Inspection on 23/01/07 for Rockliffe House

This inspection was carried out on 23rd January 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 13/12/07

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 23rd January 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rockliffe House DS0000046755.V295673.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.V295673.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.V295673.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th December 2005 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 23/01/07 their weekly fees are £327 with a £15 top up. 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.V295673.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day. Throughout the day the inspector spoke to six service users to gain a picture of what life was like for people who lived at Rockliffe House and analysed the surveys returned from them. The inspector also had discussions with two proprietors one of whom was the registered manager, the supervisor and care staff members. Information was also obtained from surveys received from staff members and visiting professionals. Comments from the surveys have been used throughout the report. The inspector 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 medication practices, 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. The inspector also checked with service users 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. The inspector also observed the way staff spoke to service users and supported them, and checked out with them their understanding of how to maintain privacy, dignity and choice. During the visit there were several shortfalls identified in the management of medication. An immediate requirement notice was issued and the inspector requested a visit from a pharmacy inspector for closer scrutiny. The report of their visit completed on 29/01/07 can be located in the health and personal care section. What the service does well: Patient information leaflets of the medication supplied are kept in a folder attached to the trolley. This is an example of good practice as it provides the staff with up to date information on medication. Only senior care staff 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. Staff turnover was low and this enabled consistency for service users. The proprietors were committed to steadily improving the environment. Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 6 Service users 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 service users lives. Service users liked the meals provided and fresh fruit was available in bowls in all the lounges. Service user meetings were held and people were encouraged to express their views about the home. The quality monitoring system of audits and questionnaires had been recognised by then local authority and the home had been awarded both parts of the Quality Development Scheme. This could be developed further. See below. The home had plenty of space and three homely communal lounges for service users to choose where to sit. What has improved since the last inspection? What they could do better: Some of the terms and conditions issued to people had not been signed by them so the inspector was unsure if they had seen them. Also some did not contain all the information required like the fee and the room number to be occupied. Some of the sections of the care plans were good but others didn’t contain all the information needed and one was not completed quickly enough after admission. This could lead to service users not receiving all the care they required. The home must also make sure that the moving and handling needs of one specific service user is kept under review as the current technique used to move them placed them, and staff, at risk of injury. The way the home manages medication must be improved to ensure that people receive the medication prescribed for them at the correct time. It must Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 7 be stored correctly and be labelled with clear instructions for staff. Medication must be recorded appropriately and consistently when received into the home, when changes in medication occur and when it is administered to people. The home needs to make sure that all complaints are recorded. They deal with them straight away but there is no evidence of this. Good recording will show that they have dealt with complaints to the complainants’ satisfaction. They monitor the quality of their services by giving service users and their relatives’ questionnaires to complete. This could be expanded to include the views of staff and visiting professionals. Induction of new staff takes place but there was no evidence that they were competent in tasks when the induction was signed off. Staff members had regular formal one to one supervision with a senior but the records did not detail what had been discussed and how staff members were being guided and supported. Staff training is a priority in the home but some areas need addressing, especially moving and handling, adult protection and medication management. Induction, training and staff supervision were important ways to make sure staff were developed and had the required skills for their jobs. The home made sure that they received references for new staff during the recruitment process; however, one person’s references were in another language so it was not possible to know what they said. The home needs to make sure these are understood and checked out. Although the home was generally clean and tidy in communal areas, some of the bedrooms needed attention regarding vacuuming carpets, dusting surfaces and cleaning sinks. The home was currently recruiting a domestic worker and when in place this should address the shortfall. 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.V295673.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes terms and conditions do not consistently contain all the information required. 