Inspection on 08/04/08 for Rose Brae Nursing Home

This inspection was carried out on 8th April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rose Brae Nursing Home 12/04/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Rose Brae Nursing Home 8 Spital Road Bebington Wirral CH63 9JE Lead Inspector Anthony Cliffe Key Unannounced Inspection 8th April 2008 08:40 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 Rose Brae Nursing Home DS0000068896.V362005.R02.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. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rose Brae Nursing Home Address 8 Spital Road Bebington Wirral CH63 9JE 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) 0151 334 5549 F/P 0151 334 5549 rosebraenursinghome@hotmail.co.uk Mr Shaid Hussain Zulqarnain Hussain vacant post Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only: Code N, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP The maximum number of people who can be accommodated is: 25. Date of last inspection 12th April 2007 Brief Description of the Service: Rose Brae is a converted three storey mature house, situated in the residential area of Spital, Bebington, and is close to local amenities. The home has two lounges and a conservatory, and at present one of the lounges is used as a dining room. All areas of the home are accessible by wheelchair, including the large, landscaped rear garden and patio area. There is car parking at the front of the building. Fees range from £390 - £550, or by private arrangement, and do not include hairdressing, chiropody, newspapers, etc. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is 1 star. This means that the people who use the service experience adequate quality outcomes. This unannounced visit took place on the 8th April 2008 and lasted eight and a half hours. One inspector carried out the visit. This visit was just one part of the inspection. Other information received was also looked at. Before the visit the owner was asked to complete a questionnaire to provide up to date information about services provided. During the visit various records and the premises were looked at. Two people that live at Rose Brae were spoken with to find out what they think about the services they received. Four staff including the manager and the owner was also spoken with and they gave their views about the service. What the service does well: What has improved since the last inspection? The staffs’ attitude appeared positive. Staff also confirmed there had been a noticeable improvement in the environment since the last site visit, especially as new windows were being fitted at the time of the site visit. The home had been repainted apart from some bedrooms. Bathrooms, communal areas and corridors were repainted. New floor covering had been provided throughout the home. Quality assurance and the records of residents and staff recruitment had improved but further improvements were needed. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Rose Brae Nursing Home DS0000068896.V362005.R02.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 Rose Brae Nursing Home DS0000068896.V362005.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use services experience adequate care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Information was available about people who use the service so their needs were met but more detailed information could be gathered to provide information about their lives so staff can provide care based on personal routines and choices. EVIDENCE: Most of the people who use Rose Brae are from the Wirral area. The service is welcoming to anyone with diverse needs. The care records of two residents who had recently moved into Rose Brae were looked at. The acting manager had visited them before they moved to the home to gather information about their needs. The information gathered about the residents was adequate enough in detail on which to provide care records so staff could help residents meet their needs. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 9 The information gathered about the residents was not detailed in their personal preferences, daily routines and arrangements on how decisions were made regarding their care. There was no information from who the information was gathered or if the resident or their family had been involved. Residents care records contained information that residents were seen by other healthcare professionals and recorded contact with chiropodists, General Practitioners (GP) and dieticians when needed. Rose Brae Nursing Home DS0000068896.V362005.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use services experience adequate care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Peoples’ care needs were met but records of people’s personal and healthcare need to improve so they demonstrate that residents receive appropriate personalised care that maintains their health and welfare. EVIDENCE: The care records of three residents were seen. These recorded the actual care delivered by staff to meet the needs of the residents, but the standard and quality of the recording and reviews varied. A new system for recording information on residents’ needs had been introduced. This allowed staff to record information on the different activities of daily living relevant to individual residents’ needs. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 11 Where care was not required this was written. For example if a resident did not have any breathing problems it was recorded. Care records generally guided staff on how to help and support residents but they lacked information on personal routines and preferences. Where a resident was unable to communicate her needs it gave advice on how staff were to approach and communicate with the resident but the resident’s preferred method of communication was not recorded. Where residents were unable to communicate or make their own decisions about their care and routines there were no references if relatives or advocates had been consulted about how decisions would be made on their behalf. Where staff made decisions for residents there was no record if they had consulted relatives or advocates. Daily records lacked personalisation and did not always describe the daily routines of residents. There were some good examples of care records reflecting the daily routines and