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Inspection on 06/09/05 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 6th September 2005.

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

The inspector found 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

The care plans were very good. They contained a lot of important information about what the residents needed help with, and how they were to be cared for. The home had a group of qualified nursing staff and care assistants who had worked there for quite a long time. A relative stated that she trusted the staff, they were "great" "brilliant" "bob on" and kept her informed. The home has a commitment to ongoing staff training and learning and has provided the manager and care team with the knowledge and skills they need to protect and meet the needs of the residents.

What has improved since the last inspection?

Management had made good progress in ensuring that most of the things that needed improving from the last inspection had been done. Although all of the building was not looked at in detail on this inspection, the inspector saw that new furniture had been provided for many of the bedrooms. There had been a big improvement in how the meals were being served. In both the dining rooms the food was always served from the hot trolley.

What the care home could do better:

To make sure that the residents have a well furnished, comfortable and pleasant bedroom, management must continue to supply new, matching bedroom furniture.

CARE HOMES FOR OLDER PEOPLE ROSE COURT (EARL OF WILTON UNIT) 44-48 Water Street Radcliffe Manchester M26 4DF Lead Inspector Grace Tarney Unannounced 6 September 2005 th 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 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 (EARL OF WILTON UNIT) F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Rose Court Address 44-48 Water Street Radcliffe Manchester M26 4DF 0161 724 9040 0161 724 5357 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Home Properties Limited Mrs Catherine Shawarby CRH N Care Home with Nursing 109 Category(ies) of OP Older Persons - 65 registration, with number DE Dementia - 2 of places DE(E) Dementia Over 65 years - 42 ROSE COURT (EARL OF WILTON UNIT) F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The home is registered for a maximum of 109 service users to include: 65 Older People (OP); and 42 Dementia - over 65 years of age (DE(E)), and two name service users in the category of Dementia (DE) under 65 years of age. Once placement for these two named people have ended the previous registration category (DE(E)) will be reverted to. The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. Date of last inspection 18th January 2005 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 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 floosr are reached either by stairs or a passenger lift. This report is about the Earl of Wilton Unit.. The unit has two large lounge/dining areas and a reminiscence lounge that is fitted out to resemble a old public house. Accomodation is provided in mainly single bedrooms,eight of which have an ensuite facility of toilet and wash handbasin. The toilets and bathrooms have aids to assist any resident with a disability or mobility problem. ROSE COURT (EARL OF WILTON UNIT) F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unit was not made aware that this inspection was to take place. This was an unannounced inspection. The inspector spent 4 hours on the unit. During this time she looked at care and medicine records to check that the health and care needs of the residents were being met. The Inspector then visited residents in their own bedrooms to check out the care that was being provided for them. In order to obtain information about the home the inspector also spent time speaking to 1 relative, 2 care assistants, 2 qualified nurses and the manager Not all the National Minimum Standards were looked at on this visit. During the next inspection the inspector will look at the rest of the Standards that are considered to be important for the residents safety and well-being. These are the Standards that have to be inspected at least once a year. What the service does well: What has improved since the last inspection? What they could do better: ROSE COURT (EARL OF WILTON UNIT) F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc Version 1.40 Page 6 To make sure that the residents have a well furnished, comfortable and pleasant bedroom, management must continue to supply new, matching bedroom furniture. 