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: The home had adjusted their terms and conditions since the last inspection and have issued these to service users, however some remained unsigned and one had not been completed fully with the correct fee. Some terms and conditions examined contained information about the room number to be occupied whilst another more recent one had omitted this. The terms and condition document needs to be consistently completed, include the information required in Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 10 national minimum standard 2 and be signed by the service user or their representative. The manager confirmed that service users needs were assessed prior to admission to the home and assessments completed by care management were obtained. The homes assessment for a new admission to the home was examined and although all sections had been completed the information was brief and more details about the degree or severity of conditions and how they affected the service user would have been helpful to the care planning stage. The home did have information from an assessment completed by care management to draw on although this had been completed a year ago. The manager confirmed that the home routinely wrote to service users or their representatives following the pre-admission assessment formally stating their ability to meet needs. This letter had not been sent in the new care file examined but was present in other care files the inspector looked at. The manager stated that a respite service was available to enable people to stay for a short while and try out the home. The first six weeks of admission were seen as a trial period before the service user made up their mind about permanent residency. The manager stated this could always be extended if necessary. Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including two visits to this service, one by a pharmacy inspector. Service users had access to health care services and care needs were met in a way that respected their privacy and dignity. A lack of consistency in the formation of care plans means that they are not always produced in a timely manner, they do not always contain all assessed needs and do not always have clear tasks for staff. This puts service users at risk of not receiving the full care required. Quality in the management of service users’ medication is poor. There are poor facilities in the home for the storage of medicines requiring refrigeration. This puts the service users at risk of receiving medication that may be unsafe. There is a lack of a robust system within the care home for the recording and administration of medicines. This puts service users at risk of not receiving medication as prescribed. EVIDENCE: Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 12 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, however those examined lacked sufficient details and the tasks required by staff in some areas. For example, one person had a need for pressure area management, continence support and assistance to cut up their food and prompt and encourage them when eating. This had not been identified in the care plan. Another service user needed full support and was unable to verbally communicate their needs. In some areas of the care plan the tasks for staff were clear but this was not consistent throughout the whole plan. When spoken to, staff knew the service users needs and how these were to be met but this information must be recorded in the care plan. This is especially important when the service user is unable to communicate verbally. Care plans were evaluated monthly in a key worker report and six monthly reviews were held. 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 was some evidence that service users had signed agreement to their care plans. It was noted that one care plan and a risk assessment were formulated a month after admission. Whilst it is recognised that staff need a period of observation to produce a full and comprehensive picture of the service users needs and abilities, the care plan and risk assessments must be produced quickly in order to give guidance to staff. Some of the information will have been available from the pre-admission assessment. Service users spoken to stated their health needs were met in a way that respected their privacy and dignity. They had access to a range of services such as GP’s, district nurses, opticians, dentists, out patients and chiropody. The inspector found recording errors in the controlled drugs book that led to a discrepancy in the stock of Oromorph liquid and one service user had not received controlled drug medication in the form of patches at the prescribed times. The inspector also found other shortfalls in the management of medication. An immediate requirement notice was issued to rectify the controlled drugs issues and a referral made to a pharmacy inspector to complete a full and detailed inspection of the management of medication. Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 13 Findings from the visit by the pharmacist inspector. Medicines policy There is a medicines policy in the home. The policy has been produced by a nursing services agency on behalf of Rockliffe House. The policy needs to be updated; the last update was June 2004. The update should include the procedure for handwriting or amending entries on the MAR (medication administration record) charts and the process for doing a risk assessment for service users who wish to self-administer. A copy of the policy is kept attached to medical trolley as a point of reference for all staff involved in the medication process. There is a list of signatures of staff that have read the policy. Record Keeping The current MAR charts were looked at. The folders containing the MAR charts have a list of staff signatures authorised to administer medicines. • There was no record of the date or quantity of medication received into the home. These records are needed to enable the safe handling of service users’ medicines to be tracked. • The recording of medicine administration is inconsistent. There were a number of gaps on the MAR. To demonstrate that service users are getting the medication as prescribed the MAR chart should record every administration. • Handwritten entries need to include the quantity supplied, the date of entry, the signature of the person making the entry and a witness signature where possible. Similar requirements