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Inspection on 15/08/06 for Rose Court Nursing And Residential Home

Also see our care home review for Rose Court Nursing And Residential Home for more information

This inspection was carried out on 15th August 2006.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Before residents went into the home one of the senior members of staff visited them in their own homes or in hospital to make sure that the care they needed could be provided by the home. The qualified nurses and care staff were very good at caring for the residents who were very ill and needed lots of specialised care. The staff teams on each unit worked well together and good systems were in place for sharing information about the residents.Activities were considered to be a very important part of the residents` day. The activities person who worked at the home was aware of what each resident liked, and was able, to do. The home has exceeded the Standard expected of them. One relative said " I am very settled in myself, I have no worries they keep me informed and they look after him well. He is always clean and well turned out"

What has improved since the last inspection?

The way that staff are recruited has improved. Staff are now properly and safely employed. The Company has now provided a useful and informative guide that gives information about the home and the staff. More training has been put in place for the care staff so that they can keep their skills up to date.

What the care home could do better:

The care staff on the residential unit (Clarence) must pay more attention to ensuring that the care plans reflect the health and social care needs of the residents. The care staff on Clarence must make sure that they continually look at anything that may be a danger to the residents. They must then make sure that they write down in the residents care plan when they have done this, and what action they have taken to reduce the hazard. The Company must make sure that the things that needed doing from the last inspection are done. This applies especially to the redecoration of the bathrooms and toilets.

CARE HOMES FOR OLDER PEOPLE Rose Court Nursing And Residential Home 44-48 Water Street Radcliffe Manchester Lancashire M26 4DF Lead Inspector Grace Tarney Unannounced Inspection 09:30 15th & 16 August 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rose Court Nursing And Residential Home DS0000017336.V298002.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. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rose Court Nursing And Residential Home Address 44-48 Water Street Radcliffe Manchester Lancashire M26 4DF 0161 724 9040 0161 724 5357 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) rosecourt@schealthcare.co.uk Southern Cross Home Properties Limited Mrs Catherine Mary Shawarby Care Home 109 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (40), Mental disorder, excluding learning of places disability or dementia (1), Old age, not falling within any other category (62) Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 109 service users to include the following: Clarence Unit. Older People (OP) 20. Both sexes. Over 65 years of age. Dementia (DE) 1 Male (Named individual under 65 years of age) Sandringham Unit. Older People (OP) 42. Both sexes. Over 65 years of age. Dementia (DE) 1 Male (Named individual under 65 years of age) Mental Disorder (MD) 1 Female (Named individual under 65 years of age) Earl of Wilton Unit. Dementia (DE)(E) 40. Both sexes. Over 65 years of age. Dementia (DE) 2 Females (Named individuals under 65 years of age). Dementia (DE) 1 Male (Named individual under 65 years of age)under 65 years of age) Dementia (DE) 1 Both sexes under 65 years of age The service should employ a suitably experienced and qualified manager who is registered with the Commission for Social Care Inspection. The named service users must be cared for on the designated units. Once placement for the 6 named service users (2 DE (female) 3 DE (male) and 1 MD (female has ended the previous registration categories will be reverted to. Suitably qualified and experienced registered nurses must provide 24 hour nursing care on the Sandringham and Earl of Wilton Units. 9th March 2006 2. 3. 4. Date of last inspection Brief Description of the Service: Rose Court is a purpose-built detached property that is situated in a residential area of Radcliffe. The home is close to main bus routes and is not too far from the motorway network. A variety of shops are close by. There is plenty of parking to the front and the side of the home for the use of staff and visitors. The front door of the home allows a level access for wheelchair users and people who have problems climbing steps. The home is registered to care for residents with a variety of needs. The home is divided into 3 separate units. On the ground floor there is Clarence Unit. This unit is for elderly residents who have social care needs. On the first floor there is Sandringham Unit. The Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 5 elderly residents on this unit have either nursing or social care needs. On the top floor is the Earl of Wilton Unit. This unit is for mainly elderly residents who have dementia. The units on the first and second floors are reached either by stairs or a passenger lift. Each unit has large lounge and dining areas. Accommodation throughout the home is provided in mainly single bedrooms, several of which have an en-suite facility of toilet and wash hand basin. Most of the toilets and some of the bathrooms have aids to assist any resident with a disability or mobility problem. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The home was not told that this inspection was to take place although the home was aware that an inspection was due. This was because several weeks before the inspection survey comment cards were sent out to the residents, their relatives and to the home itself. Some were also sent out to the GPs who visit the home. These survey comment cards asked what people thought of the quality of the service and the facilities provided. Only 1 relative comment card was returned. Two inspectors visited the home over two days and spent a total of 22 hours inspecting. During this time the Inspectors looked at care and medicine records to ensure that the health and care needs of the residents were being met. They also looked at how many staff were provided on each shift to make sure the residents needs were being met, and also looked at how management recruit and train their staff. To make sure that the home and the equipment in it was safe, an Inspector looked at the maintenance and service records of the equipment within the home. How the home manages the residents’ spending money was also looked into. The Inspectors then looked around the building at some of the bedrooms, bathrooms toilets and sitting areas to check if they were clean and well decorated. They then visited residents in their own bedrooms and lounge areas. This was to check out the care that was being provided for them. The Inspectors also looked at what the residents were having for their lunch. In order to get further information about the home the Inspectors also spent time speaking to 5 residents, 1 visitor, 2 qualified nurses.3 care assistants, the activities organiser and the manager A copy of the last inspection report is kept on display in the reception area. The provider informed the inspector that the fees within the home ranged from £339.00 to £560.00. This information was received on the 2nd August 2006. What the service does well: Before residents went into the home one of the senior members of staff visited them in their own homes or in hospital to make sure that the care they needed could be provided by the home. The qualified nurses and care staff were very good at caring for the residents who were very ill and needed lots of specialised care. The staff teams on each unit worked well together and good systems were in place for sharing information about the residents. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 7 Activities were considered to be a very important part of the residents’ day. The activities person who worked at the home was aware of what each resident liked, and was able, to do. The home has exceeded the Standard expected of them. One relative said “ I am very settled in myself, I have no worries they keep me informed and they look after him well. He is always clean and well turned out” 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. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected 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 adequate. Although assessment information is provided it lacks some details therefore does not provide sufficient detail about prospective residents needs as well as abilities. This judgment has been made using available evidence including a visit to this service. EVIDENCE: All units. Inspection of 3 resident care files on Sandringham, 3 on Buckingham and 3 on Clarence showed that assessments had been undertaken prior to admission. Before any resident was admitted to the home a senior member of the staff from the home undertook an assessment of their needs. Assessments undertaken by other professionals requesting a residents’ admission i.e. care manager/social worker were also in place. The pre-admission assessment document was not as detailed as the Standard requires, although the assessment document used to assess a resident on admission was. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 10 There was nothing on the pre-admission document about whether there was any history of falls, personal safety and risks, and carer and family involvement. A relative told the Inspector that before her husband was admitted a member of staff from Rose Court came to visit him. Standard 6 does not apply. The home does not provide Intermediate Care Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 11 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. Apart from the inadequate reviews and the inadequate care residential unit, overall the care plans reflected the support residents. The medication system was safe thereby ensuring the residents medicines safely and correctly. This judgment has been made using available evidence including service EVIDENCE: Sandringham. The care plans of 2 of the residents were looked at. The care plans were detailed and contained a lot of important information about how to care for the residents. One of the residents was of the Jewish faith. The care plan documented that this resident regularly attended the local synagogue and whilst not having a kosher diet she did not eat pork and bacon. The care plan also stated that this resident took part in Jewish festivals. Due to this residents’ medical condition she was at risk of choking on her food and fluids. A risk assessment