Care Home: Rowan - Innova House CLD

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What the care home does well They are very good at helping people settle into the home and get lots of information to help them understand what they need to do.They make sure staff get the training they need to help people. They make sure they do the proper checks on people before they start working with them. The home is looked after well and furnished in a homely way. What has improved since the last inspection? They have started recording the temperature of the fridge and freezer to make sure food is kept safely. They now have a photograph on staff files to identify who the person is. What the care home could do better: They could put hand rails on the entrance doors to make access easier for people. They should repair the radiator in the bathroom to make sure it is safe. They could create a way of checking the quality of care for people who use the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Rowan - Innova House CLD 93 Windsor Road Mansfield Nottinghamshire NG18 4ED The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susan Lewis Date: 1 1 0 8 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 30 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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. 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 Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Rowan - Innova House CLD 93 Windsor Road Mansfield Nottinghamshire NG18 4ED 01623626252 01623650099 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Innova House Health Care Limited care home 1 Number of places (if applicable): Under 65 Over 65 1 1 0 0 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is 1 The registered person may provide the following categories of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Physical Disability - Code PD Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 30 A bit about the care home Rowan - Innova House consists of a two-bedroom bungalow on a private residential estate. The bungalow has private access with a driveway providing parking for several cars. The property is set within fenced gardens to the rear and open aspect to the front. The bungalow is intended to accommodate one person with the second bedroom to be used for the safekeeping of records. There is also a lounge/dining room and a separate kitchen. One bathroom with a toilet and a wet room. Care Homes for Adults (18-65 years) Page 5 of 30 The homes ethos is `ordinary life principals? It is close to local shops and only a short bus or taxi ride away from the main town of Mansfield.. The current weekly fees are #1294 to #4,000 depending upon service users needs. Hairdressing, chiropody, personal items and holidays are not included in these fees. All required fee information is made available upon the point of enquiry Care Homes for Adults (18-65 years) Page 6 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 30 How we did our inspection: This is what the inspector did when they were at the care home We visited the home in August 2009 and we met the manager, staff and people who use the service. We asked people who use the service what their experience is like. We asked the manager how they got the information. We asked them how they learnt to give this support. We looked at peoples records. We wanted to see if people are happy with their service. Care Homes for Adults (18-65 years) Page 8 of 30 We also looked at staff files to see if it is safe for them to work with people. We looked at other paperwork the service keeps. What the care home does well They are very good at helping people settle into the home and get lots of information to help them understand what they need to do. They make sure staff get the training they need to help people. They make sure they do the proper checks on people before they start working with them. The home is looked after well and furnished in a homely way. Care Homes for Adults (18-65 years) Page 9 of 30 What has got better from the last inspection What the care home could do better They could put hand rails on the entrance doors to make access easier for people. They should repair the radiator in the bathroom to make sure it is safe. They could create a way of checking the quality of care for people who use the service. Care Homes for Adults (18-65 years) Page 10 of 30 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Susan Lewis Care Quality Commission National Processing Centre Notifications Team Citygate Newcastle upon Tyne Telephone: 03000616161 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 set out 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. Care Homes for Adults (18-65 years) Page 11 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Significant time and effort is spent planning to make admission to the home personal and well managed. Evidence: The AQAA states that We offer visits to the service at individuals convenience to enable them to meet with the current service user group and have a look around. Assess the potential service user in different environments to get a whole picture of the individuals current life style and choices. Offer transition packages to suit individual need. The home is registered for one person and currently that person is in a transition stage from where they currently live to Rowan. We saw evidence in support plans that this transition period has been designed around the individuals needs. The persons plan of care was seen this included the detailed assessment of need and how staff were going to support a transfer to Rowan. This transfer period was built around the persons needs and each visit was evaluated to see how it had been for the person. Page 13 of 30 Care Homes for Adults (18-65 years) Evidence: We observed staff with the person during the visit and they showed understanding to the persons needs and spent time explaining each question asked. Care Homes for Adults (18-65 years) Page 14 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are fully committed in supporting individuals to lead purposeful and fulfilling lives as independently as possible. Evidence: The AQAA states that Service users are involved in the assessment stage in planning their care provision. Their views, needs and choices are then reflected in their individual support plans. Currently no one lives at the Rowan full time but someone is in a transition stage moving in a planned way with support from staff. We looked at the support plan it provides detail to staff on how they are to provide support to people. The plan is created from the assessment and covers all aspects of personal, health and social support needed. We saw evidence that plans are reviewed regularly and changes made as the persons needs change. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: The person using the service was spoken with and they said that they were able to get up and go to bed when they wanted. The person moving to the home has representatives and the manager told us that they remain in contact with them to ensure that the individuals rights are maintained. We saw that risk assessments had been carried out that covered all aspects of the persons daily routine and supported the person being able to live as full a live as possible. Care Homes for Adults (18-65 years) Page 16 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. Evidence: The AQAA states that We support the service users with a wide range of social, educational and work based activities in a way that they can learn and thrive. Incorporating their individual abilities and achievements and developing identified weaker areas. We observed staff with the person due to move to the service. It was clear that they knew the persons interests and life history as they talked about these things and what they would do once they finally moved to the service full time. We saw evidence in diary notes that showed the person went out to the local pub with friends and staff supported the person to maintain contact with friends. