Care homes for adults (18-65 years) · 2014. 5. 27. · SM7 1PQ The quality ... There is also a bar...

Key inspection report

Care homes for adults (18-65 years)

Name: Rosedene

Address: 54 Higher DriveBansteadSurreySM7 1PQ

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: Date:

Lee Willis 1 4 0 4 2 0 1 0

Care Homes for Adults (18-65 years) Page 2 of 29

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 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.


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 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 Inspection report

Author Care Quality Commission

Audience General public

Further copies from 0870 240 7535 (telephone order line)

Copyright © Care Quality Commission 2010This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010.

Internet address www.cqc.org.uk

http://www.tso.co.uk/bookshop


Information about the care home

Name of care home: Rosedene

Address: 54 Higher DriveBansteadSurreySM7 1PQ

Telephone number: 02083935162

Fax number: 02083939671

Email address: [email protected]

Provider web address:

Name of registered provider(s): Prospect Housing and Support Services

Name of registered manager (if applicable)

Ms Geraldine Ann McCaffrey

Type of registration: care home

Number of places registered: 8

Conditions of registration:

Category(ies) : Number of places (if applicable):

Under 65 Over 65

learning disability 8 0

Additional conditions:

The maximum number of service users to be accommodated is 8

The registered person may provide the following category/ies of service only: Care home only (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 (LD)

Date of last inspection

Brief description of the care home

Rosedene is a residential care home that offers accommodation and personal support for up to eight generally older adults with learning disabilities, some of whom may also have mobility care needs as well. The home has been operating for well over a decade under the stewardship of Surrey and Borders NHS Trust, but was re-registered with us as a 'New' service on 1st


Brief description of the care homeNovember 2009 after the voluntary organisation Prospect Housing and Support Services took over Rosedene. The services registered manager, Geradine 'Anne' McCaffery, has worked at Rosedene for over six years and remains in operational day-to-day control of the service. Located in a quiet suburban street in Banstead the service has good access to a wide variety of community based facilities and services, including - local shops, restaurants, banks, day centres and leisure centres. The service also has its own vehicle and a local train station is nearby with good links to Sutton and central London. This large 1930's detached property comprises of eight single occupancy bedrooms located over two floors, a lounge area, seperate dining room, kitchen, laundry, and first floor office. There are sufficient numbers of suitably adapted toilets, baths, and shower facililties located throughout the property. The large garden at the rear of the property, which mainly consists of lawn, is well maintained. There is also plenty of space for parking vehicles on the front driveway. All the people who live at Rosedene, and/or their representatives, have been supplied with a copy of the homes Guide that contains all the information they need to know about what facilities and services it provides, including what they can be expected to be charged for there use. The providers are currently charging 1,1042.26 GBP a week per placement.


SummaryThis is an overview of what we found during the inspection.

The quality rating for this care home is: three star excellent service

Our judgement for each outcome:

Choice of home

Individual needs and choices

Lifestyle

Personal and healthcare support

Concerns, complaints and protection

Environment

Staffing

Conduct and management of the home

peterchart

Poor Adequate Good Excellent

How we did our inspection:

From all the available evidence gathered whilst inspection this service we now rate Rosedene as an excellent three star performing residential care home. The service has a substantial number of strengths and is providing excellent outcomes for the people who live there. We spent four hours at the home. During the visit we met five people who use the service, the homes manager, a senior manager representing the new providers, and three support workers. We also looked at various records and documents, including the care plans and risk assessments for two people whose care we had decided to case track. The remainder of this site visit was spent touring the premises and its grounds. Five of our 'have your say' comment cards were returned to us. One was completed by a person who uses the service with support from their friend, and the remaining four came back from various health and social care professionals.


The services manager completed and returned our Annual Quality Assurance Assessment (AQAA) for the home when we asked of it. This self-assessment tool tells us what the manager believes the service does well, and how it could do things better in the future. We would like to thank all the people who contributed to the inspection process fortheir time and input.


