Inspection on 15/03/07 for Rookwood Nursing Home

This inspection was carried out on 15th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rookwood Nursing Home 27/01/09

Rookwood Nursing Home 28/01/08

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

CARE HOME ADULTS 18-65 Rookwood Nursing Home 4 Victor Road Bradford West Yorkshire BD9 4QL Lead Inspector Pamela Cunningham Unannounced Inspection 15th March 2007 11:30 Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 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 Rookwood Nursing Home DS0000068154.V327337.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 Adults 18-65. 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. Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rookwood Nursing Home Address 4 Victor Road Bradford West Yorkshire BD9 4QL 01274 547597 01274 549215 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) European Care Lifestyles (B) Ltd Mrs Karen Elaine Overend Care Home 20 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (20), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (4) Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection New Service Brief Description of the Service: Rookwood Care Home is registered to provide nursing care to 20 service users who suffer from enduring mental health problems. Qualified psychiatric nurses, nurses with general nursing qualifications, and trained care staff provide twenty-four hour care. It is owned and managed by European Care Lifestyles (B) Limited and is situated in the Manningham area of Bradford, close to Lister Park. Bus connections lead to Bradford, Bingley, Keighley, and Skipton. The property is a mid to late 19th century residence, and is located on a quiet road. The home has no passenger lift. A stair lift provides access to the first floor of the home. However due to the layout of the home, some areas are not accessible to service users who have mobility problems. The bedroom accommodation is on three levels in the home. This consists of twelve single rooms and four double rooms. Communal space includes a dining room, a large lounge, and a conservatory. At the time of writing this report the cost of staying at the home varied from £502 to £650 per week. Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One visit was made to the home on 14th March 2007. This was the first inspection since the present owners acquired it. The home did not know that this was going to happen. Feedback was given to the manager during and at the end of the visit. The purpose of the visit was to make sure the home was being managed for the benefit and well being of the residents. Before visiting the home the inspector asked for information from the manager (the pre inspection questionnaire – PIQ) which asks about what policies and procedures are in place and when they were last reviewed, when maintenance and safety checks were carried out and by whom, menus used, staff details and training provided. 20-service user and 20 relative comment cards were sent to the home to be given to residents, their relatives and other visitors to find out what their views of the home were. The views of doctors and district nurses who visit the home were also asked for. At the time of writing this report ten resident responses had been returned, and their comments were very positive. Many of the respondents said they thought the home was always clean and fresh, that they were given enough information about the home before they decided to move in, and that they could do what they wanted to do. They said the staff treated them well, and that they knew who to speak to if they were not happy. In order to find out how well staff knew residents, care plans were looked at during the visit and residents and staff were spoken to. Other records in the home were looked at such as staff files, training records and complaints received. What the service does well: The home is well managed by a manager who has experience in acute mental health care settings as well as care home settings. Staff spend time with the residents doing things they enjoy. Where it is suitable, this is done on a one to one basis. Staff were seen to be doing this at the time of the inspection. The home continues to receive excellent support from the local healthcare team and outreach services and there is no problem with asking them to visit the home. Some of the residents attend some type Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 6 of day care, and many of them are encouraged to take an active part in the community within a risk management framework. Care staff are working on NVQ level 2 or 3, and qualified staff are able to keep up with PREP. (Registration requirements) All the staff attend any mandatory training courses and there was evidence in the PIQ to prove this had taken place. Training in end of life situations is provided for the care staff during NVQ training. This means that residents who become acutely ill, or are at the end of their lives are treated, as they would wish, by educated staff. What has improved since the last inspection? What they could do better: The home in general would benefit from a complete upgrade, as many areas are very shabby. Care plans could be improved by identified problems in the pre admission assessment of needs being carried over to the care planning process so that all care needs are identified, and with action plans on how the care is to be given. Risk assessment should be carried out on those residents who do not smoke, but share a room with ones that do. This is to ensure the safety of both residents. The medication system although relatively safe could be improved by potential errors being minimised if amounts of medications received into the home are accounted for on the MAR charts. Infection control procedures could be more robust; this is with particular regard to replacing worn baths, and by the use of red dispersible bags in the laundry. The laundry area would also benefit from hand washing facilities being provided. Health and Safety is compromised. Many rooms in the home do not have radiator guards fitted. These should either be fitted in those rooms identified, Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 7 or the rooms provided with cool surface radiators. The hot water system is overdue for testing for the presence/absence of Legionella, and the emergency call system should be serviced annually to make sure it operates efficiently. Policies and procedures, some of which are years out of date should be reviewed in light of changing legislation and made available to staff, and also to the residents in a style they can understand. 