Inspection on 01/05/08 for Rosina Lodge

This is the latest available inspection report for this service, carried out on 1st May 2008.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rosina Lodge 04/05/06

Rosina Lodge 09/01/06

Rosina Lodge 23/06/05

Rosina Lodge 14/12/04

Rosina Lodge 21/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Rosina Lodge 76 St Augustine`s Avenue South Croydon Surrey CR2 6JH Lead Inspector Peter Stanley Key Unannounced Inspection 1st May 2008 09:30 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 Rosina Lodge DS0000043469.V363817.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. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosina Lodge Address 76 St Augustine`s Avenue South Croydon Surrey CR2 6JH 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) 020 8760 0735 020 8760 0735 rosina@blueyonder.co.uk Mr Balasubramaniam Balachandran Ginige Pearl Srimatie Balachandran Ginige Pearl Srimatie Balachandran Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 19 3rd May 2007 Date of last inspection Brief Description of the Service: Rosina Lodge provides places for up to 19 older people in a large converted detached family home in a very pleasant residential road in South Croydon. The home has a pleasant grassed garden to the rear with flowerbeds. The frontage is tree-lined with conifers, and provides parking space for a number of vehicles. Public transport is a walk away on the Brighton Road (frequent services). A closer (but less frequent) service is available on Pampisford Road. The home is a three-storey building with seventeen bedrooms, two of which are for double occupation, the remainder singles. All floors are accessible, via a passenger lift. The manager’s office is sited on a half-landing between the second and third floors. All main public rooms (Dining room/ through Lounge and a separate smoking room) are provided at ground floor level with a small quiet sitting room on the first floor. The home has, in 2007, adopted a no smoking policy and no longer accepts admissions from individuals who smoke. The smoking room has been converted into a small sitting room. This provides a facility for residents to receive visitors in relative privacy, and is also used for staff supervision and training. Both the kitchen and laundry are at ground floor level. The proprietors are hoping, in due course, to build a conservatory at the rear of the property. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 5 Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 6 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. There are currently 11 residents at this home, with 6 vacancies. This key inspection was conducted over one day and involved discussion with the registered provider Mr Balachandrun. The registered manager, Mrs Balachandrun was on leave and was not able to be present. The inspector spoke to a number of residents during the course of this inspection, and case-tracked three recent admissions to the home. He also spoke to staff members on duty, and observed staff’s interactions with residents. The inspector examined documentation including residents’ care plans, risk assessments, activity charts and daily logs, medication records, staff supervision and training records, policies and procedures, staff rotas and logs relating to incidents, accidents and complaints. The inspector carried out a full inspection of the premises and completed checks relating to health and safety. Views expressed by residents and a visiting relative were generally favourable, with residents presenting as settled, and satisfied with the home and the care provided. Generally, the home has continued to maintain standards over the last year, with 4 of the 5 requirements issued at the last key inspection having been met. The one remaining requirement has been partly met. From this inspection there are 7 new requirements, making 8 in all, together with 2 recommendations. The inspector would like to extend his thanks to Mr Balachandrun, and to residents and staff at Rosina Lodge, for their assistance in facilitating this inspection. What the service does well: Residents are being provided with all the information they require to enable an informed choice as to where they would like to live. Each resident is being provided with a copy of their contract or terms and conditions at the point of moving into the home. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 7 Generally, the home is able to demonstrate that it is assessing the needs of prospective residents, and that care management assessments are being obtained prior to admission. However, one admission to the home did not evidence the completion of a pre-admission assessment. The home is able to demonstrate that the range of needs presented by residents is being appropriately met. Prospective residents, their relatives and friends, are able to visit to assess the suitability of the home. Residents are having their health, personal care and social needs set out in an individual plan of care, with review taking place on a monthly basis. The health care needs of residents are being fully met. Residents are being safeguarded by the home’s medication policies and procedures. All staff have completed accredited medication training. Residents feel that that they are being treated with respect and that their right to privacy is being maintained. The views and wishes of residents, and those of their relatives, regarding the eventuality of their illness and death, are being respected. Residents are being provided with opportunities for recreational and social activities sufficient to meet their existing needs. Residents are encouraged to maintain contact with their family and friends and to retain links with the local community. Residents are assisted to exercise a fair degree of choice and control over their day-to-day routines and decision-making. The meals provided are wholesome and appealing and are served at times, and in places, which are convenient for residents. Residents and their relatives can be assured that the home has an appropriate complaints policy and procedure in place, and that their complaints will be listened to, taken seriously and acted upon. The legal rights of residents within the home are being protected and promoted. The protection of residents is being safeguarded by the home’s adult protection, policies and training. Residents are living in a safe, well-maintained environment, with access to safe and comfortable facilities. