Inspection on 15/08/06 for Rose Hill Nursing Home

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 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.

Other inspections for this house

Rose Hill Nursing Home 17/05/07

Rose Hill Nursing Home 21/04/06

Rose Hill Nursing Home 15/11/05

Rose Hill Nursing Home 07/06/05

Rose Hill Nursing Home 20/01/05

Rose Hill Nursing Home 01/07/04

Rose Hill Nursing Home 30/12/03

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Rose Hill Nursing Home 9 Rose Hill Dorking Surrey RH4 2EG Lead Inspector Lesley Garrett Key Unannounced Inspection 15th August 2006 08:00 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 Hill Nursing Home DS0000013349.V307550.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 Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rose Hill Nursing Home Address 9 Rose Hill Dorking Surrey RH4 2EG 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) 01306 882622 01306 741450 Rose Hill (UK) Limited Mrs Josephine J. O. Abiona Care Home 35 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (35), of places Physical disability over 65 years of age (2) Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Of the 35 residents accommodated, up to 3 may fall within the category DE(E) Of the 35 residents accommodated, up to 2 may fall within the category PD(E) The age range for residents is: 65 YEARS AND OVER Up to 3 beds may be used for the provision of respite care Up to 2 persons may be cared for on a day care basis between 08.3018.30 21st April 2006 Date of last inspection Brief Description of the Service: Rose Hill Nursing Home is situated in a quiet residential area of Dorking in Surrey. The building appears to be Victorian in origin and is surrounded by a pleasant garden area. Accommodation is arranged on three floors, accessed by a passenger lift. The accommodation consists of single and double bedrooms, some of which have en-suite facilities. There is a communal lounge and dining room. There is a small car parking area to the front of the property, and also on road parking nearby. The facilities of Dorking are within close proximity. Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit was held over two days as part of a key inspection. The first was on the 15th August 2006 over eight hours commencing at 0830 and ending at 1630. The second visit was took place on 22nd August 2006 commencing 0800 ending at 1900. Lesley Garrett, Lead Inspector for the service carried out the inspection and was joined by Suzi Magnier, Regulation Inspector, for the second visit. The registered manager represented the establishment for both visits and the provider was present for feedback on the second day. The inspectors carried out a tour of the premises and visited every bedroom and spoke to some service users, visitors to the home and some staff. Policies and procedures, care plans, recruitment folders and service user contracts were all sampled to aid the inspection process. The inspectors would like to thank the service users, the manager and staff for their assistance with this inspection. What the service does well: What has improved since the last inspection? The registered manager told the inspector that she has now completed her registered managers award. A quality audit system is in place at the home and this also seeks the views of the service users, which is then fed back to them and their relatives or representatives at a meeting. Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 6 What they could do better: A number of requirements have been made and these can be viewed in detail at the end of the report. The majority of the requirements concern the environment and equipment in the home. The inspectors noted that the morale of the staff is quite low and this was confirmed when the inspectors spoke with them. The statement of purpose and service user guide must be changed so that any extra costs that the service users may incur for example the fee for escorting service users off the premises and administration charges must be added so that prospective service users have the information required for them to make an informed choice about the home. There is a lack of equipment in the home for use by the service users and staff. The inspectors observed one shared room sharing a commode and some of the commodes are poor in quality and are not all user-friendly. The beds in the home are divan type, which are not suitable for the needs of the service users requiring nursing care. The dining room furniture needs to be assessed to ensure that service users can eat their meals in comfort and there is enough space for the staff to support service users with their meals. The garage is used as a storage facility but this has a sign warning about white asbestos and this needs professional assessment. Some of the rubbish needs to be removed and the freezers and fridge need to be assessed for the suitability, as the lid of one freezer is rusty and worn. The proprietor told the inspector that he would clear the rubbish very soon. Action needs to be taken in this area to ensure the welfare and safety of service users and staff. The laundry and ironing room needs to have a risk assessment completed and both these buildings need to be refurbished although the provider told the inspector that this was planned for the next four months. The staffing levels in the home need to be increased by at least one nurse per shift as the inspectors found some service users still in bed at 1130 and staff unable to take a break. The proprietor told the inspectors that the home had empty beds but the inspectors had seen no change in the dependency levels of the service users. The required increase in staffing levels will ensure there is sufficient staff on duty to meet the current needs of service users. Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 7 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 Hill Nursing Home DS0000013349.V307550.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 Hill Nursing Home DS0000013349.V307550.