Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 21/04/06 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 21st April 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 inspector noticed a good range of care plans and risk assessments and there was evidence that they were reviewed monthly. Resident`s that the inspector spoke with were complimentary about the home and staff. They all looked well cared for and dressed appropriately for the weather. One resident was in the lounge enjoying a cooked breakfast, which is available every day to those resident`s who would like it.

What has improved since the last inspection?

All requirements from the previous inspection have been met and communication between manager and provider has improved so there is now clarity of managerial responsibilities.The manager stated that there has been no need to use agency staff for quite some time, which is a positive move for both staff and residents. The home has recently employed a full time activities organiser.

What the care home could do better:

Nine requirements have been made at the end of the report and these include the following: Risk assessments for the use of cot sides must be in place for all residents. A privacy and dignity policy must be written. The homes protecting adults policy must be bought in line with Surrey Multi Agency Procedures. A planned maintenance programme must be available. An action plan must be provided following concerns about the laundry facilities. Any gaps in employment history must have a written explanation. A quality assurance programme must be developed for the home. Risk assessments must be in place for all rooms in the home that are using wedges to prop open doors. Risk assessments for all areas of the home must be compiled.

CARE HOMES FOR OLDER PEOPLE Rose Hill Nursing Home 9 Rose Hill Dorking Surrey RH4 2EG Lead Inspector Lesley Garrett Unannounced Inspection 20th April 2006 09:00 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.V290337.R02.S.doc Version 5.1 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.V290337.R02.S.doc Version 5.1 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.V290337.R02.S.doc Version 5.1 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 15th November 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.V290337.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six hours and was carried out by Link Inspector Lesley Garrett and Josephine Abiona, Registered Manager, represented the establishment. A full tour of the premises tool place and some members of staff and residents were spoken to. The residents spoken to were complimentary about both the service and quality of food. ‘I’m happy here and the staff are so kind to me’. ‘I have no complaints everyone is so nice’. ‘The food is very good too much sometimes’. ‘We had a wonderful Easter’. These were some of the comments that the inspector was told about. The inspector had the benefit of a pre-inspection questionnaire following the site visit and comment cards have been posted to some relatives, residents and visiting professionals to assist with the assessment of the service. This was a positive inspection and the inspector would like to thank the manager, staff and residents for their hospitality. The manager stated that the service users are referred to as residents in the home therefore this is the name that will be used in this report. What the service does well: What has improved since the last inspection? All requirements from the previous inspection have been met and communication between manager and provider has improved so there is now clarity of managerial responsibilities. Rose Hill Nursing Home DS0000013349.V290337.R02.S.doc Version 5.1 Page 6 The manager stated that there has been no need to use agency staff for quite some time, which is a positive move for both staff and residents. The home has recently employed a full time activities organiser. 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.V290337.R02.S.doc Version 5.1 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.V290337.R02.S.doc Version 5.1 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): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All residents are assessed, by the manager, prior to admission to the home, to ensure that their needs will be met. The home does not have intermediate care beds. EVIDENCE: The manager does all pre-admission assessments and uses a recognised assessment tool. The inspector looked at two assessments and one resident was admitted from Bristol so the hospital had faxed an assessment to the home and the manager had spoken with the staff. The manger went to see the other resident prior to admission. The manager identifies their needs and the care plans are compiled from this assessment. The home does not have intermediate care beds. Rose Hill Nursing Home DS0000013349.V290337.R02.S.doc Version 5.1 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 the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans were of a good standard allowing staff the information required to meet the resident’s needs. The health needs of the residents are well met with evidence of multidisciplinary working. The systems for the administration of medication are good. The privacy and dignity of the residents are upheld but the home has no written policy. EVIDENCE: The inspector sampled care plans and found them to be of a good standard. The plans are compiled from the pre-admission assessment and the folder contained a good variety of documentation. Risk assessments were in place but in one folder there was no risk assessment for cot-sides. The manager stated that these are usually in place. It was also noted that some rooms had a wedge to prop the door open and in the same folder there was no risk assessment in place and these will be requirements at the end of the report. Rose Hill Nursing Home