CARE HOMES FOR OLDER PEOPLE
Rockwell Corbett Close Lawrence Weston Bristol BS11 0TA Lead Inspector
Sandra Garrett Key Unannounced Inspection 09:30a 28 , 29th November and 3rd December 2007
th 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 Rockwell DS0000035302.V355199.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. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Rockwell Address Corbett Close Lawrence Weston Bristol BS11 0TA 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) 0117 9825693 0117 3772448 Bristol City Council Mrs Elaine Stephens Care Home 30 Category(ies) of Dementia - over 65 years of age (30) registration, with number of places Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One named individual under the age of 65 may be admitted for regular periods of respite care. 25th August 2006 Date of last inspection Brief Description of the Service: Rockwell is owned and run by Bristol City Council. It was registered with the Commission for Social Care Inspection in March 2003. The home gives personal care only to a group of up to thirty people living with different types of dementia. The home is in the residential area of Lawrence Weston. It has a square layout with long corridors around a central courtyard. It has two floors with lift access. It has one large dining room, three small lounges (one of which is for smokers) and includes an activities room. The full weekly fee for Bristol City Council dementia care homes is £603 per week (2007 prices). Hairdressing, chiropody, reflexology, newspapers and toiletries are charged as extras. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk No copies of the most recent inspection report were seen around the home. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key (or main) inspection was the first since September 2006. Two inspectors visited and spent two days at the home. Before the visit, all information the Commission for Social Care Inspection (the Commission) has received about the service since the last inspection was looked at. At the visit one of us concentrated on looking closely at records and talking with management staff. The other spent time watching the experiences of and spending time with, people in the communal areas and as they moved around the home. This was to gain understanding of the quality of their lives. She then ‘case-tracked’ (this means looking closely at care records, medication, accident reports etc) 3 people, checking her findings with their records. Both of us looked closely at a wide range of records. These included: care files that included pre-admission assessments of need, care plans, risk assessments and daily records. Staff supervision and training records were also looked at as well as accident reports, complaints and health and safety records. We had sent out surveys to relatives asking for feedback on the service. However only a few had been returned by the time this report was written. From these, comments about the care given were largely positive. These are included throughout the report. Relatives and friends of people living at the home showed high levels of satisfaction with care given from the home’s own quality assurance survey. One person said ‘We think Rockwell is one of the best’. However, overall our own experience was depressing and very disappointing. We left the home feeling strong concern for the emotional welfare of people living there, as the culture is clearly one of avoiding risks. This makes for an overly ‘safe’ way of caring for people that ignores their needs, rights, feelings and abilities. The strong emphasis on keeping peoples belongings safe from others has led to a dominant ‘key culture’ that makes the home prison-like for the people who live there. The home also doesn’t use practices that fit with the philosophy of person centred care. This is a belief that the person is recognised as an individual first and the diagnosis of dementia is secondary. Person centred care also helps the person to take part fully wherever they are living, in relationships and activity. People living at Rockwell aren’t valued as worthwhile individuals in their own right. There was little evidence of ‘person-hood’ i.e. valuing the person that they were and are, rather than simply dealing with the effects of their dementia. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 6 Further, we clearly saw that staff struggled to meet all the needs people have. Although help was often given in a kindly way, people weren’t always treated with dignity or respect. The care given is mainly about making sure basic tasks are done and less about the more social needs a person may have. The manager has failed to make sure that care is given from a person-centred perspective. This means putting the person living with dementia at the heart of the care process. It also means making sure that their personal histories and backgrounds are used to help staff work with and care for them positively. Management staff spent most of the visit in the office (that wasn’t open to people living at the home), and didn’t interact with them often. What the service does well: What has improved since the last inspection? What they could do better:
The culture of the service needs to change quickly. Management staff must move from a position of literally acting as ‘gatekeepers’, to one of making sure people living at the home have busy, meaningful and productive lives. A large number of requirements and recommendations were made to start this process. Three immediate requirements were made. These were about: making sure people get enough to eat and drink throughout each day, doing weight recording for people at risk of losing weight and proper aftercare of accidents i.e. making sure risks are properly checked when accidents happen. Three requirements from the 2006 visit were either not met or partly met. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 7 A requirement about redecorating and improving peoples bedrooms was partly met. However, at least three or more rooms still need to be done. More worrying was the overall lack of homeliness throughout the entire building and the apparent key culture. Padlocks were being unnecessarily used and bedrooms were kept locked for large parts of the day. Lounges were clean and tidy but bare of any items for people to look at or touch. New requirements are made to make sure people are given opportunities to live in an ‘enabling environment’ i.e. open, homely surroundings that meet their needs for comfort and activity rather than one that disables them. Fire drill records didn’t show that all staff attended them regularly. The requirement to make sure night staff do three monthly drills wasn’t met that could put people at risk. The requirement is therefore moved on with a short timescale. Failure to meet the requirement could lead to enforcement action being taken. New requirements made included: An incident of alleged abuse hadn’t been reported to us and we therefore hadn’t had the opportunity to attend a protection-planning meeting. No plan was in place to show how the person was being protected from further risk of harm or abuse. Further, not all records of accidents were being sent to us so that we can make sure staff take proper action to keep people safe. Training records showed that a number of care staff hadn’t done safeguarding adults training. A further number hadn’t done it for over three years. Training in dementia awareness and care was patchy and staff spoken with were unclear of different types of dementia or how they affect people. None of the staff had done any training in person-centred care of people living with dementia. Management staff must take the lead in making sure people are cared for in a person-centred way. They must also be trained in the subject. Management staff must work more closely with care staff to support people in the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rockwell DS0000035302.V355199.