Inspection on 13/12/07 for Rockliffe House

This inspection was carried out on 13th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rockliffe House 08/12/08

Rockliffe House 23/01/07

Rockliffe House 05/12/05

Rockliffe House 07/06/05

Rockliffe House 12/10/04

Rockliffe House 06/05/04

Rockliffe House 19/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Rockliffe House 466 Beverley Road Kingston upon Hull East Yorkshire HU5 1NF Lead Inspector Beverly Hill Key Unannounced Inspection 13th December 2007 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 Rockliffe House DS0000046755.V356627.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. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rockliffe House Address 466 Beverley Road Kingston upon Hull East Yorkshire HU5 1NF 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) 01482 342906 Joanne Marie Bush Jean Susan Goodwin Joanne Marie Bush Care Home 21 Category(ies) of Sensory impairment (21), Sensory Impairment registration, with number over 65 years of age (21) of places Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd January 2007 Brief Description of the Service: Rockliffe House is a small family owned business situated on a main road approximately 1½ miles from Hull city centre. It benefits from being sited next door to Hull and East Riding Institute for the Blind headquarters, and service users can attend the day centre provided by them. There are local shops, pubs and churches nearby and the home is on major bus routes into Hull and Beverley. Rockliffe House is registered for up to 21 people and provides personal care and accommodation for both younger adults and older people with a visual impairment. Accommodation is on three floors serviced by a through floor lift and consists of six shared and nine single bedrooms. The home has three separate lounges and a dining room set out with individual tables to seat two, four or six people at each. There are sufficient toilets and bathrooms to meet the needs of service users. There is an enclosed patio/garden area at the side of the home and a small parking area at the front. According to information received from the home on 13th December 2007 their weekly fees are £338.80p in line with local authority payments. The proprietors have decided not to charge a top up fee. Items not included in the fee are toiletries, hairdressing and chiropody. The home had a statement of purpose and service user guide displayed in the home and had the facility to provide documentation in Braille. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 23rd January 2007 including information gathered during a site visit to the home, which took place over one day. Throughout the day we spoke to people to gain a picture of what life was like for them to live at Rockliffe House and analysed the surveys returned from them. We also had discussions with the registered manager and deputy manager, who were also the proprietors of the home, care staff members who were on duty, a visiting GP and also a district nurse. Information was also obtained from surveys received from staff members, relatives and visiting professionals. Comments from the surveys have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. A pharmacy inspector had visited the home in June 2007 to follow up requirements they had made during an earlier visit. How the staff continued to manage medication was also assessed during the visit on 13th December 2007. We would like to thank the service users, staff and management for their hospitality during the visit and also thank the people who completed surveys. What the service does well: The manager made sure that people were only admitted to the home after they had received an assessment of their needs. This enabled the manager and staff to be sure the home could meet the persons’ needs fully. The home also offered people the opportunity to visit the home to meet other residents and have a trial stay before making a final decision. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 6 Information leaflets of the medication supplied were kept in a folder attached to the medication trolley. This is an example of good practice as it provides the staff with up to date information on medication. Only senior care staff members are responsible for handling medicines. The staff team was small and very friendly and service users had nothing but praise for their approach and assistance in ensuring choice and independence was maintained, ‘the staff are very nice, they do everything you ask them to’, ‘the staff are brilliant and they work hard’, ‘they’ve (the proprietors) been ever so good to us since they took over, there’s been big improvements’. People had maintained their contacts with community groups and facilities, which was encouraged by staff members. Activities and social events organised by the home enhanced the quality of peoples’ lives. One person said, ‘I am very happy with the home, we went out in the minibus last night to Preston’. A district nurse said that the home provided very good care and support to a person who wanted to remain at the home to die instead of going into hospital. People liked the meals provided, ‘the meals are very hearty, hot and tasty’. They said they had plenty to eat and drink. The home made sure that any complaints were dealt with quickly and had a copy of the complaints procedure printed in Braille. The proprietors continue to be committed to steadily improving the environment. This was a slow process as the building was a listed building. The home had plenty of space and three homely communal lounges for people to choose where to sit. Generally the staff training was good and all staff completed training in how to support people with a sensory impairment. The home had seven of the eleven care staff, which equated to 63 , trained to national vocational qualification in care at level 2 and 3. However the home could look at other areas of staff training needs like dementia care and conditions that affect older people. What has improved since the last inspection? Every person had been given an updated terms and conditions of the home document. The way the home managed medication had improved a lot. This made sure people received the medication prescribed for them. New curtains had been made for some of the bedrooms. The home had replaced the mounting for the safety gate at the top of the stairs making it more secure. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 7 The home was generally tidier and bedrooms were cleaner with attention paid to sinks and personal items. The way the home recruited staff had improved so that more checks were made prior to them starting in their employment. What they could do better: Some of the sections of the care plans were good but one or two still didn’t contain all the information needed and one lacked specific information for staff. This could lead to service users not receiving all the care they required. The care plans must be signed by the person writing them and by the person they concern. This will give an indication that people are aware of the contents of their care plan and agree to what is written and planned for them. The way staff recorded the support they provided to people could be improved so that the reader has a good idea of how the person is, what the staff have done to care for them and how they have helped them to continue to be independent. Staff members need to make sure they contact health professional quickly for advice and treatment for people and not try to deal with things themselves. Two people managed some of their own medication. This is really good in ensuring that people remain independent but the home must complete an assessment to make sure the person is able to do this safely and the care plan must detail how this is to be monitored. When we visited we found the keys to the medication trolley had been left in the trolley and the staff were in another room. This meant medication was accessible to residents or visitors to the home. The keys must be kept secure at all times. Also there are new regulations coming in about the storage of controlled drugs and the home should check with their pharmacist regarding how this will affect them. There are still a few staff members who have not received training in how to safeguard people from abuse. The manager needs to make sure they are all fully aware of what to do should they suspect anything. The home must make sure they have the correct number of staff on duty at all times and they need to recruit more care staff. They are short staffed at the moment and the manager and some staff members are completing extra shifts to cover the gaps. This is acceptable in the short term but can be very tiring for people. Staff members complete an induction but the paperwork is not completed fully. This means that there is no evidence that the induction has been effective and Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 8 that staff are competent to carry out basic care at the end of it. Staff training could be broadened to cover the conditions affecting older people. Because the manager has been completing caring shifts they have not had enough time to complete management tasks and some areas have slipped, such as staff supervision, overseeing induction, staff and service user meetings, quality monitoring and checking health and safety in the home. 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. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 9 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 Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 10 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): 2, 3 and 5 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. Service users needs are assessed prior to admission which means the home is able to determine whether they are able to meet needs. The home provides an opportunity for service users to have trial visits. EVIDENCE: Since the last inspection all service users had received updated terms and conditions of their residency. We examined four care files during the visit. One of the files was for a person who was privately funded and therefore only required an assessment completed by the home, which was in place. The manager confirmed they visited people at home or in hospital to complete the homes in-house Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 11 assessments prior to admission. The staff completed generally the same initial assessment information on three separate forms duplicating work, and simplifying and streamlining the process was discussed with the manager. Those people funded by the local authority had their needs assessed by care management teams. The home had obtained copies of the assessments in all cases, which helped them decide whether the home was able to meet needs. People were encouraged to visit the home to look around and the home provided them with information about services. The manager confirmed the first four to six weeks of any admission were seen as a trial period then a review was held, to discuss the stay and whether permanent residency was required. This was confirmed in discussion with a person visiting the home for a short stay. The home also completed, ‘enquiry forms’ when someone made initial requests about services. The form stated whether the person wanted to visit for a meal and a look around. The manager stated that respite care gave people the opportunity to try the home and get to know staff and the homes way of working during regular visits before making any final decision about permanent residency. The home had produced a letter to formally write to people following the assessment stating their capacity to meet the identified needs. The home does not provide intermediate care services. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans do not always contain all assessed needs and do not always have clear tasks for staff. This may mean that important care could be missed. A delay in referral to health professional on one occasion meant that the service users needs were not met in a timely manner. Service users had access to health care services and mostly care needs were met in ways that respected their privacy and dignity. Improvements were noted in the management of medication but a lack of security regarding the drugs trolley keys could place service users at risk. The home ensures that service users are well supported and cared for should they choose to remain at the home when they are dying. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 13 EVIDENCE: Four care files were examined during the visit. Care files examined contained lots of information, for example, assessments, risk assessments, preference lists, goal and action plans, personal profiles and life histories, to use in the formation of care plans. Generally care plans contained relevant information, and there had been some improvements noted since the last inspection. However in some of the care plans there were still areas where specific care needs were not planned. For example, one person had needs associated with anxiety and low mood and dietary needs mentioned in the local authority assessment but these were not addressed in the care plan produced by the home. In one case, instructions for staff to provide particular personal care had also been omitted. Care plans were evaluated monthly in a key worker report and these did state if any changes to the care plans were required and six monthly reviews were held. There was some evidence of changes to care plans noted, however some were not dated. Care file documentation was not consistently signed and dated by the person formulating it, for example, assessments, goal and action plans and care plans. There were also some care plans that had not been signed as agreed by service users or their representatives. The lack of signing and dating on important documents was noted at the last inspection and must be improved. Daily recording by care staff in all four files examined did not fully reflect the care provided during the day. Staff were very brief with their entries, for example, ‘fine’, ‘all care given’ and ‘good diet’. Also separate bathing and activity forms were completed, however staff recorded, ‘yes’, rather than the date and signature. Service users had access to a range of services such as GP’s, district nurses, opticians, dentists, out patients and chiropody. One person stated, ‘if I need a doctor one is requested for me straight away’. A GP spoken with during the day stated he had no concerns about the home. We also spoke to a district nurse during the visit. They told us that staff had treated a service user themselves and delayed contacting them. This was also confirmed in a survey from another district nurse within the team, which stated, ‘a carer tried to treat a knee injury without professional advice and because of this the knee took a long time to heal and required antibiotics and swabs’. The survey also stated that a message was not passed on to all staff and a service user was bathed which resulted in a bandage becoming wet. The same survey praised the level of care when a particular senior carer was on duty. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 14 Service users spoken with stated their health and personal care needs were met in a way that respected their privacy and dignity, ‘I am happy with all the care and support I receive’, ‘I have a lot of praise for the home. It was the best move for me’. However a survey from a health professional stated they had observed staff not using privacy screens in shared bedrooms. Staff must make sure privacy screens are utilised even though service users have their sight impaired. Surveys from relatives indicated they were happy with the care provided, ‘first class attention’, ‘they do a very good job, my mother always looks nice and clean’, ‘provides very good care’ and ‘I am highly satisfied’. Risk assessments were completed for moving and handling, falls and allergies and the home completed a form with a score system for example, for risks associated with maintaining a safe environment, nutrition and skin integrity. One person administered their own medication and another person selfmedicated their inhalers. However they did not have risk assessments and care plans in place for this. There had been improvements in the way medication was managed since the last visits by the pharmacy inspector. The homes policy and procedure had been updated and medication was signed on admission to the home and on administration. There are new regulations coming into force governing storage of controlled drugs in residential homes. The proprietor needs to be aware of these via discussion with the community pharmacist and take the appropriate action to replace the current coded safe with a double