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Inspection on 15/11/05 for Rose Hill Nursing Home

Also see our care home review for Rose Hill Nursing Home for more information

This inspection was carried out on 15th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Staff were observed to carry out their care duties in an appropriate manner. Service Users spoken with were very complimentary regarding the home, they stated that their privacy and dignity were always maintained and they were happy at the home. Service users stated that they enjoyed the activities provided, and that they had the choice whether to participate or not.

What has improved since the last inspection?

Feedback from service users was sought and recorded following each meal. The choice of food offered was varied and appeared nutritious. A menu was displayed. Service Users spoken with stated that the food was good.

What the care home could do better:

Service Users who are funded by Social Services were not routinely issued with a contract between themselves and the home. Some medication was not stored in accordance with the manufacturers instructions. The complaints procedure was not available to all Service Users and complaints were not always recorded. Several shortfalls were found in some of the documentation, including serious shortfalls in the homes recruitment process. Some of the required records were not accurately and fully maintained. There was confusion regarding managerial responsibilities between the Registered Manager and the Registered Provider. The Registered Manager did not have full access to the documentation required to enable her to efficiently manage the home.

CARE HOMES FOR OLDER PEOPLE Rose Hill Nursing Home 9 Rose Hill Dorking Surrey RH4 2EG Lead Inspector Sarah Radlett Unannounced Inspection 15th November 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rose Hill Nursing Home DS0000013349.V262813.R01.S.doc Version 5.0 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.V262813.R01.S.doc Version 5.0 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.V262813.R01.S.doc Version 5.0 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) Up to 3 beds may be used for the provision of respite care 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 2 persons may be cared for on a day care basis between 08.3018.30 7th June 2005 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.V262813.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 5½ hours and was the second inspection carried out by the Commission for Social Care Inspection for the year 2005-2006. Sarah Radlett carried out the inspection. The Registered Manager, Ms. J. Abiona, was present throughout the inspection. As part of the inspection, the inspector also spent time with the Registered provider Mr. Chahal. A tour of the premises took place and various written records were examined, including three care plans and service user assessments, the complaints record, staff recruitment files and a sample of the medication administration records. The inspector spoke to Service Users, and some of the staff on duty at the time of the inspection. The Inspector would like to thank the staff and Service Users for their time, assistance, and hospitality during the inspection. What the service does well: What has improved since the last inspection? Feedback from service users was sought and recorded following each meal. The choice of food offered was varied and appeared nutritious. A menu was displayed. Service Users spoken with stated that the food was good. Rose Hill Nursing Home DS0000013349.V262813.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rose Hill Nursing Home DS0000013349.V262813.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rose Hill Nursing Home DS0000013349.V262813.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 The information enabling Service Users to make an informed choice about where they live was available to all prospective Service Users; however the Statement of purpose / Service user guide must be available to all existing Service Users. EVIDENCE: The Service User Guide was incorporated in the Statement of Purpose. This document had been recently updated and included a copy of the terms and conditions of residency. The Statement of Purpose was located in the main reception area and was thus not available to all Service Users. A Service User recently admitted to the home had not been issued with a contract. The Registered provider, Mr. Chahal, deals with all contracts, the Registered Manager has no input into this aspect of the homes management. Service Users who are funded by Social Services are not routinely issued with a contract between themselves and the home. Rose Hill Nursing Home DS0000013349.V262813.R01.S.doc Version 5.0 Page 9 The manager or another Registered Nurse assessed Service users prior to admission to ensure that the home can meet their needs. Intermediate care was not provided at the home. Rose Hill Nursing Home DS0000013349.V262813.