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 Rockwell DS0000035302.V355199.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): 1,3 & 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose fails to show how people from different groups in society will be welcomed and able to have their needs met at the home. Clear use of social work assessments means staff will be aware of peoples needs when they come into the home. Managers and staff fail to meet peoples specialist needs from a person-centred approach that recognises value, rights, choices and feelings. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home’s Statement of Purpose was out of date and included details that are no longer right. Further, neither the Statement of Purpose nor the service users guide included any information about meeting specialist needs of people from groups such as black or minority ethnic, sexual diversity, gender, disability or religion. An amended copy of the Statement was sent to us after the visit. However this only had a general statement about equalities and diversity. It didn’t show what actions the home would be taking to try and meet peoples needs. It further placed the responsibility for this on the people themselves to say what their needs are. The manager said that relatives now sign for a copy of the Statement. This was because one person had complained that they hadn’t been given any information about the home. However, the statement should be made available to relatives on request and the requirement to sign for it shouldn’t be necessary. Pre-admission assessments that are done by social workers are given to the home when someone comes in for a four-week trial visit. The assessments have useful information about background, past history, current issues and equalities and cultural ones. An assessment was seen for a person that had just come in for a short emergency stay. The assessment and social work care plan was clear and detailed and staff were working to it. The person had some mobility difficulties although staff had worked with her/him to become more mobile. Relatives’ views of the home and the care given didn’t match with our findings. From both the home’s own survey and our own, relatives said that they felt the care given is good and person centred. Comments included: ‘We feel that the care service does well in all aspects of care and attention required. We don’t think it can improve, as we are quite satisfied’ and: ‘ I think Mum is well looked after. I know several of the staff feel they try to look after her as they would want their own mothers cared for. Mum feels safe and looked after which I think is the main concern’. One person living at the home comes from a different culture. This person was spoken with and doesn’t like to join in with others. The manager said a staff member from a similar culture works with the person but isn’t her/his key worker. However it wasn’t clear how this person’s needs were being met to avoid isolation. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 11 Overall, the environment of the home isn’t suited to meeting the specialist needs of people living with dementia and in effect disables them. Examples of this included: the lighting in some areas was of poor quality. This can be a problem for older people who need much brighter light. The vinyl flooring in the corridors that has been subject of previous inspection requirements, is shiny and continues to show pools of light on its surface. Shadows thrown by the lighting may make people feel they are treading water and could lead to falls. Lots of accident forms show that people are found on the floor but no evidence of reasons for these was seen. There is no proper use of colours to try and help people find where they are. As the corridor runs in a large square, all areas look the same. There were no signs to help direct people around the building. Adult Community Care commissioned a report from a recognised dementia care specialist organisation in 2003. Some of the recommendations from the report had been put in place e.g. there were some picture signs on toilet doors. However, the doors were all white. The recommendation from the ’03 report had been for every toilet door to be painted a strong primary colour. This use of colour, together with the sign, should help people find a toilet on their own. We were told that they did paint the toilet doors red but the manager said it didn’t work so they painted them white again. She said that after this had been done staff had noticed a drop in the level of incontinence within the home. The pictures of toilets had been laminated and stuck on with adhesive. The manager said people kept pulling them off. Several had no picture on at all and people were heard asking for the toilet. Signs should therefore be fixed properly to the doors at heights suitable for everyone so that they can be found easily. There was very little, yet careless use of cues to help people e.g. there is a large white board in the main entrance that says what day it is, the name of the home and what the next meal may be. There is then a description of the weather for the day. This isn’t explained, so words such as ‘wet’ and ‘cold” were seen. The words aren’t changed often enough i.e. the next meal on the board was ’tea’ when in fact it should have been ‘dinner’. This was only changed when we pointed it out to the manager. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 & 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans, whilst giving basic information about meeting peoples needs, fail to show good understanding of the difficulties people living with dementia have. Failure to pick up and assess risks to peoples health means that they may not be kept safe. Poor attention to checking of risks doesn’t keep people living at the home safe particularly from falls. Failure to manage people’s psychological needs in a person-centred way can lead to further behavioural problems for them. Assumptions made about people’s capacity means decisions may be made that further disable them. Proper management of medication keeps people safe from risk of harm. Failure to treat people living at the home with respect and dignity ignores their value as individuals and can cause them harm.
Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 13 EVIDENCE: From the home’s quality assurance survey report good comments were seen about person centred care, all care being open to discussion and relatives able to contribute. Comments such as ‘staff are amazingly well informed and understand (person’s) needs – and her moods’ and: ‘all aspects of care are considered in an holistic manner and are recorded promptly’ were recorded. One of us read records about one person living in the home that was alleged to be quite disruptive to others at mealtimes. We ‘case tracked’ this person i.e. we looked in detail at all records of the care s/he receives, spent time with them and talked with staff about them. Unfortunately little was known about this person before s/he moved into the home. S/he is able to walk around independently. While we were sitting looking at records in the dining room s/he came over to us and began to busy themselves with our papers, tidying them up. When given something to read s/he happily sat with us for some time and looked at a book e.g. of pictures such as food, plants, flowers, plus famous people from bygone times, among others. One of us takes the book on inspections to stimulate interest and discussion. The book was of great interest to this person who looked at each picture carefully and talked about people like the actor James Stewart whose picture was in the book. During this time s/he sat still and was able to concentrate for at least 20 minutes. The same happened the next day when the person expressed an interest in looking at the book again and then looked at two others we had brought. Again s/he was able to concentrate for a long time and expressed pleasure at seeing the book again. From reading this person’s records and talking with staff about her/him, no efforts had been made to pick up on the ability to concentrate on something that interests them. After getting advice from a consultant psychiatrist s/he was put on a sedative type medicine for a while to try and change the disruptive behaviour. There was no evidence that this was a last resort and that other methods had been used first. The person’s care plan was quite detailed and covered many areas of need. It also said what s/he is still able to do for her/himself. Under ‘social care’ it said: “ I like to walk the corridor with my friends”, and “ I will join in activities if it is of the visual kind”. There were very few notes of this person’s key time and doing the kinds of ‘looking at’ activities s/he enjoys. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 14 There were numerous entries about the person’s behaviour and how it sometimes affects other people. There were no new suggestions in the care plan for ways of dealing with this and no assessment of any triggers for this type of behaviour. There was a remark in the plan about the person having failed to settle at another home because s/he found it difficult to live in a large group setting. No attention had been drawn to this fact and no risk assessment was in place for this person’s challenging behaviour. We were told that the person has her/his wardrobe padlocked at the relatives’ request so that s/he won’t rummage around and put on layers of clothes. This fact wasn’t in the care plan. It wasn’t clear if s/he liked to rummage or whether it was a sign of ‘ill-being’ (that shows a person is unhappy with something in their life or environment). It’s another example of an extreme reaction to a situation that may have been solved by seeking advice. A second person was seen walking round and round the unit during the course of the two days. S/he often appeared quite cross and expressed some paranoia, such as someone was trying to kill her/him. We spent time talking with this person who definitely thought people were trying to harm her/him. The care plan said, ‘I can become suspicious and angry if staff try to orientate me’. The action to be taken by staff was ‘staff to try and orientate me’. This didn’t make any sense and may be making this person’s anxiety worse, as staff aren’t stepping into her/his reality. Further, it was mentioned that there had been a recent problem with incontinence but this was put down to the person’s dementia. There had been no individual continence assessment to help her/him stay continent. For ‘personal care’ it was said that the person might not want to have a bath. However no strategies were described for staff to be able to persuade her/him. It was also written that tablets might be spat out. It was not clear how much of a problem this is and what the tablets are for. It had been picked up that the person sometimes wouldn’t eat food so staff were asked to offer finger foods and monitor her/his weight. We saw that s/he ate very little of lunch on both days of our visit. No finger foods were given or recorded. We were told that food eaten was being recorded. We looked at the food record that said for the first lunch we saw, s/he had not eaten lunch for three days in a row. Further, that s/he had eaten lunch the day we were present when in fact s/he hadn’t. The person’s last written weight record was 9th August 2007. The manager on duty on the second day said that people whose eating was being checked should be weighed weekly and everyone else monthly. Two other people in a similar situation with their food had also not been weighed since August 2007. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 15 An Immediate Requirement notice was issued for the home to action on the 29th November 2007. This was for accurate records of what people have eaten to be done and for those at risk of losing weight to be weighed regularly. The records of food eaten also included how many drinks people had. One person drank almost nothing at both lunchtime meals. A care staff member said that this was usual, and they are always reluctant to drink even though staff have tried tempting them with various drinks. This fact wasn’t written in the care plan. There were no cold drinks for people to have in any of the communal areas including the dining room. We were told that this was because they kept getting spilled. Staff will get drinks if asked, but many people would not be able to say this was what they wanted. Therefore another Immediate Requirement notice was left for the home. From 29th November 2007, staff must make sure that everyone living in the home has access to a cold drink at all times. Accurate records need to be kept for those people at risk of being dehydrated. The manager later met with us for feedback on the visit. She said that a water-dispensing machine had been ordered for the dining room and showed us an order for it. She also said that drinks were now being put in the lounges. The third person case tracked had been living at the home for a number of years. We had lunch with this person on both days of our visit. S/he talked a lot and while not all of what s/he said was understandable, there was a lot of non-verbal communication, and some very clear ‘yes’ and ‘no’. It was sad that the care plan said: ‘I tend to make noises rather than words at times’. This shows a very poor understanding of this person’s communication skills and while it wasnt clear to us it obviously was to her/him. The care plan for funeral arrangements stated that Rockwell staff should not do any resuscitation i.e. not to try and save the person’s life. This decision needs to be more detailed and show that the person doesn’t have the capacity to make that decision before it is made for them. The decision can only be made by a GP and in consultation with relatives. The care plan didn’t cover a condition described in the person’s ‘pen picture’, (e.g. a personal profile that gives details of background, family, pets and interests etc). The condition may cause a lot of discomfort and painkillers had been prescribed. The care plan also made the assumption that, as the person didn’t use their bedroom door during the day s/he wanted to have it locked. Under activities preferred it said, ‘will not always understand what is being said’. There was no clear explanation about how that had been assessed. This care plan was last updated in January 2007 and was signed by their relative.
Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 16 The home relies on the services of a team that includes a psychologist, occupational therapist and community mental health nurses. The team visits care homes to give advice and guidance on individual difficulties and to run sessions for staff (although these are only an hour at a time). As mentioned above little attention was being given to people’s psychological needs and no obvious internal checking of their mental health. We met a community mental health nurse from the team that has been visiting the home for two years. He said ‘I am reasonably satisfied overall with what happens here. It could be better. We could do a lot more for the home’. Accident records for the past two months were looked at. These are recorded and kept in one file. The manager said that if someone has more than two falls in a short space of time then an assessment of the risk would be done. We checked the records of two people who had had falls recently. The risk hadn’t been checked in their care plans nor manual handling risk assessments, to show that they were doing all they can to reduce the risk of further falls. A check of medication was done. All Medication Administration Sheets had been filled in properly with no gaps. Issues in care plans about crushing medicines and administration of medication to control behaviour weren’t seen on medication records. The manager said that medicines aren’t crushed although sometimes they’re given with a favourite food such as ready-brek or yoghurt. Medicines to calm agitation weren’t being given often. Records of controlled medication such as narcotics or sleeping pills were all listed in a special book that had been bought for the purpose. Records were all correct, tallied with the number of pills left and properly signed and witnessed. The medication fridge was checked and the temperature kept within the right limits. Records of checking the temperature were seen being done every day. Medications in the fridge were properly dated although on two lots of eye drops the date of opening hadn’t been written. As the drops can only be kept for twenty-eight days the date of prescription was checked. The drops were found to be out of date yet still being used. The manager immediately discarded the drops and opened two fresh bottles putting the date on each. During the two hour observation we saw staff coming into the lounge with rubber gloves already on, take someone’s hand, tell them they were going to the toilet, then led them out of the room. They later came back into the room still holding the person’s hand and with their rubber gloves on. This both ignores good infection control measures and takes away the dignity of the person being helped. The deputy manager was asked about this and said that staff are reminded not to keep their gloves on. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 17 Lack of consideration for people as individuals was seen e.g. a care staff member was seen flicking dandruff off the shoulders of a person without asking them if they could. When the person got cross they just stood and giggled. Another staff member was seen pulling at the lower body clothing of people they passed to check whether they had been incontinent or not, again without any conversation or explanation. Another issue that takes away peoples dignity is the use of the stable type office door, which is kept bolted even when the managers are in there. People were seen coming up to the door and being talked to over it. (Please see Standards 31-38 for more about this). During the hour we sat in one of the lounges, staff came into the room but didn’t speak to any of the people sitting there apart from the person they wanted to take to the toilet. The only person who greeted everyone was an agency care staff member. During the lunchtime observation people that took a long time to eat very little had their meals just taken away without speaking to them. On the second day a staff member came over and put a person’s sandwich back together without speaking to the person eating it. People weren’t told what meal they had been given and some staff put protective aprons around their necks without asking their permission. (Please see standard 15 for more about the lunchtime experience). Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 18 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 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Lack of a team effort to give people quality and meaningful social time fails to make sure they are stimulated and occupied. Careless regard to making sure people have enough to eat and drink when they are at risk of being dehydrated and malnourished, fails to meet their needs or keep them safe. EVIDENCE: One care assistant is allocated each day to do activities from a two-weekly planner. Something is planned for twice a day. A small group was gathered in the activities room on the first day of this visit. They were decorating a small Christmas tree. On the second day they were looking at newspapers. There were however, still a lot of people who weren’t involved in the group session who had nothing to do. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 19 The home’s Statement of Purpose states that ‘residents are encouraged to continue with their own hobbies and participate in local activities and attend day centres and other groups’. Evidence of this wasn’t seen in records although staff did tell us that some people can go out with a staff member and go to Cribbs Causeway shopping mall to choose their own clothes. Staff at the home try and gather as much information about the person from their families. Life histories and personal information sheets give a lot of useful information, which should help in the planning of meaningful occupation. However not everyone had this information and all but one staff member spoken with were unaware of peoples previous lives, jobs, interests or hobbies. The manager said that relatives don’t like to be asked about their family member’s lives and don’t always volunteer information that would help staff meet their social needs. The television was on all day in one lounge regardless of whether people looked at it or not. There was no use of soft furnishings, plants or flowers, or cues to help people know what the rooms are for. No books, magazines, or ornaments were seen in these rooms. Crates of books were seen in the home but these hadn’t been unpacked and may not be suitable for people to look at because of too much text. However they had been unpacked by the following day. People walked about but had little to catch their attention or focus on. One person repeatedly walked in and out of one of the lounges but there was nothing there for her/him to do. The lounges are for sitting in only and there had been no attempt to provide anything stimulating, such as familiar objects or a “rummage” box (a box with items of possible interest) to catch peoples attention. The Manager said that they had discussed doing a rummage box at a staff meeting but had not got around to doing it. Minutes of staff meetings held in August and October ’07 didn’t mention the boxes or anything about meeting the needs of people living at the home. One care assistant had however, picked up on this idea and made one for a person as part of her key worker role. A key worker is a staff member responsible for the welfare of a small group of people living in the home. Part of this role is for them to spend key time (one to one time) every month and this care assistant was using the box of personal and familiar things with this person. She told us she intends to do this for someone else, as this one had been a success. She also said that she intended to buy some photo albums as the person had a lot of photos and these could be organised and used for reminiscence. This is commended. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 20 The manager gave us information about what she had done about this when we met for the feedback session on 7 December. She said she had bought a number of boxes with things to go in them plus scrapbooks. A sheet from the amenity fund records was seen with a list of all the things bought. The boxes had been put around the home but the manager said people hadn’t been taking much interest so far. However staff need to understand how to work with the boxes so that they can help people with using them. Records were seen of ‘key time’. This time is given as one hour a week for each person and budgeted for as part of the key worker role. For the people case tracked the time varied in its content. Records for the past two months showed the following: One person had their weekly time that was spent doing various things such as listening and singing to ‘golden oldies’, doing puzzles, watching a video or talking about the old days. For another there were very few entries about anything of interest happening to them. They often didn’t want this key time but the entries again didn’t include their interests. Another record did say that the key worker spent time chatting with them, which is good, yet it didn’t include their previous interests or hobbies. The activity room door was often closed. There was no sign on the door to tell people what it was for. The cupboard in the room was also padlocked. The manager said this was to stop people harming themselves with the scissors or glue kept in there. She went on to say that money from the Department of Health had been given to improve the patio area and turn the activity room into a room for reflexology. However it wasn’t clear when this was done, where people could then do other activities. From the home’s quality assurance survey report, activities scored lowest at 78 . Comments about this included: ‘Maybe some at weekends?’; ‘More trips are needed to break the monotony of living in a care home environment’ and: ‘more stimulation needed’ (two comments). Staff we spoke with agreed that there aren’t enough outside activities and indoor activities are only ‘so so’. They did say however that some people are able to do things like baking and basic meal preparation. The home has a large dining room. When meals are due to be served the tables are laid with tablecloths only. Different colour cloths are used for different meals. Tablecloths were creased and no condiments or table decorations were used that would make them look more attractive and homely. The room has a blackboard by the serving hatch that has the menu written on each day. From the end of the room we were unable to clearly make out what was written on it. Further, the use of a blackboard may not meet the sight needs of people living with dementia as they may have difficulty with seeing colour. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 21 The cutlery was only put on the tables when the meal was actually being served. Everyone was offered a choice of 3 types of cold drink all of which were served in plastic beakers. The two people we sat opposite to were given their meal with no explanation of what it was. One person ate nothing at all and the other tried very hard to eat their meal. S/he had been given a teaspoon and there was a plate guard to help manage the food. No one sat and tried to guide her/him, as s/he often put an empty teaspoon in her/his mouth. Neither person drank very much at all. No one came and prompted them. After about 45 minutes their meals were taken away and nothing different offered. Both were just given a pudding. The person who tried to eat the main course with a teaspoon was given a dessertspoon for pudding. While s/he was eating it a care staff member sometimes came and helped, but she did this standing over the person, not sitting beside her or him. Another person whose care had been tracked ate almost nothing. We didn’t hear any alternative being offered. All three people are recognised at being at risk of not eating well. (Please see Standards 7 -11 above). One person living at the home with cultural diet needs is offered Caribbean food ready meals. A selection of these (frozen) meals was seen that included curried mutton and rice, spicy fried chicken with rice and peas and stewed beef with yam and sweet potato. The manager said however that the person liked English food better although there was little evidence to show this. The meals sampled on both days were tasty and people on the whole looked as if they enjoyed what they were eating. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 22 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 &18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Complaints management doesn’t take the views or concerns of people living at the home into account and doesn’t make the complaints process understandable to them. Poor management of abuse doesn’t keep people living with dementia safe and protected, nor are staff clear about how to deal with possible incidents. Further, peoples personal allowances aren’t managed effectively to protect them from possible financial abuse. Failure to advise us of incidents of abuse doesn’t make sure the Commission is able to take full part in the way people are kept safe. Inadequate management of staff training in keeping people living with dementia safe, could increase the likelihood of abuse happening. EVIDENCE: The complaints file was looked at. No new complaints had been received since the last inspection. Lots of letters of thanks were seen at the front of the file although some of these went back some time. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 23 The new Adult Community Care complaints leaflet was seen. However the leaflet wasn’t understandable for people living with dementia and the manager was unable to show how they can make their concerns known. It was clear from watching them that some peoples behaviours may mask concerns they have about the way they live but this wasn’t being followed up in any meaningful way. The manager told us about an incident of alleged abuse that affected one person. An incident had been properly recorded and a strategy meeting (a meeting of social care professionals and others) had been held to decide what to do. However we hadn’t been advised of the incident as required under regulation that meant we were unaware of the meeting. We therefore couldn’t take part or comment on how to protect the person. No protection plan was in place and it wasn’t clear what was being done to protect the person or staff from the alleged abuser. From information received before the inspection the manager had told us that she wanted to seek advice on how to make sure people are protected from risk of financial abuse. When doing a check of peoples cash it was clear that two people were at risk, as neither had any of their personal allowance (currently £18.65 per week), brought in by relatives since February ’07. Amounts that had been brought in were too low to make sure people had enough money to spend on anything they wanted. The manager hadn’t put in place the actions she had described although she had written to one family to ask for more money to be brought in. However it is the responsibility of the registered provider to support the manager in making sure people using the service are protected from financial abuse. The safeguarding adults co-ordinator was spoken with after the inspection and gave information about possible actions that were being considered about the matter, although none of these had yet happened. Staff training records were closely looked at. Of twenty-one records seen, eight staff didn’t show any record of having done safeguarding adults training. The remainder had records to show that they had done it two or three years ago. The manager showed us a sheet with training that she had listed as being needed for staff. The list did include safeguarding adults training but had no dates. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 24 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): 19,22,24 & 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst the home is clean and hygienic, the décor, layout, fittings and furnishings don’t meet the needs of people living with dementia and creates a disabling environment. Scant attention has been given to making sure the environment helps people not to be bored or frustrated. Knowledge about peoples past lives fails to be used to create an environment that they can cope with. An emphasis on locking doors and cupboards creates an institutional setting that could lead to deterioration in peoples behaviours. Further, bare rooms and heavy curtaining stops people from having things to do and see. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 25 EVIDENCE: Relatives had commented on the premises in the home’s quality assurance survey. Some people felt that the quality of the building and décor could be improved and a family room for visits made available to them. The communal areas of the home had been redecorated in bright colours. The manager said that people living at the home had chosen the colours and the wallpapers for some of their bedrooms. All three lounges had been done and looked fresh and clean. However chairs were arranged around the walls giving an institutional look. Corridors also looked and felt institutional. In the main areas of the home, heavy curtains in one corridor that has windows looking out on the courtyard, partly blocked the view that in summer would be pleasant for people to look at. In the dining room, heavy curtains and window blinds stop people from looking out. Two people were looking out at various comings and goings in the entrance hall and we raised the blinds for them to get a better look. However the blinds wouldn’t stay up. A requirement made at the last visit about redecorating and improving peoples bedrooms was partly met. A number of rooms had been redecorated and furniture bought. However it wasn’t clear if thought had been given to the type of furniture the person could use that would help them and not make their dementia worse. One person had a large, unvarnished chest of drawers that the manager had bought for her/him, that dominated the room. The manager said that the person’s armchair had to be taken out of the room at night as s/he climbed on it. This may have been because the room was crowded and no thought had been given to best use of the space. The manager knew the person’s background that gave clues to how her/his room should have been laid out, but the knowledge hadn’t been used in a way that helped her or him. Several rooms had been redecorated from a requirement made at the last visit. These rooms were fresh and bright and had new headboards and plenty of storage space. However, at least three rooms hadn’t been redecorated or refurbished at all. Wallpaper was old, dark and peeling and rooms looked bare and unwelcoming. Bedrooms were more often than not locked for large parts of the day to stop people going in them, so even if someone recognises their room they can’t go in it. The reason given for this is that people go into other people’s rooms and take things. This is not surprising given that there is nothing else to do and nothing to pick up and interest anyone anywhere in the unit. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 26 The sound and sight of rooms being unlocked then locked again after lunch was oppressive. We saw a staff member going round unlocking bedrooms that were clearly empty then locking them up again immediately. Staff said that rooms were locked after cleaning so that floors could dry, to prevent people slipping on them. However we didn’t see them unlocked again and we saw people trying to get into bedrooms that were locked throughout the two days of our visit. It wasn’t clear what happened if people wanted to go back to their rooms for a nap after lunch. Bedroom doors were numbered and also had small, fixed photo frames that should help people find their room. However, little thought has gone into this, as there had been no consultation about what the person may recognise. The pictures were very small and all at the same height so not everyone may be able to see them. Some people living with dementia may not recognise themselves as they are now, but would recognise either themselves or a familiar person or pet from their past. Other pictures of things they were interested in such as hobbies could also be used. Further, whilst each person’s name was on the door these were formal. Managers and staff knew the names people like to be called and were using them. We recommend that if names are used on doors they should be the name the person likes to be called so that they may recognise their rooms more easily. All parts of the home used by people living there were clean and smelled fresh. Some bedrooms had a slight smell but this was before being cleaned. Toilets were also being kept clean and domestic staff were seen carrying out cleaning jobs on both days of the visit. However, the home has the appearance of what is described by some dementia care practitioners as ‘opulent neglect’. This means that some providers concentrate on making sure people living with dementia in care homes have hotel standard accommodation that isn’t homely or welcoming. Advice should therefore be sought from a recognised, specialist dementia care organisation on how to make the home more comfortable and homely for people to live in. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 27 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment of more permanent staff and less use of agency staff gives people living at the home a more stable environment. However managers’ failure to support staff has lowered staff morale that in turn could affect people living in the home. A lack of training in dementia awareness and person centred care means that peoples needs aren’t met properly by staff that lack awareness or support. Continuing progress with National Vocational Qualification in Care training helps staff to be confident and gives them basic care giving skills that help them meet peoples needs. EVIDENCE: A number of staff had been taken on since the last visit. This has meant that the home relies on fewer agency staff. Staffing levels were acceptable for the days we visited although staff were kept busy the whole time. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 28 From our surveys relatives had also picked up the difficulties staff face. They commented: ‘ I think the worst thing is staff change – agency carers who come and go’. To the question ‘How do you think the care home can improve’ one person commented: ‘by knowing their jobs in the home are secure. The uncertainty about homes closing is very bad for morale’. Staff spoken with told us of their difficulties in meeting everyone’s needs. The manager had said that the first day of our visit was a ‘quiet’ day in the home. We asked staff what a ‘busy’ day was like and they gave us very clear information on this. They described a situation when, with only two care staff on duty, several people were ill whilst others needed different kinds of help. However staff were left to deal with it all while three managers sat in the office. On another occasion when a person’s behaviour was particularly challenging, managers shut the office door on staff that were trying to deal with the situation. On the second day of our visit staff that were off duty at a certain time stayed to finish records so that they went home late. Their morale was low and this was clear from their comments that ‘nothing changes - what we say doesn’t matter’. Staff showed commitment to people living at the home and said they used to involve them more e.g. folding towels to give them something to do, and would like to do more with them such as knitting or gardening. When we asked what they would do if they were manager for a day their answers were clear: ‘let them run wild a bit’, ‘go on more trips’ ‘not so much worrying about making beds - if they’re not made it’s not the end of the world’ and: ‘sing with them’. Staff also commented that some days they’re so busy they don’t get time to have a break. One person said she had felt ill when she went home one day, as she hadn’t had time to have a break or even a drink. From our survey relatives praised the staff i.e. ‘ I think the regular permanent staff are excellent. They have the skill, knowledge and experience in the care of people with dementia’. Of the twenty-two staff working in the home seventeen have National Vocational Qualification in Care at Levels 1 or 2. One assistant manager is working towards achieving Level 3. The deputy manager and one other assistant manager have qualifications in assessing the work of others. The deputy manager also has a dementia care qualification gained in 1996 and trains staff in other homes in awareness of the types of dementia. Three domestic staff have Level 1 and four have Level 2 (in domestic services). The manager said three are also currently doing Level 1. Twelve staff have Level 2 in care and three are now doing it. Records of staff qualifications were seen in the Statement of Purpose/service users guide pack. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 29 The home therefore meets the recommended target of at least 50 minimum staff with Level 2 or a similar qualification. However for other areas of training such as dementia awareness and care records were patchy. Some staff had nothing recorded since 1998, and some had nothing recorded at all. Others did a four day course spread over 2003/4. Some had done very short sessions e.g. an hour long (put on by the team mentioned previously). Staff spoken with were hazy about the different types of dementia and weren’t clear about the effects of each type. Domestic staff don’t have training in dementia awareness and care although this forms part of the staff induction. All staff, including domestic workers must have this training as all are involved in some way day to day with people living with dementia. Some staff had done training in coping with challenging behaviours. One staff member gave an example of a situation that before she had done the training she didn’t feel able to cope with. However since doing it she said she felt more confident in dealing with situations. From looking at training records generally, most staff had done essential basic training such as moving and handling, food hygiene and first aid. Night staff had done a four-day first aid course, plus administration of medicines. Certificates for these were seen in their files. However from all training records seen, none of the staff had done training in person centred approaches to care for people with dementia. However a few had done training in support and communication for people with dementia. Several staff had done ‘what is a care plan’ but it’s hard to see how this benefits them if they aren’t clear or haven’t had training in person centred care. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 30 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): 32, 33, 35, 36 & 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. From all evidence gathered at this inspection it’s clear that the home isn’t run in the best interests of people living there. Although trained and experienced, the management team fails to support staff in giving people good quality care and a fulfilling life in the home. Over concentration on getting jobs done has become the culture of the home and regarded as more important than the emotional and social well being of people living there. Peoples cash held at the home is protected and kept safe for their benefit. Failure to make sure staff are properly supervised may put people at risk.
Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 31 Failure to make sure proper fire safety drills are done for staff doesn’t keep people safe. EVIDENCE: The manager, Mrs Elaine Stephens, has many years’ experience of working in and managing local authority care homes. She is trained to National Vocational Qualification in Care Level 4. She showed a lot of knowledge of individual people living in the home, yet much of this hasn’t been made available to staff nor used to help meet environmental or social care needs. Mrs Stephens wasn’t fully open to the inspection process and said she felt intimidated by the presence of two inspectors, although we clearly explained the reasons for this. At Rockwell the culture is one of division between ‘them and us’. This was clearly seen between the managers of the home and the rest of the staff, as well as between the managers and people living in the home. The management team using the office door (which is arranged as a stable type door with split opening) as a barrier reinforced this, and they didn’t respond to anything happening outside of that office unless there was some kind of altercation. On the first day of our visit the manager and two assistant managers sat in the office for most of the day. This was repeated on the second day with different assistant managers. One came out to give out the medicines but the other two barely made an appearance in the unit. People living in the home sometimes came up to the door, but were not encouraged to come in. Indeed when it was left open someone would immediately get up and lock it again. We were told that the door has to be kept locked as people come in and mess about with important papers. We would suggest that if the officers went and found something for people to do and spent more time with them, they wouldn’t be interested in the office or their papers. All the above shows that the home isn’t run in the best interests of people actually living there and in fact is run against their interests in terms of activities, environment and attention to healthcare needs. We strongly recommend that the City Council looks again at its ‘locked door’ policy that was identified in the report from a recognised dementia care specialist organisation. This was commissioned by Adult Community Care and done in 2003. The report ‘strongly’ recommended: ‘That Bristol City Council undertakes a policy review and looks at the provisions that will address the issue of rights and safety on an equal basis. This should include consultation with the local social services legal department and inspection officers’. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 32 We are unaware as to whether a review has ever been done. Such a review is timely given the degree of security we saw within the building at this visit. The home had recently had its own quality assurance survey done by an independent organisation. The survey report that had been sent to the Commission showed high levels of satisfaction from relatives that were interviewed. The scores out of 100 were highest for health care and management and staff at 88 each. However the findings from the survey bear little relation to findings from this visit. The manager was doing weekly checks of monies held for people living in the home when we arrived. We did a random check of cash for several people and found all to be correct. Receipts were attached for items bought and where possible signed for by two staff. (Please also see Standards 16-18 re personal allowances). We looked at a number of staff supervision records. These didn’t all show that staff had regular supervision at least six times a year. Of the fourteen records seen only one person had had six sessions, plus had had a yearly appraisal (a review of work over the year and focussing on training and development). For the rest, two people had had four sessions and four people had had three sessions. Five people had only had two sessions this year. However every one had had their yearly appraisal. Some of the supervision records were brief with just a list of topics. Health and safety records showed regular checks being done monthly on fire safety equipment and water temperatures. However, a requirement made at the last inspection about fire safety drills wasn’t met. A record of day-time drills was seen but records for night staff showed that three monthly drills hadn’t been recorded since 2005. They did show fire safety training in May this year had been done that the manager said included a drill but this wasn’t mentioned in the record seen. The requirement is therefore moved on with a short timescale. Failure to meet the requirement could lead to enforcement action being taken. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 33 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 X 3 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 X X 1 X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 1 3 X 3 2 2 2 Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 34 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. Standard 1. OP8 Regulation 12(1)(a) Timescale for action Drinks must be made 29/11/07 available throughout the day so that every person can have a drink at any time. Accurate records must be kept of those people at risk of being dehydrated. This will make sure that people are protected from effects of dehydration. People with dementia at risk 29/11/07 of losing weight must be weighed regularly and an accurate record kept of the amount of food eaten. This will make sure that people get a good standard of nutrition and are protected from risks associated with malnutrition. From 30/11/07 care plans 29/11/07 and moving and handling risk assessments must be reviewed following falls. This will make sure that the risk of falls is reduced and people will be kept safe. Requirement 2. OP8 12(1)(a) 3 OP8 13(4)(c) Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 35 4. OP1 12(4)(b) 5. OP7 15(1)(2)(b(c) 6. OP8 12(1)(b) 7. OP8 13(3) 8. OP9 13(2) The Statement of Purpose must be amended to clearly show how people from different groups in society e.g. black or minority ethnic, sexual diversity, gender, disability and different religions can be cared for. Each care plan must reflect the current situation of each person and give staff clear detail as to how to meet their health, personal and social care needs. This will make sure that people living with dementia are able to lead more wholly fulfilling lives. Specialist mental health advice must be sought for those peoples psychological needs giving cause for concern and any challenging behaviour they might show, from an appropriate health care professional. This will make sure that peoples mental health needs are properly met and other people are kept safe. Rubber gloves must only be used as necessary to maintain proper infection control measures and not when giving social care to people using the service. This will make sure that people are protected from risk of infection. Any medication such as eye drops that has a limited life must be dated when opened and discarded at the end of the period. This will make sure people will benefit from medication that is suitable for them to take.