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. Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their relatives have enough information about the home to decide if it will meet their needs, however this is not easily available to them as it is currently being updated. EVIDENCE: The service user guide and the Statement of Purpose have recently been reviewed by the manager and forwarded to the Director of Mental Health Services for the group for her comments. The CSCI (Commission For Social Care Inspection) have not as yet received a copy. The draft copy of these documents were made available to me at the time of the visit. Both documents contain enough information so that prospective residents and their families can make up their mind whether or not to come to olive at the home. However a copy of the most recent inspection report is missing from the service user guide. Residents said that they received enough information about the home when they came to look round and they were offered a trial visit. One resident had an overnight stay. Residents also said that contracts were in place setting out the terms and conditions of living at the home and the services that would be provided, including anything to be paid for by them that is not covered by the fees. Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 10 Information gained from the comment cards sent to the home before the visit were very positive, and gave information that the residents could do what they wanted to do. They said the staff treated them well, and that they knew who to speak to if they were not happy. Some of the residents were admitted from Lynfield Mount, which is an NHS mental health assessment facility, and they said they much preferred living at Rookwood, because they could go out when they wanted as long as they told the staff when they were going out and where they were going. One resident goes out to a day centre. The manager said all prospective residents had a pre admission assessment done prior to coming to live at the home, and no resident is admitted to the home unless she is sure they can meet their needs, however there was only evidence to support this in two sets of care documentation reviewed. However missing assessment documentation in certain care plans was due to the fact that those residents had lived at the home for over 15yrs. Samples of contracts of residency were seen some having been signed by the resident. Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is able to meet the health and personal care needs of service users. Residents care needs are met but this is not fully evidenced in the care plans. EVIDENCE: I looked at four residents care documentation. One was of a resident who had been stayed for an overnight stay, and the remaining three were of residents who have lived at the home since 1990 and 1993. Documentation for the resident who had stayed for an overnight stay, and was being admitted under the Care Programme Approach, (which is a multi disciplinary assessment by key personnel involved in the care) included an in depth multidisciplinary assessment of needs sufficient information which had been developed by the multi agency team, and gave sufficient information to direct staff how to deal with any problems that might occur during the time the resident was at the home. Care documentation on the whole was adequate, however some care documentation reviewed identified the following omissions. Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 12 Although permission had been given by the resident to take his photograph for ease of identification, there was no photograph present in the documentation. There was no evidence to support a pre admission assessment had been done in two of the sets of documentation reviewed. Certain residents who smoke share a room with another resident. Although a risk assessment had been done for the residents who smoked, there was no risk assessment present for the non-smoking resident whom they share the room with. There were occasions when it was not documented when other health care professionals visited, for example, the nurse practitioner, and in one case an acute medical problem had not been carried forward to the care planning. There was however evidence that the residents health care needs were being met in terms of optical, chiropody and dental care. However, although the manager said it was becoming increasingly more difficult to find an NHA dentist, all residents are registered with a dentist, either privately or through the PCT. Certain residents have also had a recent medication review, this is good practice. Each resident also has a programme that identifies any planned activities, this is called the residents weekly planner and is planned with the involvement of the residents. A key worker system has been introduced. The manager is also looking at increasing the resident and staff involvement in the care planning process. The home keeps a daily record of care given, however, on occasions; subjective comments were seen in the daily record. The manager said she had already identified the problem and was taking steps to deal with it. Many of the residents are capable of going out of the home unsupervised. This is managed through a risk assessment process. Decision making opportunities are encouraged. Although some residents I spoke to said they liked how they lived their lives, some of them, throughout their lives have been restricted, in making decisions and having choices. Therefore it could be a very gradual process for many of the residents to feel comfortable in being helped to develop some skills. Certain residents spoken to also said they felt they could speak to certain members of staff (these being the designated support worker or named nurse) and that their confidences would be kept. Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to be part of the decision making process and make choices about their lifestyle. Their social needs are met. EVIDENCE: I spoke to a number of residents during the inspection. On the whole they were pleased with how they live their lives at the home. They said they could have visitors at any reasonable time, and could go out of the home unescorted to the local shops, or into Bradford, as long as they told the staff where they were going. Before the inspection a sample of the menus and food provided was included in the pre Inspection Questionnaire information. The menus were for two weeks, and although the residents I spoke to were complimentary about the food the cook prepares, the menus themselves gave very little information regarding nutritional value. There was no information on the menus to identify what the residents were provided with at either breakfast Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 14 or lunch. The menus just stated either “as selected” or “as requested” with the exception of Sunday when a full cooked breakfast is provided. Fresh fruit or fresh fruit juice is provided, and as many of these residents smoke, an essential component of their daily vitamin intake should be fresh fruit, which contains vitamin C. The cook said the menus were currently under review. She also told me that she does not have an NVQ in catering, but has one in social care, and that the home is moving towards a healthier menu. They are also trying to make a move from the staff preparing suppers, to the residents being more involved in food preparation now that the new skills kitchen for the residents has been fitted. If this happens, then resident should have some instruction on food hygiene. The kitchens were clean, tidy and well organised. Records of cleaning schedules, food delivery and serving temperatures and fridge temperatures are kept. Although there is no activity organiser, there are two support workers that act as activity co-ordinators. Residents told me they had quite an active life. Information in the PIQ said the residents had in house activities such as painting, bingo and dominoes. Some of the residents are also interested in writing poetry, lyrics and short stories, and this was confirmed on speaking to them. Other activities that the residents join in are bowling, going to Heaton House and Walker House which are day centres, being involved in Springfield and the Cellar project, and with FLIP (Friends from Lister Park) Some of the residents also attend the local cathedral centre for computer courses. The manager said that 90 of the residents would have a week’s annual holiday in Scarborough where they went in 2006 and stayed at the Bond Hotel. Certain residents also attend the Piccadilly centre, which is a support centre for people with alcohol problems. The manager said routines of the home are discussed at staff and residents meetings so that the residents can feel more involved in the day to day running of the home. She also said that they would become more involved in the laundering and ironing of their own clothing when the new laundry facility is operational. This is to encourage the residents to take responsibility for their own home. The manager also told me she is introducing an activity evaluation form to make it possible for residents to have value, self worth and empowerment Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is able to meet the health and personal care needs of residents. However some medication practices create the opportunity for error. EVIDENCE: Interaction between staff and residents was observed during the inspection. Residents were obviously very comfortable in approaching staff and the manager, who clearly demonstrated her skills when confronted by certain residents who appeared to be quite agitated. Care is provided in the privacy of the residents’ bedrooms or bathrooms when required. Currently there are fifteen residents’ who need help with washing and bathing. Residents’ said bath times are not routine, and that they could have a bath when they wanted. Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 16 Systems are in place to monitor health care needs, and the home works closely with consultant psychiatrists and out reach services to make sure residents’ mental health needs are met. A chiropodist visits the home every four months. At the time of writing the report there was one resident capable of administering her own medication and has been doing so for many years. The home has a self-medication policy. The medication system in use is a monitored dosage system. Each resident receives their medication from individually heat sealed blister packs prepared by the dispensing chemist. Sample signatures of all the qualified nursing staff were seen, as the medication administration record (MAR) sheet does not have sufficient space for full signatures to be written following the giving of medication. During the review of the medication system, certain irregularities were seen. There was no quantity of medications documented for one resident who was having a trial visit, and amounts of medications received were not identified on other MAR charts. Otherwise the system is safe. Although there is also no hand washing facility provided, the manager said there is a sink that is ready for plumbing in. This should be attended to as quickly as possible, as currently there is a potential for infection control procedures to be breached. Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected and said they feel safe living in the home however not all residents are aware of the complaints procedure and how to use it. EVIDENCE: Although there is one Adult Protection issue unresolved which was identified after the current owners took responsibility for the home in October 2006 there has been no other concerns or complaints. This matter has since been resolved satisfactorily. The complaint procedure is in place, is displayed in the foyer of the home, and is clear and easy to follow. The company policy on complaints contains the timescales for the completion of the process. The manager told me she would keep a complaints log, however at the time of the inspection the home had not received any complaints, either in-house or via the Commission. Certain residents’ said they would talk to the manager and staff if they were unhappy or not satisfied, however comments identified from the residents comment cards identified some residents’ were not aware of the complaint procedure, and confirmed this when I spoke to them Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 18 Certain staff told me they have completed some adult protection training and covered it as part of their NVQ. Adult protection procedures were available at the home and the home has the Local Authority document “No Secrets”. Information in the PIQ said “Vulnerable Adults” Training had taken place in February, June and October 2006, and that POVA (Protection of Vulnerable Adults) training is due to be arranged in this current year. Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home requires investment in decorations, bedding and furnishing in order to meet the needs of the service users, and to meet minimum standards. Service users have the specialist equipment they need for bathing. EVIDENCE: A tour of the home identified it would benefit from redecorating, providing with new furniture bedding and carpets. The upstairs bathroom is desperately in need of refurbishment. In refurbishing this facility, thought must be given to making sure the floor is covered in a non-slip covering. All bedrooms were visited with the exception of those that had been locked by the resident as they were out of the home. Not all rooms are provided with radiator guards. Rooms that do not have the benefit of radiator guards for the Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 20 safety of the residents must either be provided with guards, or cool touch surface radiators to prevent possible injury from heat. All residents have lockable space in their rooms in which to keep items of value to them. Certain rooms seen need new floor covering as the carpets were either very badly soiled or burned from cigarettes. A hot water bottle was seen in one room. This is acceptable providing the resident has had a risk assessment done to see if he/she is capable of filling the bottle with water not exceeding 43ο Celsius. Some of the rooms seen were quite sparse with very little evidence of personal belongings compared to certain rooms which the occupants had taken pride in making them as personalised as possible, however this is totally resident choice. Two of the rooms seen had duvets that were very thin, and therefore not suitable in very cold weather. The bathroom on the middle floor needs completely refurbishing and providing with a new bath as the one currently provided is badly marked with cigarette burns. The bedroom adjacent to the bathroom has a very unpleasant odour, the cause of which must be identified, and the smell eradicated. The resident occupying room 2 on this floor has personalised her room, and it looks very nice. The occupant of room seven had a lot of electrical equipment plugged into one small extension cable. Care must be taken regarding this that the system is not overloaded, cause a short circuit, overheat and maybe cause a fire in the room. In addition to the floor being marked from cigarette burns in room 3, there are cigarette burns on the wall; there is also a problem with odour control in this room. The main kitchen is fitted with a range of stainless steel kitchen units and was clean and well organised. The manager said it is due for refurbishment, and said the floor would be replaced when this happens. The cook showed me all the records she keeps and these were satisfactory. Food was stored correctly in the fridges and freezers, and there was a good stock of food in the dry food stores Colour coded chopping boards are in use, but not all kitchen knives are colour coded. This could lead to the wrong knife being used therefore creating the opportunity for cross contamination to occur. The residents’ kitchen was very clean and tidy. The manager said that six or seven residents use the kitchen and are encouraged to keep it clean. There is a safety cut off switch in the clinic room. This is designed so that the cooker can be switched off in an emergency without staff having to enter the kitchen. This is good practice. The dining room, which is large and airy, is in the process of being redecorated. It has been provided with new curtains and non-slip floor. Two new rooms have been developed in the basement. These are to be used as a laundry and ironing room so that residents can use them independently Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 21 and attend to their own laundry. There are however problems with water seeping up from the floor when it rains. The manager said this was due to the “water table”, that she had contacted drains direct who were due to visit the home imminently to assess and possibly solve the problem. The ventilation in the laundry area is also not very good, and there is no way out for the staff if there is a fire in the home in the region of the top of the stairs leading down to the basement. The manager has contacted the West Yorkshire Fire and Rescue service and sought their advice regarding this. There is also no hand washing facility in this area and no dispensed soap and paper towels. Red dispersible bags are also not being used for the treatment of soiled laundry. Tins of paint were also seen stored in the staff WC. This is unsafe practice and these should be stored outside the home in suitable locked storage. Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff demonstrated awareness of the individual needs of clients and are trained and competent to do their jobs EVIDENCE: There is a good skill mix of staff employed including a nurse with a general nursing qualification. Numbers of staff on duty during the inspection appeared adequate to meet the needs of the residents’. Residents I spoke to knew who the manager was and said they aware of the chain of command. They said they knew who to ask certain questions of, as the carers didn’t always have the answers Two carers I spoke to during the course of the visit told me they had attended all the mandatory training such as fire safety and manual handling, and one of them said she was expecting to do some extra training to be a fire marshal. She also said she has a National BTEC Diploma in care, that she is key worker for three residents and has received training in how to handle violence and aggression. Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 23 One of the carers told me she had attended a course on the Protection of Vulnerable Adults, and that it was a “fantastic course”. She has the NVQ level 2 and is going to do Level 3. It was confirmed by the care staff that formal supervision is taking place, and that this is documented. Both staff said they had received induction training, during which time they were supernumerary. Information in the PIQ said staff had also had training in common induction standards, and that planned training for the future includes Violence and aggression in April, May and June 2007. Male catheterisation in June 2007. NVQ training with learn direct, and information about the companies human resource procedures in March 2007. Recruitment documentation was reviewed. Two sets were complete with all required checks having been done, but others did not contain proof of identity, such as birth certificate. However as this information would have been required for the enhanced CRB requirements, the recruitment procedure at the home is safe. Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42 and 43. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has the skills and knowledge to provide effective leadership. Staff appear to be well motivated. EVIDENCE: The home is well run by a manager who has experience in the acute sector as well as in caring for people in care homes, and staff spoken to said they were well supported by her. She has already identified there were problems with the care recording system in the home, and has taken the task on board of improving it. Residents spoken to said they had noticed a change in the atmosphere of the home since the current manager has been in post, that it had been more organised. They said the manager was very nice and they could approach her Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 25 with any problems. They said they now had residents meetings and that they were confident their suggestions would be taken on board. Policies and procedures were chosen for review. Information in the PIQ identified many of these were out of date, some not having been reviewed since 1993 and 1999, these being the policy on manual handling and the policy on communicable diseases and infection control. These obviously are not in accordance with relevant legislation. There also appears to be no policy on the following subjects: Continence promotion, emergency and crisis, First Aid, physical intervention and restraint, record keeping, Recruitment and Employment including redundancy and Risk assessment and management. The information in the PIQ also said there was no annual development plan for quality assurance. Other policies had been reviewed last in 2000, 2001, 2002, 2003, 2005 and 2006. Considering these are and should be available to both staff and residents it is possible the information contained is out of date and not in accordance with current legislation. Information in the PIQ said there are two residents who keep their own benefit books, and one who handles their own affairs. The home handles the remainder. All residents who do not handle their own affairs have building society accounts in their name. All residents receive their full personal allowance to spend as they wish. Records were seen and were satisfactory, with receipts seen for good bought on their behalf. There are also two residents subject to power of attorney, and two who are subject to Guardianship. Safety checks in the home had been done regarding Gas Safety and five year hard wiring. The patient handling hoist was last checked I September 06, the risk assessments are in place for substances controlled by the COSHH (Control of Substances Hazardous to Health) having been supplied by the supplier, and soiled and clinical waste is collected under contract to a registered company. Safety checks not done are a check on the emergency call system, and the testing of the cold water system for the presence of/absence of Legionella, which was last tested on 20th October 2005. The home has however has had an asbestos survey done, and where samples were strongly presumed; safety notices were issued, and appropriate action taken. (this is good practice) The annual accounts for the home were not seen on this occasion but would have to have been provided during the registration process. Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 3 27 2 28 3 29 3 30 1 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 3 3 3 2 1 1 1 2 Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? First inspection since registration STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement The registered provider must ensure that problems identified in the pre admission assessment of needs are carried forward to the care plans. The registered provider must ensure all risk assessments are more specific, and contain action points how the risks can be minimised for those residents who are non-smokers and share a room with a resident who smokes. Risk assessments should also be done for those residents who use hot water bottles. The registered provider must ensure the menus are complete with what is provided at all meals, including a suitable hot alternative for the main meal of the day. A record of food provided must also be available for inspection. The registered provider must ensure that all physical and medical needs are documented in the care plans. DS0000068154.V327337.R01.S.doc Timescale for action 01/07/07 2. YA9 13(4) (b) 01/07/07 3. YA17 16(2)(i) 17 01/06/07 4. YA19 15 01/06/07 Rookwood Nursing Home Version 5.2 Page 28 5. YA20 13 The registered provider must ensure the medicine control system in use in the home is safe, and is in line with the Royal Pharmaceutical Guidelines, and the revised April 2002 NMC advisory document “Guidelines for the administration of medicines. This is with particular regard to the non recording of amounts of medicines brought in to the home. The registered person must ensure the care home is reasonably furnished and decorated, A programme that identifies decoration and refurbishment should be sent to the commission. The registered person must ensure residents have, bedding that is of a reasonable quality. This specifically relates to the thin duvets on certain residents beds. The registered provider must ensure the bath identified within the main body of the report is replaced. 01/06/07 6. YA24 23 01/07/07 7. YA26 16 01/10/07 8. YA27 16 01/07/07 9. YA30 16, 13(3) and 23(2)(k) and 23(5) The registered person must 01/06/07 ensure adequate infection control procedures are in place in the laundry and consult with the Infection control nurse attached to the Communicable Disease Control Consultant on the need to provide a sluicer disinfector. The registered provider must ensure that all policies and procedures are reviewed and up to date in line with current legislation. 01/10/07 10. YA40 YA41 17 Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 29 11. YA42 12 The registered provider must ensure that all safety checks are routinely carried out in the home, and records kept. This relates specifically to the testing of the cold water system for Legionella, and the emergency call system. 01/07/07 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 YA30 Good Practice Recommendations Provide colour-coded knives in the main kitchen. Rookwood Nursing Home DS0000068154.V327337.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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. 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