Care Home: The Rock

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What the care home does well The Rock provides a clean, homely environment for older people in need of twenty-four hour care. It also provides a home in which individuals, some of whom may have challenging behaviour, can find safety and reassurance from the one to one attention they may receive from care staff. Staff are caring and work well as a team for the benefit of the residents. A very low staff turnover is an advantage both for the residents` welfare and well-being as well as promoting good morale and team spirit amongst staff. The registered provider/manager has an open and approachable style of management. This encourages good interaction with those living in the home, their relatives and the staff.The home is run for the benefit of those living there. There is a very positive attitude towards people with dementia and efforts are made to maintain their levels of independence and to encourage choice for as long as possible. People are treated as individuals and have `special time` on their own with a member of staff on a regular basis. Relatives of people living in the home were complimentary about The Rock. One said that they had visited several homes before deciding The Rock was the right one. Several said that they had peace of mind knowing that those living in the home were well cared for. They said that the staff were kind and caring and that the home is clean, fresh and homely. Some said that they had also been provided with support by the staff. What has improved since the last inspection? The requirements made at the last inspection have been met. All except for two part time staff have had training regarding the protection of vulnerable adults and how to recognise abuse. All staff have current valid CRB checks except for the most recent appointment where the disclosure had not yet been received. Formal staff supervision has commenced. What the care home could do better: All the documents in care plans should be signed and dated. The design of the care plans could be modified to make them easier to use. If the police checks have not been received when a new member of staff is due to start a check must be made against the Protection of Vulnerable Adults register to ensure that they have not been barred from working with this client group. The Commission for Social Care Inspection must be notified of all reportable incidents. CARE HOMES FOR OLDER PEOPLE The Rock 1 Station Road Buckfastleigh Devon TQ11 0BU Lead Inspector Susan Samways Unannounced Inspection 25th September 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 The Rock DS0000003840.V372601.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. The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Rock Address 1 Station Road Buckfastleigh Devon TQ11 0BU 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) 01364 642706 the.rock1@btinternet.com Mr Julian Roger Smith Mrs Ruth Millicent Smith Mr Julian Roger Smith Care Home 14 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (14) of places The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th September 2006 Brief Description of the Service: The Rock is registered to provide accommodation and care for a maximum of fourteen people in the registration categories of Dementia - over 65 years of age and Old Age, not falling within any other category. The Registered Service Providers are Mrs Ruth and Mr Julian Smith. Mrs Smith is responsible for the day-to-day management of the home and Mr Smith manages the maintenance of the home. There is also a competent senior staff team who contribute to the daily running of the home. The home has a good record of long-term employment of its staff. The Rock is a detached house, set in attractive gardens. It is situated in a residential area of Buckfastleigh, close to the village shops and amenities. It is on a bus route. There is a private car park directly opposite the house that provides ample off street parking for staff and visitors. The home is attractively decorated, comfortably furnished and clean. The residents’ private accommodation consists of six double and two single bedrooms. Residents are encouraged to personalise their rooms. There is a dining room and a separate sitting room. The night staff room is also available during the day as a quiet area, and for any relatives/visitors who may prefer to use it for more privacy. One bathroom has a bath with a hoist; another bathroom is only suitable for those able to bathe unassisted. There is also a separate shower room. Adequate toilet facilities are provided. The Registered Providers have two dogs that visit the home. In the past residents have moved in with their pets when it has been feasible. The current fees for The Rock range from £381 to £400 according to the assessment of care needs for the individual. Extra costs include hairdressing, chiropody, and other sundry items. The home does not provide intermediate care and it is not registered to provide nursing care. The Rock DS0000003840.V372601.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 stars. This means the people who use this service experience good quality outcomes. This was an unannounced inspection which lasted for approximately seven hours. Time was spent in discussion with the registered provider/manager and the business manager. Various documents and records were examined including a sample of care plans and staff files. A tour of the premises was included in the inspection as was observation of the people living in the home and the staff engaging in their usual daily activities. Some of the staff and residents were also spoken to. Although no relatives were seen during the inspection eight of them had completed surveys about the home for the Commission for Social Care Inspection. These contained numerous comments which were very informative. Prior to the inspection the Annual Quality Assurance Assessment, completed by the registered provider, had been received. This provided information about how the national minimum standards had been met, what had improved since the last inspection and future plans for The Rock. What the service does well: The Rock provides a clean, homely environment for older people in need of twenty-four hour care. It also provides a home in which individuals, some of whom may have challenging behaviour, can find safety and reassurance from the one to one attention they may receive from care staff. Staff are caring and work well as a team for the benefit of the residents. A very low staff turnover is an advantage both for the residents’ welfare and well-being as well as promoting good morale and team spirit amongst staff. The registered provider/manager has an open and approachable style of management. This encourages good interaction with those living in the home, their relatives and the