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Inspection on 08/05/08 for Rose Hill Nursing Home

Also see our care home review for Rose Hill Nursing Home for more information

This is the latest available inspection report for this service, carried out on 8th May 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides good quality care based on individual needs assessment and well documented care plans. The activity arrangements in the home are excellent and the activities coordinator is committed to providing a varied and flexible programme of events to meet all needs and requirements. The standard of catering is good with plenty of positive feedback regarding the standard and variety of food. Staffing levels, training and recruitment are good ensuring that residents are protected by the recruitment and development of staff. The home is well run in the best interests of the residents and the health safety and welfare of staff and residents are promoted.

What has improved since the last inspection?

The requirements mad at the last inspection have been met. Staff have had updated training on privacy and dignity and manage personal care in a sensitive manner. New profile adjustable beds have been provided for residents requiring nursing care. The call bell system has been improved and is mobile to enable residents to call for help at any time. The fire safety arrangements have been reviewed and the fire safety officer has visited recently to advise on fire door closures.

CARE HOMES FOR OLDER PEOPLE Rose Hill Nursing Home 9 Rose Hill Dorking Surrey RH4 2EG Lead Inspector Mary Williamson Unannounced Inspection 08th May 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 Rose Hill Nursing Home DS0000013349.V363159.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. Rose Hill Nursing Home DS0000013349.V363159.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rose Hill Nursing Home Address 9 Rose Hill Dorking Surrey RH4 2EG 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) 01306 882622 01306 741450 info@rosehillnursinghome.co.uk Rose Hill (UK) Limited Mrs Lynda Felton-Scott Care Home 35 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (35) of places Rose Hill Nursing Home DS0000013349.V363159.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with Nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) (3) The maximum number of service users to be accommodated is 35. 2. Date of last inspection 17th May 2007 Brief Description of the Service: Rose Hill Nursing Home is situated in a quiet residential area of Dorking in Surrey. The building appears to be Victorian in origin and is surrounded by a pleasant garden area. Accommodation is arranged on three floors, accessed by a passenger lift. The accommodation consists of single and double bedrooms, some of which have en-suite facilities. There is a communal lounge and dining room. There is a small car parking area to the front of the property, and also on road parking nearby. The facilities of Dorking are within close proximity. Fees range from £720 to £780 per week. There are some additional costs for hairdressing and chiropody etc that are detailed in the Statement of Purpose. Rose Hill Nursing Home DS0000013349.V363159.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 a two star rating. This means that people who use this service experience good quality outcomes. This was the firsts visit of a key inspection and was unannounced. The inspection was undertaken by Mary Williamson Regulation Inspector. The home manager was present for the duration of the inspection and the provider was also in the home during the inspection and available for discussion. Records relating to the care of the residents and the management of the home were seen. It was possible to meet with most of the residents, and gain some feedback from them on what it is like living in the home. It was also possible to meet some of the relatives who were visiting during the day. A tour of the premises was undertaken and some residents invited the inspector to view their rooms. Lunch was observed being served in the dining room, which, was a sociable event. Discussion took place with various members of the staff team, who gave feedback on the support and training provided and their experiences of working in the home. The CSCI would like to thank the residents, residents, staff and the management team for their help and hospitality during this inspection. What the service does well: The home provides good quality care based on individual needs assessment and well documented care plans. The activity arrangements in the home are excellent and the activities coordinator is committed to providing a varied and flexible programme of events to meet all needs and requirements. Rose Hill Nursing Home DS0000013349.V363159.R01.S.doc Version 5.2 Page 6 The standard of catering is good with plenty of positive feedback regarding the standard and variety of food. Staffing levels, training and recruitment are good ensuring that residents are protected by the recruitment and development of staff. The home is well run in the best interests of the residents and the health safety and welfare of staff and residents are promoted. What has improved since the last inspection? What they could do better: Staff continue to provide good quality care to residents they care for. This should be formally recognised, during staff supervision. This has currently lapsed and provision should be made to introduce formal supervision at least six times a year. It is also recommended that the current manager apply to the CSCI to become the registered manager of the home. Rose Hill Nursing Home DS0000013349.V363159.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. Rose Hill Nursing Home DS0000013349.V363159.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 Rose Hill Nursing Home DS0000013349.V363159.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): 1, 3, and 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents have access to sufficient information to enable them to make a choice about the home. All residents have a needs assessment in place. The home does not provide intermediate care. EVIDENCE: There is an up to date statement of purpose and residents guide in place and all prospective residents and their relative have access to a copy of this in order to help make a choice about living in the home. A relative stated that this document was most helpful when viewing the home. There is a copy of this information located in individual bedrooms. All prospective residents have a full needs assessment undertaken prior to admission. This is undertaken by the manager and determines the suitability of the home to meet the individual and specific needs of the residents. Four needs assessments were sampled and were detailed and comprehensive. Rose Hill Nursing Home DS0000013349.V363159.R01.S.doc Version 5.2 Page 10 The home does not provide intermediate care and this standard was not assessed. Rose Hill Nursing Home DS0000013349.V363159.