CARE HOMES FOR OLDER PEOPLE
Rose House Rose House Rose Grove, Church Street Armthorpe Doncaster South Yorkshire DN3 3AJ Lead Inspector
Ramchand Samachetty Unannounced Inspection 20th October 2005 10:00 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 House DS0000031969.V260169.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 House DS0000031969.V260169.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Rose House Address Rose House Rose Grove, Church Street Armthorpe Doncaster South Yorkshire DN3 3AJ 01302 831450 01302 834275 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) Doncaster Metropolitan Borough Council Pamela Beverley Castle Care Home 36 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (24) of places Rose House DS0000031969.V260169.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th December 2004 Brief Description of the Service: Rose House is a Care Home providing accommodation and care for up to thirtysix service users in the category of older people. The Home is divided in two units. Twelve of the 36 places are registered for ‘ Elderly Mentally Infirmed’. The other 24 places are for older adults- (over 65 years old). Rose House is owned by the Doncaster Metropolitan Borough Council and managed by its Social services Department. There is a registered manager who is responsible for the day- to- day running of the Home. Rose House is a two-storey building, situated in the Armthorpe area of Doncaster. It is close to local amenities and is accessible by public transport. Accommodation for service users, are provided on both floors, and there is a passenger lift to facilitate access between the floors. All bedrooms are single. The Home also provides day care for up to six clients a day. The communal areas comprise of two dining areas and four smaller television lounges. The kitchen and laundry facilities are located on the ground floor. There is a secure internal garden for use by clients who suffer from dementia. Rose House DS0000031969.V260169.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was carried out on 20th. October 2005, starting at 10.00 hours and finished at 17.30 hours. The inspection included a tour of the premises, conversations with five residents, four relatives and three members of staff. The inspector checked care documentation and other records, and observed some aspects of care provision. What the service does well: What has improved since the last inspection?
The training of staff in first-aid has progressed well. There is now a trained first-aider on each shift. Staff supervision has improved. The manager has developed a supervision programme and is implementing it. Internal work has commenced in order to reorganise and improve the Unit for clients with dementia. Rose House DS0000031969.V260169.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 House DS0000031969.V260169.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 House DS0000031969.V260169.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, 3, 5. Residents and their relatives are provided with information about the Home and its services. They are encouraged to visit the home and check its facilities, before choosing it. They were, therefore, able to make a positive choice of care home. However, the Home’s statement of purpose and its service user guide need to be improved, in order to meet the regulations. Residents were assessed prior to their admission, but such assessments were not robust and comprehensive enough to address their needs. Assessments of residents on admission must be improved. EVIDENCE: Residents and relatives, who spoke to the inspector, stated that they had been encouraged to visit the Home, to look at its facilities and to meet staff and other residents. These visits usually lasted for a day and staff would use them for carrying an initial assessment of need. A copy of the statement of purpose and a brochure to welcome service users to the Home, were available. However, both sets of documents did not contain
Rose House DS0000031969.V260169.R01.S.doc Version 5.0 Page 9 the required information, for example, the arrangements for meeting the social, recreational, and privacy needs of residents and arrangements for consultation. The statement of purpose also wrongly states that residents aged 60, can be admitted to the Home. The welcome brochure did not constitute a service user guide. The care records of three residents were checked. They showed that assessments were carried out by the placing social worker and by staff at the Home, for the purpose of admitting the residents. However, assessments did not fully address important areas, such as nutritional and social care needs. Rose House DS0000031969.V260169.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 and 10. Individual plans of care for residents were based on their assessed needs, to ensure that they were receiving the appropriate care and support. Actions to meet identified needs were set out, but they were not always specific enough and therefore lacked clarity. Care staff were proactive in ensuring that the health care needs of residents were adequately addressed. Staff attitude and approach to care was based on respect for the individual and this helped to enhance the dignity of residents. However, arrangements to safeguard the privacy of individual residents could be improved. EVIDENCE: A sample of care plans was checked. They addressed identified needs and outlined the actions needed to meet needs. However, in some cases, these actions were not specific enough to ensure that appropriate care is given and the manner, in which it should be given. Residents and their relatives stated that they were encouraged to participate in developing their individual care plan. They were requested to sign the care plans to show their involvement