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: We saw evidence that the routines in the home will promote the persons independence and support their dignity. Diary notes showed that the person is encouraged to take part in domestic chores but chooses not to and this is respected by staff. We were unable to observe the midday meal as the person only spent a short time at the service on the day of the inspection visit. The manager told us that usually staff bring food over and prepare with the person. We were told that the person using the service is supported to menu plan by staff choosing healthy options and then will either do internet shopping or go to a local small supermarket. At the previous inspection it was observed that records were not kept for fridge and freezer temperatures. The manager said that after the last inspection they had started to keep these records however as the service has been empty since December 2008 it was not necessary to continue. Once the transition had taken place these records would be kept again. Care Homes for Adults (18-65 years) Page 18 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal support responds to peoples varied and individual needs and preferences. Evidence: The AQAA states Individual support plans reflect the requirements of the service user and how we provide appropriate support to meet the identified needs. We were unable to assess some parts of the standards as the service is currently not in full use. We looked at the plan of care for the person moving to the service and it showed what support was needed from staff to maintain the persons personal hygiene. The person was spoken with and they said they were happy with the support staff gave and that they were able to get up and go to bed when they wanted. We saw that suitable equipment was provided to support the person to maintain their independence as much as possible. We saw information on how to monitor the persons medical health and measures to take in the event they became unwell. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: As the service is not occupied on a full time basis yet the persons medication is not stored at the service. However the manager showed us where it will be stored once the person moves and this was suitable for the needs of the person. The manager confirmed that all staff who administer medication are trained. Care Homes for Adults (18-65 years) Page 20 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 service has an open culture that allows people to express their views and concerns in a safe and understanding environment. Evidence: The AQAA states We have a clear and workable complaints procedure, a robust Safeguarding Adults procedure and Whistle blowing policy. We saw that the service has a detailed complaints procedure. We looked at the complaints book and the manager said that the service had received no complaints since the last inspection. We have also received no complaints about this service. We spoke to the person who will live at the service and they told us they knew who to speak to if they were unhappy with anything. We looked at training records and all staff receive Safeguarding training as part of their initial induction training. The manager confirmed that staff then receive a more detailed full days training on a yearly basis. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this 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 living environment is appropriate for the particular lifestyle and needs of the person and is homely, clean, safe and comfortable, well maintained and reflects the individuality of the people using the service. Evidence: The AQAA states Purpose built service. Small group living and sole occupancy properties. The service promotes ordinary life principles and this is reflected within the environment. As part of the inspection site visit we looked at the environment to ensure it met the needs of the person using it. We saw that the person will have their own bedroom, the manager told us that they will be able to personalise it and this will take place during the transition period. Some evidence of this was seen with small personal items around the bungalow. The kitchen was domestic in nature and had all the necessary equipment, including a microwave as well as a hob and separate oven. All areas were clean and well maintained. A small leak on the radiator was noticed in the bathroom. The manager told us she was aware of this and that it was going to be dealt with by the maintenance person. The step to front and rear of the property were quite steep and the manager told us that Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: hand rails were to be fitted to assist the person moving to the home to be safe coming in and out of the bungalow. The laundry facilities were domestic and met the needs of the person moving to the service. We saw infection control policies and procedures in place to maintain the safety of people living and working in the service. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All staff receive relevant training that is focused on delivering improved outcomes for people who use the service. Evidence: The AQAA states Rowan maintains a 75 NVQ 2, 3 or first degree attainment rate with the remainder working towards qualification. There is a wide range of age, experience and skill mix within the staff group which is used proactively to build strong static teams for the individuals we support. We looked at staff records and saw that staff received the necessary training to support the individual needs of people they worked with. Where staff do not have National Vocational Qualifications (NVQ Level2 ) they are encouraged to apply and work towards it. We saw that staff are recruited following the services policies and procedures including having at least two references and Criminal Record bureau checks ensuring they are suitable to work with vulnerable people. We also saw a photographic identification was now in place. This had been a requirement at the last inspection this is now met. We also saw that staff receive structured induction training to prepare them for the work they are to undertake. The training staff receive is linked to the needs of the people who Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: use the service ensuring that their needs can be met. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this 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 service is run in the best interest of the people using it. Evidence: The AQAA states Daily contact with staff and service user group by the management team. This is facilitated by a management rota which includes evening and weekend work. We also have a 24hr on call manager facility. Team Leader meeting each week to update on weekly events, appointments and non urgent information which needs to be passed to the team leaders. Health and Safety audits on each home on a weekly basis to check for cleanliness, emergency equipment is in working order and to risk assess the environment. Findings are fed back to the staff and service users to rectify where appropriate or to the maintenance team. The manager is registered with the Care Quality Commission as suitable to manage a care service. We spoke to the manager and she told us that she kept herself up to date with training and took part in mandatory training up dates on a regular basis. Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: We asked the manager about the quality assurance system in place for Rowan. The manager told us that they use the Quality Tree system at Innova House but that this was not suitable for Rowan as it only had one person using the service. The manager said that once the person moved in to the service fully they intended to work with their representatives to develop a more suitable way of monitoring the quality of the service for that person. We looked at health and safety records to ensure the service maintained the safety of people who lived and worked there. We saw that risk assessments were carried out to maintain the safety of people and that regular checks were carried out on equipment to ensure they were safe. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 39 The manager should develop a suitable quality assurance system for the service. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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