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, and 10. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Individual care plans in place outline health, personal and social cares needs of residents. Arrangements in place meet the health care needs of residents. The medication policy in place protects the residents living in the home. EVIDENCE: Four care plans were seen and these are well maintained. They are formulated on the basis of the needs assessment, input from the resident, and relatives, care manager assessments where applicable and other relevant health care reports. Staff are aware of the content of the care plans therefore delivering quality care to the residents, for example how a resident is moved, how personal care is undertaken and how they like to spend their time. Arrangements are in place to meet the health care needs of the residents. They are all registered with a local GP who visits the home every Monday or Rose Hill Nursing Home DS0000013349.V363159.R01.S.doc Version 5.2 Page 12 more frequently if required. The chiropodist was visiting the home during the inspection and visits regularly. A domiciliary dental service and optician also visit the home. Physiotherapy is available at an additional cost. Residents stated that they can see their doctor regularly and that the manager would arrange outside appointments if required. The home has a medication in place that protects the residents. All the nurses that administer medication are qualified and follow the Nursing and Midwifery Council (NMC) Code of Professional Conduct. Boots the Chemist supplies medication to the home and they also undertake periodic audits. The medication charts were seen and are well maintained indicating that residents get their prescribed medication at the correct time. Appropriate procedures are in place for handling controlled medication. Privacy and dignity is observed. Staff address residents by their preferred name, and in a respectful manner. Screens are provided in shared rooms, and staff knock on bedroom doors prior to entering. There had been an issue at the last inspection around maintaining privacy while toileting, which has now been resolved. Rose Hill Nursing Home DS0000013349.V363159.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, and 15. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The activity programme in place meets the expectations of the residents. Family and community links are maintained, ant he nutritional needs of the residents are being met. EVIDENCE: It was possible to have a discussion with the activities coordinator who is responsible for drawing up and implementing an activities programme. She plans this every two months incorporating special events like birthdays, garden parties, St Georges Day, Fathers Day, and seasonal events. Activities include art and craft, flower arranging, bingo, puzzles and games, current affaires, music and movement, cookery, one to one reading, walking, and talking. The programme is flexible and during the inspection the weather was beautiful so a garden activity replaced the planned activity in place. Residents spoke highly of the activities and the choice available. The activities coordinator also includes activities for residents in bed or do not wish to participate in-group activity. Rose Hill Nursing Home DS0000013349.V363159.R01.S.doc Version 5.2 Page 14 The local community facilities are accessed and residents are attending a reminiscence concert in the local theatre soon. Dial a Ride transport is used. Local school children visit the home on occasions. Spiritual needs are supported and Holy Communion service is arranged regularly. Visits from various clergy are arranged on request. Family links are maintained and visitors are welcome in the home at any reasonable time. Relatives spoken to during the inspection were very satisfied with the support they receive and the information provided. The manager stated that residents meetings take place about every three months. The manager with the input from residents, and a dietician plan the menus over a six-week cycle. These were seen and the food offered is varied, and nutritious. Residents were very complimentary of the food and the choice available. Lunch was observed and included meat pie, a selection of vegetables and potatoes, a prawn salad was the second choice. A variety of deserts were also available including a pineapple sponge pudding. Special diets are catered for. Residents were enjoying their meal in a comfortable dining room in a relaxed atmosphere. Staff were observed offering sensitive support the residents who required help with feeding. The current chef has been in post for two weeks and had an understanding of the needs of the residents he was catering for. The kitchen was clean and orderly and the two requirements from the last Environmental Health Inspection undertaken 8/1/2008 have been met Rose Hill Nursing Home DS0000013349.V363159.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, and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The complaints procedure and the safeguarding procedure in place protect the residents living in the home. EVIDENCE: There is a complaints procedure in place and this forms part of the resident’s guide. All residents and relatives have access to this procedure, which is located in individual bedrooms. A complaints log is also maintained and there has been one complaint received since the last inspection. This was managed and resolved in a timely fashion. The home has a safeguarding procedure in place and all staff undertake training in this procedure during their induction training. During discussion with staff they are aware of the content of this procedure. There is also a copy Surrey’s Multi Agency policies and procedures on Safeguarding Vulnerable Adults in place. The home manager has undertaken local authority training in Sussex on 8/5/2007, and it is recommended that she also undertakes training in the Surrey procedures. Rose Hill Nursing Home DS0000013349.V363159.