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. This judgement has been made using available evidence including a visit to this service. All service users that move into the home have their needs assessed by someone competent to do so and are then assured that their needs would be met. The home has no intermediate care beds. EVIDENCE: During the inspection the inspectors were advised that the home charges £15.00 per hour for a service user to be escorted to hospital and administration charges are made for all bills handled by the home. A requirement has been made that the charges are included in the homes Statement of Purpose and Service User Guide in order that service users are fully aware of the terms and conditions of their stay in the care home. Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 10 The manager carries out pre admission assessments prior to service users moving into the home to ensure that their needs will be met. On the day of the first site visit she joined the inspector following one of these assessments as the home does have some empty beds. The documentation used assesses the activities of daily living and the manager stated that the care plans are then generated from this assessment. The home does not have intermediate care beds. Rose Hill Nursing Home DS0000013349.V307550.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 poor. This judgement has been made using available evidence including a visit to this service. The service users individual plans of care are comprehensive and demonstrate that their health and personal care needs are identified. However the needs of the service users are not fully met as a result of the staffing levels in the home (please refer to comments under staffing). The home has policies and procedures in place for the safe handling of medications. The practices in place at the home do not fully promote the respect, dignity and privacy of service users. EVIDENCE: The inspector sampled some individual plans of care and found them to be of a good standard and contained all information required to enable staff to deliver the care required. Risk assessments were also in place and there was evidence that monthly reviews take place. The manager told the inspector that they have good support from their local general practitioner who visits the home every week and reviews at least five service users so that during the month all service users have been seen and Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 12 reviewed and any service user who is unwell will also be seen. Medication reviews also take place at this time the manager stated. Other visiting professionals to the home includes the dentist who visits every six months, opticians twice a year, physiotherapist and the general practitioner refers to the dietician and speech and language therapist when required. The inspector looked at the medication procedures and documentation and found this to be of a good standard. The manager stated that she now carries out weekly medication audits to ensure good practice and the inspector noted there were no gaps on the medication administration records and the controlled drugs were sampled and no inaccuracies found. Since the last inspection the home has written a privacy and dignity policy but the inspectors raised some areas of concern with the manager and proprietor. During the tour of the laundry the inspectors noted that a service users cardigan had been badly damaged for example had shrunk in the wash. It is required that arrangements are in place to ensure that the home is conducted in a manner, which respects the service users belongings. The inspectors noted that throughout the home lists of the names of service users were attached to walls for fire evacuation purposes. The lack of privacy and confidentiality was discussed with the proprietor and manager and a requirement has been made that the notices are removed in order to ensure the privacy and confidentiality of the service users. In one service users bedroom the inspectors found that the bed linen was worn and soiled and had been put back on the bed following the service user being supported to sit in their chair. The service users hair comb was dirty and needed cleaning. A requirement has been made that the home provides in rooms occupied by service users adequate bedding and the home is conducted in a manner, which respects the dignity of service users. The provision of personal care and the gender of staff on duty were discussed with service users. One individual female service user stated that she would prefer the staff to ask her whether she preferred a male or female carer to attend to her needs prior to them doing so. Staff on duty were observed wearing protective clothing and were attentive to the appropriate disposal of clinical waste and soiled linen. Service users dignity and privacy were observed by staff knocking on the service users doors prior to entering the room and service users were addressed in a polite and courteous manner by all staff. Rose Hill Nursing Home DS0000013349.V307550.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Activities at the home are not always carried out as planned but visitors are welcomed into the home by the staff. The food at the home was of a good standard however it is required that the home must review the current skills, practice of staff supporting service users and equipment/crockery available at meal times. EVIDENCE: The home employs an activity organiser and in conjunction with the registered manager they have implemented an activity programme, which is displayed in reception and available to all service users. The inspectors noticed during the tour of the home that some of the programmes in the rooms were out of date and referred to the activities for January to March 2006. The manager stated that during the morning the activity organiser visits the service users on a one to one basis and the afternoons are devoted to large group activities. On the first site visit the inspector attended the afternoon exercise class in the lounge and although all the service users were ready the Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 14 activity organiser had been sent to the pharmacy to collect medication, as she was the only person with a car. The home has little community contact and this is an area that the organiser and registered manager could explorer.The inspectors observed many