staff. The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 6 The home is run for the benefit of those living there. There is a very positive attitude towards people with dementia and efforts are made to maintain their levels of independence and to encourage choice for as long as possible. People are treated as individuals and have ‘special time’ on their own with a member of staff on a regular basis. Relatives of people living in the home were complimentary about The Rock. One said that they had visited several homes before deciding The Rock was the right one. Several said that they had peace of mind knowing that those living in the home were well cared for. They said that the staff were kind and caring and that the home is clean, fresh and homely. Some said that they had also been provided with support by the staff. What has improved since the last inspection? What they could do better: All the documents in care plans should be signed and dated. The design of the care plans could be modified to make them easier to use. If the police checks have not been received when a new member of staff is due to start a check must be made against the Protection of Vulnerable Adults register to ensure that they have not been barred from working with this client group. The Commission for Social Care Inspection must be notified of all reportable incidents. The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 7 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. The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 8 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 The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 9 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): 3,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families can feel confident that their needs will be assessed to ensure that they can be met before moving into the home. EVIDENCE: The files for three people living in the home were examined. Each had an assessment completed by the home and, in the case of those placed by social services, an assessment by their care manager. This ensures, prior to admission that the home can meet the person’s needs. The registered provider/manager stated that wherever possible she visits prospective residents where they are currently living in order to carry out an The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 10 assessment. She also contacts any professionals involved with the person to gain as clear a picture as possible of the care and support they are going to need. She also stated that relatives were welcome to visit the home as many times as they felt necessary in order to decide whether The Rock is the right home. Evidence was seen that assessments are periodically reviewed to ensure that they are up to date and record changes in the person’s condition. The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 11 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. Those living in the home can be confident that their care needs will be met and that they will be treated with respect. EVIDENCE: Three care plans were examined. Each one was detailed and had been regularly reviewed. Daily records had been completed using appropriate language and terminology and had recorded any significant events including hospital appointments or visits by the GP. Each person’s preferences were recorded such as times for getting up and going to bed, where they liked to have their meals and food preferences. The registered provider agreed to look at the design of the care plans to make them easier to follow and to ensure that all the documents in the care plans were signed and dated. The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 12 One relative commented on the prompt attention the home obtained for a potentially serious medical condition their family member had developed and expressed their appreciation for the support they gave that person and them. Staff were observed to treat people with respect, to approach them with courtesy and to give, wherever possible, individual attention. The registered provider expressed a very positive attitude towards people who have dementia and that was seen to be followed by the staff. People admitted to The Rock often have challenging behaviour but the approach adopted by the registered provider and her staff, with support from health professionals, often result in a reduction in this behaviour which is to the home’s credit. Medication was seen to be kept in a lockable, fixed cupboard. The MAR sheets were all seen to be up to date and signed accordingly. At the time of this inspection none of the residents required any controlled medication and no one was responsible for their own medication. The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 13 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 excellent. This judgement has been made using available evidence including a visit to this service. People living in the home are encouraged to participate in activities, make choices and to remain as independent as possible for as long as possible. EVIDENCE: A relative commented that the home goes out of its way to allow the people living there to live the life they choose. This was confirmed by the information in the care plans about each individual’s preferences and by observation of staff working with people on a one to one basis encouraging them to participate in a range of activities. The registered provider stated that considerable time is spent trying to find suitable activities for each person. In addition ‘special time’ is allocated for each person for staff to be with them and listen to them. The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 14 Relatives and friends are encouraged to visit and are supported to take the person out if they wish. Several commented on how welcome they feel when visiting and others said that the home provided support to them as well as the person living in the home. The registered provider stated that they encourage those living in the home to make choices about all aspects of their life in the home for as long as they are able. This includes the time they get up and go to bed, the clothes they wear, the food they eat and the way they spend their time. Gentle guidance is given when needed to ensure that safe choices are made, but at all times the residents are recognised as being individuals and treated as such. Several of the relatives contacted commented on the meals. All praised the food, one described the meals as ‘superb’. Meals were seen to be unhurried with staff providing assistance when required in an unobtrusive way. Meals are well balanced and take into account individuals preferences whenever possible. The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 15 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. The protection of those living in the home has improved by staff having