was in place in relation to this, giving clear Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 12 plans on the needs of the received their a visit to this guidance to the staff on the risks involved and what action to take to reduce the risk. The staff looked at whether or not there was any risk in relation to the residents developing pressure sores and also if they were at risk due to problems with their diet and fluid intake. These are called risk assessments. They also assessed if it was safe to use bed rails and looked at any other general safety risks. Risk assessments were in place for whether a resident was at risk of falling. Buckingham The care plans of 2 of the residents were looked at. The care plans were detailed and contained a lot of important information about how to care for them. One of the residents on this unit was also of the Jewish faith. The care plan documented very clearly what this resident was able to eat. The nurse in charge of the unit that day had a good understanding of the Jewish faith and culture. One male resident was Asian and spoke some English. The Inspector was told that there was a male carer on the unit who could communicate with the resident in his own language. The eating and drinking care plan stated that the resident “prefers a halal diet”. There was no evidence in the planned care that he was receiving a halal diet and a discussion with the staff showed that he was not. This needs investigating by discussion with the resident and his family to ensure that the residents’ needs are being met and his culture is being respected. The staff looked at whether or not there was any risk in relation to the residents developing pressure sores and also if they were at risk due to problems with their diet and fluid intake. These are called risk assessments. They also assessed if it was safe to use bed rails and looked at any other general safety risks. Risk assessments were in place for whether a resident was at risk of falling. Clarence Three residents file were looked at. Information was orderly and easy to read. Files include the client profile, care plan, risk assessments, daily records and other relevant correspondence. Of the files seen information was found to be detailed, with care plans identifying the area of need and how this was to be met. Information held for one resident being nursed in bed was thorough, with charts being completed for nutrition, fluids, turning and personal care. However other files required further development, these include; • Notes for one resident identified 2 different dates of birth • Another resident was being assisted with continence care and nutritional drinks due to changing needs, however within the plan it identified the resident to be independent and self-caring • A social/physical assessment stated that the resident wanders and becomes anxious whilst further into the file falls assessment does not identify these as a concern Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 13 Two individuals also had continence assessments, which had not been reviewed since Jan 2006. • Risk assessment for bedrails had been undertaken in Jan 06, stating review monthly, this had not been done. Accurate information must be reflected in the care and risk assessments so that staff are aware of the level of support required. Care plans and assessments had been reviewed on a monthly basis. There were lots of very detailed care documents available for the staff to use when needed. These included accident observation, positional changes, diabetes care, wound care, challenging behaviour and nutritional intake. Information was also noted within the care plan with regards to whether residents wished to be resuscitated. Whilst relatives had signed some records others had not. This is a particularly sensitive area and decisions should not be made in isolation. The home should ensure that decisions are made with the involvement of a multi-disciplinary group and that information is clearly detailed within the care file outlining the agreement made. This too should be kept under review. From the care plans inspected it was evident the residents were weighed at least on a monthly basis and any weight loss identified and acted upon. A discussion with the residents and relatives identified that the residents had access to other health care services including hearing, sight tests and a visiting chiropodist. Evidence of these visits was kept in the residents’ individual files. Equipment necessary for the prevention and treatment of pressure sores was available on all the units. The district nurse who, due to the size of the home is a regular visitor made comments. Comments included; ‘staff are quick to respond if any concerns, staff are quite helpful and will follow plans, feels things have improved and they are willing to learn and will assist’. The medication systems on all the 3 units were inspected during this visit. The qualified nursing staff administer the medications on Sandringham and Buckingham units and only suitably trained and designated care staff administer the medications on Clarence Unit. Overall a safe system of medicine management was in place. The Company has introduced a system whereby any member of staff administering medications has to wear a red tabard that informs people not to disturb that staff member whilst they are giving out medications. This system has been put in place to hopefully reduce any drug errors. The medications were provided in pre-packed cassettes with pre-printed administration records(MAR sheets) provided The medications supplied are checked in to the home and the medicines returned for disposal are also recorded. The home has a detailed and satisfactory medicines policy and procedure that includes guidance for the self-administration of medicines and homely remedies. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 14 • No resident was dealing with their own medicines at the time of the inspection. Sandringham The medications were securely stored in a locked room and the medicine trolley was secured to the wall when not in use. Storage in the medication fridge was satisfactory and the temperature was being recorded on a daily basis. Controlled drugs were securely stored, safely administered and accurately recorded. It was identified that despite the unit having a medications returned book, there had been no record of any medications being returned to the disposing agency since the 28/06/06. There was a large amount of medicines waiting to be returned but these had not been entered into the returns book. Buckingham The medications were securely stored in a locked room and the medicine trolley was secured to the wall when not in use. Storage in the medication fridge was satisfactory, and the temperature was being recorded on a daily basis. A tube of unlabelled canesten cream was being stored in the fridge however. Controlled drugs were securely stored, safely administered and accurately recorded. It was identified that stocks of controlled drugs that had not been in use since May 2006 were being stored. These controlled drugs need to be destroyed according to the medication policy. Clarence Boots chemist supplies medication. Recent refresher training has been held with the supplying pharmacist for all senior staff responsible for the administration of medication. On examination of the system, stock levels are controlled with items returned to the pharmacy at the end of each month. Records are made of all items brought into the home as well as returns. The staff need to ensure that the office door is locked when not in use to ensure the safe management of medication, particularly items being returned. At present the unit does not have any controlled drugs, however suitable arrangements are in place should this be necessary. The unit also has a small fridge for any items that may need to be refrigerated. This was found to clean and at the required temperature. On examination of the MAR sheets it was found that some medication, tablets and cream, had not been signed for following administration. The Manager must ensure that accurate records are maintained to prevent any errors and residents being placed at risk. Personal support to residents is offered is such a way so as to promote and protect their privacy, dignity and independence. This was confirmed by a number of residents who said that the staff treat them with respect. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 15 One resident said “I am well cared for, they are all very nice and the boys especially, are very respectful”. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected 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. The home enabled residents to exercise as much personal freedom and choice as possible and most of the residents were able to find some enjoyment with the great range of activities available. The meals at the home were good, offering choice and variety, and catered for most, but not all, dietary needs. This judgment has been made using available evidence including a visit to this service EVIDENCE: The residents spoken to said that they were satisfied with the way they were allowed to spend their day, more or less as they pleased. The home has full time activities organiser who arranges activities throughout the home. There is a varied programme of activities throughout the week and the programme of activities is displayed in the reception area, in the passenger lift and on each unit. In addition the activities organiser keeps a file for each unit in which she documents the activities that have taken place. Activities such as arts and crafts, reminiscence sessions and board games are undertaken. In addition outside entertainers are brought in on a regular basis. The residents were growing sunflowers and were taking part in a sunflower competition, to see whose flower grows the tallest. Earlier in the year residents and staff had taken part in a sponsored walk raising money and awareness for ‘Elder Abuse’. Consideration is being given Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 17 to participating in another event raising money for the Alzheimer’s Society. The home has access to a mini bus when available, which can be used for outside activities. The activities organiser, management and staff had organised a Hawaiian barbecue that took place on one of the inspection days. Several members of the staff dressed up in Hawaiian costume, the gazebos in the garden were decorated in Hawaiian style and Hawaiian style food was served. The staff made sure that most of the residents were taken down into the garden to enjoy the event. The Inspector saw that several of the residents were singing along to the music and were amused watching the antics of the staff who had dressed up in Hawaiian costume for them. The Inspector was told that in the previous weeks there had been several themed