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 8 Residents’ rooms present as being safe, comfortable and pleasantly decorated, reflecting individual residents’ personal identities, and being suited to their individual needs. Residents have access to safe and comfortable communal facilities. Sufficient bathing, washing and toilet facilities are being provided for the home’s residents. Residents’ safety is being assured through the provision of sufficient aids and adaptations. Residents are living in a home that presents as being clean, pleasant and hygienic. Generally, the home has the numbers and skill mix of staff sufficient to meet the needs presented by the home’s residents, and to ensure their safety. However, should the number of residents increase from the present total of 11, to 16 or above, then the number of staff on duty should be maintained at three throughout the day. Generally, the home is being well managed, and in a way that demonstrates that it is being run in the best interests of residents. The home is consulting widely with residents, relatives and other stakeholders, and is beginning to evidence the home’s ability to meet its aims and objectives. The interests of residents are being safeguarded by the home’s record keeping, with records being kept secure, up to date and accurate. What has improved since the last inspection? What they could do better: Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 9 While the no smoking policy has been updated, references to the changes need to be included in the Statement of Purpose and Service User Guide. Generally, residents are being safeguarded by satisfactory recruitment policy and procedures. However, a recent staff appointment did not evidence the receipt of an up-to-date criminal records check. Generally, staff are being provided with the necessary induction and training with which to perform their work duties competently, and to safely meet the needs of residents. However, updated training in risk assessment has not, as previously recommended, taken place. This is required for all staff. Generally staff are being well supported through supervision, appraisal and training. However, in recent months, staff have not been receiving sufficiently regular supervision. Generally, the health, safety and welfare of residents and staff are being appropriately promoted and protected. However, hot water temperature checks have not recently been carried out on a regular weekly basis, and an effective Emergency Plan for fire safety has still to be put in place. 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. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 10 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 Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are being provided with all the information they require to enable an informed choice as to where they would like to live. Each resident is being provided with a copy of their contract or terms and conditions at the point of moving into the home. Generally, the home is able to demonstrate that it is assessing the needs of prospective residents, and that care management assessments are being obtained prior to admission. However, one admission to the home did not evidence the completion of a pre-admission assessment. The home is able to demonstrate that the range of needs presented by residents is being appropriately met. Prospective residents, their relatives and friends, are able to visit to assess the suitability of the home. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 12 EVIDENCE: The home has compiled a statement of purpose, which outlines the aims and objectives of the home, and the facilities and services it provided. This includes all the information detailed in Schedule 1 of the Care Homes Regulations (2001). The home has developed a service user’s guide; this includes all elements of Standard 1.2. All residents have been issued with a revised copy of the home’s service users’ guide. A copy of the most recent inspection report is now being included in the service user pack. Both the statement of purpose and the service users’ guide have been reviewed and updated. The home has developed a contract, which is written in an appropriate and user-friendly format. The inspector examined the files for three recent admissions and found contracts to be in place. Contracts are signed by the resident or his representative, and state the number of the room to be occupied. The inspector examined the files for three residents who have been admitted within the last 12 months. For two admissions, care management assessments had been obtained from the referring agency, the other admission having been arranged privately. One file, for an admission in September 2007, did not evidence the completion of a pre-admission assessment by the home. A risk assessment and a care plan were in place. A requirement applies. The relevant pre-admission assessments had been completed for the other two admissions. A risk assessment has yet to be completed for two residents who have just been admitted. An interim care plan has now been put in place. The evidence from care reviews indicates that residents are being involved in decisions relating to their care and that their needs are being satisfactorily identified and addressed. A sample of residents’ care plans evidenced that care plans are being regularly reviewed on a monthly basis. An appropriate induction and training programme is in place, which is helping to ensure that staff possess the relevant skills and experience with which to deliver the service to a satisfactory standard. A key worker system is in operation. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 13 Prospective residents, their friends and relatives, are invited to visit the home and to move in on a trial basis, based on their needs and choice. Staff visit prospective residents in their own home or current setting wherever possible, so as to gain as full a picture as possible of their needs and lifestyle. The Registered Providers are keen to ensure that new residents are compatible with existing residents. The home does not accept emergency admissions or provide intermediate care. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are having their health, personal care and social needs set out in an individual plan of care, with review taking place on a monthly basis. The health care needs of residents are being fully met. Residents are being safeguarded by the home’s medication policies and procedures. All staff have completed accredited medication training. Residents feel that that they are being treated with respect and that their right to privacy is being maintained. The views and wishes of residents, and those of their relatives, regarding the eventuality of their illness and death, are being respected. EVIDENCE: Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 15 Care plans are being compiled on the basis of the initial assessment prior to admission, on admission and during residency. These include a photograph of the individual and detail the person’s individual needs and how the home aims to meet these. Three residents have been admitted to the home within the last 12 months. The inspector evidenced interim care plans for two recently admitted residents, full care plans not yet having been developed. Sampling of care plans indicate that these are being reviewed and recorded on a monthly basis. All staff have completed risk assessment training. The home is attached to a GP practice, which has registered most of the home’s residents. The practice has not, however, been able to accept some of the more recent admissions and these have been allocated to a GP from a different practice. There are no longer any regular routine visits to the home, and GPs and district nurses attend residents as and when required. While not ideal, this is a health care issue that is outside of the Home’s control. Other health care professionals, including a chiropodist, visit on a periodic basis. Residents who spoke with the inspector were generally satisfied with the health care that they have received. One visiting relative did, however, feel that the home could improve in this area, though no specific health care concerns were identified. The home monitors residents’ weight and maintains weight charts. The home has a medication policy in place. Blister packs are used and kept in a locked cupboard in the providers’ office. No controlled drugs were in use at the home at the time of inspection. The inspector has found that the home is satisfactorily maintaining the medication records of residents. MAR sheets are being kept up-to-date and accurate, with staff signing these to indicate that medication has been given. A recent photograph of the person receiving medication is being attached to each resident’s MAR sheet. The home maintains a satisfactory receipts and disposals record. All staff who administer medication complete accredited medication training. Training has been evidenced with certificates. The home has received a medication audit from a pharmacist from Croydon Primary Care Trust, on 27/6/07 as a result of which a number of recommendations were made. A return visit was made on 14/3/08 to confirm that these had been implemented. The inspector was shown a copy of the report. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 16 The inspector spoke with a number of residents. Views expressed to the inspector indicated that residents feel that their privacy is being respected by staff, and that they are being treated in a caring and respectful way. The inspector observed generally good interactions between staff and residents, with care and consideration being shown. There is good provision for enabling residents to maintain their privacy. Residents are able to see visitors in the privacy of their own rooms, or in the relative privacy of a small sitting room on the first floor. There is also another small room (previously a smoking room) which is now set aside for meetings, and in which residents can receive visitors. In the two double bedrooms curtains are available to screen off the shared areas when care is being given. The home has a policy on death and dying. The home is recording residents’ wishes concerning the eventuality of their serious illness or death. These are being noted on a separate record, with a summary of these needs being recorded in the resident’s care plan. Since the last inspection, there have been five deaths of residents at the home. Two of these occurred in hospital. The family and friends of residents are involved (if that is the resident’s wish) in planning and dealing with infirmity, terminal illness and death. A Catholic priest visits regularly and there is the opportunity for service users who wish for contact with a Church of England minister, to do so. The religious and spiritual needs of residents from other faiths are addressed in accordance with the expressed wishes of the individual. Staff at the home have previously (in 2006) attended bereavement training, thus enabling staff to offer appropriate support to residents when bereavement or loss occurs. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 17 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 to 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are being provided with opportunities for recreational and social activities sufficient to meet their existing needs. Residents are encouraged to maintain contact with their family and friends and to retain links with the local community. Residents are assisted to exercise a fair degree of choice and control over their day-to-day routines and decision-making. The meals provided are wholesome and appealing and are served at times, and in places, which are convenient for residents. EVIDENCE: Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 18 The inspector canvassed the views of a number of residents regarding their daily routines and activities. Feedback indicated that, generally, residents enjoy considerable flexibility in their routines and are able to visit the local shops, parks and community facilities if they wish. There are no restrictions unless there are concerns regarding a resident’s own personal safety. If available, staff will accompany residents when accessing activities in the community. Views expressed have indicated that some residents would welcome more informal activity and input from staff. During the inspection some residents were gathered in the ground floor communal lounge. There was not at the time (just after lunch) any indication of any activity taking place, or of any staff interaction with residents, with two staff members sitting on their own at the far dining area end of the room. The inspector has, however, on previous inspections, observed staff engaging in one-to-one social interaction with residents. The home offers a range of activities that includes bingo sessions, painting, and music/movement therapy. There are visiting entertainers who visit twice a month, which includes musical sessions and sing-a-longs. There is also an exercise session organised once a fortnight. There was evidence of creative activity, with a selection of drawings and paintings by residents being displayed, weekly sessions being facilitated by staff. There are also various local events which residents are able to attend if they wish, and organised outings to places of interest. Outings and visits are occasionally arranged, two or three times a year. These have included a visit to the Croydon Airport Centre where 5 residents attended an Open Day and had tea at the Aerodrome Hotel. A day outing to the seaside is being planned, residents having voted to go to Broadstairs in Kent. Visitors to the home are actively encouraged and welcomed. Relatives and friends were invited to attend a Christmas lunch and a New Years Day afternoon tea. Some residents attended a Christmas carol concert at the Fairfield Halls. And some attended a Christmas Fair, which was held at a neighbouring school. The Home is planning an Open Day with a barbecue in the summer, and an Inter-nation Day, with displays of items, costumes and food, to which friends and relatives are to be invited. Feedback from surveys indicates that the home is welcoming to visitors and that relatives and friends are able to visit when they wish, with privacy for visits being respected. Views expressed by residents indicate that they are being consulted regarding issues that affect their day-to-day lives and that they feel able to exercise flexibility and choice. There are regular residents’ meetings, these being held on a regular two-monthly basis. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 19 The inspector was advised that two residents manage their own financial affairs, which includes collecting their own pensions. Others have assistance, generally from relatives or close friends. The home handles monies for residents only when a local authority has an agreement that the home will act as the ‘conduit’ for the payment of personal allowance. Records are being appropriately maintained for those residents (currently one) where relatives periodically provide monies for personal expenditure. Residents expressed generally favourable views about the food that is being served. Meals are home cooked by staff and are served in the communal dining area. This is pleasantly laid out and able to seat all the residents comfortably. The home’s menus evidence that the diet is well balanced and nutritional, and includes plenty of fresh vegetables and produce. The menus are changed on a regular basis, and the food on offer is discussed with residents in residents’ meetings. Three meals a day are available, together with morning and afternoon teas. A copy of the day’s menu is placed on the notice board with alternatives being available if required. The home keeps a detailed record of the food that is being provided, and caters for any special dietary needs that are required including any residents who are diabetic, vegetarian or who have ethnic minority tastes. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 20 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 to 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives can be assured that the home has an appropriate complaints policy and procedure in place, and that their complaints will be listened to, taken seriously and acted upon. The legal rights of residents within the home are being protected and promoted. The protection of residents is being safeguarded by the home’s adult protection, policies and training. EVIDENCE: The home has an appropriate complaints policy and procedure in place. A complaints book at the home details the outcome of any complaint and what action (if any) was taken. The complaints procedure is clear and simple and includes the stages and time scales for complaints to be managed. The procedure states that a complaint can, if necessary, be referred to the CSCI at any time. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 21 There has been one complaint since the last inspection. The inspector discussed this with Mr Balachandaran and was satisfied that this had been dealt with in an appropriate manner. The home aims to protect residents’ legal rights by involving family and friends in respect of their contracts, benefits and monies, and in discussing any issues at reviews. All residents are registered to vote, and are supported where necessary to vote, usually by postal vote, or by attending the polling station. Most of the residents have exercised their right to vote in the local council elections. Advocacy services are known of and publicised at the home.The home holds information on advocacy services should they be required. Both Mind and Age Concern, in Croydon, provide this service. No adult protection allegations or concerns have been recorded since the last inpection. Views expressed to the inspector indicate that residents feel safe and secure in this home, and that staff are generally perceived as being caring and considerate. All staff at the home are required to attend training in adult abuse, and have undertaken statutory adult protection training. The home has an adult protection policy (and procedures) in place, this being in line with the Local Authoritys Vulnerable Adults guidance. The home also has a Whistle Blowing Policy in place for staff to reference should the need arise. This has been developed to ensure it complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 22 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 to 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are living in a safe, well-maintained environment, with access to safe and comfortable facilities. Residents’ rooms present as being safe, comfortable and pleasantly decorated, reflecting individual residents’ personal identities, and being suited to their individual needs. Residents have access to safe and comfortable communal facilities. Sufficient bathing, washing and toilet facilities are being provided for the home’s residents. Residents’ safety is being assured through the provision of sufficient aids and adaptations. Residents are living in a home that presents as being clean, pleasant and hygienic. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 23 EVIDENCE: The home presents as being well maintained and decorated, and provides a pleasant and congenial environment. A maintenance and development programme is in place, regarding the renewal of the fabric and decoration of the home. There is a programme of ongoing redecoration and re-carpeting of residents’ bedrooms, and of the home’s communal areas including corridors and the lounge and dining areas. Since the last inspection, the communal areas within the home have been redecorated, and furniture and curtains have been replaced. The communal areas present as very pleasant and homely. There is a spacious lounge, which is divided into two distinct areas, with a separate homely dining area. The lounge overlooks a pleasant garden, which is used by residents in the summer months. A separate room, previously used as a smoking room, has now been converted into a small quiet sitting room where residents can receive visitors. The home has adopted a No Smoking policy. There are plans to develop the garden so as to include flower borders and an area for growing vegetables. The home has four bathrooms and five toilets spread throughout the home, no ensuite toilet or bathing facilities being available. There are sufficient assisted baths provided at the home. It is accepted that no more than two assisted baths would be able to be given at any one time, as the level of staffing would not allow this. The inspector spoke with a number of residents, most of whom were sitting in the communal lounge. Residents expressed their general satisfaction with the home environment and with the facilities provided. There are 15 single and 2 double rooms, both of which are being used as single rooms. Lockable spaces are provided. The inspector viewed some rooms and spoke with two residents and one visiting relative, who were present. Both residents seemed happy with their rooms, which presented as meeting their individual needs, and included personal photos and mementoes. The rooms seen by the inspector reflected residents’ individual tastes and identities, and presented as being adequately furnished and decorated. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 24 and included personal photos and mementoes. Residents are able to bring personal possessions and items of furniture with them to the home. Lockable spaces are provided. Residents’ rooms are being kept at a comfortable temperature and have good ventilation. Residents are able to control the temperature of their own rooms using temperature thermostats on their radiators. All radiators are covered for safety reasons. The lighting throughout the home is adequate, all rooms having natural light and opening windows. Thermostatic valves on baths control the heat of hot water outflow, and regular weekly checks of water temperatures are being maintained. Magnetic doorstops have been fitted to those rooms where it has been the resident’s wish for their door to be kept open. The home was last assessed by an occupational therapist, on 17 March 2007, and was found to provide ‘an appropriate, well-maintained environment’ for the home’s residents. There were no recommendations. Following a previous OT assessment in July 2004, the home placed restrictors on all