training regarding safeguarding vulnerable adults from abuse. EVIDENCE: The home has a complaints procedure but half of the relatives contacted said that they either didn’t know about it or they couldn’t remember how to make a complaint. However, neither the Commission nor the home has received any formal complaints. Since the last inspection the majority of staff have received training regarding the protection of vulnerable adults. This means that they are now aware of the different forms of abuse and what they should do should they suspect abuse may have taken place. The registered provider also has a better understanding of safeguarding procedures but needs to ensure that she remains up to date, especially with any changes in legislation, and that she ensures that the staff are also aware of their responsibilities. The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 16 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. The home is homely and appropriately equipped providing a clean, hygienic and safe environment. EVIDENCE: The inspection included a tour of the premises. The home was found to be fit for its stated purpose. It was clean and hygienic and much of the home had been re-decorated since the last inspection. The décor and furnishings are homely in nature. Bedrooms had been personalised. Screens are available in shared bedrooms to ensure privacy. One bathroom has a bath hoist to assist people in and out of the bath safely. The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 17 The registered manager stated that staff have had training in infection control. She also said that laundry equipment had been replaced and that recommendations made by the environmental health department had been followed. Relatives who commented said that The Rock is homely and not institutional. They said that it is clean and fresh. The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Those living in the home are cared for by well trained staff but recruitment procedures must be adhered to in order to safeguard the residents. EVIDENCE: At the time of the inspection there were sufficient staff on duty and this seemed to be norm from the staff rotas seen. Staff appeared to have time to give individual attention to the people they were caring for, especially doing activities on a one to one basis whenever the opportunity arose. Staff training records were seen. These were up to date and showed that staff have had a good range of training including the protection of vulnerable adults which was a requirement following the last inspection. The registered provider was advised to do an overall chart of staff training in order to see at a glance who requires what training and when refresher sessions are due. All the staff except two have NVQ level 2 in care or above. The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 19 The records for two members of staff were examined. One was a new member of staff. Generally a good recruitment process had been followed for this person, however, with regard to police checks it had not. Although new staff can commence employment before a full police check has been obtained this is dependent on a check being made against the Protection of Vulnerable Adults register. This is to ensure that the person has not been barred from working with this client group. This had not been done for this employee and therefore those living in the home were potentially placed at risk. The registered provider stated that this would not happen again. Relatives contacted spoke highly of the staff. One said that they do a wonderful job with cheerfulness and kindness, another said that they provide care and understanding. Others said that they had confidence in the staff to look after their family members well and that gave them peace of mind. The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 20 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): 31,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interests of those living there. EVIDENCE: The registered provider has managed The Rock for many years and clearly cares very much about the way people with dementia are looked after. She was seen to have an open style of management and both staff and residents approached her with confidence. Both she and the business manager have worked hard since the last inspection to improve record keeping and that was The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 21 evident from the records seen. Some tasks had been delegated to senior staff but unfortunately the most senior carer is on maternity leave which has delayed some of their plans. The registered provider said that she is in frequent contact with the friends and relatives of those living in the home so is always receiving feedback about the home. They produce a newsletter to ensure that all those interested are kept in touch with what is happening in the home. Relatives confirmed that any comments or suggestions they might make are well received and questions readily answered. Staff have opportunities on a daily basis to discuss any concerns or difficulties they might have with the registered provider. In addition to this staff supervision has been placed on a more formal and regular footing. The registered provider stated that the home does not manage money for any of those living in the home. The registered provider and business manager stated that all the necessary environmental checks and equipment servicing are carried out at the required intervals. They also said that the requirements and recommendations made by the environmental health officer have been complied with. Staff have training in safe working practices including fire safety. Accidents and other incidents are recorded. The Commission for Social Care Inspection must be notified of all reportable incidents. The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 22 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 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 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 23 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 OP29 Regulation 19 Requirement When a full CRB disclosure has not been received before a new member of staff’s start date a check must be made against the POVA register prior them commencing employment. The Commission for Social Care Inspection must be notified of all reportable incidents. Timescale for action 31/05/09 2 OP38 37 31/05/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations All documentation included in care plans should be signed and dated. The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Region PO Box 1251 Newcastle upon Tyne NE99 5AN 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 The Rock DS0000003840.V372601.R01.S.doc Version 5.2 Page 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. 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