barbecue events, such as “The Land Girls, Gypsies, and Cowboys and Cowgirls.” Photographs of these events were displayed throughout the home. Some residents had enjoyed an outing going strawberry picking and some residents were going on a trip to Southport. There is also a tuck shop within the home. Residents can buy sweets, drinks and toiletries. On the Buckingham Unit there is a reminiscence pub called the “Wilton Arms”. This is open to all the units on specified days and times. Some residents do visit the Wilton Arms for a “pub lunch” Residents are encouraged to bring personal possessions into the home. Many of their bedrooms were highly personalised with small pieces of their own furniture, pictures, photographs and ornaments etc. Residents told the Inspectors that they are able to have visitors at any reasonable time and they can see their visitors in private. One resident on Sandringham told the Inspector “I am free to see my visitors wherever I want to. My daughter is always popping in and out”. The visiting policy is described in the useful and informative Service User Guide. The inspectors did not dine with the residents but observed lunch being served. The lunch was served from a heated trolley. There was a choice of meals and the residents were asked the day before what they would like to have. A cooked breakfast is served every day except Sunday. Lunch is a lighter meal and the main meal is served in the evening. Supper snacks are mainly cakes and a choice of milky drinks. Staff told the Inspector that the residents could have toast if they wished to. Sandringham The inspector saw that some members of staff were not wearing their protective blue aprons. To prevent cross contamination they must be worn. The system for serving meals in the rooms was not acceptable. The residents were not served their meals on a tray and therefore were not given serviettes, condiments or their drinks in a timely fashion. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 18 Buckingham As previously reported, the eating and drinking care plan of 1 Asian resident stated that he “prefers a Halal diet”. There was no evidence in the planned care that he was receiving a Halal diet and a discussion with the staff showed that he was not. Clarence The dining room is a large room comprising of the lounge and dining area. Small group tables are provided. Table were nicely set with tablecloths, condiments, a teapot and cups, flowers and the menu for the day. The majority of residents take their meal in the dining room, however those wishing to have them in their own room are accommodated. One resident also requested a meal, which was not on the menu, this was provided. Staff wore protective clothing whilst serving and supporting with meals. Residents with particular dietary needs are also catered for and support is provided with meals where necessary, information about individual preferences and dietary needs are recorded within the care plans. The Manager explained that times are being reconsidered for meal times as it is felt that residents are being rushed in the mornings so that breakfast can be served. It is unclear whether this is something, which residents had agreed to or whether this is due to staffing ratios and the tasks they required to do. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 19 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. The complaint system in place enabled residents to feel that their views were listened to and acted upon. Staff had a good knowledge and understanding of what abuse was, thereby reducing the possible risk of harm or abuse to residents. This judgment has been made using available evidence including a visit to this service EVIDENCE: A discussion with residents and relatives indicated that there was a general awareness of how to make a complaint It was clear in discussion with staff that they also knew what steps to take should a resident make a complaint The complaints procedure was displayed on each unit. It did not contain the address and telephone number of the CSCI. The contact details were however, on the complaints procedure that is included in the Service User Guide No complaints have been received about Rose Court since February 2006. A policy and procedure was in place in relation to the detection of abuse and neglect (including whistle-blowing) and how to respond to suspected abuse. The home had a copy of the Local Authorities procedure for protection of vulnerable adults. A discussion with care staff showed that they were aware of the different forms of abuse and the procedure to follow in the event of any allegation of abuse. Training records were inspected and showed that not all staff had received training in abuse awareness. The Inspector was informed that this is an ongoing process and that training sessions have been planned for the future. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 20 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, 20, 21, 24, 25 & 26 Quality in this outcome area is adequate. Although the residents were living in a clean and safe home, in parts it was in need of redecoration. This judgment has been made using available evidence including a visit to the service. EVIDENCE: There is level access to the front of the home with adequate parking both at the front and to the side of the home. As a security measure the front door is kept locked. The reception area is welcoming and this is where the administrators’ and the managers’ offices are situated. Clarence is situated on the ground floor, Sandringham on the first floor and Buckingham on the second floor. The first and second floors are accessed either by stairs or the passenger lift. The Inspectors visited each unit, walked around most of the building and looked at several bedrooms, the lounges, the dining rooms, bathrooms and toilets. The lounge/dining areas were clean, well decorated and suitably furnished. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 21 Each unit had some assisted bathing facilities and the toilets had aids to assist any resident with a disability or mobility problem Toilets are within close proximity of communal spaces. Each toilet and bathroom has a lock on the door to ensure privacy and the facilities were all clearly marked. The bedroom doors had an overriding door lock and a lockable facility was provided in some of the bedrooms. The following areas of the home need attention to the environment. Sandringham There remains only one assisted bath and one assisted shower for the whole unit. The manager told the Inspector that the Company has made provision in the October 06 budget for the provision of a new assisted shower. The decor in the toilets and bathrooms was poor. Ceiling tiles were badly stained, most of the woodwork was marked and several wall tiles were cracked. The bath in bathroom 7 was badly marked. The bedrooms were decorated to a good standard and some of the bedrooms had matching new furniture. Several of the bedrooms smelt of urine. These were bedrooms 26, 27, 31, 36 & 63. Buckingham The decor in the toilets and bathrooms was poor. Ceiling tiles were badly stained, most of the woodwork was marked and several wall tiles were cracked. The bedrooms were not looked at on this inspection. The Inspector was informed that the carpet in bedroom 107 had not been replaced. The corridor carpet remained stained and there was a strong smell of urine on parts of the corridor. Clarence Clarence Unit provides pleasant accommodation for the residents. The unit provides 21 single bedrooms 6 of which have en-suite toilets. There are also 2 bathrooms and a shower room however only 1 bathroom is assisted. Several toilets are available throughout the unit. Whilst looking around the home it was noted that a lot of the woodwork had been marked and scuffed and the sluice was not working. The Inspector was informed that this had been ongoing for some time. Alternative arrangements were unsuitable and do not ensure the prevention of cross infection. This must be addressed. The bar lock fitted to room 13 must also be removed. Designated domestic staff are identified for each of the floors however due to recent shortage cover was being provided throughout the home. The Manager was aware and already taking steps to address the matter. Adequate staff hand washing facilities were available in each of the bedrooms. The rooms were naturally ventilated and individually heated. Radiators were suitably protected. Emergency lighting is provided throughout the home and the lighting in resident areas was domestic in character. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 22 The laundry was clean well equipped and looked very well organised. Feedback from residents and a relative indicated that missing clothing was not a big problem Staff hand washing facilities were in place in bedrooms bathrooms and toilets and the home was clean, although as previously reported several bedrooms did smell of urine. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is adequate. The residents’ needs were being met although the staffing levels provided were the absolute minimum. The residents were cared for by staff that were safely recruited, who were suitably experienced and trained, and therefore had the knowledge and skills to meet the residents’ needs. This judgment has been made using available evidence including a visit to the service. EVIDENCE: Sandringham Examination of the duty rotas and a discussion with staff and residents showed that the unit was working on minimum staffing levels. There were 23 residential and 17 nursing residents on the unit. It was identified on the nursing side that 12 residents needed assistance with eating and 15 residents were moved by using the hoist. Staff told the Inspector that it was during the morning and meal times that they felt the most pressure. The nursing unit was working with 1 qualified nurse and 2 care assistants between the hours of 8 a.m. to 8 p m and the residential side was working with 3 care assistants between the hours of 8 a.m. to 8 p.m. These are absolute minimum staffing levels. Management are reminded of their responsibility to ensure that staffing is provided in accordance with residents’ needs and not the number of residents The duty rosters did not document the designation of the staff members. To ensure that an accurate duty roster is in place these details must be added. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 24 Buckingham The unit is divided into 2 separate areas and there are 2 separate duty rotas. There is Buckingham on one side and Kensington on the other. The registered nurses have responsibility for a designated area. Examination of the duty rotas and a discussion with the staff identified that there was sufficient care staff on duty to meet the needs of the residents. The duty rosters did not document the designation of the staff members. To ensure that an accurate duty roster is in place these details must be added Clarence On the day of the visit there were 16 residents living on Clarence Unit with 2 staff providing the support. The rota evidenced that 2 staff were provided throughout the day and then 2 at night, any surplus staff were taken off the rota to work on one of the other units who also appear to be working with low staffing levels. Both staff spoken with felt that whilst they managed the support required this at times was a struggle. Looking at the particular needs of the residents it was noted that of the 16 people living there, 5 needed 2-to-1 support. It concerned the Inspector with regards to how this was to be provided as one the carers on duty was 24 weeks pregnant therefore was not undertaking such tasks. A workplace risk assessment had not been discussed with the carer. This should be completed to ensure that both staff and residents are safe. It was also noted that both carers were on duty for 12 hours (8am till 8pm) and that they would take periodic breaks throughout the day. This would mean that 1 member of staff would be left on the floor. The Registered Manager stated that should the member of staff need any support then this could be provided by the admin staff, herself or the activity worker, all of which work close to the unit. These arrangements are poor and should be reviewed. One of the staff members spoken with expressed that she enjoys her work however at time felt it was difficult to do all the tasks necessary due to the lack of staff. There were several male residents living at Rose Court and also several male carers and nurses. This gave the residents, at times, a choice of whom they wished to care for them. The Company is an Equal Opportunities employer. One member of staff has a physical disability but copes extremely well with the job that she does. Of the 47 care staff employed 11 have obtained their NVQ level 2 or above in care. This is a percentage of 23 and therefore the home has not yet met the Standard. The personnel files of 3 staff members were inspected. All were in order and these staff had been properly and safely employed. They had a completed application form, 2 professional references, an enhanced criminal records disclosure (CRB) check and a health status declaration. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 25 Training opportunities made available to staff including formal and in-house courses. Information is provided to each of the units with regards to what course are available for carers and senior staff, staff are then scheduled to attend. Staff spoken with confirmed this. Training records were in place. These showed training has been or is programmed to be, undertaken in the following areas: Moving and Handling. Fire Safety. First Aid. Food Hygiene. Infection Control. Health & Safety Medication Management. Nutrition Protection of Vulnerable Adults Promotion of Continence Person Centred Care Dementia Awareness Challenging behaviour Further courses have been arranged for the later part of the year, these included marketing and budgets, building on strengths, pre-admission assessments and accountability. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 26 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): 31,33,35 & 38 Quality in this outcome area is good The manager provided effective leadership and support to staff and was aware there were still areas to be improved upon which would benefit the residents. A satisfactory accounting system was in place that ensured the residents’ interests were protected. Current practices within the home in relation to the maintenance of a safe environment, promoted and safeguarded the health, safety and welfare of the people using the service. EVIDENCE: The registered manager is a Registered General Nurse who has extensive experience of working within the field of caring for the elderly. Her area of specialist clinical interest is Gerontology. She has obtained a Masters degree in this subject. The manager has a qualification to NVQ Level 5 in management and also a certificate in Nursing Home Management. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 27 The manager was able to demonstrate that she had undertaken periodic training to update her skills and knowledge. The Registered Manager on a monthly basis undertakes internal audit, this includes exploring issues related to the environment, pressure care survey, accident statistics, care plan audit and medication. This is then followed by a validation audit by the Operational Manager who also completed the Regulation 26 monitoring visit. Feedback is sought using the customer feedback surveys, which are sent out on a 6-monthly basis. All feedback is received by head office and then shared with the home. Systems for seeking feedback from staff could be improved, such as the supervisions system. Whilst some staff have received supervision this is not consistent. This should be developed further so that all stakeholders have an opportunity to be involved in the monitoring and development of the home. The system for the safekeeping of residents’ finances was good. The management of residents’ finances are generally undertaken by their families or designated representative. Generally only personal allowances are held by the home in a residents’ account. Individual computer records are made of all transactions and balances. Receipts are held for any purchases made and receipts are given to relatives when they deposit any “spending money” for their relative. The home had a detailed Health & Safety Policy. Regular weekly checking and testing of fire detection system, fire exits and emergency lights was undertaken and documented. Any accidents that happen are properly recorded and monitored. The equipment and services within the home were serviced on a regular basis in accordance with the individual requirements. Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 28 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 3 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 2 x x 2 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 14 Requirement Clarence That action identified within the body of the report is addressed ensuring residents’ needs are accurately reflected along with the appropriate level of support. Clarence That accurate records are held, ensuring information is signed and dated. (Outstanding requirement) Clarence That risk assessments reflect the current needs of service users and are reviewed on a monthly basis or more frequently if necessary. (Outstanding requirement) Timescale for action 31/08/06 2 OP7 17 31/08/06 3 OP7 13 31/08/06 4 OP8 12 All units 31/10/06 That arrangements in relation to consent to treatment are appropriately agreed and clearly documented within the plan. Clarence That records are completed with DS0000017336.V298002.R01.S.doc 5 OP9 13 16/08/06 Rose Court Nursing And Residential Home Version 5.2 Page 30 regards to the administration of creams. (Outstanding requirement) 6 OP9 13 & 17 Clarence That MAR sheets are signed following administration of all medication or the relevant code entered. (Outstanding requirement) Clarence The office door must be locked when not in use to ensure that the medication is held securely and safely. Sandringham Medications no longer required must be documented in the returns book and returned to the agency responsible for disposal. Buckingham Controlled drugs must be disposed of when they are no longer required. Buckingham Unlabelled medications must be disposed of. Sandringham Residents’ cultural dietary needs must be met. Earl of Wilton The small kitchen on the unit needs to be kept clean and redecorated. A refurbishment plan must be forwarded to the CSCI by the time frame of 31/10/06 16/08/06 7 OP9 13 16/08/06 8 OP9 13 16/08/06 9 OP9 13 16/08/06 10 11 12 OP9 OP15 OP19 13 16 23 16/08/06 31/08/06 31/10/06 13 OP21 23 Sandringham 31/10/06 A further assisted immersion bathing facility must be provided A refurbishment plan must be forwarded to the CSCI by the time frame of 31/10/06. (Previous timescales of 31/01/06 DS0000017336.V298002.R01.S.doc Version 5.2 Page 31 Rose Court Nursing And Residential Home 14 OP21 23 & 30/06/06 not complied with) Sandringham & Earl of Wilton The toilets and bathrooms must be redecorated/retiled. A refurbishment plan must be forwarded to the CSCI by the time frame of 31/10/06. (Previous timescales of 31/3/05 & 31/01/06 & 30/04/06 not complied with) Sandringham The smell of urine in bedrooms 26 27 31 36 & 63 must be eradicated. Earl of Wilton The corridor carpet and the carpets in bedroom 107 must be replaced. An refurbishment plan must be forwarded to the CSCI by the time frame of 31/10/06 Sandringham & Earl of Wilton The ongoing programme of furniture provision and redecoration for the bedrooms must continue. A refurbishment plan must be forwarded to the CSCI by the time frame of 31/10/06. (Previous timescales of 31/3/05 & 31/01/06 & 30/04/06 not complied with) 31/10/06 15 OP24 16 31/08/06 16. OP24 16 31/10/06 17. OP24 16 & 23 31/10/06 18 OP24 23 19 OP24 13 Sandringham & Earl of Wilton 31/10/06 A lockable space must be provided in each residents’ bedroom. A refurbishment plan must be forwarded to the CSCI by the time frame of 31/10/06. (Previous timescales of 31/3/05 & 31/01/06 & 30/04/06 not complied with) Clarence 16/08/06 That the bar lock on room 13 is removed. DS0000017336.V298002.R01.S.doc Version 5.2 Page 32 Rose Court Nursing And Residential Home 20 OP26 13 Clarence 31/10/06 That arrangements are made for the sluice facility on Clarence Unit to be repaired or replaced to ensure that health and safety requirements are met. Sandringham To prevent cross contamination care staff must wear protective clothing when serving meals. All units. The Registered Person must review the adequacy of the daytime staffing levels to ensure that sufficient staff are provided to meet all of the care needs of the residents. Sandringham & Earl of Wilton The designation of all staff must be documented on the staff rotas. 15/08/06 21 OP26 13 22 OP27 18 15/08/06 23 OP27 17 16/08/06 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 2 Refer to Standard OP3 OP15 Good Practice Recommendations That the assessment document is expanded upon to include all relevant areas as detailed within Standard 3.3. For those residents taking their meals in their rooms serious consideration needs to be given to serving the meals on suitably equipped trays. The contact details of the CSCI should be included in the complaints procedure that is on display. The system of quality monitoring should be developed to include feedback and inclusion from all stakeholders 3 4 OP16 OP33 Rose Court Nursing And Residential Home DS0000017336.V298002.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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. 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