are needed for a change of dose or cancelled medicines. Details of the person authorising the change should also be included. This makes sure that there is an accurate record of any changes or new medicines. • A service user was prescribed once weekly treatment for osteoporosis. The record of administration of this medication was inconsistent. This means that the person is at risk of not receiving medication as prescribed. • Medication prescribed as ‘as directed’ did not have information on the MAR or within the care plan to advise staff of when to administer. It is important to liaise with the prescriber or community pharmacist when the dose of a medication is unclear to make sure it is given as intended. • The recording of administration of eye drops was inconsistent. The record of administration did not match the dose on the MAR. There were a number of eye drops that the entry for administration had been crossed out. The staff were unable to provide an explanation why this had happened. • There was medication listed on the MAR that had been stopped the previous month. It is important to inform the pharmacy of any medication that has been stopped to make sure the most up to date MAR sheet is provided. Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 14 • • • • There were records of administration that did not match the dose on the MAR. Medication should only be given as directed by the prescriber; any changes to doses must be accurately recorded onto the MAR. There was a MAR entry for one service user that stated ‘self medicates’, however there was record of administration for eye drops. There is therefore a risk that this resident’s medicines are not being administered consistently or as they wish. For a resident prescribed insulin, it was unclear from the MAR whether a member of staff did the administration or the district nurse team. Two entries had been made on the MAR for administration, the remaining MAR sections were blank. There were a number of medicines for a service user supplied from a local hospital pharmacy. These medicines were not listed on the MAR. The inspector was informed that the medicines were current and had been administered but the MAR chart was missing. It is important that the MAR charts are kept securely to record administration and to maintain confidentiality. Administration • The morning round had finished at the time of the visit. The senior staff member responsible for the administration was observed completing the MAR chart after the round had finished. To make sure that the recording of administration is accurate and consistent the MAR should be completed at the time of administration. An audit of current stock and records showed that some medication had been signed for but not given whilst others had been given but not recorded. One service user self-administers their eye drops and inhalers. There was no record of a risk assessment for either medicine. It is important that a thorough risk assessment is done to make sure the resident is able to safely administer their medication as intended. A risk assessment had been done for a service user self-administering insulin. This needs to be reviewed as the assessment was done in September 2004. It is important that service users who self-administer are regularly assessed to make sure they are still happy to administer and they are doing it correctly. • • • Storage • A standard, lockable medication trolley was used and chained to the wall in the dining room. This room also contained equipment for keeping food warm and was in direct sunlight. At the time of the visit the inspector commented on how warm the room was although there was no thermometer to record the temperature. Medicines must be stored at a Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 15 • • • • • • • temperature that does not exceed 25 degrees Celsius, the maximum temperature recommended by most manufacturers. The fridge for storing medication was not suitable as it was also being used for food items. There was no thermometer for the daily recording of temperatures. This means it would be difficult to make sure that medicines have been stored within the required temperatures and are therefore safe to use. At the time of the visit the fridge had been turned off. Staff were unable to confirm when this had happened. The door to the fridge was opaque and in direct sunlight. As a result the temperature of the fridge had risen and the inspector advised all the medication to be removed, returned to the pharmacy and a new supply requested. Volumatic devices for two service users were stored on the bottom shelf of cupboard in the dining room. There was no door on this cupboard and the boxes containing the volumatics were open. This means that these devices are not stored securely and service users are at risk of using unclean equipment. One of the volumatics was labelled for a different person to the one using it. Once a device has been prescribed for a person it should not be shared, a prescription for a new volumatic should be requested. There was medication in the trolley that was no longer listed on the MAR. Any medication that is no longer used should be returned to the pharmacy for disposal to prevent incorrect administration. There were empty monitored dosage blister packs in the trolley that should be returned to the pharmacy to make room for the medicines in use. A tub of paracetamol was found in the trolley with the word ‘staff’ written on. The inspector was informed that this was for staff to use. The trolley should only be used for the secure storage of residents’ medication. Patient information leaflets of the medication supplied are kept in a folder attached to the trolley. This is an example of good practice as it provides the staff with up to date information on medication. Large items are kept in a cupboard within a locked room. This room is off the kitchen and is at risk of reaching temperatures that would exceed the maximum recommended of 25 degrees Celsius. Controlled drugs • • The controlled drugs storage and register are suitable for use. During the visit on 23rd January 07 the inspector had identified inaccurate recordings of the balance of controlled drugs. The manager had taken