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Comprehensive care plans are in place, they clearly set out the Service Users health, personal and social needs. However one of the Service Users assessments was not completed, and Service Users had not always signed their care Plans. The recording and administration of medication were satisfactory; however some medication was not stored in accordance with the manufacturers instructions. Care was provided in a dignified, respectful manner. EVIDENCE: Three care plans and Service User assessments were randomly selected for inspection. One Service Users admission assessments had not been completed. The Registered Manager had recently returned from extended leave and stated that this shortfall in the documentation was one of many that she had noted upon her return. Overall the care plans set out in detail the action that needed to be taken to meet the assessed needs. There was evidence of regular review. The Service Users had not always signed their care Plans, to evidence Rose Hill Nursing Home DS0000013349.V262813.R01.S.doc Version 5.0 Page 11 involvement in their care. The Registered Manager was in the process of implementing a new form to ensure that this was completed. All Service Users were registered with a local GP, who visited the home weekly; all Service Users were reviewed monthly. Service users had access to visits from other health professionals such as the chiropodist and optician. The homes recording and administration of medication were seen and satisfactory. Some medication, specifically Epipens, were being stored in the fridge at the time of the inspection, this was contrary to the manufacturers instructions. An immediate requirement was made. No Service Users had chosen to self-administer their medication. Staff were observed to carry out their care duties in an appropriate manner. Service Users spoken with were very complimentary regarding the home, they stated that their privacy and dignity were always maintained and they were happy at the home. Screens were available in the double rooms. Rose Hill Nursing Home DS0000013349.V262813.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 15 The service users were enabled to maintain their independence as much as possible. Activity provision was varied and stimulating. Service Users were complementary about the food. EVIDENCE: An activities organiser produced a programme of varied activities. This programme was displayed in each room. Service users stated that they enjoyed the activities provided, and that they had the choice whether to participate or not. The choice of food offered was varied and appeared nutritious. A menu was displayed. Feedback from service users was sought and recorded following each meal. Service Users spoken with stated that the food was good. Rose Hill Nursing Home DS0000013349.V262813.R01.S.doc Version 5.0 Page 13 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 The complaints procedure was not available to all Service Users and complaints were not always recorded. EVIDENCE: A copy of the homes complaints procedure was contained within the Statement of Purpose / Service Users Guide; however this document was not available to existing Service Users. One complaint had been recorded since the last inspection. From evidence in the complaints file it appeared to have been appropriately dealt with. Prior to the inspection, the inspector had been informed of another complaint made to the Registered Provider, Mr. Chahal, by a relative. There were no records of this complaint and the Registered Manager had not been informed. At the previous inspection it was noted that the Registered Provider dealt with complaints, and the Registered Manager did not have access to all information about the complaint and the action taken. It was therefore recommended that the Manager is fully informed and involved in a complaint investigation. Rose Hill Nursing Home DS0000013349.V262813.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The home was suitable in layout for its purpose. The home was found to be clean and tidy. EVIDENCE: The inspector toured areas of the home. It was seen to be clean, tidy and free from offensive odours. The premises were well maintained with service users able to access all areas of the home. Rose Hill Nursing Home DS0000013349.V262813.R01.S.doc Version 5.0 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 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, 29 & 30 The staffing arrangements in place on the day of the inspection were sufficient to meet the needs of the Service Users. Serious shortfalls were found in the homes recruitment process. The Registered Manager ensures that staff receive appropriate training. EVIDENCE: The staff rota inspected demonstrated that the staffing numbers and skill mix were appropriate to meet the assessed needs of the Service Users living in the home. The staff file of a new member of staff was examined at inspection. The staff member had been recruited prior to obtaining two written references, a CRB / POVA check and without verification of NMC pin number. An immediate requirement was made. Discussion with the Registered Provider and the Registered Manager revealed that there was some confusion regarding who is responsible for carrying out certain recruitment checks, including NMC pin checks. The Registered Manager stated that she is unable to perform such checks, as she does not have full access to the staff recruitment files. This was noted at the previous inspection and despite the previous recommendation this remains the case. Rose Hill Nursing Home DS0000013349.V262813.R01.S.doc Version 5.0 Page 16 The home had a comprehensive training programme and there was evidence of on-going training for staff, including Service User specific training. Rose Hill Nursing Home