DS0000013349.V290337.R02.S.doc Version 5.1 Page 10 The manager stated that the home has good G.P. cover and the inspector noted that on the tour of the building one resident told the inspector she was unwell and was waiting to see the doctor who arrived during the inspection. There was also evidence that the opticians visit twice a year, the chiropodist visits every six weeks and the dentist also visits regularly. There was also a physiotherapist visiting on the day of inspection. A continence advisor had done all the assessments and the home has access to the tissue viability nurse if required. The home has a medication policy and the manager has also written a local policy. The inspector looked at the medication administration records and found there to be no gaps. There was no evidence of excessive stock and the controlled drugs were accurate. The home had a record of the registered nurses signatures and the fridge contained appropriate stock. It will be a recommendation at the end of the report that when medication that is not given, an explanation should be given on the back of the MAR sheet and all handwritten orders should have two signatures of registered nurses. As the inspector toured the building evidence that the staff respected the privacy and dignity of the residents was witnessed. Staff knocked on doors prior to entering and shared rooms had curtains that could be pulled when required. The residents can all receive visitors in private and all visits by visiting practitioners can be seen in private. The home has no privacy and dignity policy and this will be a requirement at the end of the report. Rose Hill Nursing Home DS0000013349.V290337.R02.S.doc Version 5.1 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 the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities are varied and tailored to their needs. Contact with families, friends and the community are encouraged. There is a varied menu and special diets are catered for and residents were complimentary about their food. EVIDENCE: The home has employed a new activity organiser who has now been in post for three weeks. She told the inspector that she was in the process of getting to know the residents so that she could tailor the activity requirement to their needs. She visits all the residents on a one to one basis to assess their needs. The residents enjoy a weekly gentle exercise class, which has been set up in consultation with a visiting physiotherapist. There are also art and craft afternoons and recently the residents decorated cakes for Easter. The home encourages contact with the community and a local school visits to sing and some residents have visited the school for concerts. There is a monthly communion church service, the hairdresser visits weekly and relatives and friends are encouraged to visit at any time. All residents are able to make choices about their daily lives. The inspector saw that the rooms had been personalised and that the residents were given choice about the clothes they should wear. The menu is chosen every day and they Rose Hill Nursing Home DS0000013349.V290337.R02.S.doc Version 5.1 Page 12 can also get up in the morning when they would like to. The manager stated that no one in the home handles their own finances. The inspector met the chef who is a fairly recent appointment and has experience of working in other nursing homes. There is a six-week cycle of menus and the chef sees all new admissions. The inspector saw some residents enjoying a cooked breakfast and the pureed diet at lunch was appropriate with each item pureed individually. The residents that the inspector spoke to were complimentary about the food. Rose Hill Nursing Home DS0000013349.V290337.R02.S.doc Version 5.1 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an adequate complaints policy and although residents are protected from abuse the homes local policy needs adjusting. EVIDENCE: The home has a complaints policy, which is displayed on the wall, and is available to all the residents in their rooms. Only one complaint, since the visit in February, and resolved by the manager. There has been no vulnerable adult issues since the last inspection in November. The home uses the Surrey Multi Agency Procedures but the local policy does not reflect this practice therefore there is a requirement at the end of the report. The manager was advised to attend the next available training by Surrey and to cascade her knowledge to the rest of the staff. Rose Hill Nursing Home DS0000013349.V290337.R02.S.doc Version 5.1 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home needs to have a planned programme of maintenance, which is available to CSCI, and although the home was clean, the laundry area needs refurbishment to comply with the regulation that all areas of the home are hygienic. EVIDENCE: The manager stated that all rooms are re-decorated on an on going basis and when the room is empty it is re-decorated before the new admission arrives. The inspector noted that the rooms were pleasant and the residents had positive comments about their environment. The communal areas however need some maintenance. The lighting needs to be improved in the communal areas and the home needs to provide CSCI with a planned programme of maintenance and this will be a requirement at the end of the report. The inspector visited the laundry room, which is located outside in a brick and wooden structure, which looked cluttered having unpolished surfaces that Rose Hill Nursing Home DS0000013349.V290337.R02.S.doc Version 5.1 Page 15 makes it difficult to maintain a good level of hygiene. The management needs to give serious consideration to upgrading the laundry facilities for this service. Rose Hill Nursing Home DS0000013349.V290337.R02.S.doc Version 5.1 Page 16 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes duty rota showed adequate staffing levels for the number