advice from the community pharmacist on how to amend the register and had updated it to record the new balance. The inspector provided further advice on how to record future errors. The register must include details of controlled drugs returned to the pharmacy for disposal. • Training Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 16 • Staff have undergone medication training run by Selby College. The manager advised the inspector that in house training had also been arranged. Other • • The care plans for four residents were looked at. All the care plans needed updating to include current medication and medical conditions. One care plan recorded a resident as diet-controlled diabetic. However the current MAR chart listed diabetic medication. It is important that the care plans provide details when a residents medical condition changes or medicine is started to make sure staff have the most up to date information. There was information on the staff notice board on what action to take if one of the resident’s blood sugar levels were low. This information should be also in the care plan. • Rockliffe House DS0000046755.V295673.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, 13, 14 and 15 Quality in this outcome area is good. 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 provided activities for service users to participate in and outings to local venues had taken 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. Comments on two service users surveys received indicated that the home had not got it quite right with the provision of activities for them and the manager was advised to discuss this at the next service user meeting or with service users individually to capture all views. Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 18 Service users spoken to confirmed that their relatives were able to visit at any time and were made welcome. Staff members spoke about how they supported people to make choices about their lives, how they read care plans, personal profiles and preference lists and the importance of getting to know service users quickly in order to help people maintain their independence. They knew the service users needs and what they needed to do to meet them. The manager also spoke about how they consulted service users regarding any change in the positioning of furniture within the communal areas. This was especially pertinent for people with sight impairments. Service user meetings and reviews were held and there was clear evidence in minutes that people had expressed their views about the service. People spoken to stated 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. One person stated they liked to be coordinated with clothes and staff helped them with this. Some service users spoken to 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. The majority of service users spoken to 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 good’, ‘the meals are very tasty, I wouldn’t change a thing’ and ‘we have cooked breakfasts at the weekends’. The menus offered variety and choice at each meal. Service users described how their special diets were catered for, for example diabetic diets and low fat and how the home provided bowls of fresh fruit in each of the lounges. The meal sampled on the day was well prepared and presented and the inspector saw evidence of alternatives to the main choice on offer being served. Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the home provides an atmosphere where the majority of service users feel able to complain about services, some people are not fully aware of the complaints process. The home does not record all incidences of complaints or niggles. This affects the audit trail and does not evidence complainant satisfaction. Not all staff have received training in the protection of vulnerable adults from abuse and this could place service users at risk. EVIDENCE: The home had a complaints procedure that was displayed in the home. This had been updated since the last inspection. Staff members were aware of the procedure and the documentation used to record complaints. Service users spoken to said they would complain if necessary and some mentioned the manager and other staff by name. Four of the eight surveys received from service users stated they were unsure about the complaints process, although one person did state they didn’t think they would need to complain. Two surveys stated they were unsure who to speak to if unhappy about anything. In view of these results it was suggested the manager alert service users again to the complaints process and have copies produced in braille for the service users who would like them. Minutes of service user meetings evidenced that people were asked if they had any Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 20 complaints but people may not want to complain in group situations and not all people attended meetings. A complaint that the home had received had been dealt appropriately although not recorded. It was important for all complaints, even those of a minor nature or niggles be recorded to evidence an audit trail and complainant satisfaction. The home had policies and procedures that linked to the multi agency policies and procedures regarding the protection of adults from abuse. Discussions with staff and documentation evidenced that not all staff had received training in the protection of adults from abuse. Staff stated they would report any incidences of abuse to the manager but were unclear about signs, symptoms and types of abuse to look out for. The manager was aware of referral and investigation procedures. Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 21 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, 24 and 26 Quality in this outcome area is adequate. 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 and the dining room floor, and improving general domestic tasks in bedrooms will enhance the quality of the environment for service users. EVIDENCE: Generally the home was well maintained and the proprietors had developed an ongoing maintenance plan. Some of the toilets and bathrooms and the dining room floor has been designated for refurbishment. During the last year curtains and carpets had been replaced in several bedrooms and the lounges, and new beds and chairs had been purchased. A toilet area that required attention at the last inspection had been refurbished into a new staff room and was awaiting completion before use. The home had met the targets it set for Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 22 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. 