CARE HOMES FOR OLDER PEOPLE
Rosalyn House King Street Houghton Regis Dunstable Bedfordshire LU5 5TT Lead Inspector
Katrina Derbyshire Unannounced Inspection 15th June 2006 09:30 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 Rosalyn House DS0000017690.V300633.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. Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Rosalyn House Address King Street Houghton Regis Dunstable Bedfordshire LU5 5TT 01582 896600 01582 896601 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) SAH Nursing Homes Limited Vacant Care Home 46 Category(ies) of Dementia (16), Dementia - over 65 years of age registration, with number (46), Learning disability over 65 years of age of places (46), Mental Disorder, excluding learning disability or dementia - over 65 years of age (46), Physical disability over 65 years of age (46) Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Mental nursing care for Elderly people (over 65 years) Up to 16 Adults (40-64 years) Date of last inspection 18th October 2006 Brief Description of the Service: Rosalyn House is a purpose built Care Home (with nursing) specialising in caring for both younger and older adults with mental health care needs. The home is in Houghton Regis very close to the town centre and in walking distance of local amenities and public transport routes. The home can accommodate up to 46 individuals in single rooms with en-suite facilities arranged over three floors. There is passenger lift access to all areas of the home. The home has a secure courtyard area at the rear and a designated parking area. The fees for this home vary from £786.38 per week, to £2000.00 per week, depending on the needs of the resident and funding source. If a higher staff ratio is required due to the assessed needs of the resident, fee levels will be above this figure based on the additional staffing costs. Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The purpose of this visit was to undertake a key inspection. This unannounced visit was carried out on 15th June 2006. The Deputy Manager Chipo Chiwanga was present throughout the inspection. During the inspection all areas of the home were visited and the inspector spent time with many of the residents’ in the sitting areas of the home. The care of four residents’ were examined by looking at their records and interviewing the residents’ and staff who look after them. The views of residents, relatives and visiting professionals were also received and their feedback has been used alongside information from the home through a pre inspection questionnaire to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit and information received by the Commission for Social Care Inspection since the homes last inspection. Observations of care practice and communication between the residents’ and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well:
This home has a very safe system for managing small amounts of monies for residents if they need help in this area. The home keeps very good records of the amount held for each resident and receipts for any spending that takes place. This means residents know that their money is safe and they can easily check their own personal balances. They are also good at managing health and safety. All staff working at the home are trained in areas such as fire safety and food hygiene. Contractors are employed to make sure all the equipment in the home is serviced and safe to use, and the home has a good system for assessing any risks for the residents that live there and putting in measures to reduce these risks. Many of the residents think that the food at the home is very good. Several residents spoke of the ‘good standard’ of food and said that there was plenty of choice. One resident said “ l enjoy my dinner the most its always very nice especially the pudding”. Menus are available so residents select what they would like and special diets are also catered for at this home. Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The standard of assessment of residents prior to their admission is good and ensures the home has sufficient information to make an informed decision on whether they are able to meet the needs of residents and provide the care and support that they require. EVIDENCE: Within the care records of residents evidence of pre admission/admission assessments was seen and gave sufficient information to describe the needs of the resident. The pro-forma in use detailed personal care, physical well-being, sight, hearing, communication, mental state, cognition, social interests and cultural needs. Residents referred through Care Management arrangements have copies of the health and social services assessment on their individual files. Intermediate care is not offered at the home.
Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 9 Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Care planning is not sufficient to ensure staff have all the required information and guidance to ensure residents receive continuity of care. EVIDENCE: The care records seen showed documentary evidence of the involvement of residents in planning their care. The majority of care plans were sufficient in detail and made clear the level of support to be provided by staff to meet the residents assessed needs. However further improvements are still required as the only guidance to staff for one resident who would become agitated was ‘to be calmed down’ another resident had a behaviour monitoring chart in place and the last entry made within this was on 01/06/06, although the daily notes showed that there had been an incident on 15/06/06. Staff through discussions demonstrated that they were aware of the care to be provided to residents, which reflected the entries contained within the care plans. Records showed that residents had access to medical services if required, appropriate aids were available and advice is sought from Healthcare specialists in the care of residents.
Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 11 There was evidence of nutritional screening prior to or after admission on each file, if a resident need a diabetic/specialist diet this is provided. However one resident assessed as being at risk of weight loss had only been weighed three times since January 2006 another resident diagnosed with a thyroid problem had no plan in place to guide or direct staff in the support that they should provide to help this resident. The incidences of pressure sores and their treatment were appropriately maintained and documentary evidence of this was seen. All residents are registered with a General Practitioner and access to dental, chiropody and community health services had been accessed on behalf of the residents by the home. The receipt, recording, current storage and handling of medication are appropriately carried out, and the home utilise a sealed dispensing system for the administration of medication. Controlled Drugs are administered by two appropriately trained staff and recorded in a Controlled Drugs Register. Observation of the personal support to residents by staff to be sensitive and respectful. It was noted that all staff knocked on resident’s doors before entering and used only a preferred form of address. Resident comment cards received by the Commission for Social Care Inspection indicated that residents believed their privacy was respected and Relative/Visitor comment cards all indicated that they could meet their family member in private. . Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The activities and recreational opportunities available to the residents are of a good standard so resident’s social needs are met. EVIDENCE: Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 13 Resident’s interests are recorded in their personal files and the home employ an activities coordinator. Activities are advertised on a notice board in the home. Resident comment cards sent to the Commission for Social Care Inspection stated that they believed the home provided suitable activities. Local places to visit include local pubs, churches, libraries and shops. Residents said that the home has an open visiting policy. Residents are able to choose whom they see and do not see and are able to receive visitors in private. Residents are supported and encouraged to maintain and develop appropriate control over their own lives. Their financial affairs are managed by them for as long as they are able and wish to do so. Many had personal possessions that they were encouraged to bring with them at the time of their admission to the home. Menus are in place and detail that there are options available from the lunchtime menu. Through discussions with residents and staff it was confirmed that the practice of offering choices did take place. The kitchen is clean, tidy and well organised and in place are robust monitoring procedures for hygiene and food preparation standards. Cleaning schedules, temperature checks and storage are carried out in the correct manner. Snacks and beverages are available at all times and offered regularly to residents. Special therapeutic, religious or cultural diets are provided when required or requested. Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a satisfactory complaints system in place with some evidence that resident’s feel that their views are listened to and acted upon. EVIDENCE: The homes complaints procedure gave sufficient guidance to staff on the action that they should take on receiving a complaint. The procedure described the rights of residents and that all complaints must be responded to. Within the homes statement of purpose a summary of how to complain had been included for residents and their relatives. Several residents confirmed that they knew how to complain and would not hesitate in doing so. The home also had in place a policy for the protection of vulnerable adults; the local policy in this subject area was also in place. Reporting procedures were clear if an alleged incident of abuse was to be made and staff records showed evidence that they had been trained in this area. Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Systems in place for hygiene and the control of infection in the home is good and ensures the environment is clean for the residents to live in. EVIDENCE: Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 16 The home is purpose built. The grounds are attractive and well maintained and accessible to residents and their families. Documentary evidence was seen to show that at this time the home met all fire and environmental health requirements. Individual rooms of residents contained items, which assisted in the personalising of the rooms. The décor and furnishings and fittings were of a good standard, domestic and well maintained and the home was seen to be clean and tidy throughout. The home was seen to be clean and free from offensive odours. Policies are in place regarding infection control and staff were seen to be using protective clothing. The home had a laundry area, with the walls and floor easily cleanable. Industrial washing machines and dryers are available. The disposal of clinical waste is through a contractual agreement. Hand washing facilities are sited in the areas where infected material/clinical waste is handled. Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Systems in this home for the recruitment of staff are robust and lower the risk of appointing unsuitable to work with vulnerable people and protecting the residents. EVIDENCE: Both staff and training records confirmed that staff had access to a wide range of training opportunities. Registered nurses were supported in attending courses to maintain their continuing development including safe administration of medication, wound care and professional practice. Staff when questioned were very clear in their own roles and responsibilities. However the induction of staff did not show that the home had a system in place to ensure staff had understood the areas of learning in this area. There must be evidence to show that staff have demonstrated that they have understood and could apply this to their role in accordance with national guidance. Feedback from resident comment cards and on speaking to residents indicate that they feel that there are enough staff to meet their needs. One resident said “ although l have to wait sometimes when l call them, its not for long not even a couple of minutes”. Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 18 The examination of staff files demonstrated that references had been obtained before an appointment was offered. The files contained proof of identity and that Criminal Reference Bureau clearance had been obtained. Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The systems at this home for managing health and safety are good protecting the residents through reducing risks in this area. EVIDENCE: Standard 31 was not assessed as there is no Home Manager in post at this time. Day-today management is provided through a nurse consultant who offers guidance and support alongside the Deputy Manager at the home. Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 20 The home had a Health and Safety policy. There was evidence within the training records that staff had undertaken fire, manual handling, food hygiene and first aid training. Risk assessments had been undertaken and were seen on the residents care files. Records kept by the home include fire prevention and training, equipment checks, moving and handling risk assessment, food hygiene, infection control and COSHH. The home had undertaken a review in which they had sought the views of residents on the standard of care at the home. They now need to develop an action plan relating to the views received and demonstrate how they have used the information to influence the running of the home. The management of monies held on behalf of some residents showed that a robust system was in place that provided a clear audit trail. Balances seen were correct and receipts of all expenditure are maintained and available for inspection. Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 21 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 3 Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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 OP7 Regulation 12(1)(a) &15. Requirement There must be a care plan in place for all assessed needs of residents that is clear in the support that needs to be provided by staff. Monitoring charts in place for residents must contain up-todate entries to ensure they are effective and accurate evaluation tools. The weight of any resident assessed as at risk of weight loss must be monitored in accordance with the assessment guidance. Systems must be in place to show that staff have demonstrated their understanding following induction and foundation standards in accordance with national guidance. The home must show how the views of residents influence the running of the home, and report on and supply a copy to all residents. Timescale for action 31/08/06 2. OP8 12 &13. 31/08/06 3. OP8 12 & 13. 31/08/06 4. OP28 12 & 18 30/09/06 5. OP33 24 30/09/06 Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 23 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 OP30 Good Practice Recommendations Staff should be trained in the appropriate way to address residents. Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rosalyn House DS0000017690.V300633.R01.S.doc Version 5.2 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
