Care Home: Rowan Lodge

What the care home does well The home provides a service to people who have different cultural and/or religious needs. The care needs of prospective residents are comprehensively assessed by the home prior to placement. Care plans are appropriately undertaken and regularly reviewed. The health care needs of people who use the service are fully met. Varied, nutritious and appealing meals are provided to residents. Health and safety records are satisfactorily maintained and indicative of the health, safety and welfare of residents being protected. Care staff are attentive and competent in meeting the needs of residents and relate with them in a friendly and respectful manner. Residents were appropriately dressed. They appeared comfortable and content and expressed satisfaction with the service they received. Overall, the premises were clean, hygienic and well maintained. The environment was safe, pleasant and homely. What has improved since the last inspection? Requirements made at the last inspection had been complied with. Specifically, residents are able to participate in increased activities within the community and are supported if they wish to attend Church. Staffing levels are appropriate for meeting the needs of residents when activities in the community are planned. What the care home could do better: Refresher training on Safeguarding Adults and Moving and Handling must be delivered to all care staff. Key inspection report Care homes for older people Name: Address: Rowan Lodge 36 Keble Close Northolt Middlesex UB5 4QE     The quality rating for this care home is:   three star excellent 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: Jean Bovell     Date: 1 7 0 7 2 0 0 9 This is a review of 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 2 1 0 stars - excellent stars - good star - adequate 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. that people have said are important to them: They reflect the things 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 Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People 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 Older People Page 3 of 25 Information about the care home Name of care home: Address: Rowan Lodge 36 Keble Close Northolt Middlesex UB5 4QE 02084239095 F/P02084239095 laima200@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Ramnarain Dyanan Sham care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category 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: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Rowan Lodge is a care home providing support for three older people, who are over sixty-five years of age, and have past or present mental health needs. All of the current service users are female. The home was first registered in 1991. The Registered Provider owns another larger home in Harrow. The home is situated in a quiet road in Northolt and there is easy access to local shops and to a bus route. The accommodation for the service users consists of a good-sized lounge/dining area, a kitchen and a small utility area on the ground floor. Two bedrooms are located on the first floor and one bedroom is located on the ground floor. There is a small paved area to the front of the home and a good-sized garden to the rear of the house. Care Homes for Older People Page 4 of 25 Over 65 0 3 Brief description of the care home Care Homes for Older People Page 5 of 25 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was carried out between 12 noon and 4:00pm on the 17th July 2009. The Registered Manager, one care worker and three residents were present. During the course of the inspection, records, documents, policies and procedures in relation to key Standards were examined. A tour of the building was undertaken and observations were made. Discussions were held with two care workers on separate shifts. Three residents were spoken with. Requirements made at the last inspection and all key Standards were examined. Care Homes for Older People Page 6 of 25 A completed annual quality assurance assessment (AQAA) was considered. The Registered Manager was co-operative and provided appropriate assistance throughout the inspection. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care needs of prospective residents are fully assessed prior to admission. Evidence: Personal files regarding three residents were viewed. Each file contained an initial written needs led assessment undertaken by the home. It was indicated that prospective residents, social workers, health professionals and relatives, where appropriate, were involved in the process of assessing and determining the suitability of the service to meet separate identified needs. There was documented evidence, also, that prior to placement, prospective residents received written confirmation regarding the homes capacity to meet individual assessed needs. Care Homes for Older People Page 10 of 25 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are being drawn up comprehensively. The care needs of residents are being met appropriately. Medication procedures are being fully followed. People who use the service are treatred with respect. Evidence: Care plans in relation to three residents were examined and were comprehensively undertaken. It was reflected that changing personal, social/occupational, cultural/religious, dietary and physical, mental and emotional health needs were being appropriately assessed. Care plans were clearly detailed and signed by the respective resident and care worker. Care Homes for Older People Page 11 of 25 Evidence: Care plans were reviewed on a monthly basis. Risks identified in relation to specific activities within care plans were also assessed. These included falls, moving and handling, dry skin, swollen legs, wandering and confusion. There was recorded evidence that individuals received access to appropriate health professionals when required. There were regular visits from the Community Psychiatric Nurse. Routine dental and eye tests were arranged and residents were accompanied to medical appointments. A CPN visited the service at the time of the inspection. Medication procedures were in place. All medicines were safely and appropriately stored. Records were maintained of medications received from and returned to the pharmacist. Medication administration sheets were accurately documented and signed. There was documented evidence that medication audits were carried out by the pharmacist on a six monthly basis. There were recorded indicators that the GP was informed when residents consistently refused prescribed medicines and medication reviews were requested where appropriate. We were informed by the Registered Manager that residents lacked capacity to selfadminister medication. Training records were reflective of staff training on medication being delivered. Issues regarding privacy and dignity were incorporated within a Charter of Rights for Residents. People spoken with confirmed that their privacy and dignity were at all times respected by care staff. Care workers were observed interacting with residents in a friendly and respectful manner. Care Homes for Older People Page 12 of 25 Evidence: Care Homes for Older People Page 13 of 25 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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 social and religious needs of residents are being adequately met and they are able to maintain regular contact with relatives and/or friends. People who use the service are able to be independent in relation to day-to-day routines. Varied and nutritious meals are provided to residents. Evidence: Separate cultural/religious needs and social