CARE HOME ADULTS 18-65
Rosehill House 30 Rougemont Avenue Torquay Devon TQ2 7JP Lead Inspector
Sam Sly Announced 17 May 2005
th 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Rosehill House D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Rosehill House Address 30 Rougemont Avenue, Torquay, Devon, TQ2 7JP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 615538 01803 291856 info@craegmoor.co.uk Parkcare Homes Limited vacancy Care Home 4 Category(ies) of Physical disability (4) Mental Disorder (4) registration, with number of places Rosehill House D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 10th February 2005 Brief Description of the Service: Rosehill House cares for 4 people with physical disabilities and/or mental disorder. It specialises in caring for people who have suffered a brain injury and is owned by a subsidary of Craegmoor Healthcare Limited. The house is in a residential area of Torquay and near to community amenities. Rosehill is wheelchair accessible with level access throughout and adapted shower rooms and a bathroom with an electric chair. There are four single bedrooms, an office/staff room, lounge, dinig room, kitchen and laundry room. The garden to the back of the house is ramped with a patio area. Rosehill House D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Inspection was announced and took place over 4 hours on a weekday. Time was spent with all three residents, and a meal was shared with two of them. Judgements were based on observation of staff/resident interaction, written records, discussion with residents, staff and the acting Manager Helen Tremlett, a tour of the building, and comment cards received from relatives. The staff at Rosehill House had successfully enabled a previous resident to move recently into his own flat in the community. What the service does well: What has improved since the last inspection? What they could do better:
The acting manager had only been in post for under a month so was still getting to know the management processes, and an application to register her had not yet been sent to CSCI. Dedicated time for the acting manager to
Rosehill House D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc Version 1.20 Page 6 undertake her managerial responsibilities was under negotiation with the Owners but not yet agreed. A formal notice was left with the acting manager as medication given to residents had not been recorded properly, and staff had not received appropriate training leaving residents open to harm. All the required information to prove the fitness of staff could not be found in staff files, and staff, including the acting manager, had not received adult protection training so residents were potentially at risk of abuse. The present methods for monitoring quality in the Home need to include the views of residents and others involved, and provide information so that the Owners, CSCI and other interested parties know, overall, what Rosehill House dies well and still needs to do to improve. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rosehill House D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Rosehill House D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 There was clear information so residents could make an informed decision about moving to the Home. EVIDENCE: There was a clear Statement of Purpose, and individualised Service User Guide’s so that residents and their representatives were clear about what to expect from the Home. Rosehill House D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc Version 1.20 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 Care plans had clear detailed information, including responsible risk taking and decision-making, so staff could promote as independent lifestyle as possible. EVIDENCE: Care plans were examined and found to be up to date, and regularly reviewed with the residents and their representatives. Plans accurately reflected the needs of residents as expressed by them and staff. There were examples in the daily records of residents being able to make choices on a regular basis. Rosehill House D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc Version 1.20 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15, 16 and 17 Residents lead active, interesting, fulfilling lives including a range of educational and leisure activities in the community. Residents are enabled to develop and maintain relationships, and their rights are respected in their everyday lives. Meals are chosen by the residents, and are healthy and enjoyable. EVIDENCE: The routines of the Home were flexible to the needs of residents. Staff said that having 3 staff on duty made taking residents out and about much easier, this had not yet been agreed long term with the Owners. Residents said they did lots of activities that they had chosen and enjoyed. On the day of Inspection one resident went out for a drive and a drink, another went riding and another was attending a Board meeting for Torbay Council. Two residents had recently been on holiday abroad, and another told me they regularly had contact with parents. The acting manager was able to demonstrate that she was constantly looking for new activities for residents.