What the care home does well:

All the written and verbal feedback we received from all the aforementioned stakeholders was extremely complimentary about Rosedene and the standard of care provided there. The service has a very experienced manager and staff team who have all worked together for sometime ensuring the people who live at Rosedene receive continuity of care from people who are familiar with their unique needs and preferences. The service also ensures its staff team have the right mix of knowledge, skills, and support to perform their care duties extremely well, and are always available in sufficient numbers to meet the personal, social and health care needs and wishes of the people they support. Furthermore, all the managers and staff we met were observed interacting with the people who use the service in a very kind, respectful and professional manner. Care plans have been significantly improved since the last inspection and are more person centred, easier to read, and are more focused on an individual's strengths, personal preferences, and life experiences. Plans also set out in greater detail how staff should support them to ensure their current needs and aspirations are to be met. The service remains good at ensuring all the people who live there have lots of opportunities to express their views about how their home is run and influence its future development. For example, we commend the service for allowing advocates, who are independent of the home, to facilitate and Chair monthly service user meetings. It was also positively noted that staff actively encourage and support the people who use the service to help them plan the weekly menus and go food shopping. The people who use the service continue to have the chance to participate in a wide variety of 'age' appropriate and stimulating social, leisure, and recreational activities, both within at Rosedene and the wider community. Finally, the atmosphere remained extremely homely, relaxed, and congenial throughout the course of this inspection.

What has improved since the last inspection?

This section of the report summary is not applicable on this occasion because this is Rosedene's first key inspection since being re-registered with us as a 'new' service in November 2009. See 'what the service does well' for what has improved in the past six months since being taken over by Prospect Housing.

What they could do better:

All the positive comments made above notwithstanding the manager of the service acknowledges Rosedene is far from 'perfect' and recognises there remains scope to continue improving the standard of care it provides. At the end of this report we have made a number of good practise recommendations for the services manager and new providers to consider: It was evident from the feedback we received from all the staff we met and comments


made by most of the social and health care professionals who returned our surveys that the only concern most of them raised was about the state of some of the paintwork in the communal areas and the rather 'shabby' looking kitchen cupboards. The services manager told us the new providers have already acknowledged the interior decor of the home needs improving and have established time specific action plans for all the communal areas to be redecorated and the kitchen to be replaced. We will monitor closely progress made by the new providers to achieve these aims over the next year or so. The service should develop some more pictorial prompt cards to ensure all the people who live at Rosedene have more opportunities to express their views and make informed choices about the food and drink they eat and drink each day. Finally, the new providers will need to establish a rolling programme to start the process of reviewing all the outmoded policies and procedures they inherited from the services previous owners (Surrey and Borders NHS Trust) and ensure they are all up dated to reflect current 'best practise'.

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 [email protected] or by telephoning our

order line 0870 240 7535.


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


Choice of home


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.


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 people who live at Rosedene and others enquiring about it have access to allthe information they need to know about the facilities and services it offers.All prospective new service users have their needs assessed as part of a thorough admissions process and they and their representatives are always offered the chance to meet all the people who live and work at Rosedene through planned visits. This ensures prospective new service users, their representatives, and the home have all the information they need to decide whether or not the placement is right for all concerned.

Evidence:

The manager was able to provide us with a copy of the services Guide, which had been reviewed in the past twelve months and up dated accordingly to reflect all the changes that had occurred in that time. The document contained all the information people who used the service and their representatives want to know about the facilities and services offered at Rosedene, including the name and organisational structure of the new owners. The Guide was also written in plain English and illustrated with lots of colourful photographs, pictures, and symbols the people who


Evidence:

used the service could easily understand. The manager confirmed that as she had stated in the AQAA the service still had two vacant bedrooms, but had not received any new referrals or had any placements breakdown since Rosedenes last key inspection. The manager demonstrated a good understanding of what constituted good practice regarding the processing of new referrals and told us she would always ensure a prospective new service user and the people close to them were given the opportunity to visit Rosedene and meet all the people who lived and worked there. Most of the health and social care professionals who returned our surveys told us the services assessment arrangements usually ensure that accurate information is gathered and that the right service is planned for.