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, 22, 24, and 26. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home meets the individual and collective of the residents and is suitable for its stated purpose. It is clean, comfortable and well maintained. EVIDENCE: Accommodation is arranged over three floors with lift access to all areas. The lounge is bright and airy and providing ample communal space. The dining room is well laid out having recently been equipped with new dining chairs. It was good to note that this room can also accommodate wheelchair users. Individual accommodation is provided in single and shared rooms. Bedrooms are well furnished; comfortable and personalised with residents own possessions. Shared rooms are provided with screens. Rose Hill Nursing Home DS0000013349.V363159.R01.S.doc Version 5.2 Page 17 The home has been adapted to meet the mobility needs of the residents. There are assisted bathrooms and shower rooms in place and toilet areas have been fitted with grab rails and raise toilet seats. The call bell system in pace is mobile and easily accessible to residents. This was a requirement from the last inspection. The home is clean and hygienic and free from odour. It was possible to talk with the housekeeper who explained that there are currently three domestic vacancies. She stated that staff have been employed and are currently awaiting their CRB (Criminal Records Bureau) disclosures prior to commencement of work. Meanwhile agency staff are employed to do the cleaning. Rose Hill Nursing Home DS0000013349.V363159.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, and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s needs are met by the number and skill mix of staff with the competence and training to do their job. The recruitment procedures in place protect the residents living in the home. EVIDENCE: The staff duty rota was seen and the amount of staff on duty was sufficient to meet the assessed needs of the residents. Staff were observed undertaking their duties in a responsible and professional manner. Individual staff training and development profiles are in place. All staff undertake induction training within the first six weeks of employment. One carer was undergoing this training and was able to explain various topics he had been inducted in, for example safeguarding vulnerable adults, care plans and fire safety. The manager keeps electronic records of all training undertaken and when refresher dates for mandatory training are due. NVQ training is ongoing and over 80 of the staff have an NVQ level 2 or 3. One member of staff is undertaking NVQ level 4. Opportunity is available for all qualified nurses to undertake professional development study days. Rose Hill Nursing Home DS0000013349.V363159.R01.S.doc Version 5.2 Page 19 There is a recruitment procedure in place and this was sampled during the inspection. Three staff employment files were seen. These are well maintained and include written references, an employment history, a job description and contract of employment and a CRB (Criminal Records Bureau) disclosure. Residents are protected by this procedure. Rose Hill Nursing Home DS0000013349.V363159.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, and 38. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is well manager in the best interests of the residents. Personal finance is not managed in the home. Staff supervision needs to be formalised. The home promotes the health, safety, and welfare of the residents and the staff. EVIDENCE: A manager who has been in post since March 2008 is currently running the home. She is in the process of completing an application pack for submission to the CSCI to become the registered manager. She is a qualified nurse and Rose Hill Nursing Home DS0000013349.V363159.R01.S.doc Version 5.2 Page 21 undertaking her Registered Manager Award (RMA). She has the management support of a deputy manager and the providers. The home has systems in place to monitor quality assurance. Annual surveys are sent to residents, relatives and other people with an interest in the service. The information obtained from these surveys are analysed and acted upon. Regular residents meetings take place and any issues relating to the operation of the home discussed and reviewed. Relative meetings take place and the manager stated that these would be changed to a more convenient time to accommodate the commitments of relatives. The home does not manage personal finances for residents. Relatives or designated representatives are invoiced for fees, and the home may hold small amounts of money to pay for sundries. Staff supervision is ad hoc and needs to be more regular and formalised. A discussion took place with the manager regarding the delegation of this and the frequency and format this should take. The health, safety and welfare of the residents and the staff are promoted and observed. All staff undertake health and safety training during their induction training. This includes manual handling, first aid, fire safety, food hygiene, and COSHH. Risk assessments are in place for all identified risks. The maintenance person in post manages an ongoing programme of maintenance and repairs in the home. He is also responsible for the fire safety procedures including the weekly testing of the fire alarms. There is a contract in place for the maintenance and servicing of fire fighting equipment and emergency lighting. The fire safety officer had visited the home the previous week to advise on door closures and safety systems as a requirement from the last inspection. These are now in place. Rose Hill Nursing Home DS0000013349.V363159.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Rose Hill Nursing Home DS0000013349.V363159.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP31 OP36 Good Practice Recommendations It is recommended that the current manager apply to the CSCI to become the registered manager of the home. It is recommended that formal staff supervision is reintroduced, and is undertaken by staff qualified to do so at least six times a year. Rose Hill Nursing Home DS0000013349.V363159.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rose Hill Nursing Home DS0000013349.V363159.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. 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