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 to were happy with their rooms. All bedroom doors had privacy locks and lockable facilities were provided. Two of the shared rooms did not have privacy screens in place although the manager assured that there were enough screens for all the shared rooms and these must have been removed. The manager will address this. Service users spoken to were happy with the cleanliness of their room, the laundry service and the home in general. However a tour of the building did evidence a shortfall in general cleanliness especially in bedrooms and upstairs corridors. Carpets needed vacuuming, surfaces dusting and sinks cleaning. The manager advised they were currently recruiting one domestic staff member and agreed this area was to be a priority. Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 23 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff members have access to training. Shortfalls in moving and handling training, adult protection and the management of medication could affect service users health and safety. Adjustments to the recruitment process is required to ensure service users are fully protected. EVIDENCE: The home used the residential care staffing tool to calculate how many care hours they were required to provide each week. For the twenty service users currently admitted 369 care hours were required per week and the home provided 392. This equated to three care staff during the day, two in the evening and two at night. Some service users spoken to stated staff members were available when needed but sometimes it took a while to answer bells especially in the evenings when they were busy. Comments were, ‘the staff are very good’, ‘they look after us well’, ‘the girls work very hard, there is not always enough on duty’, ‘they see to every need and yes they do treat me with respect’. The inspector observed very good staff interaction with service users. They spoke to people in a pleasant, friendly manner. They ensured mealtime had a Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 24 relaxed atmosphere and it was clear staff had developed good relationships with people. The home had a small staff team and was progressing well with training. Most had completed mandatory training of moving and handling, first aid, basic food hygiene, health and safety and fire. Staff who administered medication had completed a safe handling of medication course but in view of the pharmacy inspectors report an update in training must be put in place. Two staff had not received moving and handling training and others were due updates. Not all the homes staff had completed training in protecting adults from abuse. 41 of care staff had completed national vocational training (NVQ) at level 2 and with the three further staff progressing through the course the home was on target to meet the required 50 of care staff trained to this level. Three additional staff members were due to register on the course later this year. This was a good achievement. The homes induction process did not evidence staffs’ competence, although was signed off by senior staff. The inspector provided information on the new Skills for Care Council induction standards that requires competence to be tested and evidence to be collated. The manager confirmed all new staff will progress through the new system. The homes recruitment process required some adjustment to ensure service users were protected. Application forms were completed and references and police checks obtained. However references for staff employed from overseas had not been translated and the home could not be sure of their content. The home had not contacted the referee for confirmation. Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 25 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 and 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 was well managed. Expanding the quality assurance system, improving the documentation of supervision and adherence to moving and handling guidance in one instance will promote good practice and improve further the health, safety and welfare of service users and staff. EVIDENCE: The registered manager (one of the proprietors) and a second proprietor (who provides care support in the home) had both completed the Registered Managers Award and NVQ Level 4 in care. They had both also completed a four-day first aid course, health and safety compliance, safe handling of medication training and fire training. They had completed adult protection training with the local authority. Both spoke about the high priority they Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 26 attached to staff training and ensuring the team had the correct skills and knowledge for their roles. 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 consists of audits of the services provided and questionnaires to service users and relatives. To improve the system further the views of visiting professionals and staff members within the home should be obtained. Staff and service user meetings were held and there was evidence that views were expressed and acted on. Staff received regular supervision sessions and six monthly appraisals, which were an added forum for them to express their views. Staff spoken to indicated supervision covered a range of subjects such as service user needs, key working, training and problems. However supervision records need to reflect these discussions as most stated, ‘no concern’ but did not indicate what had been discussed. A clear audit trail of staff supervision is required. Service users finances were managed appropriately and documentation maintained. Generally the home was a safe environment to live and work in. Equipment was serviced regularly and fire drills and alarm checks completed. Environmental health had visited recently and praised the staff for the cleanliness of the kitchen and the systems in place regarding food management. The manager confirmed that two safety gates on the stairs had been seen and agreed by fire and health and safety officers. The inspector needed to see evidence of their checks and these are to be forwarded to CSCI. One service user, unable to weight bare, was manually lifted from their bed as the use of the hoist caused them distress. This had been a longstanding intervention, however the lift placed the service user and staff at risk. An immediate requirement notice was issued for the manager to arrange a moving and handling assessment for the service user and to produce guidance for staff. Rockliffe House DS0000046755.V295673.