Rosehill House D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc Version 1.20 Page 11 The meal shared was enjoyable with a relaxed atmosphere between staff and residents. Residents chose the menu and shopped for the food. Rosehill House D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc Version 1.20 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 All residents receive personal and health support in the way they prefer and require. The present training for staff and administration of medication does not protect residents. EVIDENCE: Care plans detailed the way residents wanted and needed their personal and health care needs met, and residents spoken to confirmed that they liked the way staff helped them. Records also showed that appropriate health and social care professionals monitored residents. Residents had appropriate aides to maximise their independence. One resident was very pleased with the communication aide they now had. An immediate requirement was left with the Acting Manager as the mistakes were found in the medication records, and staff administering medication had not received appropriate training. This left residents open to potential harm. Rosehill House D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc Version 1.20 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Arrangements for listening and acting on residents concerns were appropriate, but a lack of appropriate training on adult protection for staff meant residents were potentially at risk of harm. EVIDENCE: The complaints procedure was clear. Neither the Home nor CSCI had received any complaints since the last Inspection. When questioned the Acting Manager did not know the correct procedure to follow if faced with an abusive situation, and the appropriate written procedure could not be found. However, the Acting Manager made arrangements, whilst the Inspection was taking place, for all staff to attend adult protection training with Torbay Council in June 2005. Rosehill House D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc Version 1.20 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 The premises are suitably adapted, maintained and furnished for it’s stated purpose so the residents living there have a sae, comfortable home. EVIDENCE: A tour of the house showed that some improvements had been made, and that the Acting Manager had carried out a detailed assessment of the deficits in the environment and there was a rolling programme of refurbishment about to begin. The Home had not been visited since the last Inspection by the Fire or Environmental Health Departments. Rosehill House D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc Version 1.20 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 and 35 A range of staff training meant residents needs were met, however there was a lack of some evidence in staff files to demonstrate the fitness of staff meaning residents were not fully protected. EVIDENCE: The Owners now oversaw the recruitment procedures, however the Acting Manager was unclear of these procedures, as she was new to the role. Several staff files were examined and found to lack appropriate paperwork. The acting manager made arrangements, whilst the Inspection was taking place, to get assistance to reorganise the staff files. Staff attended a range of training, and the Owners employed a training coordinator who had developed a training plan for the Home, unfortunately adult protection training was not included. Staff said they were happy with the training they received and felt it helped them meet the needs of residents. Rosehill House D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc Version 1.20 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 and 42 Without dedicated time, and registration with CSCI, the acting manager cannot fully undertake her managerial responsibilities and therefore the home cannot be run as well as it should be. The Owners methods for monitoring quality were not underpinned by the views of residents or others involved, and did not enable them to identify, overall, what they were doing well or needed to improve, or inform CSCI or other interested parties of this. The residents health, safety and welfare was protected and promoted by the Owners and acting manager. EVIDENCE: There has been an outstanding requirement for four Inspections now that the manager/acting manager is given dedicated time to carry out her management responsibilities. The acting manager said the Owners had agreed in principle to this, but no firm plans had yet been made. The acting manager had only been in post for under a month and was still settling in, so an application to CSCI had not yet been made to register her.
Rosehill House D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc Version 1.20 Page 17 The Owners were aware that the quality assurance system needed work as requirements had been made at the last 4 Inspections. There were some monitoring methods in place: the Owners visited Rosehill House monthly, and regular health and safety checks were carried out. The Acting Manager said questionnaires had been sent out in the past, but the Owners did not give feedback. There were no overall quality audit results that could provide information for CSCI and other interested parties. Records showed staff had received a range of health and safety training. Required records like the fire book and accident book were up to date, and the environment was safe and protected residents and staff. SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x x x x Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No
Rosehill House Score Standard No 24 25 26 27 Score 3 x x x
Version 1.20 Page 18 D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc 6 7 8 9 10
LIFESTYLES 3 3 x 3 x
Score 28 29 30
STAFFING x x x Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x x 2 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 2 x x 3 x Rosehill House D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc Version 1.20 Page 19 yes 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. 1. Standard 23 Regulation 13 (6) Requirement All staff must have adult protection training and there must be an appropriate policy and procedure in place. The acting manager must be given enough dedicated time to undertake her managerial responsibilities (Previous timescale of 16th April 2005 not met). All staff files must contain all the required evidence to demonstrate their fitness An application must be sent to CSCI to register the acting manager. There must be a complete Quality Assurance system in place which captures the views of the residents and stakeholders. An annual report must be produced, with a copy available for CSCI and other interested parties (Previous tomescale 16th April 2005 not met) Medication administered by staff must be recorded correctly. All staff that administer medication must receive appropriate training. Timescale for action 20th August 2005 20th August 2005 2. 37 18 3. 4. 5. 34 37 39 19 Schedule 2 8 24 20th July 2005 20th July 2005 20th August 2005 6. 20 13 (2) 17th May 2005 Rosehill House D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc Version 1.20 Page 20 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 16 Good Practice Recommendations Appropriate locks be fitted to all bedroom doors as the rooms become vacant. Rosehill House D54-D07 S18418 Rosehill House V214573 170505 Stage 4.doc Version 1.20 Page 21 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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