CARE HOMES FOR OLDER PEOPLE
Rose Lawn Rose Lawn All Saints Road Sidmouth Devon EX10 8EX Lead Inspector
Teresa Anderson Key Unannounced Inspection 10:00 15 and 24th August 2007
th 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 Lawn DS0000022020.V340113.R02.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 Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Rose Lawn Address Rose Lawn All Saints Road Sidmouth Devon EX10 8EX 01395 513876 01395 579519 roselawnsidmouth@aol.com www.keychange.org.uk Key Change 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) Mrs Margaret Mary Haxton Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is permitted to admit one resident under 65 years of age at any one time 11th October 2006 Date of last inspection Brief Description of the Service: Roselawn provides personal care and accommodation for up to 29 older people. It is owned by Key Change, a not for profit organisation, which has a Christian and spiritual ethos. The home is situated a few minutes walk from the town centre, shops, local amenities and seafront of Sidmouth. Communal areas are made of a reception area with seating, two lounges, a quiet room, a private meeting room/quiet room, conservatory and a large dining room. The kitchen is equipped to a very high standard. The area to the rear of the property is paved and some rooms having direct access onto this through patio doors. There are views over the local rugby ground at the rear of the property. Bedroom accommodation is provided on the ground and first floors of the home, and floors are linked by a passenger lift. All bedrooms have en suite facilities. There is level access throughout the ground floor. The current level of fees is approximately £615.00 per week. Details are given by the home when an application is made. Fees do not include services such as hairdressing, chiropody and transport. Information about the home is available direct from the home or from the Key Change website www.keychange.org.uk Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place as part of the normal programme of inspection. One inspector carried out the site visit which started at 10.00am and finished at 4.00pm. As some information was not available on this day, we went back on a second day. During the time spent at the home we looked closely at the care and services offered to three people as a way of judging people’s experiences and the standard of care and accommodation generally. Where possible we spoke with these people in depth, and tried to contact their relatives and any health or social care professionals involved in their care. We looked at their care assessments and care plans closely, and spoke with staff about their knowledge and understanding of the plans. We looked at their bedrooms and we looked at the overall environment from their perspective. We also spoke with approximately 10 other people, with the manager (by phone), with carers and with kitchen staff. We looked around the building at all communal areas and saw many of the bedrooms. We looked at records including medication, staffing, accident and incident reports, training, fire safety and recruitment. Prior to the visit to the home we sent surveys to 10 people who live here and 8 were returned; to 8 relatives and 3 were returned; to care staff working at the home and 3 were returned; to health and social care staff and 4 were returned. Their feedback and comments are included in the report. In addition, and before we visited the home, the manager provided information about the management of the home and an assessment of what the home does well and what they plan to improve upon. What the service does well:
Each person who comes to live here is assessed to make sure that the home can meet their needs. Each person is encouraged to look around the home before making a decision to live here. When people come to live here they have a contract which details the terms and conditions of occupancy. The vast majority of people living here have their healthcare needs well met with referrals being made to appropriate healthcare and allied professionals. People’s medications are well managed and are handled safely. People living here are treated with respect and have their privacy protected. For example, staff always knock on bedroom and bathroom doors before entering and offer assistance with personal care discreetly. They are also helped to make choices about their daily lives, choosing how to spend their time and who to spend the time with.
Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 6 The majority of people living here tend to be able bodied and therefore able to meet their own social and leisure needs. For example the home is close to Sidmouth town and seafront and many people take themselves off for walks or to the local coffee shop. This is a home with a Christian ethos so people who live here are invited to join in daily prayers and there are frequent ecumenical services held in the home. The home recently have a ‘sausage sizzler’ event. This included a BBQ and live music. Meals are described as ‘excellent’ and each lunch is a social occasion. Those people who prefer not to join in have their meals delivered to their rooms. Meat and vegetables are sourced locally from specialist suppliers. People feel safe and well cared for and generally have their complaints or requests taken seriously. Like the food the environment of this home is described by the people living here as ‘excellent’. It is clean throughout with lots of homely touches and fresh flowers. The home is very well maintained and decorated. Staff are described as ‘helpful’ and ‘thoughtful’. There are usually 5-6 carers on duty in the morning and 4-5 carers until 9pm. At night there are 2 waking carers. In addition the home has a manager, a clerical assistant, 2 cleaners, a maintenance man, a chef and a 2 kitchen assistants. (The home normally also has a deputy manager and an assistant to the manager who, at the time of this inspection, were on long term leave). The manager is committed, experienced and holds the Registered Manager’s Award. She is praised by the people who live here for her kindness and gentle manner. The manager ensures that staff receive mandatory training and that maintenance contracts are in place to ensure the home is safe. What has improved since the last inspection?