Individual needs and choices


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.


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 very person centred and can be easily read and understood by the people who use the service, and staff that work there, thus ensuring all the relevant parties have access to all the up to date information they need.The service has developed excellent arrangements to enable the people who use it to be consulted on, and participate in, all aspects of life at Rosedene.Staff actively encourage and supported the people who use the service to do as much for themselves as they can, while their ages, willingness and capacity to undertake certain activities safely is always taken into account.

Evidence:

We looked at two care plans in depth. The manager told us the care plan format had been improved in the past year to contain more detailed information about the personal goals of the people for whom they were intended. Both these plans were available in easy to read formats and contained very detailed information about the specific support each individual required to ensure staff were able to effectively meet all their identified personal, social and health care needs. The service is also


Evidence:

commended for ensuring care plans set out exactly each individuals preferred method of communication and what everyones likes and dislikes are in relation to their social interests, and food and drink. All the staff we spoke with told us the new care plans was a much better working documents than the previous versions. The manager told us care plans continue to be reviewed at least once every six months with all the interested parties, including the people who use the service. The service is also commended for ensuring individuals from an approved local advocacy/befriending scheme, who are independent of the home, have the opportunity to facilitate an Chair monthly service user lead meetings. Thus ensuring the views expressed by the people who use the service during these meetings and not unduly influenced by staff who work at Rosedene. The manager told us these meetings were always well attended and the agenda usually included what activities people would like to participate in and where they would like to go on holiday. In addition to these meetings staff we met told us they actively encouraged people to help them plan the forth comings weeks menu and then go shopping for the food. The manager told us based on professional advice from a speech and language therapist staff had developed some pictorial prompt cards to help people who use the service express themselves more easily. The manager acknowledged communication was an area where the service could do better and has agreed to consider our recommendation that it develops some food and drink prompt cards as a means of promoting greater choice at mealtimes. The manager and all the staff we met confirmed that based on one individuals expressed wish to play a more active role in running their home they have been delegated in charge of letting staff know about any maintenance issues. During a tour of the premises we also noted an information board in the entrance hall which contained a photograph of each member of staff who was on duty that morning. The two care plans we looked at in depth both contained a comprehensive set of individualised assessments that set out in detail what management strategies staff were required to follow in order to help the people who use the service take responsible risks and do as much for themselves as they were willing and capable of doing. Staff we met demonstrated a good understanding of what action they needed to take to minimise the risks associated with an individual being transfered in and out of their wheelchair, travelling in the homes vehicle, having a bath, eating and drinking, and falling out of bed at night.


Lifestyle


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.


Judgement:


The social, educational and vocational activities the people who use the service have the chance to participate in each day, both at Rosedene and in the wider community, remain extremely meaningful, varied, and 'age' appropriate. The service is commended for ensuring it actively encourages the friends and relatives of the people who use the service to remain involved in supporting them, and where this is not possible the professional services of an independent local advocacy scheme are sought. The service continues to offer the people who use the service a real choice of nutritionally well-balanced and varied food and drink at meal times, which meets everyones specific dietary requirements and tastes.


Evidence:

All the care plans we examined referred to peoples spiritual needs and preferences. The manager told us staff always support individuals to attend services at a local church when they choose to go. On arrival we noted two people who use the service relaxing in the lounge watching television and another doing their own thing in their bedroom. The manager told us the rest of the service users were either out with staff doing the weekly food shop for the home or attending sessions at a local day centre. It was evident from the comments made by the staff and activity records they kept that the people who use the service have lots of opportunities to participate in a variety of 'age' appropriate and stimulating social activities, both within their home and the local community. A social care professional who completed our survey also told us the service is good at arranging leisure activities and events which are tailor made to meet the needs and social interests of the people who use the service. Furthermore, a person we spoke at length with about activities provided at their home told us they liked watching live football and gardening, which staff always supported them to do. Typical activities the people who use the service could choose to participate in each week, included:- attending hydrotherapy sessions at a local swimming pool, in-house aromatherapy sessions, and a singing and signing club. The manager told us the service had improved the type of social activities people could choose to participate in by making them more 'age' appropriate and home based. For example, a number of people had recently joined the Royal Horticultural Society and the service was arranging for more community based entertainers to visit Rosedene on a more regular basis. On arrival the member of staff who let us in checked my identity and asked us to sign the visitors book in accordance with good security practises. All the staff we spoke with about visiting times told us the service has an open visitors policy. We commend the service for arranging a local befriending organisation to act as independent advocates for those people without anyone to represent them. An individual we spoke at length with about their life at Rosedene told us they liked the food there. It was very clear in the care plans we looked at what people food likes and dislikes were and staff we met knew what everyones favourite meal was. As previously mentioned in this report people who use the service are actively encouraged to plan the forth coming weeks menu every Sunday.