preferences of residents but information about residents’ families and their life histories of could be improved to inform staff about them before they moved into the care home. Information in some plans was inconsistent with other supporting records. For example residents were identified as needing certain diets due to their health condition but nutritional records were not completed. Residents were identified as having problems with their mobility and at being risk of falling but assessments were incomplete. An example being a resident with poor eyesight and walked with a walking aid that was known about before moving into Rose Brae did not have care records or a risk assessment to guide staff on managing the risks identified. A falls risk assessment identified a risk of falling but had not been signed or dated by the person completing it. The care records of another resident described very positive approaches to be used by staff to promote good communication with the resident, helping the resident to maintain dexterity and promote continence. However the reviews of these records did not say if the approaches to be used by staff were working or not as they only recorded ‘no change’. Records made reference that GPs, NHS services and visiting professionals were involved in resident’s care. Staff was completing forms to identify if residents’ nutrition or skin integrity was at risk and that residents’ weight was being monitored. People with diabetes were having their blood sugar levels looked at by staff to make sure they were safe. The owner and manager confirmed that a resident’s mental health needs were being looked at due to deterioration in mental health. A number of residents appeared to have memory problems and confusion. Residents were seen and heard to shout out in response to one another causing upset to others. The manager agreed to look at the mental health needs of a number of residents to see if they needed to be seen by the mental health services. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 12 Also available were monthly reviews, but these varied from being detailed about the residents’ needs and recorded ‘care as plan’ or ‘continue as plan’, which was insufficient. Medicines were recorded as received and included the date they arrived. Records of medicine administration were completed, including creams, which were recorded on separate sheets as the care staff was applying them. The record sheets had letters to use as a code to show that a dose of medicine has not been given. Staff was using the appropriate codes to record when residents refused or when medicines were not administered. There was one occasions when a signature to record the administration of medicines or code was not recorded. A resident was prescribed a variable dose of a strong sedative medicine. There was no plan in place to indicate when this should be used and how much time between doses must be allowed as the GP had prescribed a variable dose but not made the instructions clear. The manager said she would write to GP’s as some prescriptions for pain relied medicines had the instruction ‘to be used as directed’ on and this was not clear enough for staff administering medicines. There were records that information had been gathered on residents’ ability to take responsibility or manage their own medicines. The manager completed the quality assurance audit of medicines weekly. These were looked at including a more detailed audit the manager had started in March 2008. The audit identified that on some weeks there were missing signatures on medicine administration sheets but did not detail who was responsible for the errors and what action was being taken in response to them. The manager agreed to record what actions she had taken with individual staff when errors were found. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 13 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 and 15 People who use services experience adequate care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Residents’ make limited lifestyle choices as residents do not have a choice of social activities or leisure pursuits due to a lack of staff to provide support so they are inactive and do not socialise. EVIDENCE: An activities coordinator was not employed but the owner produced employment records to confirm that the employment of an activities coordinator had been completed but the individual had not been in contact to accept and confirm the position so never commenced employment. The provider was aiming to provide regular activities for residents. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 14 Details of a weekly activities programme were displayed on a notice board near to the main lounge. The weekly consisted of; leg exercises, board games, exercise of arms and wrists, memory games, dominoes, bingo, music quizzes, manicures and facials, body exercise and at weekends reading newspapers, watching films and songs pf praise. Regular outside entertainers were arranged to come into Rose Brae to entertain residents. Every two weeks an entertainer visited to pay the piano for residents. The home had long established links with local churches and received visits from them regularly. Of the three residents whose care records were looked at activities plans were not completed for two of them. Three residents sat and chatted in the garden room throughout the day and a male resident sat reading or doing puzzles from a quiz book. The majority of residents sat sleeping or possibly watching TV as they were looking in the direction of the two televisions that were on throughout the day. Other residents were noisy at times and disturbed others. Staff was constantly busy helping residents and would acknowledge residents as they walked through the lounge areas. Staff was seen to be polite and respectful to residents and if asked for help staff would respond. They also anticipated the needs of some residents. For example when a resident started to shout and was agitated they would sit next to him and explain he was being noisy and upsetting other residents. They offered him his music, which he accepted. This helped him to calm. A resident spoke to said, “I’m one of the few people here that can hold a conversation. Nearly all the patients or residents are confused, can’t hear or are too infirm to do anything. You cannot have a conversation. No mental or physical stimulation to keep you going, that’s so important. Everyone just sits around doing nothing”. Four residents returned surveys as part of information requested about Rose Brae. Three of the residents said that activities were sometimes arranged and one recorded, ‘There is a need for some stimulation, to take part in one to one conversation and or an activity. For example an activity coordinator’. Staff member said that staffing levels were insufficient to allow them time so sit with residents. A staff member said, “We don’t have time do activities as it’s very busy, and some days we only had two care on and never sit down the whole day. We’ve no activities coordinator and haven’t had in the months I’ve been here”. Another staff member said, “Activities are displayed but we never do them as we don’t have the time, there’s no activities staff and hasn’t been in the months I’ve been here”. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 15 Residents were seen having breakfast and lunch. Breakfast was a choice of cereals and toast. Lunch did not offer a choice of an alternative menu, as the main course was a chicken dish with vegetables. The cook said the residents that did not want the chicken dish could have an alternative but there was no alternative on the menu. The menu was a set one covering a four-week period. The menu offered varied choices to residents. At meals times residents sat in the main dining area at a dining table or in armchairs with small table off which to eat at. Staff was on hand to assist residents that required help. Meals were prepared and brought to residents not served in the dining area. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 16 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 and 18 People who use services experience adequate care in this outcome area. We have made this judgement using available evidence, including a visit to the service. The awareness of the safeguarding process needs to improve so residents are protected from risk of abuse. EVIDENCE: Rose Brae had a complaint and adult protection policy and procedure in place. The complaints procedure is displayed near to the front entrance. Four residents surveys returned as part of the information CSCI requested about Rose Brae recorded that residents knew who to raise concerns and complaints with and knew about the complaints policy. The CSCI has not received any complaints about this service since the previous inspection but had received some concerns, which we discussed with the owner and were assured would be addressed. The local council adult protection procedure was in the main office and the contact number for the safeguarding adults team displayed near the entrance to the building. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 17 The adult protection procedure included information on ‘whistle-blowing’, and staff spoken to were aware of the whistle blowing policy and the circumstances in which they would use this. Staff discussed the adult protection or safeguarding procedures. Staff had completed training on recognising adult abuse and how to report this. Staff said that they had not been asked questions following the training or given any information from the owner on the local authority procedure but had only done the training provided at the care home. The training consisted of watching a DVD and completing a questionnaire on it. Another staff member spoken with seemed knowledgeable on the procedure and how to report allegations of abuse. Staff said they had looked at the procedure during induction and were aware of the whistle blowing policy, but were unaware of the whereabouts of the local council procedure. The owner provided the training on adult protection but had not completed the local council’s training. The owner had made a safe guarding referral to the local council in 2007 and cooperated with the council’s investigation. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 18 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 and 26 People who use services experience Good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Residents live in a comfortable well maintained building but additional storage space is needed so residents’ privacy and dignity is not compromised. EVIDENCE: At the time of the site visit the windows were being replaced with white UPVC windows. The owner said he had spent considerable funds on the building and equipment. This included redecoration of the corridors, toilets, stairways, fourteen bedrooms and staff room. All of the bedroom carpets had been replaced and three electric beds and a reclining armchair had been purchased. A new walk in shower had been provided on the first floor. Bedrooms were highly personalised, with many residents bringing in their own furniture and personal effects. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 19 A resident said that she had requested an en suite bedroom and had the choice of one. She said her bedroom was very nice and spacious with a nice view. She said the building was comfortable but lacked quiet private facilities were people could sit and talk. The toilets contained small waste bins with swing lids. In some of these staff had put aprons and gloves in following assistance with personal care, this was not clinical waste. The ground floor sluice contained a resident’s bed that was being stored in it as her bed had been replaced. There was no clinical waste bin in this sluices room. The owner said it would be cleared out and a foot operated metal-sided clinical waste bin provided. There were no odorous areas noted and the building was clean but untidy in areas with incontinence products left on shelves and in bathrooms when these were the personal properties of residents and should have been left in their bedrooms. The owner had a health and safety assessment of the building and working practices completed by MENTOR services from The National Westminster Bank completed in March 2008 and had received a copy of this. A fire risk assessment of the building was completed on 4th April 2008. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use services experience adequate care in this outcome area. We have made this judgement using available evidence, including a visit to the service. The numbers and deployment of staff and the training programme needs improving so residents are protected and in safe hands at all times. EVIDENCE: At the time of the site visit there were sufficient numbers of staff on duty meet residents’ essential needs. Staffing rotas were seen from 22nd March 2008 to 21st April 2008. Examples of low staffing levels were seen. For example when only one registered nurse and two care assistants on duty for a twelve-hour shift. Staffing difficulties had been resolved since the site visit. The Annual Quality Assurance Assessment (AQAA) completed by the home recorded the number of staff with NVQ qualifications. Thirteen care staff was employed inclusive of 1 bank staff. Eight staff had an NVQ level 2 or above qualification and three staff were working toward an NVQ level 2 qualification. In addition to this staff member had completed an NVQ level 3 in February 2008 and another care staff registered for NVQ level 2 in April 2008. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 21 Two staff did not have the required recruitment checks. On the files of a registered nurse and a domestic staff only one reference was present in their files. The domestic staff had been employed without the completion of an application form. All staff had an enhanced Criminal Records Bureau check completed and POVA First check done before being employed. Recently appointed staff spoken to said a senior carer supervised them during their induction. Despite an improvement in the recruitment of staff the requirement made at the previous site visit had not been met in full. Staff induction consisted of staff completing a programme of reading relevant policies and procedures, being shown the fire procedure, how to use portable lifting and handling equipment and watching DVD’s on health and safety, protection of vulnerable adults, food hygiene and moving and handling. The owner did not have the Skills for Care induction standards and the induction did not follow a set programme. The owner agreed to obtain the Skills for Care induction standards and introduce them. The owner had provided details on the AQAA of training completed by the staff team. All the catering staff and 38 of care staff had completed food hygiene training. Care staff had not been provided with training on the Control of Substances Hazardous to Health (CoSHH) Regulations and was undertaking domestic duties. Staff training records and certificates recorded training taking place for fire training, protection of vulnerable adults, moving and handling, health and safety, nutritional training, use of bedrails and food hygiene. Mandatory fire training and first aid was arranged for 23rd April 2008. Five staff including the acting manager and a recently recruited registered nurse was to attend. First aid training should have been renewed in February/March 2008. The owner had written a programme to be introduced for mandatory training to take place throughout the year. The proposed programme included fire training, protection of vulnerable adults, moving and handling, Control of Substances Hazardous to Health, infection control at either Arrowe Park or Countess of Chester hospitals, health and safety and first aid. Certificates for staff attending training were kept in individual staff files. The owner did not have a training plan for all staff to record when training took place and when it was due again so staff training could be monitored. Despite an improvement in staff training the requirement made at the previous site visit had not been met in full. Despite staff having moving and handling training staff were observed assisting a resident to stand from a chair to a standing position by lifting the resident form under the arms to a standing position when the resident could just about bear her weight but was also putting her weight onto the staff assisting her. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 22 The staff then shuffled her around to sit in a wheelchair. One of the staff was interviewed and said that she understood that this was not correct and could be a ‘drag lift’. She said the resident could weight bear but did put her weight onto staff. When asked why she did not use moving and handling aids such as a transfer belt or a turning circle she said she was unaware of these but then said she had seen these aids in the moving and handling DVD she had watched. She said these aids were not available. Another staff member spoken with said that she had received moving and handling training from a senior carer who showed her how to use the hoist. She said she was aware of the use of other moving and handling aids but did not see transfer boards, transfer belts and turning circles used and did not know if the home had them. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 23 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, 33, 35 and 38 People who use services experience adequate care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Management of the home needs to improve so that staff roles, training and staffing improve so people that use services benefit from a well managed, consistent service that is run in their best interests. EVIDENCE: The acting manager had only been in post a few months and had not made an application to CSCI to register as the manager. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 24 The owner was working as part of the management team and said he worked at Rose Brae five days a week so was not doing the Regulation 26 visits. He said he was doing this to support the manager who had not yet been registered. He was not involved in clinical management but had responsibility for the budget. He said he did most of the maintenance and decorating. He did not have a maintenance record. There was evidence that satisfaction surveys were being done by the owner and surveys that had been sent out from December 2007 to March 2008 to relatives were seen. Example of the comments received were relatives giving the home an overall good score and making comments such as, ‘ Staff are very good and the owner is very helpful. Will recommend to other people’. ‘Excellent service, but the activities coordinator would be nice. Staff should encourage residents to move and exercise so they are not sitting around and it would be more beneficial to their health. Information on menus and activities is a god idea, activities need to take place though’. ‘More