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 (EARL OF WILTON UNIT) F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection ROSE COURT (EARL OF WILTON UNIT) F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 3. The Statement of Purpose provides enough information about the services provided by the home to allow an informed decision about whether the home can meet a residents’ needs. The system for ensuring that all prospective residents had a detailed assessment undertaken before their admission to the home, gave an assurance both to residents, relatives and staff, that a resident was only admitted if the home could meet their needs. EVIDENCE: The Statement of Purpose was detailed but it needs to be amended to reflect the fact that there has been a change in the registered provider. The registered provider must ensure that the amended Statement of Purpose sets out the new company’s aims, objectives and philosophy of care. Before any resident was admitted to the home an assessment of their needs was undertaken either by a senior member of the nursing staff from the home or from the professional i.e. care manager, requesting their admission. The assessments were detailed and gave a clear indication of their needs and their capabilities. The assessments looked at the physical, mental and social care needs of the residents as well as the involvement if any, of their relatives. ROSE COURT (EARL OF WILTON UNIT) F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7,8,9,10 &11. The care plans reflected the support needs of the residents. Care practices ensured that the residents’ health care needs were met, that they were treated with respect and their dignity was upheld. The medication system in place was safe and residents received their medicines correctly. EVIDENCE: Individual care plans were in place for each resident. The care plans of two residents were examined. The care plans gave clear instruction and guidance on how the care needs of the residents were to be met when problems had been identified. The daily report was kept with the care plan. This is good practice. The care plans were evaluated as and when necessary, but at least on a monthly basis. Risk assessments were in place and covered such areas as moving and handling, nutrition, pressure sores, use of bed rails, general safety and falls. The residents were weighed at least on a monthly basis and the weight recorded on a chart kept in their care plan. The home also has a Malnutrition Universal Screening Tool. This allows close monitoring of weight loss and nutritional risks. Inspection of care records identified that residents had access to other health care professionals such as dentists, opticians and chiropodists. ROSE COURT (EARL OF WILTON UNIT) F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc Version 1.40 Page 10 Equipment necessary for the prevention and treatment of pressure sores was available within the home. Concerns were raised however about the issue of the unit not having its own suction machine. In view of the fact that 2 of the residents have swallowing problems and that the residents on the unit, by the nature of their condition can be susceptible to choking, there must be at least one suction machine on the unit. Continence aids were in use and the staff were aware of how to contact the continence nurse advisor for advice, if deemed necessary. A safe system of medication management was in place. The medicine room was kept locked and medications were securely stored. Staff were reminded however, of the requirement to ensure that the temperature of the drugs fridge is taken and recorded on a daily basis. Due to changes in legislation, a new system for returning medications was in operation. The home was complying with the new requirements, however it seemed a cumbersome and time consuming operation for the staff. Large amounts of medication were awaiting disposal, which is now on a 3 monthly basis. The inspector has requested a visit from the CSCI pharmacist to seek her views and any possible advice that she may have. In the interim, staff should ensure that there is a written procedure in place in relation to the new system for disposal of medications and a risk assessment undertaken. During the inspection staff members spoke with residents in a kindly and respectful way. Staff spoken to gave examples of how privacy and dignity were promoted. Staff gave good practice examples of how they would care for a resident who was terminally ill. ROSE COURT (EARL OF WILTON UNIT) F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc Version 1.40 Page 11 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 standard(s) 15. The dietary needs of the residents were well catered for. EVIDENCE: The inspector did not dine with the residents but observed lunch being served. The tables were nicely set with napkins and cruets. Hot and cold drinks were served. A light meal is served at lunchtime and the main meal is served in the evening. On the day of inspection lunch was either soup and sandwiches or hot pot. The food is served from a heated trolley. This trolley is taken to both dining rooms to ensure that the food is served hot and therefore appetising. A discussion with the care staff identified that the breakfast menu is varied. A full cooked breakfast is served once weekly and eggs, served in various ways, are on the menu daily. There is a board in each dining area that displays what the menu is for the day. This had not been updated however and showed the previous Sundays’ menu. Staff wore protective clothing and assisted service users appropriately. ROSE COURT (EARL OF WILTON UNIT) F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc Version 1.40 Page 12 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 standard(s) 18 Despite formal training not yet being undertaken for all the staff, they have a good knowledge and understanding of adult protection procedures, thereby reducing the possible risk of harm or abuse. EVIDENCE: A copy of the Local Authorities Vulnerable Adults Procedure was in place and a discussion with staff identified that they were aware of the procedure to follow in the event of any allegation of