upstairs windows, completed risk assessments for all residents who use the stairs, and placed warning signs on all doors that open outwards. The home has stair rails and rails fitted along corridors. There is a passenger lift to all floors. There is a loop system for the television and telephone. Raised toilet seats, commodes and adapted bath chairs are in evidence throughout the home. Arjo hoists are in regular use to assist with bathing. These are being regularly serviced on a six-monthly basis, most recently on 21 December 2007. The home presents as being clean, pleasant and hygienic, with kitchen, washing/toilet and communal areas being maintained to a satisfactory standard. All COSHH items are securely stored in locked cupboards. Environmental Health last inspected the home on 6 Feb 2007. This inspection proved to be satisfactory. A mechanical sluice/pan sterilising machine is separately located in its own room on the first floor, enabling access from all areas, without risk of crossinfection. An infection control policy is in place, and infection control training is provided for staff. This training has been updated within the last year, on 21 June 2007. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 25 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 to 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally, the home has the numbers and skill mix of staff sufficient to meet the needs presented by the home’s residents, and to ensure their safety. However, should the number of residents increase from the present total of 11, to 16 or above, then the number of staff on duty should be maintained at three throughout the day. Generally, residents are being safeguarded by satisfactory recruitment policy and procedures. However, a recent staff appointment did not evidence the receipt of an up-to-date criminal records check. Generally, staff are being provided with the necessary induction and training with which to perform their work duties competently, and to safely meet the needs of residents. However, updated training in risk assessment has not, as previously recommended, taken place. This is required for all staff. EVIDENCE: Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 26 The home was evidenced to have the numbers and skill mix of staff sufficient to safely meet the needs presented by the home’s residents. The inspector checked the staff rota. A minimum of two staff is being provided at all times, day or night (both waking staff), with at least three staff being present at peak times in the morning. The extra staffing in the morning allows for some ancillary work without reducing from the two care staff being available to residents at all times. Given the present number of vacancies (8) the current staffing levels are assessed as being sufficient for the current number of residents (11). However, should the number of residents increase back to 16 or over, then the home would need to have at least three staff on duty throughout the day, from 8am to 6pm, rather than from 8am to 2pm as at present. This is in line with a requirement from the last inspection. This was, in part, because of the high level of care need among the resident group, due to a number of residents having become increasingly frail and disabled. There was also a need for more staff input in the afternoons in interacting with residents and engaging them in activities. The inspector examined the staff files for two new staff members and found that both staff files included evidence of identity and recruitment checks, and a photograph of the staff member. However, for one recently started staff member, the inspector evidenced that a CRB certificate has not yet been obtained, although possessing CRB clearance from the agency with whom she had, until recently, been working with at the Home. Given that the POVA check and 2 satisfactory references, and all other checks had been completed, it was agreed that the staff member could continue to work, but only under supervision, with no one to one contact with any resident, until CRB clearance has been obtained. The registered provider, Mr Balachandrun gave an assurance that these conditions would be met. A requirement applies. Mr Balachandrun was advised that, in future, no staff appointments can be made without an up-to-date enhanced CRB certificate having first been obtained. He was also advised that only exceptionally (and subject to a number of conditions being met) could the agreement (in writing) of the inspector be given for an appointment going ahead pending the receipt of a CRB. Given past concerns regarding the completion of CRB and POVA checks, there will be continuing close monitoring on future inspections. The home has developed an induction programme for new staff. An induction pack, which evidences the induction training that each new staff member is completing, has been put in place. This includes health and safety, the values and principles of care, resident care, and key policies and procedures (including adult protection). Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 27 The registered providers are keen to ensure that all staff have the opportunity to develop their knowledge and skills and to obtain an NVQ qualification. The home has increased the proportion of staff who possess an NVQ Level 2, 11 out of 15 staff having achieved this, and the remaining 4 staff having commenced or registered for study leading to this qualification. 