Inspection on 29/05/08 for Rockwell

This inspection was carried out on 29th May 2008.

CSCI found this care home to be providing an Poor service.

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 28/11/07

Rockwell 25/08/06

Rockwell 18/08/05

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Rockwell Corbett Close Lawrence Weston Bristol BS11 0TA Lead Inspector Sandra Garrett Unannounced Inspection 09:00 29 30th May and 3rd June 2008 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.V361810.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.V361810.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.V361810.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. 28th November 2007 Date of last inspection Brief Description of the Service: Bristol City Council own and run Rockwell. 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), includes an activities/reflexology room, plus a tea room for people living at the home to meet with their relatives. A large garden, mostly laid to lawn, surrounds three sides of the home. The full weekly fee for Bristol City Council dementia care homes is £619.71 per week (for 2008-9). 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 dated November 2007 were seen around the home. A copy of the 2006 report was pinned up in the entrance lobby. Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was the second key inspection within six months. The inspection was to follow up requirements and recommendations made at the November visit to see if the quality of life for people living at the home had got any better. Before the visit, all information the Commission for Social Care Inspection (the Commission) had received about the service since the last inspection was looked at. This included: the home’s Annual Quality Assurance Assessment (AQAA) for 2008 and notices about things affecting people in the home. At the time of writing this report we had received five surveys filled in by relatives and two from staff. Comments from these will be found throughout the report. Two inspectors looked at the quality of care people with dementia experience when living in care homes. In particular looking at dignity, choice and rights as an important part of people’s quality of life. We looked for clear evidence of person-centred ways of working with people. This means looking at a person’s whole life, history and needs. It recognises and values them as individuals with rights and choices, rather than just focussing on doing basic physical care tasks. Because people with dementia aren’t always able to tell us about their lives, one inspector used a formal way of observing people to help us understand better. We call it the: ‘Short Observational Framework for Inspection’ (SOFI). This means using a methodical and structured way of watching four people who used the main lounge and dining room on the ground floor. The inspector did this for two hours and recorded their experiences at frequent intervals. It included looking at their wellbeing, how they interacted with staff members, other people living at the home and the environment. Over the two days we also spoke to the duty manager in charge on the first day, the acting manager, four staff members, seven people living at the home and two visitors. We looked at records and documents, including people’s care plans, daily records, risk assessments, accident reports and healthcare records as well as staff and health and safety records. What the service does well: The home gives people a clean and hygienic space in which to live. Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 6 Meals are well cooked and menus showed people get a healthy, well-balanced diet. To the question in our survey ‘what do you feel the home does well?’ relatives commented: ‘I feel it offers a caring environment where the resident is safe and relatively happy’, ‘Communicates with me. Keeps my mum safe. Knows individual residents really well. Encourages residents to remain as independent as possible. Handles complaints efficiently and promptly. Is welcoming in a homely environment. Home is immaculately clean’, ‘Communication is very good and the staff are well trained looking in from the outside as a relative. They are helpful and informative’ and: ‘It looks after their day to day needs i.e. medication, general hygiene, food and domestic needs well’. What has improved since the last inspection? What they could do better: Whilst we acknowledge that work has started to improve the situation for people living at the home, our overall findings are that the improvements made so far haven’t been enough to move away from the institutional culture or meet peoples needs in a person centred way. Further, some of the records Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 7 we saw showed chaotic management with frequent changes, confusion and missing records. We were disappointed that more hadn’t been done to make sure people’s health and welfare is kept at the highest level. An example of this was particularly seen in dealing with peoples eating difficulties. Whilst people were now being weighed regularly, the weights recorded showed that the scales were in fact wrong. Further, people that ate very little or nothing at all weren’t being helped in ways that would make it easier for them. People weren’t being respected at mealtimes and not enough was being done for people that were clearly unwell or unable to eat. Five requirements were moved on from the last inspection. These were to do with: - Helping people to eat and making sure staff are trained to do this in a person-centred way, - Review of care plans and risk assessments following falls to make sure people are kept safe, - Treating people with respect and dignity and: - Getting advice on the environment to make sure it meets the needs of people with dementia . A requirement about night staff attending fire safety drills regularly was partly met. We saw evidence of this but it wasn’t dated or properly recorded. A new requirement was therefore made. A further thirteen new requirements were made together with six good practice recommendations: - The latest version of the inspection report wasn’t available. People living at the home and/or their relatives must have copies of the report or at least made available to them so that they’re aware of the quality of care given to people, - Four were made about care plans, risk assessments and reviews. Whilst care plans had improved not enough information was being recorded when things changed for people i.e. after falls or when unwell, - The management of peoples money gives cause for concern. Better and stronger ways of making sure peoples cash is handled safely and securely will mean that they are at less risk of financial abuse happening. Further, people mustn’t be charged in advance for services such as reflexology or chiropody, - Three requirements were made to continue improvements to the fabric of the home. These were made to make sure people have full access to all areas, that they have a pleasant and accessible home in which to live and that all areas are made safe for them, - People must be treated with dignity and respect by all staff. We saw actual and written instances where people weren’t being treated as valuable individuals, rather as ‘problems’, or their needs were being ignored. The ‘institutional’ culture of the home must be replaced with a clear person-centred one, - Whilst we acknowledge staff training and supervision has improved, our observation and records showed that not all staff have taken the training or Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 8 our previous requirements on board. Action must be taken to address poor performance where this has been clearly found, - Prescribed medication must not be allowed to run out for any person. Strong efforts must be made to make sure repeat prescriptions are