Since the last inspection the way that medicines are managed has improved with staff ensuring that records are up to date. Staff knowledge in relation to reporting suspected or actual abuse has improved with additional training. Induction training is now based on Skills for Care common induction standards, as is good practice. The manager reports that the home has updated their television so that it can receive a digital signal. Two new baths have been installed which are suitable for people with mobility problems or who are more frail.
Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Rose Lawn DS0000022020.V340113.R02.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 Lawn DS0000022020.V340113.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 (as this home does not provide intermediate care, Standard 6 was not inspected). Quality in this outcome area is good. The people who come to live here can be assured that their needs will be assessed and that they will be helped to settle in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home assesses each person before they come to live here. Assessments cover all their basic needs, ensuring that the home can be sure that they can meet those needs. People who come to live here have low needs and therefore assessments are not comprehensive because they do not need to be. People spoken with say that although they had been given or offered a guide to the home, they chose the home by reputation and by looking around. Some people had visited friends or relatives here. One person said ‘ we were given a
Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 10 full tour and information on what is offered. This was a very full visit and helpful. People say they are pleased with their choice. In surveys people say they have a contract. People spoken with say they have a copy of this. They say they are informed of any fee rises and are aware of what the fees do not cover. We saw three contracts and these detailed the terms and conditions of occupancy. People say they were helped to settle into the home by kind and caring staff. They say that staff get to know them and then provide care and services in a way that suits them. Rose Lawn DS0000022020.V340113.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. The majority of people who live here have their health needs planned and met. Others, who have developed more complex needs, are potentially at risk. People have their medications needs safely met and their privacy and dignity is respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In surveys people living here say that they usually or always receive the care and support they need. When spoken with the majority of people say that although staff are busy they meet their needs. Health care professionals raised no concerns about this service. People who live here tend to be quite able and the majority do not have complex needs. The care plans of these people are written in enough detail to
Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 12 ensure their needs are met. Records show that referrals are made to the doctor and for example to the optician, chiropodist and dentist as needed. Records also show that the district nurses are called when needed. However, a few people living here have become less well and have more complex needs. Their care plans and the communication system in the home do not provide staff with the information they need to care for these people safely. We looked closely at the care plans and care offered to three people with more complex needs. These care plans contain assessments relating to identifying risks of people developing pressure sores and risk of malnourishment. Some people have been identified as being at risk. Care plans do not contain instructions for staff on how to minimise these risks, although the manager reports that no one living at the home currently has a pressure sore. However, one care plan states that this person has a pressure sore and another person reports that they are sore. The manager says that staff do not know the difference between a pressure sore and a pressure area and have made incorrect recordings. People have some pressure-relieving equipment. One person has a pressurerelieving mattress on their bed, but does not have a pressure-relieving cushion on the chair they like to sit in. One person is losing weight and they say they are buying their own supplement drinks. When we checked, the manager said that the home has a variety of supplement drinks available and does not know why this person is buying their own. One person has a complex medical problem. Records show that an assessment has been carried out and a course of action was recorded which staff followed. However, this was not time limited, it is not clear that the course of action chosen is the most appropriate and the person it related to was very unhappy with the course of action taken. The care plan also states that this person should drink a certain amount of fluid each day. Staff spoken with were unaware of this and records of how much this person is drinking are not being kept. This person says that they would have liked, during this time of illness, to be helped to get up earlier because they had soiled their clothes but this did not happen. Another person living here was noted to be choking when drinking. This may be due to their medical condition. Records show that the manager was informed of this approximately two weeks ago and carried out an assessment. She made a record in the care plan of the course of action that staff should take. It is not clear that this is an appropriate course of action. When asked, a carer helping this person to drink was not aware that this person was at risk of choking and was not aware of any special instructions about how to support this person to drink. Two other carers said they did not know this person was at risk or of any instructions. When we showed them the entry in the care
Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 13 plan, they said they had not seen this. A referral had not been made to the Speech and Language Therapist for assessment and advice (this has since happened). One care plan recorded that a person had a very low pulse rate. This person is receiving medication to slow their heart rate. Whilst staff have not been instructed by health staff to do this, once the problem was noticed it was not followed up. Staff spoken with were unaware that this person had experienced a problem. The manager reports that two new members of staff have recently been recruited who she is confident have the skills to bring about improvements in these areas. Medication is on the whole managed well. Since the last inspection a fridge for storing medications that need refrigeration has been installed. However, staff spoken with are not aware of the temperature at which the fridge should run and are not recording the temperature of the fridge. Medication records were checked and are all up to date. We carried out an audit of some controlled drugs and records matched the stock. A carer reports that only those who have received training administer medication. People say they get the right medicines and they get them on time. People who live here say that staff are respectful and try to help them to maintain their dignity. One person said that when they need help that staff are discreet. A man said that he has male carers when possible and this is good. The manager reports that since the last inspection people are asked if they would prefer a same gender carer. One woman said that since the last inspection she has had female carers and she prefers this. However, other women say they have not been informed that this is policy and feel anxious that should they need help they might get this from a male carer. Staff were seen knocking on people’s doors before entering and quietly speaking into peoples’ ears when asking them if they needed help with personal care. Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. Links with the community and visitors are good. People who live here, on the whole, have their social care needs met although some people would welcome improvements to the social calendar. Support is offered in a way that promotes choice and flexibility. People benefit from a diet which is varied and nutritious and which they thoroughly enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Roselawn does not have a programme of activities and the care plans we looked at do not contain information about people’s interests or the leisure activities they wish to pursue. In the pre inspection information provided by the manager, she has identified this as an area that could be improved. In surveys and when spoken with people say they are generally happy with their social lives. Many of these people have friends and family who live locally. Many can go into town independently and some are helped to do this by staff.
Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 15 One relative reports that although their mother does not go out that staff often offer to take her. One person said they thought card games, board games and/or occupational activities would be a good idea. Another person said they would welcome something different to do. Visitors are made very welcome and there are good links with the local community. The majority of people living here lived locally and continue with their established community links. The home hosts daily prayers and frequent interdenominational services. People who live here say their spiritual needs are well met. The home has consistently excelled at using meals and parties to celebrate events such as birthdays and festivals. Tables are always laid and decorated. People say the food served is excellent. Comments include ‘couldn’t better’ and ‘excellent’. One person summed it up by saying ‘the variety and quality of food is good. The dining room is very pleasant and presentation of food is good’. Those people who need to have a soft diet have their food presented in a manner that ensures it looks attractive. The meat is minced and the vegetables are served soft. This is good practice. Two people said they would like to know where the meat and vegetables were sourced. We checked with the cook who reports that all fresh foods are sourced locally from specialist suppliers. In turn the cook gave this information to these people. Residents say they are offered lots of choices. For example they choose the food they eat and where they eat it, what they wear and how they spend their time. During this visit those who wanted to eat in the dining room did so and others chose to have their meals in their rooms. Each resident was seen to be treated as an individual by the staff. People say that staff know and understand them. Rose Lawn DS0000022020.V340113.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. People who live here have their complaints heard and acted upon. They are kept safe and are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In surveys people say they know who to make a complaint to and that staff listen and act on what they say. Some people said that nothing is too much trouble for the staff. One person said ‘you only have to ask and it’s done’. One person said they had cause to ‘comment’ and that this was being addressed by the Operations Controller (the manager’s manager). Neither the home nor the commission have received any complaints. At the last inspection we were concerned that staff were not familiar with the procedures to follow if they suspected abuse or if an allegation of abuse were made. When we talked with staff at this inspection they said they had received extra training. Two members of staff demonstrate a good understanding of what abuse is and the procedures to be followed if an allegation were made. In addition to staff training, the manager has completed a training course that equips her to carry out training. People living here say they feel safe, respected and well cared for.
Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26. Quality in this outcome area is good. The environment of this home provides people who live here with a homely and clean place to live. Additional training in fire procedures for staff would further enhance the safety of the home. The addition of some specialist equipment to promote independence and mobility would further enhance the lives of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In surveys and during discussions with the people who live here, all said that the home is always clean and fresh and that the cleaners work hard to keep it this way. People are really proud of their home and of their bedrooms which are personalised to the taste of the resident. Many have been helped to hang pictures, place furniture and ‘make them as homely as possible’ as one person said.
Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 18 The home is extremely well maintained and decorated to a high standard. There are fresh flowers and many homely touches throughout the home. Two new baths have recently been installed which are suitable for people with mobility problems. The home has also recently upgraded the television so that a digital signal can be received. Staff were observed following infection control procedures to prevent infection. People who live here say that staff always wash their hands and wear gloves and aprons when needed. During the inspection we noticed that a number of chairs in the home are quite low. The inspector observed some people having to ask for help to rise from them and some people ‘flopping’ into them. Two people said they could do with taller chairs. This was discussed with the manager at the last inspection. She reports that some new higher chairs had been ordered to aid mobility and independence. We did not see these at this inspection. One person has told the inspector that they think it would be a good idea to have a seat outside the lift for people to sit on whilst waiting. However, she has been told that this cannot happen but does not know why. We checked the fire log and found that training and fire checks are taking place. However, when we checked staff knowledge about what to do if there were a fire one person identified the correct procedure and two did not. Although the home has designated fire wardens who have extra training and knowledge, none of these people usually work outside office hours. Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. People who live here are supported by kind and caring staff who would however benefit from further training. Staffing levels meet the needs of all the people who live here. Recruitment processes have improved, helping to ensure that only suitable people are recruited. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rota shows there are usually 5-6 carers on duty in the morning, 4-5 carers until 8pm and 2 carers until 9pm. At night there are 2 waking carers. In addition the home has a manager, a clerical assistant, two cleaners, a maintenance man, a chef and 2 kitchen assistants. The home usually also has a deputy manager and an assistant to the manager. Both are on long-term leave. In surveys people say that they always or usually receive the care and support that they need, that staff are always or usually available when needed and that staff always listen and act on what they say. Comments include ‘everyone is extremely kind and helpful’ and ‘very caring and helpful’. People say that all the staff at the home are lovely. However, they also say that the two male carers who work at the home are often on duty together,
Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 20 meaning that those who prefer a female carer have to wait longer or that they might feel they have to accept help from a male carer. We checked the duty rota and found that the male carers do often work together from 7.45am until 9pm. There are 23 females and 6 males living at the home. The number of female carers available to female residents is therefore reduced on these days. Some people commented that it could be short staffed at the weekend. Staff report that this is because there is not a weekend cook and one of the carers has to cook. They say this was addressed when a weekend cook was employed, but that this person has now left. The manager reports that care staff only undertake cooking duties when the cook has phoned in sick. Two members of staff are on long-term leave and this includes the deputy manager. To try to address the shortfall, agency staff are used. The manager tries to always have the same staff and employs Registered Nurses to work as carers. Staff report that they receive induction training which they found useful. Records show that induction training is based on ‘Skills for Care’ guidance as is good practice. The manager reports that 40 of care staff hold a National Vocational Qualification (NVQ) in care. This is less than the 50 recommended. However, 4 people are currently studying for this qualification. Records show that staff receive additional training which includes care planning and caring for people who are dying. Some people at the home are visually impaired, some have Parkinson’s Disease and some have had a stroke. Staff have not received training in these areas. We checked the recruitment records of three staff working at the home. These contain all the checks needed to help ensure that only suitable people are recruited. This includes two written references, proof of identity and a police check. Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38. Quality in this outcome area is adequate. People who live here and their belongings are generally safe. They would however benefit from improved communication and from being more involved in the running of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Roselawn is managed by an experienced and committed manager who holds the Registered Managers Award. People who live here are extremely complimentary about her kindness and thoughtfulness. The person registered with the commission as the person who, together with the Registered Manager, is legally responsible for this service has delegated
Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 22 monthly visits to the Operations Controller. Visits by this person include speaking with staff and with the people who live here. Prior to this site visit the manager completed a pre-inspection questionnaire giving information about the management of the home. The information provided was brief and did not demonstrate a good understanding of what the home might need to improve upon. A previous key inspection (October 2006) and a random inspection (February 2007) identified shortfallings in care planning resulting in risks to some of the people who live here. On both occasions we legally required the home to make improvements in these areas. In the preinspection questionnaire the manager reports that peoples needs are fully met and that comprehensive records are kept. We found during this inspection that shortfallings and risk remain, some peoples needs are not being met and records are not well kept or reviewed. The preinspection questionnaire did indicate that improvements could be made in the activities offered to the people who live here. Some people told us that they would like to be consulted about this. People who live here and who were spoken with say they are rarely consulted on decision making in the home. Some people say they might not like to get involved in everything but they would like to be offered the choice. The manager reports that she has an ‘open door’ policy and that she speaks with all the people who live here every day. Some people say they would like to have residents meetings. One person said they have lived at the home for over three years and have never attended a residents meeting. In the preinspection questionnaire the manager reports that these happen ‘when requested’. Another person said that they have not completed a quality assurance questionnaire in the time they have lived here. The manager reports (in the preinspection questionnaire) that quality assurance questionnaires are completed when people first come to live here. Records show that a survey was undertaken in January this year and that there was an article about quality assurance in the homes Newsletter. 11 of the 29 people living here were involved in the survey. Some people commented in these that they would like a residents meeting, but this has not been arranged. In surveys staff say they receive enough support from the manager. Records show that staff meetings are held. Staff spoken with say they know what is expected of them and this is communicated to them by the manager. Some say that staff are not encouraged to speak up or put forward ideas at staff meetings. They say these meetings are for the manager to pass on instructions to the staff. Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 23 The manager reports that staff receive mandatory training including health and safety, manual handling and fire training. We checked the kitchen and the laundry and found them to be clean and well managed. The Environmental Health Officer, at the last inspection, made no recommendations. Contracts are in place for the removal of waste from the home and for the maintenance and upkeep of the home. We checked the accounts of 3 people whom the home supports to manage their monies. Good records are kept along with receipts ensuring that all accounts are auditable and monies accounted for. Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 24 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 X X 3 Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 25 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 OP7 Regulation 15 (1) Requirement All the people living here must have an up to date and detailed plan of care. This will ensure that their health and welfare needs are met in a consistent way. This particularly relates to those people who are physically unwell. (This requirement is outstanding from 30/06/06 and 30/01/07) Each person’s plan of care should be reviewed when needs change and the plan of care should be altered accordingly. In this way when people become less able, risks to their health and welfare will be minimised. If any person living at the care home develops a health problem (in this case low pulse rate or swallowing difficulties) advice should be sort from the appropriate healthcare professional so that healthcare needs can be met. Timescale for action 31/10/07 2. OP7 15 (2) 31/10/07 3. OP8 13 (9) (b) 31/10/07 Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 26 4. OP19 23 (4) (e) 5. OP32 26 The manager should ensure that 31/12/07 all staff are aware of the procedure to be followed if the fire alarm sounded to help ensure the safety of the people who live here. The person with delegated 30/11/07 responsibility who visits the home monthly must use these visits and the resulting reports to form an opinion of the standard of care provided in the care home and to take action where needed. The reports should be sent to the commission after each visit. The manager should develop a 31/12/07 quality assurance system which gives people living at the home the opportunity to comment on the quality of the services provided and to make their views known. In this way the manager will be able to measure the services success in meeting its aims and objectives. (This requirement is outstanding from 31/03/07) 6. OP33 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The temperature of the fridge where medicines are kept should be recorded on a daily basis. This will ensure that medications are kept at the correct temperature. Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 27 2. 3. 4. 5. 6. 7. 8. OP12 OP22 OP27 OP28 OP30 OP32 OP33 The people who live here should be consulted with about their social and interests. This will help staff to support them to meet these needs in a way that suits them. There should be enough raised chairs and appropriately placed seats for people with mobility problems to sit on. There should always be enough female carers on duty to ensure that those females who wish to have a female carer can be assured this will be the case. You should continue with the work already undertaken to ensure that 50 of care staff are trained to NVQ level 2 (or above). Training for care staff should be based on the needs of the people living at the home. You should develop strategies for enabling staff and the people who live here to affect the way in which the service is delivered. You should develop a development plan for the home based on a plan of what needs to happen, taking action to make this happen and reviewing the outcome of the actions taken. Rose Lawn DS0000022020.V340113.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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