Personal and healthcare support


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.


Judgement:


The service has developed some excellent arrangements to ensure all the people who live at Rosedene receive the personal and health care support they each require and in a way they prefer. The service is also particularly good at seeking the agreement of all the relevant parties to to introduce preventative measures to minimise the likelihood of identified health care risks occurring. The services policies and procedures for handling medicines on behalf of the pope who use live at Rosedene are sufficiently robust to keep them safe. The ageing, illness and death of a service user is always handled with respect and as the individual would wish.

Evidence:

All the people we met who use the service were suitably dressed in well maintained clothes that were age and seasonally appropriate. Care plans we looked at each contained manual handling assessments that set out in detail what these individuals


Evidence:

mobility needs were and how they preferred staff to help them be transferred. The manager showed us health care plans for the two people whose care we were case tracking. The plans contained detailed information regarding the dates and outcome of all the appointments these individuals had attended with various health care professionals. It was evident from the comments made by the staff we met and the information they recorded in the health care plans that the people who use the service routinely meet with various health care professionals, including - their GP, district nurses, physiotherapists, speech and language therapists, continence advisor's, dentists, and opticians. All the health and social care professionals who returned our surveys told us the health care needs of the people who use the service are usually properly monitored, reviewed and met by staff at Rosedene. It was also evident from comments we received that the service is good at seeking the advice of health care professionals to minimise identified health care risks. Most of the people who returned our surveys told us they always seek professional advice to ensure the health care needs of the people they support are continually met. We commend the service for seeking the agreement of all the relevant parties, including the people who use the service and their relatives/advocates, before introducing any professionally sanctioned risk management strategies. For example, based on a professionally agreed advice, the service uses:- a relieve mattress to prevent pressure sores; bedside rails to stop an individual falling out of bed; and risk assessments to minimise the likelihood of individuals choking on their food. No recording errors were noted on any of the Medication Administration records (MARsheets) we looked at. These records accurately reflected stocks of medication currently held by the service on behalf of the people who lived at Rosedene. The manager told us the risk of medication errors occurring is minimised, because: the service uses a recognised monitored dosage system; two staff are now required to witness and counter sign any medication they handle; all staff have their medication training refreshed each year; and, the manager and other senior staff representing the provider carry out regular medication audits and spot checks on staffs medication handling and recording practises. All the staff we spoke with told us the training they had received gave them enough about the medication needs of the people using the service.We commend the service for ensuring the passing away of an individual who had lived at Rosedene for many years was handled sensitively and in accordance with their wishes, as set in their care plan. The manager told us all the people who use the service and staff were actively supported to play an active in arranging and participating in the funeral.


Concerns, complaints and protection


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.


Judgement:


The service has good arrangements in place for dealing with complaints, which ensures the people who use the service and other major stakeholders feel any concerns they may have will be listened to and acted upon.People who use the service are kept safe because staff understand what constitutes abuse and know what to do if they witness or suspect it.