activities’. ‘All staff very helpful and polite, carers very helpful and polite’. Medicines were audited weekly and the manager had completed her first monthly audit of medicines in March 2008. Where mistakes were found the staff that had made them would sign to say they had rectified them but there was no record of individuals who had made the errors and if their accountability and responsibility was discussed and what action had been taken. Audits of the records required such as care records; supervision and maintenance were not completed. There was no systematic approach to quality assurance in place. Prior to the site visit concerns were raised about the routines of residents living at Rose Brae. These were looked into with the provider during the site visit and were unfounded. During the site visit a staff member discussed the routines staff had to help and support residents. She said that residents were respected. Monies for residents were not routinely held at the home and relatives were billed directly for services. One resident had his own monies and the manager had agreed arrangements to support the resident to go to the bank with the help of staff. The AQAA confirmed that all maintenance checks were completed. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 25 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 26 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. 1. Standard OP12 Regulation 16(2)(m) (n) Timescale for action The registered person must 08/04/08 ensure that people that use services are consulted about their social interests and lifestyle choices and the planning, coordination, variety and a choice of social activities provided so they can lead fulfilling lives. The registered person must 08/04/08 ensure that at all times there suitably qualified, competent and experienced staff working in the care home inclusive of care, catering and domestic staff so people that use services’ health, social and welfare needs are met at all times. The registered person must 08/04/08 ensure that all records specified under Regulation 19 Schedule 2 paragraphs 1 to 9 are obtained for all persons employed so people that use services are protected from potential abuse. Requirement 2. OP27 18(1)(a) 3. OP29 19(1)(b) Schedule 2 paragraphs 1 to 9 Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 27 4. OP30 18(1) (c) 5. OP31 8(1)(2) 6. OP31 13(5) The registered person must 01/09/08 ensure that all staff complete training suitable to the work they are to perform including infection control, first aid, Control of Substances Hazardous to Health and moving and handling so people that use services’ health and welfare is protected and promoted at all times. An application to register as the 01/09/08 registered manager for the care home must be made to the Commission for Social Care Inspection so that people that live there will be confident it is run in their best interests. The registered person must 08/04/08 ensure that suitable arrangements to provide a safe system for moving and handling residents inclusive of moving and handling aids are made so people that use services will be in safe hands at all times. 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 OP3 Good Practice Recommendations Detailed information about people that use services should be gathered from a variety of sources before they move in so they will be confident that important information about their lives and life histories is known about them on which personalised records of care can that reflect their lifestyles can be based. Reviews of care records should include what is important to and for people that use services and how they benefit from the support plans in place and detail if the plans are working or not working so they will be confident their DS0000068896.V362005.R02.S.doc Version 5.2 Page 28 2. OP7 Rose Brae Nursing Home 3. OP8 4. OP12 5. OP14 6. OP15 7. OP18 8. 9. OP19 OP30 10 OP31 11. OP31 12. OP33 needs are being met. People that live at Rose Brae should have their needs reviewed to see if Rose Brae is the appropriate place for them to live so they will be confident they are receiving appropriate care. Care records of residents should include information on their life history, lifestyle and leisure pursuits so staff have important information about them they have opportunities to be involved in activities appropriate to their age. Consultation on decisions about the routines and choices of people that live at Rose Brae that do not have relatives or representatives, cannot use words or communicate their needs should be done so their routines and lifestyle choices are known and respected and routines not imposed upon them. Storage for the serving of food should be available in the dining area so food served is kept at an appropriate temperature so it is served at the convenience of the people that live their. Training on the safe guarding of vulnerable adults and prevention of adult abuse should include information for staff to keep so they are aware of the procedures to follow should they suspect and need to report allegations of abuse. Additional storage facilities should be provided so personal care items and furniture belonging to people that use services is stored discreetly. The provider should provide all grades of staff with training suitable to the needs of the people that live at Rose Brae so they will be confident they are cared for by a skilled work force. The provider and manager should obtain and follow the CSCI guidance on the completion of the AQAA and use of surveys so important and factual information is gathered about the facilities and services provided at Rose Brae. All care staff should be provided with individual copies of the General Social Care Council code of practice so the people that live at Rose Brae will be confident staff are aware of their responsibility and accountability for protecting them. A more robust quality assurance system should be in place so the way in which Rose Brae is conducted and managed will improve and the health and welfare of residents will be promoted. Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.northwest@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 Rose Brae Nursing Home DS0000068896.V362005.R02.S.doc Version 5.2 Page 30 - 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. 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