Inspection on 02/06/06 for Rockrose

This inspection was carried out on 2nd June 2006.

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

Other inspections for this house

Rockrose 25/09/09

Rockrose 07/07/09

Rockrose 10/02/09

Rockrose 12/02/08

Rockrose 27/04/07

Rockrose 21/10/05

Rockrose 03/06/05

Rockrose 01/02/05

Rockrose 02/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Rockrose Rockrose 10 Kingsfield Road Herne Bay Kent CT6 7EA Lead Inspector Jenny McGookin Unannounced Inspection 2nd June 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 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. Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Rockrose Address Rockrose 10 Kingsfield Road Herne Bay Kent CT6 7EA 01227 740549 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) Mr Sookdeo Sawock Miss Uyjayantimala Aubeeluck Care Home 7 Category(ies) of Old age, not falling within any other category registration, with number (7) of places Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st October 2005 Brief Description of the Service: Rockrose is a care home, registered to provide accommodation and personal care for 7 older people aged 65 years and over. Currently, 4 older people live in the home. It is owned and managed by Mr Sawock and Miss Aubeeluck, who live on the first floor of the premises. They have been the registered owners / managers of this home since 1998. This is a detached chalet-style property located in a quiet residential area of Broomfield. There is access to public transport close by, with local amenities being situated at a further distance. All the residents’ bedrooms are single occupancy, ground floor rooms, with en-suite facilities. The communal areas consist of a lounge and dining room/ sun lounge. There is an enclosed garden to the rear of the property. The current fees for the service at the time of the visit range from £350 per week. Some additional charges may be payable. Information on the Home’s services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. There is no e-mail address for this home. Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which was intended to review findings on the inspections of June and October 2005 in respect of the day-to day running of the home; and to check compliance with matters raised for attention on those occasions. The inspection process took just over seven and a half hours, and involved meeting with both proprietors (one of whom is also the registered manager); one resident individually and three over lunch, as well as three visiting relatives and an agency member of staff. The inspection involved an examination of maintenance documents; one personnel file and two residents’ files were selected for care tracking. What the service does well: What has improved since the last inspection? The registered manager has successfully completed her Registered Managers’ Award accreditation, and the resultant certificate was available for inspection. Matters raised by the last inspection had been addressed or plans were being made to address them, which indicates good use is being made of the inspection process. The care-planning format has been revised to record the agreement of interested parties, most notably the resident. And there is now a policy in place to commit the home to welcome independent advocacy services. Some refurbishments and redecoration has been carried out. Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 7 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 Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 1. Not all the documentary information necessary for potential residents to make an informed choice is available. Some matters were raised for attention at the last inspection and were found to be outstanding. 2. There is a contract governing each placement, though some matters were raised for attention at the last inspection in respect of its content and were found to be outstanding. 3. There is a systematic preadmission assessment format to ensure a consistent approach 5. The admission process includes an invitation to visit the premises, taste the food and stay for trial stays 6. This home does not provide intermediate care. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 9 EVIDENCE: The home has a Statement of Purpose, Service User Guide and placement contract, each of which is judged generally compliant with the elements of the National Minimum Standard. Recommendations were made to further improve all three documents at the last two inspections, and although some work had been done, some elements were found to be still outstanding. These have been reported on separately to the proprietor. No other languages or formats are currently warranted. Feedback on the day of this inspection confirmed findings from the last visit, specifically that the decision to apply to this home was influenced more by its locality (i.e. close to where the resident or relatives lived) and personal recommendation - than by any public information produced by the home itself. The proprietors carry out an assessment of the prospective resident in their current setting – home or hospital. There is a standard assessment form to ensure a consistent approach. The placement contract confirms the proprietors’ advice that there is a month’s trial stay, during which time the initial assessment is reviewed on a day-to day basis. A care plan is set up during the first month, following a meeting with the resident or their relatives. This is reviewed monthly. This home does not provide intermediate care. Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 7. The assessment and care planning processes cover health and personal care needs, as well as some social care needs 8. The home is served by a range of healthcare professionals as appropriate, and there are adequate facilities for privacy. 9. Residents are protected by the home’s medication arrangements and each individual’s capacity to self-administer is subject to risk assessment. 10. Residents feel they are treated with respect and their right to privacy is upheld. Observed interactions between staff and residents were respectful during this inspection. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The format of the care plan, which follows on from the preadmission assessment is clearly designed to address the health and (to a much lesser extent) the social care needs of the residents. Since the last inspection, the Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 11 format has been revised to record the agreement of the residents or their relatives / representatives. When questioned about the care plans, neither the residents nor their relatives recognised the term “care plan”, though it was clear there was an ongoing dialogue about care issues with the manager and proprietor, so and this new format will be evaluated in future inspections when it has had a chance to run more conspicuously. There was still clearly an overwhelming physical care bias in care plan objectives, and the two residents’ files selected for case tracking showed no changes at each monthly review. Nor was there any record of attempts to pursue their emotional needs (reliance is placed on relatives to provide this) or to establish any unmet needs. These elements will require attention, to ensure a holistic approach. The home has access to a range of healthcare professionals and residents must be registered with a GP as a condition of their admission. Residents would have to fund any alternative therapies themselves. Each bedroom is single occupancy, so that examinations and treatments can be given in privacy. Each bedroom has an en-suite WC and hand-wash basin, so their privacy and availability is assured, but commodes are routinely used at night in case of falls. The bath has a shower attachment, so that residents have some choice, and the bath has an integral hoist / bath seat. All the residents and both relatives confirmed that they felt well cared for. The home uses the Royal Pharmaceutical Society Guidance on the administration and storage of medication, and an examination of medication administration records showed compliance with required standards for record keeping. Since the last inspection, the home’s policy on managing the death of residents has been revised to obtain further compliance with the National Minimum Standards, though it still needs to specify the timescale for the retention of records (three years from the date of the last entry). Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 12. Residents are generally content with their lifestyles in this home, and the home has been able to match their expectations. 13. There are open visiting arrangements, and the home is reasonably well placed for access to local shopping outlets and transport links. 14. There is choice and control over most aspects of daily routines. 15. Meals are well prepared and presented, and staff are readily available to assist residents. Mealtimes are unhurried and the setting is congenial. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The findings from this inspection generally confirmed those of the last two inspections. Residents can choose when to go to bed or get up, and what to do during the day, but tend in practice to have their own fairly set routines. Although there is a notice on the front door stating that the residents’ resting time is between 1.30-3.30pm each day, Mr Sawock said this arrangement was being trialled and was being applied flexibly. This home has always had an Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 13 open visiting policy and this was confirmed by the visiting relatives. There was anecdotal information to indicate that where there had once been a conflict of opinion over one visitor’s access, the resident’s wished had prevailed and the situation had been resolved appropriately. Each room has a telephone point, though the installation of private telephone lines would be at the residents’ own expense. One resident has done so. There is also a cordless communal phone, which can be taken into the privacy of bedrooms. There is no charge for its use. The home keeps some records of activities and visitors. This showed a limited range of activities inside – rather fewer outside the home. Examples include: watching television or sitting in the conservatory, listening to music, reading or chatting. One resident prefers her own company and does not like to socialise. The home organises outings but only very occasionally (e.g. to see a daffodil display) if it can arrange a driver, or walks; quiz games, music and dance / exercise sessions; tabletop games (dominoes, snakes and ladders, puzzles, crosswords). During this inspection an entertainer visited and all the residents and their visiting relatives were heard laughing and singing with him. Discussions with the residents, their relatives and staff confirmed findings from previous inspections – that residents can choose when to go to bed or get up, and what to do during the day, but tend in practice to have their own fairly set routines. Religious preferences are identified as part of the initial assessment and care planning process. Although the inspector was shown a photograph of a visit by a Church of England vicar (to give Communion), it was clear that there has not been much interest from the residents. In terms of managing finances, the situation is as reported at the last two inspections. No monies are held on behalf of residents – an arrangement has been reached with family members that residents would have access to a small personal allowance. The inspector joined the residents for lunch. The meal was well prepared and presented and the residents clearly enjoyed what they were presented with. The dining area was well decorated and maintained, and provided a congenial setting. Adapted cutlery and crockery are not currently warranted. As reported at the last inspection, the proprietors have dispensed with fourweek menu rotas, and are catering on a daily basis. Records are kept of all the meals, as required. One resident spoke of how she liked to get up during the night and have a light meal, which indicates a flexible and responsive approach. Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 16. Residents and relatives said they knew who to tell if they were unhappy about any aspect of the care they were receiving, and there is a complaints procedure readily available, though it requires amendment. 18. Residents are protected from abuse. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure, which is detailed in its contract and referred to in its Statement of Purpose and Service Users’ Guide. Some matters were raised for attention in respect of each version to ensure full compliance with the National Minimum Standard and complainants should not be required to put complaints in writing. This judged likely to be off-putting to anyone with a visual or literacy impairment. All these matters have been reported separately to the Proprietor. With one exception, all the residents and relatives have said at each inspection that they knew who to talk to if they had any complaints, but went on to say they had not had any cause to make a complaint. The home keeps a hardback book as its complaints register, but there is still no format for recording complaints to ensure a consistent approach, and there were no complaints registered. Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 15 The home has a policy on adult protection, which usefully addressed the home’s philosophy and the legal position; types of abuse and possible indicators as well as monitoring and prevention measures and a checklist of action to take if abuse is suspected or evidence is found. The home also has a copy of the latest Kent and Medway protocol to ensure a timely and coordinated approach. The home also has a policy on whistle blowing. All the residents have said they felt safe at this home. Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 19, 25. The layout of this home is generally suitable for its stated purpose and the environment is safe and well maintained. 20. Residents have a choice of communal areas, and furnishings tend to be domestic in character. There are homely touches throughout. 21. Residents have access to suitable and sufficient WC and bathing / washing facilities. 22. Records demonstrate that an assessment of the premises and facilities has been made by suitably qualified persons, including a qualified occupational therapist, with specialist knowledge of the client groups catered for, and there is evidence that the recommended disability equipment has been secured or provided and environmental adaptations made to meet the needs of service users. 23, 24. The residents’ own rooms suit their needs, and they can have their own possessions around them. 26. The home is well maintained, clean and free of offensive odours. Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 17 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The findings from this inspection generally confirmed those from the last two inspection visits, and the inspector is happy to report that progress had been made with some matters raised for attention in each case. All areas of the home inspected were found to be homely, comfortable and clean. The furniture tends to be domestic in style and there were homely touches throughout. All the radiators have guards as a precaution against the risk of accident. All bedrooms, bathroom, WC and communal areas have accessible call bells. The rear garden area provides a pleasant and generally private area to walk or sit in. The home has a “No Smoking” policy, which is clearly stated in the contract. Communal areas There is a lounge and conservatory, with a ramp and handrail to the rear garden. Each area has a TV and either a radio or video so that residents have a choice, and there was a range of seating, to meet residents’ individual needs and preferences. There is also a dining area, with tables arranged to enable residents to sit as a group or alone. One dining room chair had arms for support. The kitchen was inspected on this occasion, and judged compliant with all the elements of the National Minimum Standards. It was maintained in a satisfactory level of cleanliness and fridge temperatures were invariably in line with recommended standards. Communal WC / bathroom This is sited on the ground floor and has an integral shower attachment so that residents have a choice, plus a hoist and grab rails. There is also a dedicated WC for staff. Bedrooms In terms of their furniture and fittings, the bedrooms have been judged generally compliant with the provisions of the National Minimum Standards. Each bedroom door can be locked, although only one former resident chose to do so. One current resident expressed a wish to do so. However, all the locks are standard which would make it difficult to access the rooms if the keys were left in. Records show that this had occurred on several occasions in respect of one former resident. This matter was raised at the last two inspections and found to be still outstanding. Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 18 One resident has a lockable drawer and the rest have been provided with lockable cash tins, and these have been more appropriately secured against a firm immoveable surface. Each bedroom has a telephone point for private landline, though this would be at the resident’s own expense. Every bedroom also has a TV point – though the provision of personal TVs is also at the resident’s own expense. Each bedroom has an en-suite WC and hand-basin. This clearly ensures these facilities are readily accessible to them and that privacy is assured. All bedroom doors have magnetic door closers linked to the fire alarm system, so that they can be left open to suit individual preferences but will slam shut when the fire alarm is activated. The bedrooms are linked with a call bell system, which can only be reset at source, in line with recommended practice. Spot checks of maintenance records indicated that they were up to date and that there were no outstanding matters requiring attention. Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 27. Service users needs are generally well met by the staffing arrangements. 28. Service users are in safe hands at all times. 29. Service users are generally well supported and protected by the home’s recruitment policy and practices Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Both proprietors live on site (on the first floor of this property) and are involved in the direct care of the residents as well as working in a supernumerary capacity. There is also a handyman who works from 9.30am till 12.30 every weekday and he was present during this inspection visit. Records confirm that the recruitment process was generally systematic; although the proprietor will need to better evidence checks run on agency staff. The home’s own recruitment practice requires two references; a health declaration; Equal Opportunities monitoring information and a formal interview. The file selected for inspection on this occasion confirmed that a satisfactory Enhanced CRB check was carried out, and that a contract was issued. Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 20 There is a formal induction programme, which addresses a range of personnel and care principles as well as health and safety related issues (e.g. manual handling, fire safety, and health and safety). The personnel file included good evidence of training and accreditation. Less clear still, however, was evidence of formal supervision sessions to comply with the National Minimum Standard. The member of staff interviewed on this occasion was from an agency and was not subject, therefore to the same arrangements for supervision but she did say that she had good day-today management support. See section on “Management and Administration” for details on the proprietors’ experience and training. Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 38 31. This home is run and managed by a management team which is fit to be in charge, of good character and able to discharge their responsibilities fully. 32, 38. Feedback, maintenance records and observation confirmed that the residents benefit from the ethos, leadership and management approach of the home. 33. The proprietor needs to better evidence that the home is run in the best interests of service users. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: One of the proprietors is a retired SRN – and has not renewed his PIN number. Records confirm that since 2001 his qualifications have been enhanced by Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 22 specific training on fire safety, basic food Hygiene and nutrition awareness; health and safety; safer moving and handling; infection control (with special reference to working with older people). Update training is planned but there was no date for this. He is also trained as the home’s Appointed Person for 1st Aid. The other proprietor is an RGN and has successfully completed her Registered Managers Award. The inspector was shown the resultant certificate. Over the past two years she has augmented her qualifications with a range of relevant training over the past two years: Quality Assurance; Adult Protection Awareness; Fire Prevention; training to meet the underpinning knowledge of NVQ Management Level 4; Caring for the Terminally Ill; Staff supervision in social care and Supervision and Appraisal for Managers. She also has a Foundation Certificate in Food Hygiene. The fact both proprietors live on site and are actively involved in the day-today care of the residents means that there is a shared and visible line of accountability; and staff, residents and relatives always know who to talk to. Work is now being done to review and update the home’s policies to ensure they comply with best practice and a checklist has been introduced to confirm that staff have read and agreed to comply with their provisions, to ensure a consistent approach. This is judged a good start and will be further assessed at future inspections. When questioned, the proprietor had only started formally seeking the views of service users and other stakeholders last year, but only a few feedback forms were available for inspection and although these were very positive, these views were not publicised. Nor were they interacting with other monitoring systems (such as financial audits or OT assessments – see below), to measure the home’s success in meeting its aims, objectives and statement of purpose. There is no formal annual development plan for the home, based on a systematic cycle of planning, review, or evaluation against the outcomes for service users. This is required. The arrangements for managing residents’ finances were not inspected on this occasion, as families and other parties outside the home’s control have responsibility for this. Records confirm that periodic assessments of the premises by suitably qualified officers have been arranged e.g. the fire safety officers (March 2004), and an Occupational Therapist (July 2003), to ensure the home maintains its capacity to meet the needs of the residents and to ensure compliance with health and safety standards. Spot checks of maintenance records indicated that they were all up to date and that there were no outstanding urgent matters. Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 23 The inspector has previously judged the home’s policies adequate. However, not all the policies listed by the CSCI were in place; and some were not dated so that their currency could not be judged. Since the last inspection, the proprietor has subscribed to the Kent Care Homes Association, which issues its own manual of sample policies, and this was shown to the inspector. This is intended to be used to inform the revision of the home’s own policies and to supplement them. The manager also reported having worked with her course tutors to revise key policies. All of which should obtain a sound frameworks for maintaining safe working practices, particularly now there is a checklist for staff to sign and date each one, to provide evidence of their ownership. The residents confirmed a generally high level of satisfaction with their care; the way they were treated by staff, activities and food. One said it was all “tip top” and one relative said that he had visited fifteen other homes and that this was the best of the lot. They all said they felt safe knew who to talk to if they were unhappy with their care. Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 24 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 2 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X 2 X 2 Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 Requirement Statement of Purpose. This document must include all the elements listed by Schedule 1 to obtain full compliance. Original timescale for action - 31 08 05 Revised timeframe – 31/01/06 Placement Contract. This document must include all the elements listed by the NMS to obtain full compliance. Original timescale for action - 31 08 05 Revised timeframe – 31/01/06 The policy and procedure in the event of death needs to include the relevant timeframe for the retention of records; to include the duty to notify the CSCI (still refers to NCSC) Revised timeframe – 31/01/06 There need to be effective quality assurance and quality monitoring systems in place, based on seeking the views of service users, to measure success in meeting the aims, objectives and statement of purpose of the home. There is an annual development plan for the home, based on a DS0000023526.V294561.R01.S.doc Timescale for action 31/07/06 2. OP2 5(1)(b) 31/07/06 3. OP11 12 31/07/06 4. OP33 24 31/12/06 5. OP33 24 31/12/06 Rockrose Version 5.1 Page 26 systematic cycle of planning – action – review, reflecting aims and outcomes for service users. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose would benefit by statements outlining who would or would not be eligible to apply to the home; by a statement outlining the day-to-day staffing arrangements; a description of local religious resources; the arrangements for making / receiving telephone calls or mail; inclusion of the homes complaints and fire action procedures The challenge will be to demonstrate the active participation of all interested parties, most notably the resident. The hardback book used as the homes complaints register should have a pre-set format for recording complaints to ensure a consistent approach. Complainants should not be required to put complaints in writing. This judged likely to be off-putting to anyone with a visual or literacy impairment. The home will need to demonstrate that not only do residents and other interested parties know how to make complaints but are actively assisted to do so i.e. though independent advocacy services. A directory of local resources would assist in this Bedrooms. Standard locks on bedroom doors should be replaced with double acting locks so that staff can access the bedrooms in an emergency. 2. 4. 5. 6. OP7 OP16 OP16 OP16 7. OP23 Rockrose DS0000023526.V294561.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 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. 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