Evidence:

Staff we met told us the service has developed a complaints policy which is illustrated with pictures and symbols to make it easier for the people who use the service to understand. Most health and social care professionals who corresponded with us said staff always responded appropriately to anyone who was concerned about Rosedene. The manager confirmed that as she had stated in the services AQAA the provider had received one formal complaint about Rosedene since its last inspection. Documentary evidence was produced on request that revealed the concerns raised were taken seriously by the new providers and fully investigated within 28 days in accordance with their own timescales for responding to complainants. We our satisfied the providers dealt with this complaint, which they did not upheld, in a very prompt and professional manner.All the staff we met demonstrated a good understanding of what constituted abuse andknew who they needed to notify without delay if they suspected or witnessed it. Staff


Evidence:

also told us they had received training on how to prevent, recognise, and report abuse and/or neglect. The manager showed us a copy of the host local authorities safeguarding protocols and a senior manager we met who represented the providers was also very clear which external agencies they needed to notify without delay if abuse was suspected or witnessed within the home.


Environment


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.


Judgement:


The people who use the service live in a very safe, clean, and above all homely environment. However, there remains scope to improve the overall decor of the service by repainting most of the communal areas and replacing the rather worn out kitchen cupboards.

Evidence:

During a tour of the premises we noted the services layout and all its furnishings and fittings gave the place a very comfortable and homely feel. Bedrooms we viewed with the permission of the people who currently occupied them were also well furnished and very personalised to reflect the unique tastes and lifestyles of these individuals. However, a lot of the paintwork we saw in most of the other communal areas looked rather 'shabby' and worn in places, especially in the front porch and skirting boards in the hallway and dinning area. All the cupboards in the kitchen have also seen better days and were overdue a refit. All the managers and staff we spoke with about the interior decor of the home agreed most of the communal areas could do with repainting. One member of staff told us 'the whole place could do with a lick of paint, and i don't know how old the kitchen is, but its about time we had a new one.' Similarly, a health care professional who returned our survey also told us the home needed decorating. A senior manager representing the providers and the services


Evidence:

manager both told us money was now ring fenced and a time specific action plan agreed for all the homes communal areas to be repainted by the end of the year and for a new kitchen to be refitted by the end of 2011. Progress made by the new providers to achieve these environmental aims will be closely monitored by us. Staff we met told us tables in the dinning room were no longer suitable for their intended purpose because a number of the service users new wheelchairs no longer fitted under the tops of these table. The manager told us she was aware of this relatively new issue and new tables were now on order. During a tour of the premises we noted bedrooms, toilets, and bathrooms, had all been suitably adapted to meet peoples individual mobility needs and wishes. Fittings and mobility equipment, included: a Parker bath on the ground floor; a wheelchair accessible shower unit on the first floor; overhead tracking for hoists in some bedrooms; and, a mobile hoist. The premises looked spotlessly clean throughout and smelt very fresh. The service washingmachine is capable of washing clothes at appropriate temperatures to comply withinfection control standards and away from any areas where food is stored, prepared or eaten. The manager stated in the AQAA that the service has established a action plan to deliver best practice in the prevention and control of infection.


Staffing


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.


Judgement:


The service employs sufficient numbers of competent staff on a daily basis to ensure the needs and wishes of the people who use the service are met by people who are familiar with their needs and preferences. Furthermore, staff receive regular support from their manager and fellow peers, as well as on going training, which ensures the staff team has the right mix of experience, knowledge, and skills to effectively meet the needs and wishes of all the people they support and care for.

Evidence:

Most health and social care professionals who completed our surveys told us staff at the home always respected the privacy and dignity of the people who lived at Rosedene, and most had the right skills and experience to meet their social nd health care needs. We observed all the managers and staff we met during the course of this inspection interacting with the people who use the service in a very kind, respectful, and professional manner. On several occasions we observed staff listening to the views expressed by the people who use the service, and use makaton sign language to communicate back to them. A member of staff told us they had recently received