Rose House DS0000031969.V260169.R01.S.doc Version 5.0 Page 11 and consent. Care plans were reviewed on a regular basis, but the process used to carry out such reviews, was not clear and was not recorded. Care records showed that residents were appropriately referred to other health care professionals as necessary. These included referral to GPs’, chiropodists and district nurses. In discussion, residents and relatives commented that staff were ‘very good and helpful’. Good interactions were noted between staff and residents and this helped to maintain a relaxed and happy atmosphere. Residents were offered personal care in the privacy of their own rooms or in bathrooms. Residents were in good attire and this enhanced their selfconfidence and dignity. However, there was no provision of a public telephone at the Home.. Residents could use the telephone available in the office or they could install their own telephone in their room, at a cost to them. Rose House DS0000031969.V260169.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 and 15. Social activities were well organised. Residents and relatives were satisfied with the way daily life was organised at the Home, which they felt was flexible and enjoyable. However, social care needs of residents must be appropriately assessed in the first place, to ensure that such needs are fully met. Residents and relatives were satisfied with the meals served. Menu planning was inadequate as it failed to a choice of the main food served at meal times. Action must be taken to residents are given an appropriate choice of food at all meal times. EVIDENCE: Residents stated that a number of activities and leisure events were organised for them. There were indoor activities like bingo, board games and sessions by visiting entertainers. Outdoor activities included outings and shopping trips. A programme of activities was not available. Care plans checked, showed that social acre needs were not always adequately assessed. It was therefore unclear how the social care needs of those who were less capable, were catered for. The issue of appropriate assessment is also addressed in standard three of this report. Rose House DS0000031969.V260169.R01.S.doc Version 5.0 Page 13 Residents and relatives, who spoke to the inspector, stated that the meals served were ‘well prepared and very good’. They said that they have a good range of breakfast items to choose from. However, menus checked showed that there was no choice for the main protein part of cooked meals. Rose House DS0000031969.V260169.R01.S.doc Version 5.0 Page 14 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. There is a corporate complaint procedure in use, and the information associated with it, is not customised to the Home. This may lead to lesser use of the procedure, if it is seen as being external. The information about the Home’s complaint procedure should be improved. Care practices and procedures seemed to protect residents’ welfare, thereby creating a safe environment for them. However, training on adult protection issues must be provided to all staff, to make sure that existing procedures are appropriately implemented. EVIDENCE: Senior care staff commented that they regularly seek feedback from residents and their relatives, in order to address any concerns straight away. Residents and relatives, who spoke to the inspector, confirmed this approach, which they found to be helpful and reassuring. No complaints had been received since the last inspection. However, the complaint procedure, in use at the Home, was a corporate one and it made no reference to the Home and to the Commission for Social Care Inspection. The Home has use also, of the Doncaster Council’s policy on adult protection and whistle blowing and it operates to those standards. However, staff have not yet received training on adult protection issues. It is now necessary for this training to be prioritised. Rose House DS0000031969.V260169.R01.S.doc Version 5.0 Page 15 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. Although some structural work internal to the building was being undertaken at the time of this inspection, the home appeared to be generally in good sate of repair. There were, however, a few items that require decoration and replacement, in order to keep the place in good condition and to make it more comfortable. The standard of hygiene was adequately maintained, and this helped to make the Home more pleasant. EVIDENCE: The inspector, accompanied by a senior member of staff, undertook a tour of the Home. The communal areas and some residents’ accommodation were viewed, (the latter with residents’ permission). Residents’ private rooms appeared to be adequately decorated and furnished. However, there was no access to nightlight for residents, in a number of bedrooms. One bedroom had not been provided with a double electric socket.
