan House Address 9 Darwin Road Shirley Southampton Hampshire SO15 5BS 023 8022 5238 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) angehurley@gmail.com Mrs A Hurley Mr R Hurley Mrs A Hurley Care Home 16 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (16), Mental disorder, excluding learning of places disability or dementia (3), Mental Disorder, excluding learning disability or dementia - over 65 years of age (16), Old age, not falling within any other category (16) Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A total of 3 service users in the categories (DE) and (MD) may be admitted at any one time between 55-64 years of age. 19th December 2007 Date of last inspection Brief Description of the Service: Rowan House is a large three-storey older style house situated in a residential area of Southampton. The service is registered to provide personal care to 16 people in the older person, dementia and mental disorder categories. Up to three people can be accommodated from 55 years of age with mental health problems. Accommodation is provided on the ground and first floor of the property with a shaft lift that allows access to the first floor. Mrs Hurley is the registered manager. The home has seven shared rooms and two single rooms, none of the rooms have en suite facilities. They are all fitted with wash hand basins. The home has a kitchen, dining room/lounge on the ground floor and all of these rooms are accessible to people. There is a small garden at the rear of the service. The current fee charge is £340-£430 per week, this depends on the type and level of support required. Further information regarding fees can be obtained by contacting the home directly. Rowan House DS0000011873.V366814.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 report details the evaluation of the quality of the service provided at Rowan House and takes into account the accumulated evidence of the activity at the home since the last inspection, which was carried out in December 2007. The inspection took into account the home’s Annual Quality Assurance Assessment (AQAA), which was returned prior to the visit. Comment cards were sent out to residents and staff but unfortunately at the time of writing this report no responses had been received. Included in the inspection was an unannounced site visit to the home, which took place on the 30 June 2008. Further evidence for this report was obtained by touring the home, reading and inspecting records and by observing the interaction between staff and residents. It was also possible to speak with 3 members of staff, 6 residents, 1 visitor to the home and the homes manager who assisted the inspector throughout the visit. The home is registered to provide support for 16 residents and at the time of the inspection there were only 12 residents accommodated at the home. What the service does well: What has improved since the last inspection? Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 6 Since the last inspection a great deal of work has been carried out on the internal decoration: • New carpets have been fitted throughout. • New double-glazing has been installed. • New sinks have been fitted in bedrooms. • New bedroom furniture has been provided for residents. • New curtains have been purchased. Requirements made at the last visit to the home have been complied with and the home now has clear policies and procedures for the receipt storage and administration of medicines and a new controlled drugs cupboard has been purchased. 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 DS0000011873.V366814.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. No one moves into the home without having his or her needs assessed. The home does not provide intermediate care. EVIDENCE: The home carries out an individual needs assessment prior to residents moving into the home and there is a clear admission process. Assessments were on file at the home and were looked at for the 2 users of the service who were case tracked. Assessments were made using a needs assessment form and residents were visited by the homes manager or a senior carer before they moved into the home. Care management assessments were also on file. We were told that the initial assessment forms the basis of the residents plan of care and the completed AQAA told us that a thorough assessment takes place and that the prospective resident, their family, friends and social worker are all involved in the assessment process. Intermediate care is not provided at the home. Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal and social care needs are set out in a plan of care and staff have the information they need to provide the support that residents need and in the way they prefer. Risk assessments in care plans provide clear information for staff on how identified risks can be minimised. The home has a satisfactory system for storing and administering medication and the health care needs of residents are met and they are treated with dignity and respect. EVIDENCE: Care plans were inspected for 2 residents and these had information on: Time of going to bed and getting up, personal history, relationships, social contacts, behaviour, diagnosis, washing, dressing, undressing, bathing, shaving, hair care, continence, general appearance, finances, oral hygiene, foot care, daily routine, night time routine, likes and dislikes, diet and food preferences. Care plans were simple and easy to follow and gave staff clear guidance on how care should be delivered. Daily recording takes place to provide details of care Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 10 delivery and care plans were reviewed monthly, however, review notes did not always provide information on how the care plans were working. Review notes seen had very little information and they would benefit from more information and evaluation on how the care plan has been working and should provide information on progress