interests were identified within care plans. The Registered Manager confirmed that a Cleric from a local Christian denomination visited the home every six weeks and residents were able to attend Church on a Sunday. We were informed also, that a barbeque had been held in the garden and an outing to the sea-side was planned. There were recorded indicators that residents attended the day centre and participated in outdoor activities such as shopping trips and regular visits to the hairdresser. Care Homes for Older People Page 14 of 25 Evidence: An organist visits the home on a weekly basis. Although residents were not involved in activities in the community at the time of the inspection, they confirmed visiting the day centre, being asked if the wished to attend Church and were accompanied on shopping trips. Residents reported being happy with the increased level of activities provided. People were observed watching TV in the lounge and/or walking around the garden. Contact between residents and their respective relatives are encouraged and facilitated. People spoken with said that they were able to make and/or receive regular telephone calls. They were also routinely visited by relatives. We were informed by the Registered Manager that people were able to maintain their independence in relation to day-to-day routines such as times of getting up on mornings, retiring at night, what they wore each day and hairstyles/make-up. People are able to manage personal cash which may be secured in lockable facilities within individual bedrooms. Those with capacity are able to be independent in the commmunity. Residents were observed moving freely around the house and individual choices/interests were reflected in personalised bedrooms. Varied and nutritious meals were reflected on menus. Breakfast included cooked options and cooked meals were provided at lunch and also in the evening. Snacks and drinks were served on a regular basis. Wholesome and appealing lunch options were offered to residents at the time of the inspection and they were observed enjoying their meal. People spoken with expressed satisfaction with quality and quantity of food provided. A barbecue was held in August and an outing to the sea-side was planned. Care Homes for Older People Page 15 of 25 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 complaints procedure is appropriately detailed and accessible to residents, relatives and/or friends. People who use the service are being protected from abuse. Evidence: The complaints procedure is clear and concise and accessible to residents and relatives and/or friends. Incidents and accidents were not reflected on records. The Registered Manager confirmed that no accident or incident had occured at the home since the last inspection. There was, however, documented evidence that a resident had been admitted to hospital following GP referral. A notification to that effect was submitted to the Commission. We were informed by the Registered Manager that the home does not hold financial responsibility for residents. People who use the service receive state benefits which are paid directly into their bank accounts. Personal cash allowances are, however, being secured on behalf of residents. Individual financial records were examined and no discrepancies were identified in relation to income and outgoing expenditure. Care Homes for Older People Page 16 of 25 Evidence: Policies and procedures on Safeguarding Adults were in place and inclusive of Whistle Blowing. There were no indicators that up-to-date staff training on Safeguarding Adults had been delivered. This was discussed with the Registered Manager and we were assured that appropriate action would be taken. Care Homes for Older People Page 17 of 25 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, 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. 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 home is being well maintained. The environment is pleasant and homely. Evidence: The premises are adequately spacious and suitable for shared and/or individual activity. All furnishings and equipment are of good quality and appropriate for meeting the needs of resident. The garden was being maintained. No issues were identified in relation to the laundry. Overall, the service was clean, hygienic and well maintained. The environment was bright, airy, homely and pleasant. Care Homes for Older People Page 18 of 25 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. Staffing levels are satisfactory and care staff are suitably trained and qualified for meeting the needs of people who use the service. Recruitment procedures are being fully followed. Evidence: We were informed by the Registered Manager that three permanent care staff are employed at the home. Staff rotas were reflective of one care worker being on duty during waking hours and two covered duty on days when separate outings in the community, such as shopping trips, were planned. There was one sleep-over at night. The records indicated new care staff received induction training and subsequent training and refreshers for meeting the needs of the people who use the service were delivered. There were no indicators, however, that up-to-date staff training on Safeguarding Adults and Moving and Handling had been delivered. This was acknowledged by the Registered Manager. Care Homes for Older People Page 19 of 25 Evidence: The Registered Manager confirmed that three care staff had achieved NVQ level 2 or above. Care workers were observed being attentive and competent in meeting the needs of residents and related with them in a friendly and respectful manner. The recruitment files of three care staff were viewed and each file contained all documents as required under Schedule 2 of the Care Homes Regulations. Care Homes for Older People Page 20 of 25 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 Registered Manager is appropriately qualified and experienced. Quality assurance has been satisfactorily undertaken. Residents financial interests are safeguarded. The health, safety and welfare of residents are being protected. Evidence: The Registered Manager has been in post for three years and has achieved NVQ level 4 in Health and Social Care. A completed annual quality assurance assessment (AQAA) was submitted to the Commission. It was clear and all required information was provided. Care Homes for Older People Page 21 of 25 Evidence: The service is not responsible for the financial affairs of residents but personal cash allowances are being safeguarded by care staff. Individual financial records were examined and all were satisfactory. Health and Safety records were viewed and all were up-to-date. These included fire safety checks and water temperature checks, gas maintentance and portable appliances tests. There was recorded evidence that fire drills were regularly and appropriately undertaken. Environmental risk assessments were in place. The records indicated that care staff received up-to-date training on Health and Safety, Fire Awareness, First Aid and Infection Control. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Older People Page 23 of 25 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 Requirement 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 Requirement Timescale for action 1 30 18 The Registered Person must ensure that refresher training on Safeguarding Adults and Moving and Handling is delivered to all care staff. This to ensure that all care staff are fully competent in meeting the needs of people who use the service. 31/12/2009 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 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!