3 staff have completed an NVQ Level 3, a further 7 staff having registered to study for this. This represents a significant improvement from the previous inspection. There is evidence of a commitment to developing staff training, this being evidenced in an annual staff training plan. This includes all mandatory training and training specific to the needs of the resident group. Staff records evidence a range of qualifications that have been obtained by staff. This includes evidence of training for staff in Adult Protection, First Aid, Fire Safety, Manual Handling, Medication, Food Hygiene and Infection Control. There has also been training in areas such as Bereavement and loss. Training is being updated on an ongoing annual basis. The inspector previously recommended that staff undertake updated training in risk assessment. This training has not, as yet, taken place, and becomes a requirement. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 28 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 to 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally, the home is being well managed, and in a way that demonstrates that it is being run in the best interests of residents. The home is consulting widely with residents, relatives and other stakeholders, and is beginning to evidence the home’s ability to meet its aims and objectives. Generally staff are being well supported through supervision, appraisal and training. However, in recent months, staff have not been receiving sufficiently regular supervision. The interests of residents are being safeguarded by the home’s record keeping, with records being kept secure, up to date and accurate. Generally, the health, safety and welfare of residents and staff are being Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 29 appropriately promoted and protected. However, hot water temperature checks have not recently been carried out on a regular weekly basis, and an effective Emergency Plan for fire safety has still to be put in place. EVIDENCE: The registered persons, Mr and Mrs Balachandrun, took over the ownership of the home in June 2003. Mrs Balachandrun is the registered manager and has completed her Registered Managers Award and NVQ Level 4. Mr Balachandrun has indicated that he is also intending to complete training for the Registered Managers Award. In the period since taking over the day to day management of Rosina Lodge, early in 2005, Mrs Balachandrun has gained substantial experience of managing the home, and has demonstrated a high level of commitment and competence in fulfilling this role. She also has skills in counselling and complementary therapies. From the views expressed by residents, relatives and staff, the home is being managed in a competent, caring and open way. Residents indicate that they are able to exercise choice in their day-to-day lives and that they are being consulted regarding their daily activities and any decisions that affect them. Meetings with residents are being held on a regular two-monthly basis, and inspection of the minutes indicates that issues affecting the welfare and daily lives of the residents are being openly discussed. Staff members expressed generally favourable views about the home and the support that is being provided. Feedback from staff members indicates that staff are generally happy working in the home, and that the management style is perceived as being supportive and enabling. There are regular monthly staff meetings, and staff handover meetings between shifts. The home has quality assurance processes in place. Questionnaires are completed with the home’s residents, the relatives/friends of residents, visiting care managers and other professionals. The home has developed a quality assurance audit report, and a Development Plan has been put in place for 2007-08. The Plan has been developed so as to collate all the feedback and information gathered from surveys and other sources, and identify the actions/plans to address any deficiencies or improvements required. The report is made available to residents, their relatives and other stakeholders, and a copy forwarded to the CSCI, local office. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 30 The home is able to demonstrate its financial viability. Audited accounts for the year ending 2006-07 are currently being prepared, and a current Business Plan has been published. A Policies and Procedures checklist, detailing the date of adoption and review of each policy and procedure is included in the Policies and Procedures manual. All policies and procedures have been reviewed within the last 12 months (in February 2008). Staff sign to indicate that they have read and understood key policies and procedures, together with any updates relating to them, meeting a recommendation from the last report. Mrs Balachandrun has stated that key policies and changes are discussed in staff meetings, and within induction, training and supervision sessions. A requirement, for the No Smoking policy to be updated, has been partly met. References to the changes still need to be included in the Statement of Purpose and Service User Guide. Supervision of staff is being undertaken by the registered manager and two senior care workers (both of whom have received supervision training). Supervision agreements are drawn up with staff. The inspector sampled a number of staff files and found that 5 staff had not received supervision within the last two months, 3 of whom had not been supervised for more than three months. A requirement applies. There are also two recommendations relating to supervision. Mr Balachandrun was advised that staff supervision must be held at least two monthly for all staff, and that this needed to be monitored more closely. To assist this, the inspector recommended that a supervision log be maintained, detailing the dates when supervision for each staff member has been held, and is next due. A structured format for recording supervision has been developed to ensure that all relevant issues relating to practice, performance and training/ development are covered within supervision. The inspector examined supervision notes for a