of lack of it as the case may be. Care plans seen had risk assessments in place and provided information on the identified risk and also gave staff information on how any risk could be minimised. Residents at the home are registered with different GP surgeries and they may keep their own GP if possible. District nurse services are provided and a Community Psychiatric Nurse from a local hospital is available for advice and also calls into the home on a regular basis. Dentists are arranged through a local NHS dentist in the community and a visiting optician service calls at the home. The home has a visiting chiropodist who calls on a regular basis. Residents spoken with said that they were well treated at the home and we spoke to a visitor to the home who said her mother was well cared for. The completed AQAA told us that residents’ health care needs were met and that individual plans of care ensured that residents are well looked after. Medication procedures at the home have been reviewed and all staff who are authorised to administer medication receive appropriate training. We were informed that the medication policy and procedure has been reviewed and rewritten and we looked at this and found it to be in order. The home uses a monitored dose system provided by a local pharmacist and there are clear routines in place for the receipt storage and disposal of medication. Medication administration records were checked and these were in order with no gaps. Controlled drugs were stored appropriately and there was a controlled drugs book, which kept accurate records of medication administered and also contained 2 signatures. Staff were observed interacting with residents appropriately and they were seen to treat them with dignity and respect. Staff were heard to use residents preferred form of address when talking to them and staff were seen to knock on residents doors before entering. It was clear from observing staff supporting residents that they got on well together and there was a pleasant atmosphere in the home. Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a range of activities for residents, which meet their expectations and the religious and recreational interests of residents at the home are provided for. Residents are able to maintain contact with family and friends and visitors are welcome at any time. Residents are supported to exercise choice and control over their lives as much as possible and they are provided with a balanced diet in pleasant surroundings at time convenient to them. EVIDENCE: The home employs an activities co-ordinator who works between 2-6pm Monday to Friday and she organises a range of different activities for residents, these include; board games, skittles, jigsaws, memory games, knitting, crosswords, manicures, and gentle exercise. Activities take place the afternoons and residents appeared satisfied with the activities provided. Church services are held at the home every 2 months and 1 resident goes to church every Sunday. The homes completed AQAA told us that residents enjoyed the activities provided and that the majority of residents take part. Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 12 The home has a clear visitors policy and there are no set times, visitors are asked to sign in at the home and the visitors book is kept in the hallway. We had the opportunity to speak with a visitor to the home who told us that she visits 3 or 4 times a week and that she is always made welcome and there are never any restrictions on visiting. Residents were observed to be free to choose where and how they spent their time and there were no restrictions imposed upon them. We observed staff supporting residents and they were able to make informed choices and are able to control their own lives as much as possible. A tour of the home showed us that a number of residents had bought some of their own personal possessions into the home and rooms had been personalised. The home operates a three-week rolling menu and residents told us that they were very happy with the food provided by the home. Residents are offered a choice at meal times and staff informs residents what is on each day and this is also displayed on a blackboard in the dining room. Residents are encouraged to eat their meals in the dining room but may eat elsewhere if they prefer. Lunch on the day of the inspection was “toad in the hole”, but one resident had fish. Breakfast was flexible and ran from 0630 until the last resident was up and about. Breakfast was normally a choice of cereals, toast, or fresh fruit and the main meal of the day was at lunchtime. The evening meal was a snack type meal but we were told that the kitchen is always open and staff will make residents a drink or snack at any time. We observed lunch being taken in the dining room and meals were unhurried and staff provided suitable support for residents if needed. Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a simple, clear and accessible complaints procedure, which includes timescales for the process and any complaints are logged and responded to appropriately. The homes policies and procedures protect residents from any form of abuse. EVIDENCE: The home has a clear complaints procedure, which contains all of the required information and there is a complains log where any complaints made to the home are recorded, together with the actions taken to investigate the complaint and gave information on the homes response. Residents told us that were confident about raising any concerns they may have. Staff members spoken to were aware of the complaints procedure and said that they would support anyone to make a complaint if they wished to do so. The homes completed AQAA told us that there had been no complaints made since the last inspection and the manager confirmed this when we visited. Staff receive training on adult protection and the home has a whistle blowing policy and also a copy of the Hampshire Adult Protection procedure. Staff spoken to were aware of their responsibilities in this area and knew what to do should they suspect any form of abuse had taken place. We also spoke with the manager and she was aware of her responsibilities in this area. Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe and well-maintained environment and have access to comfortable indoor and outdoor facilities, they are provided with the specialist equipment they require and the home was clean, pleasant and hygienic and generally free from offensive odours. EVIDENCE: We conducted a tour of the building and this included all communal areas of the home including bathrooms, toilets and lounges, the kitchen and some bedrooms were also seen. All areas of the home were clean and tidy and furniture was in a good state of repair. A great deal of work has been carried out in the home to improve the appearance and fabric of the home. Improvements have been made since the last inspection and items of furniture and carpets have been replaced and double-glazing has been fitted. The lounge area was pleasantly arranged with 3 different sitting areas each with a TV. Residents told us that they liked living at the home and that it always looked nice. Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 15 Infection control procedures were observed to be followed and the laundry at the home contains 2 washing machines and a tumble drier. Care staff at the home carry out laundry tasks and they told us that suitable protective equipment is provided. The home was clean pleasant, however one bedroom had a slight odour that the home needs to address. Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing numbers and the mix of staff currently meets the needs of residents. Staff morale was good and there was a good rapport between residents and staff. Residents are protected by the homes recruitment procedures and the home provides training for staff to enable staff to support people effectively. EVIDENCE: The homes staff rota was examined and this showed that the home provides 3 members of staff on duty between 8am to 8pm and between 8pm and 8am there is 1 staff member awake and 1 staff member who sleeps in. The manager who lives in a flat above the home is around the home every day and she is in addition to the care staff. There home has a handyman who works 2 days per week and an activities co-ordinator who works 2pm to 6pm Monday to Friday. Staffing numbers were discussed with the homes manager and we were told that at present she felt that staffing levels were sufficient. However she will continue to monitor staffing levels based on residents needs. The home employs a total of 14 staff, and of these 11 already hold or are working to achieve National Vocational Qualifications. The home has policies and procedures in place with regard to recruitment and staff recruitment records were inspected for 2 staff members. Records seen for both staff members included: application form, refs x 2, CRB & POVA check, Photo, medical questionnaire and birth certificate. Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 17 We discussed staff training with the manager and she stated that there is a clear induction procedure for new staff. Mandatory training is carried out in adult protection, fire safety, moving and handling, first aid and dementia training. Additional training is carried out in infection control, personal care, continence management mobility and nutrition. Staff training records were inspected and these were kept in individual staff files, those seen showed that staff were provided with the training required to enable them to support service users effectively. Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements in place at the home are satisfactory and the home operated in the best interests of residents. Quality assurance procedures are in place and service users financial interests are protected by the homes policies and procedures and the health, safety and welfare of residents and staff are protected by the arrangements in the home. EVIDENCE: The management arrangements in place at the home are satisfactory and the manager has been running the home for some considerable time. She has updated her skills and has recently completed a course in “business skills in care”. Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 19 The homes manager stated that satisfaction surveys have been sent out to residents, relatives, GP surgeries, district nurses and a number of replies have been returned and these are currently being collated. She told us that all responses to surveys had been positive. She stated that she intends to undertake regular quality control audits. Financial arrangements in the home remain unchanged from previous inspections and the manager is appointee for one resident and holds personal spending money for some other residents. There are clear records of all transactions and these provide a good audit trail. Health and Safety policies are in place and available to all staff members and staff have undertaken training in health and safety. The homes completed AQAA told us that regular testing of equipment takes place and we saw records that the fire equipment was last tested in December 2007, the passenger lift was tested in June 2008, the fixed wiring was inspected in November 2007 and a new boiler was fitted in September 2007. The fire log was inspected and all relevant training and testing is carried out within the specified timescales. All residents and staff spoken to were happy with the health and safety arrangements in the home. Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 21 No Are there any outstanding requirements from the last inspection? 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. Refer to Standard Good Practice Recommendations Rowan House DS0000011873.V366814.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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