abuse. The manager informed the inspector that some staff had undertaken training in the protection of vulnerable adults but the 4 staff spoken to by the inspector had not received any training in this area. ROSE COURT (EARL OF WILTON UNIT) F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc Version 1.40 Page 13 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 standard(s) EVIDENCE: Standards 19 and 26 will be a looked at in detail during the next inspection. Compliance was checked however with regards to the previous requirements relating to the environment. These were as follows: The grounds were untidy and not easily accessible to residents. This had been complied with. The grounds and the forecourt had been well tended with lots of flowerbeds and plant pots. There was plenty of garden furniture in place for the use of the residents. A gazebo was in place for the use of the residents. Staff pointed out that the guide ropes securing the gazebo were a trip hazard for the residents. Staff stated that even though the residents are supervised in the garden they are allowed to wander around without physical assistance. The pub reminiscence room must have a call bell in situ. ROSE COURT (EARL OF WILTON UNIT) F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc Version 1.40 Page 14 This had been partially complied with. A call bell was in place but needs to be more visible. It has been painted over to blend in with the mural. It was difficult to actually activate the call button. A call lead must therefore be provided. The carpet in the pub reminiscence room was very stained. It needs deep cleaning or replacing. This had been complied with. Several of the bedrooms were without a lockable space. This had been partially complied with. There was an ongoing programme of furniture provision and each new chest of drawers had an integral lockable space. Several bedrooms had mismatched furniture. This had been partially complied with. There was an ongoing programme of furniture provision. Bedrooms 74 & 91 had a smell of urine. This appeared to emanate from the carpets. These carpets must be cleaned or replaced. This had been complied with. Staff hand washing facilities were not in place in the en-suite toilets This had been partially complied with. Room 96 remained without staff hand washing facilities. ROSE COURT (EARL OF WILTON UNIT) F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27. The residents were cared for by sufficient numbers of staff that were suitably qualified and trained and therefore had the knowledge and skills to meet the residents’ needs. EVIDENCE: Examination of the duty rota and a discussion with staff and a relative showed that there was enough staff on duty to meet the care needs of the residents. 24-hour nursing care continues to be provided by qualified nurses. Suitably trained care assistants support them. Although training records were not inspected during this visit, staff told the inspector that there was an ongoing commitment to staff training. Staff stated that they felt valued. ROSE COURT (EARL OF WILTON UNIT) F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Standards of 33, 35 and 38 will be looked at during the next inspection. ROSE COURT (EARL OF WILTON UNIT) F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x x x x x x x ROSE COURT (EARL OF WILTON UNIT) F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc Version 1.40 Page 18 Yes Are there any outstanding requirements from the last inspection? 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 1 Regulation 4& Schedule 1. Requirement Timescale for action 31/1/06. 2. 3. 4. 8 9 9 5. 6. 7. 8. 18 19 20 24 The Statement of Purpose needs to be amended to reflect the fact that there has been a change in the registered provider. The registered provider must ensure that the amended Statement of Purpose sets out the new company’s aims, objectives and philosophy of care. 13(4)(c) At least one suction machine 23(2)(n) must be provided for the sole &16(2)(c) use of the unit. 13(2) The temperature of the drugs fridge must be taken and recorded on a daily basis. 13(2) Staff must ensure that there is a written procedure in place in relation to the new system for disposal of medications and a risk assessment undertaken. 13(6) All care staff must have training in the protection of vulnerable adults. 13(4)(a) Staff must ensure that the ropes attached to the gazebo are not a trip hazard. 13(4)(a) A call lead must be provided in the pub reminiscence room. 16(2)(c) & There must be an ongoing 23(2)(m) programme of furniture provision for the bedrooms.(Previous F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc 31/10/05. 7/9/05. 31/10/05. 31/1/06. 7/9/05. 7/9/05. 31/1/06. ROSE COURT (EARL OF WILTON UNIT) Version 1.40 Page 19 9. 26 13(3) timescale of 31/3/05 not complied with) Staff handwashing facilites must be provided in all ensuite rooms..(Previous timescale of 31/3/05 not complied with) 31/10/05. 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 15 Good Practice Recommendations Staff should ensure that the daily menu is displayed on the dining room notice board. ROSE COURT (EARL OF WILTON UNIT) F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI ROSE COURT (EARL OF WILTON UNIT) F56 F06 S17336 Rose Court (Earl of Wilton Unit) V237870 060905 Stage 4.doc Version 1.40 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!