DS0000013349.V262813.R01.S.doc Version 5.0 Page 17 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, 32 & 37 There was confusion regarding managerial responsibilities between the Registered Manager and the Registered Provider. The Registered Manager did not have full access to the documentation required to enable her to efficiently manage the home. Shortfalls were found in some of the documentation. records were not accurately and fully maintained. EVIDENCE: The Registered Manager had been in post since June. She had recently returned from extended leave. Several shortfalls in the documentation within the home had occurred during her absence, specifically the assessments of a recently admitted Service User were not completed and there were no records of a complaint made by a Rose Hill Nursing Home DS0000013349.V262813.R01.S.doc Version 5.0 Page 18 Some of the required relative. It is required that appropriate management arrangements are put in place in the absence of the Registered Manager. At the previous inspection it was noted that the Registered Provider dealt with complaints, and the Registered Manager did not have access to all information about the complaint and the action taken. It was therefore recommended that the Manager is fully informed and involved in a complaint investigation. Prior to the inspection, the inspector had been informed of a complaint made to the Registered Provider, Mr. Chahal, by a relative. There were no records of this complaint and the Registered Manager had not been informed. Serious shortfalls were observed in the homes recruitment procedures. Discussion with the Registered Provider and the Registered Manager revealed that there was some confusion regarding who is responsible for carrying out certain recruitment checks, including NMC pin checks. It is required that there is clarity of managerial responsibilities between the Registered Manager and the Registered Provider. The Registered Manager stated that she is unable to perform the required checks, as she does not have full access to the staff recruitment files. It is required that the Registered Manager has full access to all the information relating to the registered establishment which is required to efficiently manage the home. The Registered Manager demonstrated good leadership qualities at inspection, all staff and Service Users spoken with talked very highly of her and appeared very pleased to see her after her extended leave. Rose Hill Nursing Home DS0000013349.V262813.R01.S.doc Version 5.0 Page 19 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 2 2 3 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 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X X X 1 X Rose Hill Nursing Home DS0000013349.V262813.R01.S.doc Version 5.0 Page 20 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 OP1 Regulation 4(2)5(2) Requirement The Registered Provider must ensure that the Statement of Purpose / Service Users Guide is available to all Service Users. The Registered Provider must ensure that all Service Users have a contract between themselves and the home. The Registered Manager must ensure that all Service Users admission assessments are fully completed. The Registered Manager must ensure that care plans contain a service users signature or their representatives to indicate agreement and evidence their involvement. This is the second time this requirement has been made. The Registered Manager must ensure that all medication is stored in accordance with the manufacturers instructions. The Registered Provider must ensure that the complaints procedure is available to all Service Users. The Registered Provider must DS0000013349.V262813.R01.S.doc Timescale for action 15/12/05 2 OP2 5(a) 15/02/06 3 OP7 14(1a) 17(1a&3a ) 12(2-3) 15(1-2cd) 15/12/05 4 OP7 15/12/05 5 OP9 13(2) 15/11/05 6 OP16 22(5) 15/12/05 7 OP16 22(3-4) 15/12/05 Page 21 Rose Hill Nursing Home Version 5.0 8 OP16 8(1) 10 OP29 19(1&4abi ) Sch2(19) 8(1) 11 OP29 12 OP31 8(1) 13 OP31 8(1) 14 OP31 8(1) ensure that all complaints are fully investigated and record is maintained of all complaints. The Registered Provider must ensure that the Registered Manager is fully informed and involved in any complaint investigations. The Registered Provider must ensure that staff are not be recruited prior to obtaining the information listed in Schedule 2 The Registered Provider must ensure that the Registered Manager has full access to the staff recruitment files. The Registered Provider must ensure that appropriate management arrangements are put in place in the absence of the Registered Manager. The Registered Provider must ensure that there is clarity of managerial responsibilities between the Registered Manager and the Registered Provider. The Registered Provider must ensure that the Registered Manager has full access to all the information relating to the registered establishment that is required to efficiently manage the home. 15/12/05 15/11/05 15/12/05 15/12/05 15/12/05 15/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rose Hill Nursing Home DS0000013349.V262813.R01.S.doc Version 5.0 Page 22 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. Extracts may not be used or reproduced without the express permission of CSCI Rose Hill Nursing Home DS0000013349.V262813.R01.S.doc Version 5.0 Page 23 - 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. 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