Inspection on 18/08/05 for Rockwell

This inspection was carried out on 18th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Rockwell 08/10/08

Rockwell 29/05/08

Rockwell 28/11/07

Rockwell 25/08/06

Rockwell 26/01/05

Rockwell 18/08/04

Rockwell 10/02/04

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

CARE HOMES FOR OLDER PEOPLE Rockwell Corbett Close Lawrence Weston Bristol BS11 0TA Lead Inspector Sandra Garrett Unannounced 18 August 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Rockwell Address Corbett Close Lawrence Weston Bristol BS11 0TA 0117 9825693 0117 3772448 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bristol City Council to be appointed CRH-PC Care Home only 30 Category(ies) of DE(E) Dementia - over 65 (30) registration, with number of places Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: One named individual under the age of 65 may be admitted for regular periods of respite care Date of last inspection 30 April 2005 Brief Description of the Service: Rockwell is a purpose built home owned by Bristol City Council and registered with the Commission in March 2003. The home is registered to provide personal care only, to a group of up to thirty residents all of whom experience various types of Dementia. The home is located in the residential area of Lawrence Weston. It is arranged over two floors with lift access. It has one large dining room and several small lounges and includes a library and activities room. Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day and focussed on activities, routines of residents’ daily lives and contact with the community. Two inspectors spoke to several residents and a range of records were examined including health and safety and care records. The inspection was followed up by attendance at a relatives meeting on 24 August that gave an opportunity to discuss a number issues with of relatives and representatives. What the service does well: What has improved since the last inspection? Management staff have dealt positively with a situation in respect of Protection of Vulnerable Adults that has been ongoing. Staff have been rigorous in maintaining residents’ rights and choices whilst protecting more vulnerable residents. Record keeping has improved with clear records for monitoring the medications fridge now in place, in order to ensure residents’ medication is kept at the right temperature. A new programme of regular social activities has been introduced and outings arranged that will keep residents stimulated. The highly polished flooring in corridors that was a risk to residents has been stripped of polish. This has improved the flooring for residents as the highly polished surface was hazardous. Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 Page 6 Three good practice recommendations have been implemented. These were to find ways of improving contact for residents with the local community, making sure bedside lighting was accessible to residents with dementia and that residents’ personal allowances should be paid at least monthly. 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. Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 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 standard(s) 1 & 3 The admission process is well managed that ensures the home is able to meet residents needs. Although residents’ relatives or representatives are given information regarding the service this needs attention to ensure the information given is correct. EVIDENCE: A requirement made at the last inspection was not met. Although the manager has developed clear admission information, the Statement of Purpose needs further amendment to ensure that residents, their relatives or representatives get correct information about the service. It’s understood that the Elderly Person Homes (EPH) team will be carrying out a review of the Statement of Purpose following discussion with the Commission. Therefore the requirement is withdrawn at this time. Pre-admission information was seen in residents’ files that included copies of care management assessments and eligibility check lists done by social workers. Where the pre-admission identified assessed needs didn’t match the home’s experience of managing them, it was noted that an early review during the trial period was held. This is good practice. Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 Page 9 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 standard(s) 7,8 & 9 Improvements to developing holistic care plans needs to be maintained to ensure residents assessed needs will be met. Attention needs to be given to ensuring any changes or issues in respect of assessed needs are recorded for residents’ protection. Administration of care records needs to be improved. Residents are well looked after in respect of healthcare needs. Medications management is improved that ensures the protection of residents. EVIDENCE: Care plans continue to be developed by the home and showed clear information about the meeting of assessed needs. Comments from relatives were recorded at six monthly care plan reviews. Plans showed evidence of monthly review but specific dates weren’t recorded. Care records generally showed improvement and were more person-centred and holistic. However where issues in respect of meeting assessed needs had been found, these didn’t appear on the care plan. This was particularly noted in respect of memory or emotional needs or continence. Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 Page 10 Some care records were also disorderly and ‘scrappy’ that could be interpreted as poor administration. Attention needs to be given to keeping each resident’s records separate and a system of numbering daily record sheets should be found. Care records gave lots of information about how residents’ healthcare needs are met. The GP and district nurses visit regularly and evidence was seen of psycho-geriatrician visits and assessments carried out. A requirement made at the last inspection in respect of recording of the medications fridge temperatures was met. A new sheet had been developed that clearly showed day, date and time of monitoring together with the minimum/maximum temperature. This is good practice. Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 Page 11 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 standard(s) 12, 13 & 15 Social activities, outings and daily routines show improvement. Community contact is being explored. Improvement in communication with relatives/representatives is needed so that they are kept fully informed and involved in the home on residents’ behalf. New menus offer residents a greater choice but need improvement to ensure residents with eating difficulties can access food more easily. EVIDENCE: A new programme of activities was seen pinned up in the entrance hall. Activities include: gardening, video nights, reminiscence, crafts and enhanced personal care (including manicures, pedicures and massages). A resident was observed having a foot massage and manicure in the hairdressing salon and the staff member said the resident enjoyed it very much. The manager told relatives about forthcoming outings planned for residents until the end of the year. Relatives commented on wanting to attend events but had been prevented when times changed. It was noted communication with relatives about meetings and events could benefit from improvement, to ensure they are able to attend if they wish. This would enable relatives to be more aware of what goes on in the home for residents that they can be part of. Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 Page 12 Management staff gave information about how they had been trying to improve contact with the local community that was a good practice recommendation from the last visit. This included: contacting local religious groups, approaching the local school to arrange a carol service at the home this Christmas, and taking residents to the local pub on a more regular basis. New menus were seen that showed a wider choice at all meals. However it was noted from the responses by relatives in the recent Quality Assurance survey, that meals do not always meet the needs of residents who may need to eat with their fingers. A good practice recommendation is made to develop a menu especially for residents who because of their dementia may need a greater variety of ‘finger food’ that they can manage to eat more easily. Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 Page 13 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 standard(s) 16 & 18 Complaints recording is satisfactory and relatives or representatives are aware of the complaints process. Residents’ benefit from a well managed and regularly monitored protection strategy. EVIDENCE: No new complaints had been received. The complaints record showed that a complaint about care practice earlier this year had been referred to a SS&H team manager who had dealt with it promptly. At the meeting on 24th August relatives and residents’ representatives were able to speak openly about any concerns they had. A good rapport between them and the acting manager and deputy manager was observed. An ongoing situation in respect of protecting residents from harm or abuse has been well managed by officer staff. Regular meetings have taken place over a period of time and actions agreed have been carried out and monitored. The situation has now improved and all staff are aware of the need to be vigilant in ensuring residents are protected. This is good practice. Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 Page 14 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 standard(s) 1 9,22,24 & 26 The environment is clean and hygienic although improvement to the fabric of the building and fixtures and fittings is needed to protect residents from harm. Toilet facilities need attention to ensure residents can find them. EVIDENCE: A number of accidents had been reported to the Commission over the last eighteen months where there was no apparent cause for the resident to be injured. On touring the premises inspectors noted a number of issues that could put residents at risk. These included: patched areas in corridors that covered previous electrical installations were raised with sharp edges. The area by the lift has a triangular pattern that is part of the flooring and the points where the grab rails meet at corners were also observed to be sharp. In residents’ rooms shelving with sharp corners that protrude into the room could cause injury if residents fall against them. To avoid residents falling into them, bushes of stinging nettles to the rear of the home need to be removed. Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 Page 15 A requirement is made to address all issues of safety to protect residents from harm or risk of harm. Residents rooms were clean and the home smelled fresh throughout. Lighting suitable to meet the needs of people with dementia was seen in place although a comment by relatives from the Quality Assurance survey report, suggested dimmer switches could be installed in each room. This would enable lighting to be reduced to a low level and kept on at night. It wasn’t clear if the home has a development plan whereby ideas like this could be investigated and put in place. Relatives further commented on the lack of suitable reading material for people with dementia that has been subject to previous requirements. The manager said that magazines are provided but residents like to take them to their rooms. Although toilet doors are painted red to show residents where they are, some of the pictures that help residents further identify them were missing. A difficulty in respect of this at night was highlighted and a good practice recommendation is made to consider putting lights over the toilet doors to further aid residents to find them. Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28 & 29 Permanent staffing is limited and needs improvement to ensure stability and consistency for residents. Progress is being made with ensuring staff gain care qualifications. Staffing records kept for residents’ protection need attention to ensure they are protected from harm. EVIDENCE: The opportunity was taken to observe a staff meeting during the course of the inspection. The meeting focused solely around grumbles from staff about colleagues, particularly about their failure to complete certain allotted tasks. No time was given to staff development or to the welfare of residents. The manger discussed her frustration about the negative content of these meetings. It was recommended that in order to reduce staff complaints about colleagues she consider introducing job lists for staff to sign to indicate they have completed set tasks at least until there is some improvement. It is further recommended that an agenda is circulated prior to staff meetings which focuses more on staff development and the care to residents. Four care staff have gained their NVQ Level 2 and two staff are doing it. A local college has been approached to enable domestic staff to do NVQ Level 1 that is good practice. Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 Page 17 A requirement in respect of keeping personnel records at the home continues not to be met. The Commission for Social Care Inspection is taking up this matter with the City Council. A new requirement is made to ensure that photographs and proof of identity of each staff member is kept at the home for residents’ protection. Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,31,33, 35, 37 & 38 The home benefits from more stable management although this may not be permanent. Responses from the Quality assurance survey need to be part of a clear development plan for the home so that residents or their relatives/representatives can influence progress. Residents’ daily care records have improved and Health and safety records are satisfactorily maintained. EVIDENCE: The current acting manager was welcoming and open to the inspection process. She demonstrated an open and inclusive style of management and residents clearly benefit from her approaches to them. At the meeting on the 24 August, the manager and deputy manager demonstrated that there is a good rapport and relationship between themselves and relatives and representatives attending. Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 Page 19 The home’s Quality Assurance survey had been completed and a copy given to the inspector. Relatives had commented on a series of questions about the premises, care records, activities, staffing and meals among others. Whilst levels of satisfaction were high in most of the areas covered, some of the survey’s findings mirrored inspection findings. It wasn’t clear if a development plan to address some of these issues had been developed. Care records showed improvements in the way they are written. Daily records particularly were more detailed and holistic although some negative language was still being used in respect of behaviours. Health and safety records were satisfactory. However a requirement is made under Standard 19 (see above) in respect of environmental safety matters that need to be resolved both internally and externally. Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 x 15 2 COMPLAINTS AND PROTECTION 3 x 2 3 x 3 x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x x 3 2 Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard OP7 OP29 OP38 Regulation 15(2)(b) 19(1)(b)(i ) Sch 2 13(4)(c) Requirement Care plans must include all assessed needs identified and how they will be met A photograph and proof of identity of each staff member must be kept at the home Ways must be found to make all areas of the home safe both internally and externally in order to protect residents Timescale for action 1 October 05 30 December 05 30 December 05 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 OP13 Good Practice Recommendations Communication between the home and relatives and representatives should be improved to ensure they are able to be informed and take part in activities, outings or entertainment with residents A specific menu for residents only able to eat finger foods should be developed Toilets should be made accessible to residents at night by means of specific lighting 2. 3. OP15 OP21 Rockwell D56_S35302_Rockwell_V244663_180805_Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 300 Aztec West Almondsbury South Gloucestershire BS32 4RG 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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