number of staff and found that that supervision recording was very thin in some cases. Recording needs to be more detailed so as to provide a fuller picture of the issues discussed between the supervisor and supervisee, and the actions required. The home is completing annual staff appraisals, these being evidenced during the inspection. New staff receive two appraisals within their first 12 months. All maintenance checks including gas safety, water supply/legionella, fire safety, food hygiene, soiled waste disposal, lift and hoist servicing checks have been completed and are up to date. The home’s lift is inspected every three Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 31 months in line with the LOLER regulations 1998. Six-monthly inspections of emergency lighting, fire alarms, fire safety equipment and the emergency call system have been completed. Renewal of the 3-year inspection for electrical installation and wiring, and checks on portable electrical appliances, were completed in October 2007. There were two concerns identified. The inspector was concerned to note from the records that hot water temperature checks have not recently been carried out on a regular weekly basis, the last two recorded dates on the day of inspection (1/5/08) having been 3 April and 14 April. There was also a two-week gap between readings on 13 March and 26 March. A requirement applies. The home received an inspection from the LPFA on 4/12/07, as a result of which four concerns were identified. Three of these have been addressed, but as required in the LPFA inspection report (Article 15) of 4/12/07, an effective Emergency Plan for fire safety, has still to be put in place. A requirement applies. Subsequent to the inspection, the Fire Risk assessment was revised and updated (on 17/2/08) in line with the recommendations. There have been regular checks of fire doors, fire alarms and emergency lighting, with fire drills being held every few months, the last one being on 31/1/08. Risk assessments for safe working practices have been completed and updated on 17.3.08. Health and safety risk assessments have been carried out for areas of risk including the premises, manual handling, drugs, COSSH and waste disposal. The accidents and incidents record was examined and found to have been satisfactorily maintained. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 32 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 3 2 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 X 2 2 2 Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? Yes 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 OP4 Regulation 14(1)(a) & (c) Requirement Assessment of needs. For prospective residents’ needs to be fully identified, the registered providers must ensure that a pre-admission assessment is completed for each admission to the home. One file, for an admission in September 2007, did not evidence the completion of a pre-admission assessment. 2 OP4 14(1)(a) & (c) Risk assessment. To enable prospective residents’ risk factors to be fully identified, the registered providers must ensure that a risk assessment is completed for each admission to the home. A risk assessment has yet to be completed for two residents who have recently been admitted to the home. 3 OP29 19 (1b), Schedule Criminal records checks. DS0000043469.V363817.R01.S.doc Timescale for action 30/06/08 30/06/08 30/06/08 Version 5.2 Page 34 Rosina Lodge 2, No 7 To ensure the protection of residents, the registered providers must ensure that a CRB certificate has been received prior to commencing any staff appointment. The inspector evidenced that a POVA check and 2 satisfactory references had been completed for a recently started staff member where a CRB has not yet been obtained. It was agreed that the staff member could work under supervision, with no 1 to 1 contact with any resident, until CRB clearance has been obtained. 4 OP30 !3(4)(c) & (6) 18(1)(a) & (c) 18(2) To ensure the protection and safety of residents, staff must undertake updated training in risk assessment. Staff supervision. The registered providers must ensure that all staff receive regular two monthly supervision. 31/10/08 5 OP36 31/05/08 6 OP37 12(1)(a) No Smoking Policy. The policy needs to be amended so that staff, residents, relatives, and prospective users are clear as to the Home’s position regarding its ban on smoking. Partly met. While the no smoking policy has been amended, references to the changes still need to be included in the Statement of Purpose and Service User Guide. 30/06/08 Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 35 7 OP38 13(4) (a) & (c) 24 (4)(a) & (c) Fire Safety. As required in the LPFA inspection report (Article 15) of 4/12/07, an effective Emergency Plan for fire safety, must be put in place. Health and Safety. To ensure the safety of residents, hot water temperature checks must be carried out on a regular weekly basis. 30/06/08 8 OP38 13(4) (a) & (c) 31/05/08 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 OP36 Good Practice Recommendations The home needs to monitor staff supervision more closely so as to ensure the required regularity for all staff. To help facilitate this, the inspector recommends that a staff supervision log is maintained, with details of the dates when supervision sessions have been held and are next due. The registered providers should monitor the log on a regular weekly basis. 2 OP36 Supervision recording needs to be more detailed so as to provide a fuller picture of the issues discussed between the supervisor and supervisee, and the actions required. Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Rosina Lodge DS0000043469.V363817.R01.S.doc Version 5.2 Page 37 - 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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