in the home before peoples meds run out and: - Care records must be kept in a more orderly way and all records about people living at the home including those in message books, must be written in a person-centred way. The good practice recommendations included: - The service users guide and other information should be made easier for people with dementia to understand, - Better recording of ‘as required’ medication makes sure people will get it when they need it, - Photographs of people displayed on their bedroom doors should be chosen to respect their dignity and to help them recognise themselves better, - A new and extended range of activities should be put in place so that people have more stimulating and enjoyable ways of passing the time, - Individual patterned aprons or tabards that are easily cleaned should be bought for people to choose and wear at mealtimes rather than thin plastic aprons and: - Work should be done in the gardens to make them more interesting, pleasant and accessible for people. Pictures should be put up in the first floor corridor to give people more to look at and reduce the institutional look of 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.V361810.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 & 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Failure to give people information about our inspections doesn’t make sure they’re made aware of the quality of care (or lack of it) that the home gives to people living there. Failure to try and give information in a way that people with dementia can understand better means they don’t know what they’re entitled to or how their needs will be met. Whilst efforts have been made to meet specialist needs, more needs to be done particularly in understanding how dementia affects people. This will make sure their needs will be properly met. EVIDENCE: We saw a copy of the 2006 inspection report pinned up in the entrance lobby. At that time the home was rated as ‘good’. The latest inspection report when Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 11 the home was rated as ‘poor’, that was published in December ’07 wasn’t displayed anywhere although a copy of it was seen on the manager’s desk. We did however see minutes of a relatives meeting held in February ’08. Fourteen relatives attended. The manager went through the latest report and discussed our findings in detail. The notes of the meeting showed that the manager encouraged people to get a copy of the report from the Internet and that the written copy was available in the office. However, as at least half of peoples relatives didn’t attend the meeting and other interested people such as friends also visit people living at the home, the report should be available to all. Information about the home for people living there wasn’t seen at all. It’s appreciated that people with dementia may not be able to read text but the home should find ways of putting information such as the service users guide and the complaints leaflet into e.g. a picture format so that people can understand it better. We’re aware that the team that oversees management of all the local authority homes is doing some work on this but it needs to be done as soon as possible. The home is a specialist one to care for people with dementia. Further in this report are examples of how specialist needs are met i.e. through training, aids and adaptations and equipment. We followed up a good practice recommendation made at the last visit about getting advice from professionals working with people with dementia as to how to meet peoples needs in a more person-centred way. This had been partly adopted. Staff from the In-Reach team that helps staff with any difficulties they have in dealing with mental health problems have been visiting the home. The occupational therapist working in the team has been doing work around person-centred activities for people with dementia and staff have been having training in this. However progress has been slow. Please see below in Standards 12-15 for more about this. We also had concerns that not all staff were working with people with dementia in person centred ways that improve peoples well being and not doing so could lead to greater ill being. We case tracked a person with cultural needs currently living at the home. This means looking at all aspects of the person’s care and observing whether needs, wishes and feelings are being respected. As far as possible evidence showed that the person’s needs were being properly met. We saw the person at this visit and her/his behaviour bore out what was written in the care plan that showed staff are aware of her/his needs. Rockwell DS0000035302.V361810.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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Continuing failure to make sure people are helped to eat and get nourishment puts their health at greater risk. Whilst healthcare professionals visit regularly, failure to make sure people get their medication when they need it puts them at risk. Further, failure to record and review risks e.g. after falls doesn’t keep them safe. Lack of person-centred ways of working and an institutional approach to care doesn’t respect peoples privacy or dignity. EVIDENCE: We followed up requirements from the last inspection about making sure people are given regular drinks, are regularly weighed and helped to eat. From watching people closely we saw that at least three out of four people showed signs of wellbeing. One was positive throughout and showed a strong character, was confident, able to speak her mind, let her views be known and Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 13 argue with others. She was smiling, singing, having a good banter, chatty, was aware of others and offered kindly support to another more tearful person. At one point she was worried about paying for her lunch. However a staff member reassured her and distracted her from her worries. This person was offered a choice at lunch and at first chose the hot meal. She didn’t eat any at all so was then given a cheese sandwich. This she picked at, eating very little, although given some prompting and encouragement. On the second day of the visit we sat with her and saw the same thing happening. The person was bright and chatty and occasionally winked at us! However she ate almost nothing of the meal of grilled fish and mashed potato and spent time moving it around the plate. She then told us she found it difficult to swallow. A staff member took it away with her agreement and offered something else. She then had baked beans with bread and butter that she ate a little more of although overall still ate very little. We looked at the care plan. A softer diet and prompting to eat was recorded. The plan also showed that she had been weighed regularly although had recently lost weight. S/he had been on a food chart but had been taken off as ‘weight was stable’. We suggest that weight may not be the only reason for keeping food charts. If people have frequent difficulties eating they may not get the nourishment they need that could lead to a deterioration in health. We noticed similar issues with another person who showed signs of being unwell at this visit. Again she had stopped eating. We looked at her care plan that showed she was on a food chart. Food likes were also recorded e.g. finger foods and sweet things. We couldn’t find a food chart anywhere and staff were unable to give a reason for it. She had been weighed regularly but the weight records were clearly wrong e.g. she had apparently gained a stone in one week and lost it again by the next. Further, the scales were bathroom type ones that would be difficult for frail people with dementia to stand on. We immediately advised that new sit on scales be bought and an order for this was seen by the end of our visit. The new scales must however, be checked and looked after regularly so that the right weights can be recorded. From looking at daily records some mention of giving the person food was written together with clear references to her/him not eating or drinking. Several references were to the person only eating small amounts of cereal for supper. We discussed this with the acting manager and a fluid chart was done from the evening of the first day of our visit. When we looked at it later it was clear that the person was drinking very little. We watched another person who was given choice of lunch, and had three puddings. However she looked as though she was struggling with or choking on her meal at the end of lunch. A kitchen staff member saw and asked if she was ok but didn’t come out of the servery. A care staff member in the dining room didn’t respond at first, then reluctantly went to assist. Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 14 Overall care plans were much improved and those we saw were written in person-centred ways that showed what the person liked, could tolerate and how s/he wanted to be cared for, in some detail. Care needs and actions were all person-centred although when recording the outcome of the care given the language moved back into ‘person will be‘ and ‘person needs’ rather than ‘I will be’ or ‘I need’. No concerns were noted with moving or handling people or the use of wheelchairs. One person’s moving and handling risk assessment was dated October 2007. However s/he had a number of falls since then and her/his health and abilities had got worse since. Evidence showed care plans were being looked at monthly and changes noted. However these reviews didn’t fully show the changes in the person’s needs, nor did they demonstrate what action was taken to ensure that her/his needs are being met. There was no clear direction or guidance for staff recorded that would tell them what extra care the person needed. A local GP visits regularly and knows people living at the home well. A chiropodist and reflexologist visit the home regularly and staff said people love to have reflexology that relaxes them. However we didn’t see any record of qualification for the reflexologist that had been working at the home for several years. From our survey a relative commented about a lack of clear information given about her/his parent: ‘Information can be slow to filter through and be abstract i.e. ‘under review’ seems to mean something has changed without being exact e.g. ‘medication is under review‘ meant a medication increase had taken place’. We did a check of medication and watched the practice of one of the assistant managers when giving it out in the dining room at lunchtime. We followed up a requirement from the last visit about dating ‘short life’ medicines such as eye drops. All those seen in the medication fridge had the date of opening on them and were stored properly. We saw the assistant manager patiently helping people with their medication and respecting peoples wishes e.g. one person didn’t want to take the medicines and left the dining room. Shortly after s/he returned and when offered it again took it willingly. The assistant manager recorded meds after each time of giving and medication administration sheets showed regular signatures. We saw that for ‘as required’ meds such as painkillers, some spaces had a code letter to show that the meds weren’t needed. Others had a staff signature when they’d been given. However, there were also gaps where nothing was written at all. This meant that it wasn’t clear if the meds had been given or not. Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 15 We also found that one person didn’t have their prescribed stock of pain relief tablets as they’d run out. The assistant manager said a new prescription had been asked for but hadn’t arrived. This meant that the person hadn’t been able to have any pain relief for several days. The assistant manager said she didn’t believe the person was in pain but could only guess this from behaviour or the expression on her/his face. We immediately required that the GP surgery or pharmacy be contacted and a new supply arrived by the end of the day. However we remain concerned at the apparent lack of urgency about chasing up medicines that are needed but don’t arrive. This can lead to discomfort, risk and a lowering of the person’s quality of life. We saw that encouraging people to use the toilet wasn’t done discreetly. The whole lounge was loudly informed by staff that it was ‘toilet time’! This is an institutional practice and should be stopped. At the end of the observation one person that was sleeping soundly, sat in a pool of urine, dripping off clothing and on to the floor. No one noticed until we pointed this out to staff. However staff then dealt with the situation properly. We also followed up the requirement made last time about staff not leaving their rubber gloves on when giving personal care to more than one person. At this visit care staff only used gloves when they needed to and only domestic staff doing cleaning kept their gloves on. Overall, people’s privacy and dignity were respected (but see standards 27 –30 below). However we had concerns about the way records were written that showed an institutional culture. Please see standards 31 –38 below for more about this. Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Greater concentration on activities, outings, entertainment and one to one time would benefit people and give them more enjoyment and stimulation. Lack of contact with the nearby community further restricts peoples lives in the home. Choices are limited based on staff availability and whether all areas are accessible to people. Failure to meet peoples needs at mealtimes doesn’t give them an enjoyable experience or meet their needs. EVIDENCE: The lounge we used to observe people was bright, clean and smelled fresh. It had three rummage boxes, none of which were open. However one person had a soft handball in her hand for all of the time frame and really engaged with it e.g. looking at the label, reading it out and squeezing it. On the TV was an old Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 17 black and white film that those who watched seemed to enjoy and it wasn’t too loud. Juice in a jug with glasses was available and people were seen drinking tea mid morning. During this time everyone in the room (except one person who for most of the time was withdrawn and looked uncomfortable and another that slept for most of the time) were positive, engaged with others, with objects around them and with the TV. They looked and listened to what was going on and also looked out of the window. With the exception of the person who looked to be unwell during the visit who showed signs of ill being, peoples engagement with objects, task and with each other was good. Only the person unwell showed fewer signs of a positive state of being. Staff engagement with people was generally good, particularly one assistant manager, one permanent care staff member and one agency care staff member. Kitchen staff were mostly neutral, as was one care staff member who showed a poor standard of care. Please see standards 27 –30 for more about this. However we weren’t aware of any organised or impromptu activities going on. On the second day we saw a group of people following a staff member to do something but we weren’t clear what. The acting manager told us that she was arranging for more outside entertainers to come into the home and posters for these were seen in the entrance hall. From surveys we received the lack of activities or outings was commented on: ‘Staff are very caring but do not appear to have the time to spend much key time or take residents out on a warm summer day’, ‘broaden the skills of staff so more interaction and guidance to occupy peoples time’ and: ‘more social stimulation and days