Evidence:

training in the use of Makaton sign language and was able to show us some of the basic signs the people who lived at Rosedene most frequently used. The manager told us the service continued to experience extremely low rates of staff turnover, which meant the existing staff team were very experienced and familiar with the unique needs and preferences of the people they supported. Staff duty rosters for the week revealed that a minimum of three staff work across the day, while one waking and one sleep-in member work at night. On the day of this inspection we found four members of staff on duty, which included the manager. The manager and staff we met all agreed current staffing levels were adequate to meet the assessed needs of the people who lived at Rosedene. The manager wrote in the services AQAA that satisfactory pre-employment checks, including Criminal Records Bureau and previous employer references, are always obtained in respect of all new staff before they can start working at Rosedene. The manager confirmed that due to low rates of staff turnover she has not needed to recruit any new staff since the services last inspection. The manager showed us annual appraisals she had carried out in respect of each member of her staff team which highlighted all their training strengths and needs. Information contained in these assessments and all the feedback we received from staff we met revealed that overall the team had the right mix of knowledge, experience, and skills to meet the needs of all the people who used the service. Sufficient numbers of staff have either achieved an National Vocational Qualification in care (Level 2 or above), or are enrolled on a suitable course. Sufficient numbers of staff have also received training in fire safety, moving and handling, first aid, food hygiene, infection control, safeguarding vulnerable adults, equality and diversity, makaton signing, and the safe handling of medication. All the staff we met told us they have one to one supervision sessions with their manager and group meetings with their fellow peers approximately once a month. The manager was able to provide us with copies of the minutes of these meetings when we asked for them which revealed that were being held at regular intervals.


Conduct and management of the home


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.


Judgement:


The people who use the service continue to benefit from living in a home that is well run by a very experienced and competent manager who receives all the support she needs from the new providers.The service has also established some excellent quality assurance systems which ensures all the people who use the service and their representatives can influence how Rosedene is run and have a positive affect on its future development.The services fire, and health and safety arrangements are sufficiently robust to safeguard the welfare of the people who use the service, their guests, and staff.

Evidence:

We received a lot of positive feedback from the staff who work at Rosedene about the managers approach to running the service. Typical comments included - 'the manager always listens to us and takes on board what we say', and 'the manager is great, shes always on hand to offer us advice and support'. The manager is a qualified learning disability nurse and has been in operational day to day control of Rosedene for six years. The manager told us she feels shes gets enough support from the new providers and has regular one to one supervision sessions with her new line manager.


Evidence:

In the past year the manager has completed an understanding dementia course. The manager confirmed senior managers representing the new providers take it in turns to carry out inspections of Rosedene. It was evident from the services last three internal inspections that senior managers focus on the views of the people who live at Rosedene, as well as the staff that work there. The manager also completed and returned our AQAA when we asked for it. Both the managers we met were aware a large proportion of the services exiting policies and procedures were well overdue a review and that most would need to be up dated to reflect the philosophy of the new providers. We recommend the new provider develops a time specific action plan setting out how they intend to review and up date all the policies and procedures they inherited from the previous owners. The manager provided us with documentary evidence on request that showed us suitably qualified engineers had in the past year tested the homes gas installations, portable electrical equipment, fire detection and alarms, fire fighting equipment, water heating system, mobile hoists, and passenger lift. Fire records revealed the services fire alarm system continues to be tested on a weekly basis and fire drills are being carried out every quarter in line with good fire safety guidance. All the staff we met demonstrated a good understanding of the services fire evacuation procedures and were able to show us were all the fire exits and assembly points were. All the fire resistant doors we tested at random closed flush into their frames when we released them and none were being inappropriately wedged open at the time of this inspection. The manager has reviewed the homes fire safety risk assessment for the building in the past year and up dated it accordingly. The manager told us the temperature of hot water used in baths was tested every time it was used and a record kept of the result.


Are there any outstanding requirements from the last inspection?

Yes £ No R

Outstanding statutory requirementsThese 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


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

RecommendationsThese 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 7 The service provider should develop some more pictorial prompt cards to ensure all the people who use the service have more opportunity to express their views and make informed choices about the food and drink they eat and drink.

2 40 Finally, the new providers will need to establish a rolling programme to start the process of reviewing all the outmoded policies and procedures they inherited from the services previous owners (Surrey and Borders NHS Trust) and up date them all accordingly to reflect current 'best practise'.


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Care homes for adults (18-65 years) · 2014. 5. 27. · SM7 1PQ The quality ... There is also a bar...

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