DS0000035302.V355199.R01.S.doc 31/01/08 28/02/08 31/12/07 15/12/07 15/12/07 Rockwell Version 5.2 Page 36 9. OP10 12(1)(4)(a) 10. OP12 16(2)(n) 11. OP18 13(6) 12. OP18 13(6) All staff must behave in a manner that respects each person, promotes their dignity and seeks their permission before attempting to touch them. This will make sure that people are treated as valuable individuals in their own right and not as objects. Advice from a recognised dementia care specialist about activities suitable for people with dementia must be obtained. This will make sure that people are kept free from boredom and frustration in their daily lives. All incidents of suspected or actual abuse must be reported to the Commission without delay. This will make sure people are kept safe and protected from risk of harm or abuse. A clear system must be put in place and followed to protect people from financial abuse in relation to their personal allowances. This will make sure people living with dementia will have any money they need and they will be protected from risk of abuse happening. 15/12/07 31/12/07 15/12/07 31/01/08 Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 37 13. OP19 23(1)(a),(2)(a) Specialist advice from an 31/03/08 organisation expert in dementia care and registered to give such advice, must be sought on: -Use of lighting in all rooms and corridors; -Flooring that meets the needs of people living with dementia; -Style and content of communal rooms to enable provision of social and cultural activities and: -Proper use of directional signs, signs on toilet doors and nameplates on bedroom doors. This will make sure that people are kept safe in the home, don’t get bored or frustrated and will be able to keep their independence for as long as possible. 14. OP22 23(1)(a) People must be able to get 15/12/07 into their rooms at any time of the day. Bedrooms must only be kept locked if there is clear safety reason for doing so. Where bedrooms need to be locked a proper risk assessment showing the need for this must be put in place. Unnecessary use of padlocks particularly in peoples bedrooms must stop. All the above will make sure people living with dementia are able to use all parts of the home freely and without restraint. (Timescale not met from the September ’06 inspection)
Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 38 15. OP24 23(2)(b)(c) met from the September ’06 inspection) All remaining bedrooms 28/02/08 especially rooms 30 and 31 must be redecorated paying attention to décor and furnishings that meet the needs of people living with dementia. This will make sure that people will have homely and comfortable rooms that meet their needs. (Timescale not Eight named staff must have 31/01/08 training in safeguarding adults. All staff including domestic staff must have dementia awareness training delivered by a specialist dementia care provider. All staff including the management team must have training in personcentred care. This will make sure people living in the home are cared for by staff that understand their needs and are able to help meet them. All staff must have 31/03/08 supervision at the frequency as set out in the organisation’s own policy. Records of supervision must be kept in enough detail to show that people are able to discuss issues affecting their work with people in their care. Where supervision can’t be given for any reason, records must show alternative dates 16. OP30 18(1)(c)(i) 17. OP36 18(2) Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 39 18. OP38 37(1)(e) 19. OP38 23(4)(e) have been arranged. This will make sure that staff are able to think about their work practice and have opportunities to discuss issues that may affect people living at the home. Any incident that adversely 15/12/08 affects people living at the home must be reported without delay. This will make sure people are protected from risk of harm and kept safe. All night staff must attend 31/12/07 fire safety drills every three months and all such drills must be regularly recorded separately from fire safety training. This will make sure people living at the home will be kept safe at night.
(Timescale not met from September ’06 inspection). 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 OP4 Good Practice Recommendations Advice should be sought from an organisation experienced in working with people living with dementia as to how to meet their specialist needs from a person-centred approach. This will make sure people will get proper support so that they can enjoy fulfilled lives in the home. It is strongly recommended that the City Council’s ‘locked door’ policy should be reviewed as a matter of urgency to include the use of locks within the home. This will make sure that people will have freedom to move
DS0000035302.V355199.R01.S.doc Version 5.2 Page 40 2. OP19 Rockwell 3. OP30 4. OP37 about and ‘own’ the home and their sense of well-being will increase. A training plan that shows when staff are due or have had safeguarding adults training should be put in place. This will make sure all staff receive the training and people living at the home will be kept safe and protected. Information for personal profiles of each person living at the home should include as much detail as possible. Family and friends should be regularly asked to give information that will help make sure people get the person centred care and support they need. Rockwell DS0000035302.V355199.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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
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