visitors to the home of family and friends and they were always made welcome by the staff. One relative told the inspector that she had lunch with her husband every week and was always made to feel welcome. During the initial site visit the inspector noted that dried foodstuffs had not been stored/labelled in compliance with the current food safety regulations. It was noted that the home had met the immediate requirement made and all containers had been labelled and the pantry area in the kitchen was clean and well presented. On the second site visit the inspectors noted that a container of prunes had been left unlabelled in the homes refrigerator. A requirement has been made that the all food is stored in compliance with the current food safety legislation in order to ensure that the safety and wellbeing of all service users within the care home. During the course of the second site visit the serving of the midday meal was observed. This was of a good quality with a variety of fresh vegetables. Homemade cake was observed to be on the menu for afternoon tea. The dining area within the home had a selection of individual tables, which seated 20 service users, some in wheelchairs and with varying meal- time support needs. The furniture was worn and an assessment should take place on the dining room furniture to assess the suitability for the service users and staff who need to support them. The lighting in the dining room was viewed as inadequate for the needs of the service users with visual impairment. The lighting in other communal areas and bedrooms appeared dull and this also needs to be assessed. The service users sitting in wheelchairs were at a distance from the table, which caused difficulty for them to sit up appropriately in order to reach their meal comfortably. The tables were noted to be well-decorated and contained cutlery, condiments and napkins. The inspector noted that several service users had a different meal, which promoted choice and preference. Kitchen staff served the plated midday meal from the servery, which was brought to the dining room by care staff and served to the service users. There was observed to be little or no interaction between the two care staff and service users during the midday meal. One staff member was observed to take the fork from a service users hand without permission and preceded to feed the service user with the meal, which was not tested by the carer regarding the temperature thus potentially causing harm through burning to Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 15 the service user. The staff member was also observed to cut a service users meal whilst standing above them and did not seek permission or interact in any way with the service user. Another incident involving a senior member of staff forcibly feeding a service user has been reported under the section of protection within the report. Due to the level of dependency regarding the service users meals times it was observed that the activities organiser was deployed to support service users eating their meals. This was discussed with the proprietor and registered manager during the feedback at the close of the visit and called into question the staffing levels in the home, which are reported in more detail in the staffing section of the report. Due to the concerns raised it is required that the home must review the current skills and practice of staff supporting service users at meal times, the furniture, lighting and décor available to service users, must be individually assessed, and to ensure that meal times are unhurried and a pleasurable activity for service users. The home uses disposable bibs and several service users bibs were soiled by a trail of food, which looked undignified and unsightly. Rose Hill Nursing Home DS0000013349.V307550.R01.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 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 adequate. This judgement has been made using available evidence including a visit to this service. Service users and their relatives and friends are protected by the homes complaints and safeguarding policies. EVIDENCE: The home has a complaints policy and this is available to all service users and is displayed in reception. There is a complaints log for the home, which the manager showed the inspector and a recent complaint had been logged regarding a service users personal belongings. The manager had just started an investigation into this concern. During the visit a senior staff member was observed forcibly feeding a service user who was clearly indicating that she did not want any more food. The staff member was noted as standing over the service user and whilst leaning down, the service user was pulling the staff member’s hair. The registered persons were advised to immediately refer this incident under the local authority safeguarding adult’s procedures to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Appropriate action was immediately taken by the registered person regarding the conduct of this member of staff and this ensured that the service users in the home were safe and their welfare promoted. Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 17 Rose Hill Nursing Home DS0000013349.V307550.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 21 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment needs to be refurbished internally and externally to ensure that both service users and staff live and work in a well-maintained environment. The home does not provide adequate lavatories and suitable washing facilities to meet the service users needs. The laundry facilities are not adequate to meet the needs of the service users and could present staff with a health and safety issue. EVIDENCE: The laundry is sited externally to the main building and comprises of two out buildings, which consist of an ironing room and the laundry. The staff told the inspectors that there is often a backlog of laundry, especially after a weekend. Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 19 The inspectors observed that there were a variety of health and safety concerns within the laundry area, which included soiled linen in close proximity with clean linen. It is required that the home ensures that the arrangements of handling soiled and clean laundry are in place to prevent infection, toxic conditions and the spread of infection at the home. The space in the laundry was cramped and cluttered and it was observed that the space could potentially cause harm to a person working in the laundry with regard to moving and handling issues. The inspectors were advised that the service engineers have been known to climb through a window in the laundry to gain access to the back of the washing machines. It is required that the home makes suitable arrangements for the staff to undertake safe moving and handling and access in the laundry area. The flooring of the laundry was worn and damaged and required replacing due to the potential trip /slip hazards. It is required that the homes premises are kept in sound construction and in a good state of repair and the flooring of the laundry is replaced. During the feedback to the proprietor and the registered manager at the close of the site visit the proprietor advised the inspectors that plans were being discussed to seek planning permission to rebuild the laundry area within a four month time span. The ironing room comprised of a wooden shed, which had a cardboard lined ceiling, which was noted to be damp. The step into the laundry area was made of brick and was noted to be potentially hazardous with regard to a trip hazard. Service users clothes were stored in individual marked plastic containers on shelves. The staff member allocated to work in the laundry advised the inspectors that the room was cold in the winter and the only source of heating was a portable radiator. It is required that the premises of the ironing room is risk assessed to include the hazards identified during the inspection and the ironing room is kept in a good state of repair both externally and internally. The area by the laundry/ironing room and garage was noted to be littered with various items of rubbish, which included a macerator, used cardboard, bricks, roof tiles and a bidet. The garage area was also cluttered with armchairs, mattresses, tables, walking frames/sticks and disused wheelchairs. It is required that the rubbish is removed, as discussed during the feedback with the proprietor, and a risk assessment with action plan provided to the CSCI by the registered person in order to ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. The inspectors met with the homes chef and discussed the storage of foodstuffs in several freezers, a fridge and a cupboard within the garage. The inspectors noted that vegetables were stored in the cupboard and one freezer was in a state of disrepair for example condensation was noted on the side of Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 20 the freezer and the lid was rusting. The fridge, which was being used to store vegetables, was viewed as dirty and required cleaning. Concern was raised regarding foodstuffs being brought into the home and passing the general and clinical waste bins. A requirement has been made that the home must ensure that all food is stored in compliance with food hygiene standards to ensure as far as reasonably practicable the home is free from hazards to service users safety and unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. The inspectors noted that signs alerting people in the garage to the presence of white asbestos and not to damage the walls were present. A requirement has been made that home arrange for an external specialist to undertake a risk assessment regarding the presence of the white asbestos in the garage in order to ensure that the premises of the care home are of sound construction and kept in a good state of repair both internally and externally. It was noted that the home had a significant number of divan beds and a minimal number of adjustable high/low profiling beds, which assist in the comfort and safe moving and handling of service users. It is required that the home review the number of adjustable beds for service users receiving nursing care to ensure that service users have the specialist equipment they need to maximise their independence, comfort and promote safe moving and handling techniques. The bathrooms and toilets throughout the home were clean. It was observed that one service user requested to use the toilet and was told by a staff member that they would be supported downstairs, as it was lunchtime. When questioned about this arrangement it transpired that the toilet on the first floor was not suitable for use by the service user who required moving and handling. In addition the double room in which the service user was accommodated contained one commode and it was observed that the service user was not offered to use the commode but was taken downstairs. A bathroom seen by the inspectors contained a Parker bath and the proprietor and registered manager advised the inspectors that the home has Parker baths throughout the building. It was noted that the use of the Parker bath on the first floor was restricted, as a portable hoist could not be used due to the site of the bath and the lack of space within the bathroom. A requirement has been made that the home provides at appropriate places within the premises sufficient number of lavatories and bathrooms suitable to the needs of the service users. The home uses portable hoists to support service users with moving and handling. Several hoists inspected indicated that they had been recently serviced and maintained. The inspectors observed two staff members supporting a service user without using a transfer belt causing a potential risk to the service users and staff members. A requirement has been made that the Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 21 home must make arrangements to provide a safe system for moving and handling service users. The home provides single and shared bedrooms. The majority of the bedrooms were well decorated and contained personal items belonging to the service user. Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The number of staff on duty does not support or meet service users needs during a twenty-four hour period. Service users are not protected by the home’s recruitment policy and practices. Staff receive training on a regular basis, which enables them to competently do their jobs. EVIDENCE: The inspectors noted that the staff on duty during the site visits did not have a break until their lunch break at approximately 13.00. This meant that staff was working from 08.00 until 13.00 (5hours) without a break. The inspectors also noted that a significant number of service users had not received support with personal care and eight remained in bed or in nightclothes until 11.25. The staff spoken with during the inspection advised that they work as quickly as they can. During the night shift it was stated that there are three members of staff on duty for thirty-one service users and that they are required to do the laundry Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 23 in a building, which is separate from the home. This means that the staff on duty have to leave the building to do the laundry duties which results in a reduction in the number of staff in the home and available to attend to the service users’ needs during the night time period. The registered persons must ensure that due to the current dependency needs of the service users the staffing arrangements of the home are immediately reviewed over the 24 hour period and to increase their number by at least one person per shift in order to ensure that service users needs are met and that there are sufficient staff on duty. The registered persons must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of the service users. Several staff told the inspectors that the care home has adaptation students and that they have an induction yet are not supernumerary on the rota. The staff told the inspectors that due to the high turnover of staff in the home comparatively new staff were giving the induction to the other new staff. In general the staff morale was low and several staff told the inspectors that it would be helpful to have more encouragement and praise from the homes owners. Several service users told the inspectors that the staff was very kind and willing to help. The manager told the inspector that over 50 of the staff have the national vocational qualification at level 2 and that staff are trained both on day and night duty. All mandatory training is planned or has taken place and this includes fire safety, food hygiene and safeguarding adults. The manager stated that she had recently attended an equality and diversity course and she will now cascade this information to the staff team. Induction is carried out over four days and is linked to the skills for care and the manager told the inspector that she does all the induction and adaptation training herself. The inspectors sampled some staff files and found that one belonging to a senior member of staff had no references from their previous and current employers or reason for leaving this employment. There will be a requirement made that the registered persons will ensure that all checks are made prior to staff being employed in the home. Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 24 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 poor. This judgement has been made using available evidence including a visit to this service. Service users live in a home that is managed by a person who is fit to be in charge and who seeks the views of the service users and has regular quality audits. No service user handles their own finances. The health and safety of service users are not protected or promoted. EVIDENCE: The inspectors observed that there was a breakdown in the management and staff communication regarding a service users relatives wishes for the service user to remain at the home and not to be transferred to hospital in the event of a serious illness. The manager told the inspector that the service users Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 25 wishes were well documented in their care plan but some members of staff had not read these. Staff spoken with during the inspections advised the inspectors that the registered manager was hard working. Since the last site visit in July the manager now does quality audits that seeks the views of the service users and the manager stated that the findings of the audits are fed back to service users during relative and resident meetings. The home does not hold money for service users. Anything they wish to purchase will be invoiced to them directly. The manager stated the proprietor adds an administration fee for this service but a requirement has been made for these prices to be added to the statement of purpose. Concern was raised by the inspectors regarding the site of the clinical and general waste bins, which were sited outside the bathroom window of a service user. The general waste bins were noted to be overflowing and the staff advised that there was another three working days before the bins were due to be collected. A requirement has been made that the home make suitable arrangements for appropriate collection of general waste from the home to prevent infection, toxic conditions and the spread of infection at the care home. The inspectors met with the specialist contractor who has been contracted by the home to remove clinical waste. The contractor spoke favourably of the way in which the home disposes and stores clinical waste awaiting specialist collection. The inspectors observed that a drain guard outside the laundry area was broken and required replacing. A requirement has been made that the drain guard is replaced in order to ensure that safety and welfare of all persons outside the area of the laundry. During the tour of the premises the inspectors observed the servery within the homes kitchen area. It was noted that there were a significant amount of notices attached to the walls of the servery to instruct staff regarding service users preferences and the codes of conduct regarding serving meals. The inspectors have strongly recommended that the notices are removed and placed into a file, which staff can refer to. Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 1 Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 27 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 OP2 Regulation 5 (1)(bc) Requirement The registered persons must ensure that all charges (including administration charges) are included in the homes Statement of Purpose and Service User Guide in order that service users are fully aware of the terms and conditions of their stay in the care home. The registered persons must ensure that arrangements are in place to ensure that the home is conducted in a manner, which respects the service users belongings. The registered persons must ensure that that the notices displayed in the kitchen are removed in order to ensure the privacy and confidentiality of the service users. The registered persons must ensure that the home provides, in rooms occupied by service users, adequate bedding and the home is conducted in a manner, which respects the dignity of service users. The registered persons must DS0000013349.V307550.R01.S.doc Timescale for action 22/09/06 2. OP10 12 (4) (a) 22/09/06 3. OP10 12(4)(a) 05/09/06 4. OP10 12(4)(a) 16(2)(c) 22/09/06 5. OP13 16 (2)(n) 22/09/06 Page 28 Rose Hill Nursing Home Version 5.2 6. OP15 13(4)(c ) 7. OP15 12 (1)(ab) 12.(4) 14.(1a) 8. OP21 23(2)(j) 9. OP24 16(2)(c ) 10. OP25 23(2)(p) 11. OP25 23(2)(c) ensure that the home consults service users about their social interests, and makes arrangements to enable them to engage in local, social and community activities. The registered persons must ensure that all food is stored in compliance with the current food safety legislation in order to ensure that the safety and wellbeing of all service users within the care home. The registered person must review the current skills and practice of staff supporting service users at meal times, the crockery and equipment available to service users, which is individually assessed, and ensure meal times are unhurried and a pleasurable activity for service users. The registered persons must ensure that the home provides at appropriate places within the premises sufficient number of lavatories and bathrooms suitable to the needs of the service users. The registered persons must ensure that the home review the number of adjustable beds for service users receiving nursing care to ensure that service users have the specialist equipment they need to maximise their independence, comfort and promote safe moving and handling techniques. The registered persons must ensure that the lighting in the home is assessed and replaced where necessary to ensure that it is suitable for service users as the current lighting is very dull. The registered persons must ensure that the furniture in the DS0000013349.V307550.R01.S.doc 05/09/06 22/09/06 22/10/06 22/09/06 22/09/06 22/11/06 Page 29 Rose Hill Nursing Home Version 5.2 (g) 12. OP26 13(3) 13. OP26 13(5) 14. OP26 23(2)(b) 15. OP26 23(2)(b) 16. OP27 18(1)(a) dining room is assessed and where necessary replaced to ensure that service users can reach and sit at the table comfortably and there is adequate room for the staff who support the service users at mealtimes The registered persons must ensure that the home ensures that the arrangements of handling soiled and clean laundry are in place to prevent infection, toxic conditions and the spread of infection at the home. The registered persons must ensure that the home make suitable arrangements for the staff to undertake safe moving and handling and access in the laundry area. The registered persons must ensure that the homes premises are kept in sound construction and in a good state of repair and the flooring of the laundry is replaced. The registered persons must ensure that the premises of the ironing room is risk assessed to include the hazards identified during the inspection and the ironing room is kept in a good state of repair both externally and internally. The registered persons must ensure that due to the current dependency needs of the service users the staffing arrangements of the home are immediately reviewed to increase the staff numbers by at least one for each shift over the 24 hour period in order to ensure that service users needs are met and that at all times suitably qualified, competent and experienced DS0000013349.V307550.R01.S.doc 22/09/06 22/09/06 22/09/06 22/09/06 22/08/06 Rose Hill Nursing Home Version 5.2 Page 30 17. OP29 19 (1)(b) & schedule 2 13(4)( c ) & 23(2)(o) 18. OP38 19. OP38 13(4)(a) (c ) 20. OP38 23(2)(b) 21. OP38 13(5) 22. OP38 13 (3) 16 (2)(k) persons are working at the care home in such numbers as are appropriate for the health and welfare of the service users. The registered person must ensure that all recruitment records are obtained prior to the employment of a person in order to ensure the safety and wellbeing of service users. The registered persons must ensure that the rubbish is removed from the garage and the laundry area and a risk assessment with action plan provided to the CSCI by the registered person in order to ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. The registered persons must ensure that all food is stored in compliance with food hygiene standards to ensure as far as reasonably practicable the home is free from hazards to service users safety and unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. The registered persons must ensure that an external specialist undertakes a risk assessment regarding the presence of the white asbestos in the garage in order to ensure that the premises of the care home are of sound construction and kept in a good state of repair both internally and externally. The registered persons must ensure that the home make arrangements to provide a safe system for moving and handling service users. The registered persons must ensure that the home make DS0000013349.V307550.R01.S.doc 22/09/06 22/09/06 22/09/06 22/10/06 22/09/06 22/09/06 Page 31 Rose Hill Nursing Home Version 5.2 23. OP38 23(2)(b) suitable arrangements for appropriate collection of general waste from the home to prevent infection, toxic conditions and the spread of infection at the care home. The registered persons must ensure that the drain guard is replaced in order to ensure that safety and welfare of all persons outside the area of the laundry. 22/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rose Hill Nursing Home DS0000013349.V307550.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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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