of residents and the home has good number of staff that have been adequately trained for NVQ. Recruitment folders were sampled and the residents are protected by the homes policy and practice. EVIDENCE: On the day of inspection the home had three empty beds and one resident in hospital. The rota was looked at and there was adequate cover for that day however the manger must always continue to assess the situation and adjust the rotas as necessary according to the needs of the residents and their dependency levels. The manager does all the rotas and she does spot checks at night which are unannounced. The manager stated that 77 of the carers have NVQ level 2 qualification and the induction follows the skills for care process. The manager told the inspector that she no longer uses agency staff as her own staff are able to cover any extra shifts required by the home. The inspector sampled some employment folders and found them to be satisfactory containing all of the necessary paperwork. CRB’s had been kept on file and the manager was asked to check the guidelines for destruction of these documents. It was noted that although some folders had explanations for gaps in the employment history this was not consistent, for example, explanations for extended holidays or periods of unemployment must also be explained Rose Hill Nursing Home DS0000013349.V290337.R02.S.doc Version 5.1 Page 17 fully. This will be a requirement at the end of the report. The home has training on a regular basis and mandatory training has taken place as required. It is recommended that the manager attends Surrey’s Protection of Vulnerable Adults training and then cascade this to the rest of the staff. Rose Hill Nursing Home DS0000013349.V290337.R02.S.doc Version 5.1 Page 18 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is now clear communication between the Registered Manager and Provider and the manager now has access to all information required. The home has no recognised quality assurance system and the views of family, friends and the community who visit the home are not sought. The financial interests of the residents are safeguarded. The manager needs to complete risk assessments for all areas of the home to protect residents and staff. EVIDENCE: The Registered Manager is an experienced registered nurse who has nearly completed her RMA. There are now clear lines of accountability between her and the provider. Rose Hill Nursing Home DS0000013349.V290337.R02.S.doc Version 5.1 Page 19 The manager showed the inspector the result of one resident survey but this did not include the opinions of families, friends or other visiting professionals and this will be a requirement at the end of the report. CSCI has posted to the home, and a selection of families, their own comment card to complete if they wish. The home does not hold any money on behalf of the resident. Anything that they require can be purchased and they will then be invoiced. There is a small safe in the manager’s office, which can be used to hold valuables for a short period. These are entered into a book and signed for when removed. The manger needs to ensure that risk assessments for all areas of the home are completed to ensure safe working practices and this will be a requirement at the end of the report. A pre-inspection questionnaire was received by CSCI which detailed all relevant health and safety checks had taken place and that the various certificates were in place. Rose Hill Nursing Home DS0000013349.V290337.R02.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Rose Hill Nursing Home DS0000013349.V290337.R02.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13 Requirement The registered persons must ensure that risk assessments for the use of cot-sides are in all resident folders that require this form of restraint The registered persons must compile a privacy and dignity policy for the home. The registered persons must ensure that their local protection of vulnerable adults policy is in line with Surrey Multi Agency Procedures. The registered persons must ensure that a planned maintenance programme is available to CSCI as there was no record of any routine maintenance. In particular to look at lighting in some areas of the home and that the furniture in the dining room is appropriate for the residents and replace where necessary. Action plan to be provided. The registered persons must ensure that the laundry room is reviewed, as the area was very cluttered and may give rise to DS0000013349.V290337.R02.S.doc Timescale for action 04/05/06 2. 3. OP10 OP18 12 13 20/05/06 20/05/06 4. OP19 23 20/05/06 5. OP26 23 20/05/06 Rose Hill Nursing Home Version 5.1 Page 22 6. OP29 19 & schedule 2 24 7. OP33 8. OP38 12 9. OP38 13 infection control issues due to the decoration. Action plan to be provided to determine if refurbishment is required. The registered persons must ensure that any gaps in employment history has a written explanation. The registered persons must develop and implement a quality assurance programme and develop an annual development plan. The registered persons must ensure that if door wedges are used then the appropriate risk assessments are in place. The registered persons must ensure that there are risk assessments are in place for all areas of the home. 20/05/06 20/05/06 04/05/06 20/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP9 Good Practice Recommendations It is strongly recommended that any omissions in the administration of medications is clearly recorded on the back of the MAR chart giving the explanation for omission. It is strongly recommended that all hand written entries on the MAR chart should contain the signatures of two nurses. Rose Hill Nursing Home DS0000013349.V290337.R02.S.doc Version 5.1 Page 23 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.V290337.R02.S.doc Version 5.1 Page 24 - 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!