Rose House DS0000031969.V260169.R01.S.doc Version 5.0 Page 16 One part of a ceiling was noted to be requiring some decoration. An area of floor covering was affected by cigarette burns. There was a computer for use by residents and it was placed in the ‘smokers’ lounge. The location of this computer should be reviewed to ensure that access to its use, is not hindered to non-smokers. The structural work in hand was in relation to changes to the ‘ EMI’ Unit. There is a proposal increase the number of beds in that Unit. The work involved the creation of new corridors and secure access. Both residents’ private accommodation and communal areas were found to be clean and tidy. Residents and relatives commented that the Home is always kept in hygienic condition. Rose House DS0000031969.V260169.R01.S.doc Version 5.0 Page 17 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 and 29. The number of care staff deployed on duty, appeared adequate to meet the needs of the resident group, although the same staff complement provides the day care service at the Home. However, the hours worked by the registered manager must be considered supernumerary to care staffing hours, to ensure that all management tasks are adequately addressed. Care staff have the skills and knowledge to fulfil their roles within the Home. The corporate staff recruitment and selection procedures used, are designed to meet good employment practice, but issues relating to record keeping, must be improved. EVIDENCE: On the day of this inspection, there were one senior carer and four care assistants on duty, besides the manager. There were also some staff in support services, like administration, catering and domestic duties. There were 19 residents, 9 of whom were ‘ EMI’ clients. There were also day service users, in the Home. The number of care staff deployed on that day appeared adequate to meet residents’ needs. The current deployment of care staff is not calculated on the dependency of individual residents. The duty rota was checked. It showed that on several occasions, the registered manager was working two to six shifts a week, on direct care provision. In discussion, the manager stated that the Home would be employing a ‘shift manager’ in due course, so that she could focus more on her management tasks.
Rose House DS0000031969.V260169.R01.S.doc Version 5.0 Page 18 Staff spoken to, showed that they had the knowledge and skills to provide a good standard of care to the resident group. Of the 16 care staff employed at the Home, 8 had completed their National Vocational Qualification in Direct Care- level 2. Staff files, including information about recruitment and selection procedures and safety checks, were not available for inspection. Action must be taken to ensure that staff files and in particular, references and disclosures are available for inspection. Rose House DS0000031969.V260169.R01.S.doc Version 5.0 Page 19 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 and 38. The Home is well managed to ensure the safety and wellbeing of residents. The registered manager is appropriately qualified and provides good leadership and guidance to staff. This helps to promote good and consistent quality of care to residents. Although health and safety issues are adequately addressed, the overall risk assessment for the Home and for safe working practices must be reviewed and updated, in particular, in view of the changes to the building. EVIDENCE: Residents, relatives and staff stated that they were satisfied with the way the Home was managed. The registered manager was described as being ‘very able, honest and professional’ in managing the Home. The manager has a social work qualification and has also completed her National Vocational qualification in Management and Care- level 5. Rose House DS0000031969.V260169.R01.S.doc Version 5.0 Page 20 The overall safety and welfare of residents is safeguarded. Equipment used at the Home is appropriately maintained. However, no overall and up to date risk assessment was available for the Home and for safe working practices. Rose House DS0000031969.V260169.R01.S.doc Version 5.0 Page 21 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 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 2 Rose House DS0000031969.V260169.R01.S.doc Version 5.0 Page 22 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 OP1 Regulation 4, 5 Requirement Timescale for action 30/01/06 2 OP3 12, 14 3 4 5 OP7 OP10 OP12 12, 15 12, 16 12, 14, The statement of purpose and service user guide must be improved in line with the regulations. Assessment of care needs must be improved to ensure all health, personal and social factors relating to individual residents, is considered on their admission. The care planning process, including the review of care plans must be improved. Access to a public telephone must be provided at the Home, for use by residents. 16 Social care needs of residents must be appropriately assessed and catered for. Menu planning must be improved. An appropriate choice of food items, in particular, the protein part of meals, must be offered and displayed as part of the menus. Training on adult protection issues must be provided to all staff.
DS0000031969.V260169.R01.S.doc 30/01/06 13/02/06 27/02/06 30/01/06 6 OP15 12, 16 30/01/06 7 OP18 12, 13 13/02/06 Rose House Version 5.0 Page 23 8 OP19 9 10 OP19 OP27 11 OP29 12 OP38 12, 16, 23 Bedside lighting and double electric sockets must be provided in all residents’ bedrooms. 12,16,23 The part of a ceiling as identified, must be decorated. 12,18 The hours worked by the registered manager must be considered supernumerary, to allow her to discharge her responsibility and fulfil her duties. 12, 18, 19 Staff files, in particular, references and disclosures must be kept at the Home and made available for inspection as necessary. 12, 13, 23 The risk assessment for the Home and for safe working practices must be reviewed and updated as necessary. 27/02/06 13/02/06 13/02/06 30/01/06 13/02/06 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 OP16 OP19 Good Practice Recommendations The complaint procedure and literature should be customised for the Home. The location of a computer in a ‘smokers’ lounge should be reviewed. Rose House DS0000031969.V260169.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Doncaster Area Office 1st Floor, Barclay Court Heavens Walk Doncaster Carr Doncaster DN4 5HZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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