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 2 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 X 2 Rockliffe House DS0000046755.V295673.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 OP9 Regulation 13,17 Requirement The registered person must ensure that the medication procedure is followed and recording improved (previous timescale of 05/02/06 not met) The registered person must ensure that all staff undertake training with regard to the Protection of Vulnerable Adults (previous timescale of 05/02/06 not met) The registered person must ensure that the terms and condition document is consistently completed, includes the information required in national minimum standard 2 and be signed by the service user or their representative. The registered person must ensure that care plans, and in one case a risk assessment, are completed in a timely manner after admission, they include all assessed needs and have clear tasks for staff. DS0000046755.V295673.R01.S.doc Timescale for action 28/02/07 2 OP18 12,13,18 31/03/07 3 OP2 5, 17 & Sch. 4 31/03/07 4 OP7 15 28/02/07 Rockliffe House Version 5.2 Page 29 5 OP9 17 & Sch. 3 6 OP9 13 7 8 9 OP9 OP9 OP9 13 13 13 10 11 OP9 OP9 13 Sch. 3 (m) 12 13 OP9 OP9 17 13 14 OP16 17 & Sch. 4 (11) 23 15 OP19 The registered person must ensure that controlled medication within the home is recorded appropriately. Contact must be made with the pharmacist for advice on how to rectify the three months of recording errors in the controlled drugs book. Immediate requirement issued. The registered person must ensure that a specific service user receives the controlled medication prescribed for them at the correct time. Immediate requirement notice issued. The recording of medication administration must accurate and consistent. Alterations to the MAR charts and handwritten entries must be accurate. Medication requiring refrigeration must be stored securely in a separate fridge and the temperature recorded daily. Medication must be administered in accordance with the prescribed dose. Care plans and risk assessments for people who self medicate must be regularly reviewed to make sure they contain the most up to date information on residents’ medical conditions and treatments. MAR charts must be kept securely. Stock control must be monitored and medication no longer used must be returned to the pharmacy. The registered person must ensure that all complaints are recorded to evidence an audit trail and complainant satisfaction. The registered person must DS0000046755.V295673.R01.S.doc 24/01/07 24/01/07 28/02/07 28/02/07 28/02/07 28/02/07 28/02/07 28/02/07 28/02/07 28/02/07 31/03/07 Page 30 Rockliffe House Version 5.2 16 OP26 23 17 OP29 19 18 OP30 18 19 OP30 18 20 OP38 12 21 OP38 13 ensure that the home continues the good progress made with last years refurbishment plan and produces a new plan for the coming year. The registered person must ensure that bedrooms are consistently vacuumed, dusted and sinks cleaned. The registered person must ensure that the contents of references are understandable and employment verified with the referee. The registered person must ensure that induction of new staff assesses their competence and is evidence based allied to Skills for Care standards. The registered person must ensure that all care staff have up to date certificates in moving and handling and receive further guidance on the management of medication. The registered person must ensure that information regarding the safety of the stair gates is forwarded to CSCI for inspection. The registered person must ensure that contact is made with a moving and handling assessor to give advice to staff on the moving and handling needs of a specific service user who is unable to weight bare and chooses not to use the hoist. Immediate requirement issued 28/02/07 28/02/07 28/02/07 28/02/07 28/02/07 24/01/07 Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 31 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 4 5 6 7 8 9 10 11 Refer to Standard OP9 OP9 OP9 OP9 OP9 OP9 OP9 OP16 OP28 OP33 OP36 Good Practice Recommendations Advice should be taken from the prescriber or community pharmacist for medication with unusual or ‘as directed’ doses. The medication policy should be updated. A thermometer should be installed in the area where the medicines trolley is stored to make sure medicines are being stored at the correct temperature. The recording of medicine administration should be at the time of administration and not at the end of the round. Controlled drugs returned to the pharmacy for disposal should be recorded in the register. All medication should be signed into the home. Medication devices prescribed for one person should not be used for another. In light of survey replies the manager should ensure that all service users are aware of the complaint process and provide copies in Braille as required. The home should continue to work towards 50 of all care staff trained to NVQ level 2. The registered manager should consider expanding the quality assurance system to include collating the views of visiting professional and staff members. The registered manager should improve the documentation of staff supervision to evidence thoroughly the topics discussed. Rockliffe House DS0000046755.V295673.R01.S.doc Version 5.2 Page 32 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.V295673.R01.S.doc Version 5.2 Page 33 - 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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