out’. Another relative gave more detailed information about the lack of activities: ‘When visiting last time I was taken to the lounge where my relative was. There didnt appear to be much for people to do. I feel the home isnt a very stimulating environment, certainly there seem to be very few resources, e.g. books or magazines in evidence in the lounge to interest anyone. The TV was on constantly with no-one watching. I noticed the lack of cushions to make people confortable - who probably sit for lengths of time on the utilititarian plastic covered armchairs - it doesnt take much to make an environment more comfortable. I noticed in my relative’s bedroom a 4 year old magazine was the only thing of any interest’. The activity room wasn’t in use and was locked. Some effort had been made to interest people in their surroundings e.g. by the use of mobiles and rummage boxes but often people were left to their own devices rather than staff spending time going through them together and stimulating their interest. Few picture books, magazines or scrapbooks were seen and people were mostly walking or sitting about aimlessly. A staff member that filled in our survey Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 18 commented on ‘what could the service do better?’ by saying: ‘make more time for peoples needs i.e. religion and race. Also I think it would help if we had more one to one time with people’. The acting manager was unsure about any involvement with or from the local community. Only relatives or friends visit and people weren’t seen being taken out for walks or shopping. Since the last inspection a ‘dining room experience working party’ had been set up. This involved management and other staff and discussions had been held about how to make the dining room a better and more welcoming place. An action plan had been drawn up. This included: - Coloured table cloths, - A form to be drawn up regarding peoples likes and dislikes, - Crockery colours e.g. blue for people with diabetes to signify their dietary needs, - Background music, - Chairs or stools for staff to use when helping people to eat, - Pictures on all dining room doors to help people understand the purpose of the room e.g. table and chairs and food etc and: - Staff to observe during meal times. Whilst efforts to improve the dining room experience for people are commended, we saw that the working party had been meeting since January ’08. The April minutes however showed that progress had been slow in some areas e.g. buying of crockery and other items. However we saw that new crockery, cutlery, glasses etc had all been bought and were in place at this visit. The minutes also showed however that most of the actions discussed were more for the staff’s benefit, rather than people living at the home. From our observation the dining room was bright, clean and fresh with comfortable chairs and light music playing. The clock was set at the right time; the menu board had been updated. There were flowers, linen tablecloths, serviettes, fresh cold drinks, condiments and breadsticks on the tables. These were a good distraction for people and occupied them whilst they were waiting for their lunch. The atmosphere in the dining room was busy but calm. People were given time, not rushed and good ways of showing choices were given. Plate guards were being used for those who needed them. On some occasions people called out. Staff responded to them and quickly stopped potentially difficult situations from happening. One person clearly had difficulties eating. Lunch was put in front of her that she didn’t touch at all. She looked at it, tried to reach for knife but didn’t touch it. A member of staff came, stirred the meal, said a few words to her then walked away. Later the meal was taken away without anything being said. Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 19 Soon after another care staff member brought a sandwich, pulled over a chair and sat with the person. She showed empathy and at all times was patient, kind, caring, gentle and supportive in her approach. She spoke in a clear calm voice and tried to encourage the person with an appropriate use of touch. She saw that she was struggling with a glass and got her a beaker, which she managed better with. After all this encouragement the person picked up her sandwich. The staff member was really pleased with this and praised her. However she then got up and walked away! Almost at once the person put the sandwich down and didn’t try to eat it again. A relative commented to us about her/his observations when visiting a person at the home: ‘At mealtime on my very first visit a member of staff seemed to be pressuring a lady to eat. This lady had tilted back her head and tried to turn away from the food and clearly didnt want it, but eventually she had the spoon put in her mouth a few times and ate the food. Also a lady at the same table seemed to be having difficulty eating a plate of spaghetti hoops with a large spoon. She wasnt getting the help she needed and when I mentioned it I was told: ‘shes fine. She really likes spaghetti because she gets it all over her face’. The staff member was obviously making an assumption. It was a while before someone came to clean up her face and her blouse and she did look distressed during the meal’. We saw that nine people had thin, disposable aprons (usually worn by staff when doing care tasks), on at lunchtime. These were tied up around their necks and drawn up under their arms. People looked uncomfortable .The aprons didn’t help them keep their dignity and looked institutional. For one of the people not eating we saw in the monthly care plan update that s/he ‘seems to eat much better when not wearing an apron - to monitor and observe’. It wasn’t clear how this was being done. We recommend getting washable or wipe clean tabards in different colours or patterns for people to choose at lunchtime. This will help their dignity as well as keeping their clothes clean. The cook told us she was well aware of peoples likes and dislikes and talked about the special diabetic diets to be catered for. However, when asked “if it was known that a person was a vegetarian but was eating sausages at lunchtime and staff said they were enjoying them, what would you do?” she wasn’t really able to answer and was unsure. Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Management of complaints adequately helps peoples relatives to raise concerns that are properly dealt with. Improvements in handling of some abuse issues keeps people protected from risk of harm or abuse happening to them. However concerns about possible financial abuse need further action to keep people safe. EVIDENCE: We looked at the complaints records and saw lots of compliment letters. No new complaints had been received since the last visit. Relatives that filled in our survey answered ‘yes’ to the question ‘do you know how to make a complaint about the care provided at the home if you need to?’ We also asked if the care service had responded appropriately if concerns had been raised about a person’s care. Two people said ‘always’ and two people said ‘usually’. One person commented: ‘If I have ever had any concern I have spoken to the officer in charge and things have been sorted out without any delay – couldn’t ask for more really’. We followed up two requirements about making sure people are kept safe from abuse. We’d been told about any meetings held to discuss keeping people safe and had attended where necessary. No new incidents had been reported under Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 21 the Department of Health guidance ‘No Secrets’ (making sure services have proper measures to report and take action against abuse happening). One of the requirements about possible financial abuse wasn’t fully met however (please see standards 31-38 for more about this). We looked at the training plans and records of a number of staff. The registered manager had drawn up sheets to show what training in safeguarding adults from abuse was needed. The plan showed previous, recent and future dates for all except three staff. Staff will be slotted in for these on the next available dates. Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 22 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): 19,21,2, 24 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst progress is being made with unlocking of doors people still don’t have free access to all areas. Several areas including bathrooms and the garden, still need updating so that people live in a comfortable and accessible home. Proper cleaning and hygiene makes sure people are protected from risk of infection as far as possible. EVIDENCE: A requirement made at the last visit about unlocking of doors was partly met. No padlocks were seen in any areas. Bedroom doors were all kept unlocked and it was nice to see individuals sleeping or resting in them. Staff told us that since they’d been unlocked there had been little evidence of people going in and out of other peoples rooms. This may be due partly to the larger picture frames on doors that all have different pictures on to help people recognise Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 23 their own rooms. Each person had a different picture e.g. of an animal, country or beach scene or other things of interest to them. A picture of each person was also included in the frame although it was disappointing to see the photos were of people as they are now – that because of their dementia they may not recognise - and one person had a photo taken when s/he had a facial injury that looked undignified for her/him. Other improvements included: canopies had now been put up in the central courtyard to shade people on sunny days. Following a requirement made at the last visit, room 30 had been decorated. However, room 31 needed to be finished as one wall wasn’t papered. We saw rummage boxes in two lounges although it was disappointing to see that they were ‘tidied away’ – one under a coffee table that people wouldn’t be able to see. The boxes weren’t being used while we were visiting. We saw that lots of brightly coloured hanging mobiles had been put up in lounges for people to look at. One of the lounges now had a small TV that was on and more people were using the room than before. Both the activities room and a room upstairs had been redecorated and refurbished. The activity room is also used for reflexology that’s very popular with people living at the home. Lots of lighting decorations including a water feature that changes colour, a silver glitter ball, coloured lighting and flexible lighting that can be handled, were in place together with a reflexology couch. A comfortable armchair had been also been put in there and the redecoration made it a nice place for people to use. However the room was kept locked. When we asked why staff said it was because there are paints and other substances that could be dangerous if swallowed kept in there. Further, the picture on the door (of toiletries) didn’t reflect the use of the room, neither did the word ‘reflexology‘ that went with the picture. The same situation applied to the upstairs tearoom. This had been done to give people and their visitors a room to make tea or coffee and enjoy having it together. The room had been nicely decorated with a fridge and nice touches including pictures, new crockery and canisters for tea, coffee, sugar and bread. However the room was locked and staff couldn’t really tell us why except that it ‘wasn’t finished’. People and their relatives should clearly be made aware of the room so that they can get pleasure out of using it. Where use of rooms may give rise to any sort of risk, these should be properly assessed to make sure people are kept safe. The board in the entrance area to tell people information about each day had the correct date (although the dining room board had the previous day’s lunch written on it when we first arrived). The board in the dining room had been recovered in white material to make it easier to read. Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 24 There was little evidence to show that specialist advice about the environment had been gained from an organisation expert in dementia care. This had been a requirement from our last visit. We did see that the style and content of communal rooms had been improved, together with the use of individual nameplates and better signs on toilet doors. However the décor in the long corridors makes them look dark and the flooring still throws pools of light that can be mistaken for water. This may have an effect on people (e.g. causing them to fall) if they can’t see things as they actually are. One relative commented: ‘The place itself is not so inviting with an institutional feel to it corridors look like those in a hospital’. Stairwell areas were being redecorated during our visit. However in the kitchen the extractor hood was thick with dirt, dust and grease. This was at risk of falling into pans of food being cooked. The acting manager told us the kitchen was being deep cleaned the week following our visit. All high areas e.g. tops of freezers and hanging utensils were also in need of cleaning. Whilst there are enough toilets and bathrooms for people the ground floor ‘parker’ bath area looked dated and tired. Areas hadn’t been made good where a wall heater had been replaced and the ceiling area had lots of cobwebs and was in need of attention. The flooring seal was also coming away and loose radiator grilles weren’t safe. On the first floor the shower area was the same although the flooring was better. However some wall tiles had come away from under the sink unit. We found the situation was the same in all bathrooms and they were all kept locked. Throughout the home including communal areas, corridors, bathrooms and bedrooms, curtains left a lot to be desired. Many didn’t reach the windowsills, were faded and outdated, didn’t hang properly and the net curtains were very thickly patterned. Curtain colours didn’t match the décor and spoiled the effects of recently re-decorated rooms. It was however, good to see that the dining room blinds had been taken down so that people can see comings and goings in the car park. The acting manager said she had ordered some thin, voile curtains to hang there to give people privacy while eating. We toured the garden (and for a short time locked ourselves out!). This gave us an opportunity to look at the garden closely. The area is large, secure and mostly laid to lawn. However it could be improved for peoples benefit. The garden has bushes and shrubs but few flowers. An area where the barbeque equipment is stored needs to be cleared as there were tools, ant powder and a gas cylinder that must be removed. Garden benches were in a poor state with peeling paint. They were arranged in a straight line facing into the home rather than being arranged in different parts of the garden. A large tree had paving stones leading to it. However the tree roots had uplifted the slabs that were now a risk to people walking there. Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 25 From inside the home, at one end of a corridor close to room 2, a large window looks out onto a sunny corner of the garden. This was overgrown with weeds, bushes and nettles. We recommend it be cleared and re-planted with perhaps a bird-table that would give people something interesting to look out on. If a gardening group is set up there are plenty of areas that they could work in if they choose. We found that the stable door to the office was left open more on occasions and people were able to come and spend time while we were there. However it was clear that old habits die hard for some staff that often made sure the door was kept closed. The home was very clean and hygienic at this visit and smelled fresh. When people had ‘accidents’ they were cleaned up quickly and without fuss. Staff were seen cleaning bedrooms and doors were only locked while the floors were wet. No substances dangerous to health were seen left about. Several staff had done training in the control of substances hazardous to health. Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 26 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, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Improved staffing levels help people get their care needs met. However treating agency staff differently fails to make sure that all staff give consistent care. Adequate recruitment practices make sure people are kept safe by properly checked staff. Whilst training in more person-centred ways of working had happened, failure to put things learned in place negatively affects the well being of people living at the home. Further, staff need to be trained in better ways of helping people to eat. EVIDENCE: Five care staff were on duty in the mornings of both days of our visit. Other care staff went to a training session on person-centred activities for people with dementia. Some of the staff on duty were permanent and some were agency staff. Of the surveys we received back from relatives all answered ‘usually’ to our question ‘do the care staff have the right skills and experience to look after people properly?’ Comments included: ‘The permanent staff have excellent Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 27 skills. I have noticed that on occasions agency staff do not always have such a dedicated approach’ and: ‘mostly, although with some mental health issues I think some staff would benefit from training in these areas’. We spoke to an agency staff member that’s worked regularly at the home for some time. S/he said s/he enjoyed working with people with dementia. However although the agency had given training in all areas including dementia awareness (though not recently), s/he hadn’t been given the opportunity to attend the recent training put on for permanent staff. Further, s/he told us that agency staff can’t attend staff meetings, neither do they have regular supervision. This may be why differences are noted in their approach if they aren’t included in the staff team. We did a separate inspection of the local authority’s personnel department and checked three staff files randomly. These showed that proper checks had been done at recruitment stage including references and Criminal Records Bureau checks. Staff that filled in our surveys commented on training and support: ‘night staff very rarely have a night staff meeting. I feel it should be more often considering the responsibility we have at night’. However day staff commented: ‘there is always support and training if you are unsure. There is always somebody you can ask’ and: ‘with all the training people have been on like activities and dementia, the care and understanding can be much higher’. Management therefore need to make sure training, information sharing and support happens across all staff groups whether permanent or agency or day or night. We followed up a requirement from the last visit about making sure staff had training in dementia, person-centred care and meaningful activities. We saw records of a new, two-day course in supporting people with dementia that some staff said was ‘brilliant’, that they had enjoyed. Many of the care staff had attended both days of the course although a few still had to do it. Dates were seen for these over the next month. Team building sessions had also happened with separate ones for management and care staff. Again almost all care staff had attended and the last session was to be held on 4 June. From the records however it wasn’t clear if domestic staff were included in both the dementia training and the team building. We recommend this happens so that people living at the home get better care from staff that are aware of needs of people with dementia and work together better. Four separate sessions in activities for people with dementia were also being held with the occupational therapist from the In-Reach team and staff were attending these over a period of time. Key time records showed that some of Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 28 the things learned e.g. helping people use the rummage boxes, looking at books and photographs and hand massages were already happening. However, throughout the whole of the time we watched people in both lounge and dining area we had concerns about staff behaviour. One person was observed to be in discomfort and shifted about in her seat. Most of her/his behaviours were passive with either neutral or no interactions from staff. There was also poor contact from one care staff member who ignored her/him. We later watched as the same staff member fed the person. There was poor contact with no talking or eye contact and no encouragement. We saw the same thing happen while s/he helped another person. We noted a marked disinterest in people and the behaviour was the same. Later the person was again in distress, crying and wincing in apparent pain trying to leave the table. S/he struggled several times to get up but couldn’t. During this time the staff member ignored her, was dismissive and told her/him she would have to wait till someone could help. S/he then proceeded to clear tables, doing nothing to assist. The situation only changed when an assistant manager came in, immediately responded, got the person a wheelchair and spoke comfortingly to her/him. We had similar concerns about the staff member’s behaviour with other people who exhibited some distress or showed they needed help. The behaviours we witnessed showed clear issues about lack of ability, empathy, style and approach. We looked at this person’s supervision records and saw there had been issues around working with people and other staff. However there were no clear actions recorded to help the person improve their work performance. We were also concerned to see that the staff member had recently done the two-day training course in supporting people with dementia, before we inspected. This is of concern as none of the behaviour we witnessed showed that the training had had any effect. One relative told us: ‘Again, one has a sense of the staff doing their best. I dont know what level they have been trained to but hope they treat everyone with respect. I have got no way to judge and only get a sense of function is more important than being person-centred. It is little things like she’s not wearing her own slippers although she had three of her own pairs in her room, and she has chipped nail varnish on her fingers (and I know this was painted on before she came here). From all the evidence included in this report it’s clear that staff need more training and support in how to help people eat. We saw examples of staff trying to help people but this didn’t work well for some and didn’t lead to them eating much. One person continually kept putting an empty spoon to her/his mouth but when a staff member came to help stopped eating. Staff need more training in ways of helping people to eat that preserves their dignity, doesn’t Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 29 distract them and continues to give them some independence in feeding themselves. Rockwell DS0000035302.V361810.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): 31,32,35,36,37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Failure to move forward into more person-centred ways of managing the home keeps a negative and institutional culture in place. Failure to safeguard peoples money puts them at risk of financial abuse happening. Failure to keep records properly and regularly puts people at risk and doesn’t make sure they’re protected. Improvements in recording staff supervision makes sure people get opportunities to discuss their work. However failure to deal with poor performance through supervision with clear actions taken, puts people at risk. Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 31 EVIDENCE: The registered manager of Rockwell was on an extended period of unavoidable leave at this visit. An experienced deputy manager from another local authority home, Mrs Sharon Baker, has been assigned as acting manager of the home but had only been in this post for three weeks when we visited. Mrs Baker had worked at Rockwell many years previously as a care assistant and knows the layout, the area and some of the staff. She has National Vocational Qualification in Care, Level 4 in management and is quick to take action on issues that come up at inspection. Mrs Baker was welcoming and open to the inspection process. On the first day of our visit she went to do training in person-centred activities for people with dementia and took care staff with her. She was on duty on the second day however. We had previously had concerns about the management team’s behaviour at the last visit. These were around the locking of doors and staying in the office. This had improved, although there were still issues of people being kept out of the office while some staff were on duty and not all assistant managers spent time working alongside care staff. We remained concerned about the failure to meet all the requirements from the last visit and, despite training, the apparent reluctance to move forward into more person-centred ways of working. We did a check of peoples money. We checked several peoples cash held against their record sheets. All of these were correct except that one person had a few pence over. However of greater concern were records recently put in place for staff to sign when they took cash to buy things such as clothing for people. The record sheet is designed to reduce the risk of errors when staff take the money that belongs to people living at the home. We found several of these that showed large sums of money had been taken out some time previously yet still not returned. The sheet has space for recording the return of any money not spent and has to be signed by a manager. Some of these had no signatures at all and nothing to show money had been returned. Neither were there any receipts. We took records away for further examination and a meeting was later held with the responsible individual for the home (a representative of the local authority that keeps in contact with the Commission and makes sure the home is run to the required standard), and the safeguarding adults co-ordinator to discuss further investigations to be made. The acting manager told us that she had found it difficult to reconcile some of the cash sheets when she took over management of the home and cash sheets that were archived couldn’t be checked easily as there was no clear system to Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 32 track them back. Whilst there was no clear evidence of financial abuse, sloppy record-keeping doesn’t make sure people are protected from risk of financial abuse happening. Further, we also saw that not everyone was getting their weekly personal allowances paid regularly by relatives. This had been an issue previously and we discussed it again with the responsible individual. Following this inspection and after the discussions held above, the responsible individual put in place a stronger system to safeguard peoples money for all homes to use. However, the system was not fully in place at the time this report was finalised. Therefore the requirement will remain and be followed up at our next visit. We had other concerns at this visit about recordkeeping and management of records. Examples were as follows: Accident reports were brief and didn’t record what action had been taken to stop (where possible) further or similar accidents happening. We had been sent some notices required under regulation about incidents affecting people living at the home. However, we were told that several people had died. When we checked we hadn’t been notified of all of these and had no cause of death for any of them. The assistant managers on duty said they didn’t know they had to tell us about cause of death although some people had died suddenly or after falls. One person’s death is subject to a Coroner’s report and possible inquest following an incident at the home. Therefore it’s important that staff find out what causes people to die. The home’s message book showed chaotic ways of managing with lots of questions, confusion and changes. Further, negative recording was seen that was both disrespectful and institutional e.g. a question about moving one person who was ‘no problem’ at night and asking for another person to be moved who ‘is a problem at night’. We suggest that at times some staff may use records to express their feelings, including use of an institutional approach, rather than a person-centred one (i.e. making the person the problem rather than the situation staff have to deal with in caring for the person). Therefore the content isn’t always respectful and doesn’t take into account peoples dementia, physical impairments and age. Further, the record suggested people are moved to suit staff. In fact people sign a contract for a certain room so shouldn’t be moved without consultation. The person we case-tracked who was unwell had a sheet of daily records missing from 2–10 May. The records showed staff were concerned about her/his health and referred to pain and discomfort in one limb. However the missing sheet that could have thrown some light on this couldn’t be found. We followed up a requirement from the last visit about making sure night staff attend fire drills. On looking at the records we couldn’t find any evidence of this. The team manager later explained that night staff do regular training and Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 33 ‘walk-throughs’ that mimic a fire emergency. This tests out their knowledge and responses to a potential fire. We were given copies of these and were told that records would be made clearer to show this had happened. However the records we were given weren’t dated so could have been done at any time. We followed up a requirement about making sure staff have regular supervision. We looked at a number of staff records. Nearly all of these showed that supervisions were being held more often in accordance with the Council’s own policy. Records although brief, showed training, fire safety and infection control had been discussed although there was less evidence about issues affecting people that live in the home. Further there was no clear evidence of how performance issues were being managed (Please see Standards 27 –30 above). A meeting to discuss the issues highlighted from our visit was held on 3rd June with the responsible individual (the manager of all the local authority care homes that’s registered with us and responsible for making sure homes follow the National Minimum Standards) and the team manager responsible for overseeing Rockwell. Both were told of our concerns and what action would be taken if things don’t improve for people living at the home. The responsible individual gave information about actions being put in place that would start to improve matters quickly. Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 34 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 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X 1 1 X 3 X 3 STAFFING Standard No Score 27 1 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 1 1 1 2 Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 35 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. OP1 Regulation 5(1)(d) Requirement A copy of the most recent inspection report should be displayed for anyone to look at or made available to the person if they wish it. This will make sure people are made aware of the overall quality of the home and the results of our inspections, so that they can make informed decisions about care for relatives. Care plan monthly reviews must show that peoples needs have been fully looked at and assessed and that changes to plans are made. This will make sure the plans give clear guidance and direction for staff including specialist needs e.g. nutrition. Each care plan must be properly reviewed at least once a year involving the person and/or their relative. The results of such reviews must be properly written up. This will make sure that DS0000035302.V361810.R01.S.doc Timescale for action 30/06/08 2. OP7 14(2)(b) 30/06/08 3. OP7 15(1)(2)(b(c) 31/07/08 Rockwell Version 5.2 Page 36 4. OP8 12(1)(a) people living with dementia are able to lead fulfilling lives and changes or other issues are picked up quickly. 1.People with dementia that 30/06/08 are frail, unwell or at risk of losing weight must be properly helped to eat 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. (Timescale not met from November ’07 inspection) 5. OP8 13(4)(c) November ’07 inspection) 2.Further, new weighing scales must be regularly checked to make sure they’re accurate and correct weights are recorded. This will make sure that potential weight issues are picked up quickly. 30/06/08 From 30/11/07 care plans 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. (Timescale not met from 30/06/08 6. OP8 13(4)(c) Accident reports must record what actions have been taken to reduce the likelihood of the same thing happening again. Monthly care plan reviews must be updated following an accident that results in injury. This will make sure that people are kept safe from harm. Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 37 7. OP9 13(2) 8. OP10 12(1)(4)(a) 9. OP19 23(1)(a),(2)(a) Repeat medication must be got in time for people to have an unbroken supply. This will make sure people are kept free of pain and as healthy as possible. All staff must behave in a manner that respects each person and promotes their dignity. This includes in the writing of any document or record. This will make sure that people are treated as valuable individuals in their own right and not as objects. (Timescale not met from November ’07 inspection) 1.Specialist advice from an organisation expert in dementia care and registered to give such advice, must be sought on: -Use and positioning of lighting in all bedrooms and corridors; -Flooring that meets the needs of people living with dementia. (Requirement and timescale partly met from the November ’07 inspection) 30/06/08 30/06/08 31/07/08 2. Curtains that are old, faded, ill-fitting or heavily patterned must be replaced with those that are suitable for people with dementia. 3.All radiators, particularly those in bathrooms must be repaired and made safe. 4. Uprooted concrete paving slabs in the garden must be removed and the area levelled. This will all make sure that Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 38 10. OP21 23(2)(d) 11. OP22 23(1)(a) 12. OP30 18(1)(c)(i) people have a safe, enjoyable and comfortable environment so that they will be able to keep their independence for as long as possible. All bathrooms must be 01/09/08 repaired and redecorated so that they are a pleasant space for people to enjoy baths in. Communal rooms that people 30/06/08 and/or their relatives can use must be kept unlocked following removal of any substances harmful to health and a clear risk assessment put in place. This will mean that people are able to use the home freely and their human rights respected. 1.Agency staff that have 30/06/08 worked at the home for months or years must have the same dementia training as permanent staff, have regular supervision and be able to attend staff meetings. This will make sure people get a consistent service from staff that are properly trained and supported. 2. All care staff must be given training in how to help people with dementia to eat from a person-centred perspective. This will give people a more enjoyable mealtime experience and help them keep well. A safe and secure system of 30/06/08 making sure peoples cash is handled properly must be put in place that staff adhere to, to protect people from DS0000035302.V361810.R01.S.doc Version 5.2 Page 39 13. OP35 12(4)(a) Rockwell financial abuse. This will make sure people living with dementia will be protected from risk of abuse happening. People with dementia must not be charged in advance for any service such as reflexology or chiropody is provided for them. This will make sure their financial independence is recognised and kept up. Where there are serious concerns about a staff member’s conduct or poor performance, clear and swift action must be taken by e.g. close supervision and/or further training. This will make sure that people with dementia will be kept safe and treated with dignity and respect. All care records including daily reports must be kept in good order and filed properly. This will make sure events and issues affecting people can be properly tracked to show they’re kept safe. Any incident that adversely affects people living at the home must be reported without delay. This includes deaths and cause of death. This will make sure that events can be checked so that people are kept safe. Night staff attendance at fire training, including ‘walk through’ practice drills and actual fire drills must be regularly recorded properly and regularly. This will make sure people DS0000035302.V361810.R01.S.doc 14. OP36 18(2)(a) 30/06/08 15 OP37 17(3)(a), (b) 30/06/08 16. OP38 37(1)(e) 30/06/08 17. OP38 23(4)(e) 30/06/08 Rockwell Version 5.2 Page 40 living at the home will be kept safe at night. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The service users guide and other information needed (e.g. the complaints leaflet) should be put into a format suitable for people with dementia to understand. This will make sure people have the information they need about the home, given to them in a way that they can more easily understand. When people don’t need their ‘as required’ medication this should be properly recorded on the medication administration sheet. This will show that people have or haven’t taken their medication and whether they still need it. Photographs of people on their bedroom doors should be chosen carefully to maintain their dignity and help them recognise themselves better. This will make sure people are able to access their rooms more independently. A new or extended range of activities should be put in place so that people have more stimulating and enjoyable ways of passing the time. Individual patterned aprons or tabards that can be wiped over and washed should be bought for people to choose and wear at mealtimes. This will make sure their dignity is maintained and reduce the institutional feel of mealtimes. 1.One corner of the garden that’s close to room 2 should be cleared and space made that’s pleasant for people to look at e.g. having a bird-table. 2. All garden areas should be made more interesting and accessible to people with dementia by better use of plants, flowers and seating. 3. The upstairs corridor would benefit from more pictures displayed for people to look at. This will give people a more enjoyable, interesting and homely space in which to live. DS0000035302.V361810.R01.S.doc Version 5.2 Page 41 2. OP9 3. OP10 4. 5. OP12 OP15 6. OP19 Rockwell Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 42 Commission for Social Care Inspection South West 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 © 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 Rockwell DS0000035302.V361810.R01.S.doc Version 5.2 Page 43 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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