lockable controlled drugs cupboard. However there were still some areas of medication management to be completed. One person was prescribed anticoagulant medication and it is good practice to ensure written confirmation regarding changes to the dosage is held with the medication administration record. The person in charge of the shift had not kept the keys to the medication trolley secure, as we found them in the trolley. This was a requirement at the last inspection and must be addressed by all staff. The temperature of the room where medication is stored next to the kitchen, still requires to be monitored with a thermometer to ensure storage is below 25°C, as requested at the pharmacy visit in June 2007. A district nurse spoken with stated the home provided very good care to a service user who chose to remain at the home when they were dying. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 15 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 home ensured that service users were able to make choices about aspects of their lives and provided flexible routines and nutritional meals. EVIDENCE: There was evidence that the home continued to provide activities for service users to participate in and outings to local venues took place. Some people were more active than others in their participation in such activities as dominoes, crafts, quiz sessions, reminiscing, hand massage and nail care, musical evenings and sing-a-longs. Every Saturday evening the home had some form of entertainment with food and drinks and people expressed they enjoyed this. Some people continued to attend external functions, clubs and local churches for services. Staff encouraged and supported this. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 16 One person stated in a survey, ‘the activities are good and I enjoy them very much especially Saturday nights’. All surveys received from service users had ticked that activities were available, ‘always’ or ‘usually’. Service users spoken to confirmed that their relatives were able to visit at any time and were made welcome. Staff members read care plans, personal profiles and preference lists and get to know service users quickly in order to help people maintain their independence. They know the service users needs and what they need to do to meet them. It was unclear whether service user meetings were taking place, however people spoken with stated they were able to make suggestions and talk to the manager. They said routines were flexible and they had choices about aspects of their lives. For example times of rising and retiring, meals, continued employment, activities, attending local facilities and day centres, bathing, how they personalise their bedrooms and the clothes they wear. Two people managed parts of their medication and some people managed their finances. Some service users spoken with were very independent and were keen to maintain this. They chose to visit local facilities and use public transport independently but knew staff members were available if required. Service users spoken with and surveys received commented on how good the food was. They enjoyed the home cooked meals and had plenty to eat and drink. Comments were, ‘the meals are very hearty, hot and tasty’, ‘the meals are lovely’, ‘I enjoy all my meals’, ‘the food is excellent and you can have alternatives if you want’ and, ‘always hot and lovely meals’. The menus offered variety and choice at each meal, although the menus were not adhered to on the day of the visit. The home did not have a cook and the proprietor was completing catering as well as caring duties due to staff shortages. Service users described how their special diets were catered for, for example diabetic diets and low fat meals. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 17 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 home provided an environment where people and their relatives felt able to complain. The home protected service users from abuse by staff training and adherence to policies and procedures, however not all staff had completed training in safeguarding adults from abuse. EVIDENCE: The home had a complaints procedure, and a copy in Braille, that was displayed in the home. Staff members were aware of the procedure and the documentation used to record complaints. The home had a complaints book and a niggles book as well as complaints forms. We discussed with the manager having one system for all complaints and use of the complaints forms positioned in the entrance would suffice as it detailed the complaint, how it was resolved and could be signed by the manager and the complainant when satisfied with the outcome. Service users spoken to said they would complain if necessary and some mentioned the manager and other staff by name, ‘I would see Joanne (the manager) or my keyworker’ and , ‘I would go to Joanne and Jean, the two heads’. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 18 All of the eight surveys received from service users stated they knew how to complain and who to speak to if they were unhappy with anything. The home had documented one complaint since the last inspection, which had been resolved. Training records confirmed that three staff, two of which were ancillary staff, had still to complete safeguarding adults from abuse training, however most staff had completed the training and policies such as whistle blowing had been discussed with them. Senior staff had completed training and knew what to do should any issue of abuse be reported to them. The manager needs to discuss the safeguarding policy and procedure with the remaining staff and ensure they are able to recognise signs of abuse and who to report any concerns to. The home used the multi-agency policy and procedure regarding safeguarding vulnerable adults from abuse and the manager was fully aware of the referral and investigating procedures. Policies and procedures were in place regarding the management of service users’ money. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 19 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, 20, 24, 25 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users lived in a homely and well-maintained environment and had the opportunity to personalise their bedrooms. Further refurbishments of toilets, bathrooms, some bedrooms and the dining room floor, will enhance the quality of the environment for service users. The security of the building was insufficiently robust to fully protect people living there. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 20 EVIDENCE: Generally the home was well maintained and last year the proprietors had developed an ongoing maintenance plan. Since the last inspection the home had received notification of a grant from the local authority and this was to be used to convert two bathrooms and a toilet into a walk-in shower and disabled toilet. Work was due to start shortly. The other toilets and bathrooms and the dining room floor were still awaiting refurbishment. A redecoration and refurbishment plan needs to be produced to detail planned work. During the last year new curtains had been replaced in two of the bedrooms and a room had been refurbished into a staff room. The home had met the targets it set for refurbishment during the last year and this demonstrated the proprietors’ commitment to continually improve the environment for service users and staff. The home had plenty of communal space with three lounges and a dining room set out with individual tables. All were clean and spacious and the lounges had been re-carpeted last year. The large entrance had a section just outside for people who wished to smoke and inside there was a seated area close to a telephone. Bedrooms were personalised to varying degrees and those people spoken with were happy with their rooms. All bedroom doors had privacy locks and lockable facilities were provided. Shared bedrooms had privacy screens in place. Some of the bedrooms were also in need of refurbishment but the manager confirmed it was a long and expensive process, as the building was a listed building. Service users spoken with were happy with the cleanliness of their rooms, the laundry service and the home in general. Some comments were, ‘I love living at the home and have done so for many years – it’s clean and tidy’, ‘it’s a very nice home’ and ‘its clean and tidy and the laundry is nice’. All surveys received from them stated they thought the home was clean and fresh. One person did state in a survey that occasionally laundry went missing or their relative received the wrong clothes but it was sorted out. It was noted during a tour of the building that communal bathrooms and toilets had towelling hand towels. This can be a source of cross-infection and paper towels need to replace them. Water temperature records in bathrooms were checked and were recorded as between 38 and 39°C. The temperature needs to be approximately 43°C for an ambient bathing temperature. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 21 There was an issue with security of the home that needs to be addressed. When we visited we were able to access the home, as the security system had not been activated and staff were busy elsewhere. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 22 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 adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Insufficient staff numbers and some gaps in staff training could mean that service users may not receive the required level of care. EVIDENCE: Observation of staffing numbers and examination of staff rotas indicated the home was very understaffed. Existing staff members and management were filling in gaps but there was evidence they were working long hours, which was acceptable for a very short-term basis only. The rota indicated that management on some occasions had been completing night duties as well as working through the day. This was an unsafe practice. There were usually three staff members on duty in the morning and two in the evenings and at night. On the day of the visit there were two staff members in the building who were supporting service users and preparing breakfast. The majority of service users had fairly low level needs although there were two people that required more support due to their increasing needs. The manager/proprietor arrived later in the morning and it was clear they had also worked the night shift. The home had no cook so the manager/proprietor Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 23 was completing this role. The homes statement of purpose specifies that the home employed a cook. It needs to be clear within the statement of purpose the specific staff structure and the roles they complete. The manager confirmed there were shortages of sixty care staff hours and recruitment was progressing to enable two care staff members to start in January. This should address the shortfall. Staff members had access to training and seven of the eleven care staff had completed level 2 or 3 of the National Vocational Qualification in care. This was a good achievement and showed the proprietors’ and staff teams commitment to training. The training plan consisted of mandatory training and a course specifically for supporting people with sensory impairment. Staff would benefit from dementia care training, and other service specific areas such as diabetes, strokes, tissue viability, Parkinson’s disease and arthritis, which would enhance their overall skills. The induction records of two staff members started in employment since the last inspection was assessed. Neither had fully completed Skills For Care induction standards required for new staff. Both had started with the induction but they had not been followed through. The homes recruitment process indicated that application forms, references, and criminal record bureau checks were completed prior to the start of employment. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 24 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, 32, 33, 35, 36, 37 and 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager has not been overseeing the home to the required level due to filling in for staff shortages in other areas. This could affect the welfare and safety of service users and supervision of staff. EVIDENCE: The registered manager (one of the proprietors) and a second proprietor (who provided care support in the home) had both completed the Registered Managers Award and National Vocational Qualification at Level 4 in care. They had both also completed a four-day first aid course, health and safety Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 25 compliance, safe handling of medication training and fire training. They had completed safeguarding adults from abuse training with the local authority. Because the registered manager had been completing care and catering tasks some management duties had slipped. For example staff supervision and, staff and service user consultation. One person had received only two supervision sessions in nine months, whilst two other staff members had received four sessions since the inspection in January 2007 but the last two sessions had not been signed by the staff member and it was unclear whether they had taken place. Supervision covered training needs, care practices, service user issues, concerns and whether the supervisor had seen the care plan and updated documentation. Staff and service user meetings had minutes for meetings every month. However on closer scrutiny the minutes were the same for several of the meetings and it was unclear whether meetings had actually taken place. Service users stated they attended meetings sometimes but could not recall when the last one had been. The manager needs to hold regular staff and service user meetings to aid consultation and accurately record what is discussed and suggested at each one. The home had gained parts A and B in the Quality Development Scheme with the local authority. This means that the local authority considers the home to have good systems in place to monitor the quality of care provided. The quality assurance system consisted of audits of the services provided and questionnaires to service users, relatives, staff and visiting professionals. The quality assurance documentation examined indicated that the home needed to address some elements of the process. For example, questionnaires were sent to visiting professionals in March 2007 with three replies. Although a shortfall was identified an action plan was not produced. The same shortfall occurred in August when it was eventually addressed. Seven relatives responded to questionnaires in mainly positive ways and it appeared that action to address minor shortfalls was taken. There was no date on the questionnaires for service users and the analysis was confusing. Staff questionnaires had been completed with a supervisor, which may have affected answers. It did not appear that a full audit of systems within the home had taken place and therefore the quality of the service provided could not be thoroughly tested. However the home had produced a comprehensive annual quality assurance assessment in November 2007, which was required by the Commission. In the document they had analysed what they do well and the areas for improvement. This needs to be followed through. Service users finances continued to be managed appropriately and documentation maintained, although this area was not fully assessed at this inspection. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 26 Service users files and personal information was accessible on the day of the visit, as the staffroom door could not be locked. Care must be taken to secure the information in line with data protection legislation. There were some health and safety concerns that management need to address, for example the fire door stop on the kitchen door and one bedroom did not work properly and the doors were wedged open. Two wheelchairs were noted to have footplates missing. A hot water outlet accessible to service users on the upper floor was not thermostatically controlled. The keys to the medication cupboard were not kept secure and the building was easily accessible on the day of the visit. Since the last inspection the home had replaced the mounting for the safety gate at the top of the stairs making it more secure. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 X 18 2 2 3 X X X 3 2 2 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 2 2 2 Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement The registered person must ensure that care plans include all assessed needs and have clear tasks for staff. This will ensure that important care needs are not missed. (Previous timescale 28/02/07 and 22/07/07 not met) The registered person must ensure that staff members promptly contact health professionals for advice and treatment instead of trying to deal with problems themselves. The registered person must ensure that risk assessments are completed for service users wishing to self medicate all or part of their medication. Care plans must detail how this is to be monitored. The key to the medicines trolley must be kept secure at all times. This helps to reduce the risk of unauthorised access to the medicines (previous timescale of 29/06/07 not met). DS0000046755.V356627.R01.S.doc Timescale for action 29/02/08 2 OP8 13(1)(b) 31/01/08 3 OP8 13(4) 31/01/08 4 OP9 13(2) 31/01/08 Rockliffe House Version 5.2 Page 29 5 OP18 13 (6) 6 OP26 13(4) 7 OP27 18 8 OP30 18 The registered person must ensure that all staff undertakes training with regard to the Protection of Vulnerable Adults. The manager must discuss policies and procedures with remaining staff, including ancillary staff who have not had training to ensure they can recognise signs of abuse and know who to report concerns to (previous timescale of 05/02/06 and 31/03/07 and 22/07/07 not met). The registered person must ensure that communal hand washing facilities have paper towels instead of towelling ones. This will minimise the risk of cross infection. The registered person must ensure that the home has sufficient numbers of care and catering staff on duty at all times to meet the needs of the service users living at the home. The registered person must ensure that when new staff commences skills for care induction standards, this is monitored and progress checked at regular intervals. This will ensure management support and give the new staff member the opportunity to discuss issues that arise. The skills for care booklets need to be completed with evidence of learning. The staff-training plan must contain training in conditions affecting older people, for example such as dementia, strokes, diabetes, Parkinson’s disease and arthritis. This will enable the staff team to enhance their skills and knowledge in important areas and provide 31/01/08 29/02/08 31/01/08 29/02/08 Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 30 9 OP31 10 10 OP32 12(1)(a) 11 OP33 24 support to people within the home with a range of ages. The registered person must 31/01/08 ensure that sufficient management hours are available to complete management tasks within the home. The registered person must 29/02/08 ensure that staff and service user meetings are re-started to enable further consultation about the services provided. The registered person must 29/02/08 ensure that audits of the environment, records and systems in the home are completed as part of quality monitoring. Action plans must be completed when shortfalls identified. The registered person must ensure that care staff members receive a minimum of six supervision sessions each year that covers the philosophy of the home, care practices and training and development needs. All care staff members to have a supervision session by timescale for action date. The registered manager must ensure that accurate records are maintained in relation to service user and staff meetings, staff rotas and the food provided to people. 12 OP36 18 29/02/08 13 OP37 12(1)(a) & Schedule 4 31/01/08 14 OP38 13(4) Personal in formation in care files must be held securely in line with data protection legislation. The staff room where care files are maintained must be locked when not in use. The registered person must 31/01/08 ensure: Wheelchairs are checked to Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 31 ensure they have footplates and that these are consistently used when transporting people. Cleaning products covered by care of substances harmful to health regulations are kept secure and inaccessible to service users. Fire door stops to the kitchen and some bedroom doors are repaired to prevent staff using wedges to keep the doors open. The hot water outlet on the upper floor accessible to service users is thermostatically controlled. It currently has very hot water, which could be harmful. Security of the building is reviewed and staff made aware of utilising the security code in place on the main door. 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 3 Refer to Standard OP3 OP9 OP9 Good Practice Recommendations The home should consider streamlining assessment documentation to avoid duplication. A thermometer should be installed in the room near the kitchen where the medicines are stored to make sure medicines are being stored at the correct temperature. Written changes to the dosage of coagulant medication DS0000046755.V356627.R01.S.doc Version 5.2 Page 32 Rockliffe House 4 OP9 5 OP19 6 OP25 should be held with the medication administration record. The registered person should contact the pharmacist to discuss how the new regulations regarding the storage of controlled drugs in residential homes will affect them. Advice should be taken from them within the required timescales. The registered person should ensure that the home continues the good progress made with last years refurbishment plan and produces a new plan for the coming year, which includes bathrooms and toilets. The registered person should ensure that the hot water outlets in bedrooms, bathrooms and toilets have the required ambient temperature of approximately 43°C. Currently the temperature is between 38 and 39°C and could be cool for bathing for some people. Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Rockliffe House DS0000046755.V356627.R01.S.doc Version 5.2 Page 34 - 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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