Inspection on 16/07/08 for Rose Lawn

This inspection was carried out on 16th July 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rose Lawn 15/08/07

Rose Lawn 11/10/06

Rose Lawn 22/02/06

Rose Lawn 05/08/05

Rose Lawn 16/02/05

Rose Lawn 09/11/04

Rose Lawn 01/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Rose Lawn All Saints Road Sidmouth Devon EX10 8EX Lead Inspector Rachel Fleet Unannounced Inspection 16 July 2008 09:15 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.V363493.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rose Lawn Address All Saints Road Sidmouth Devon EX10 8EX 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) 01395 513876 01395 579519 roselawn@keychange.org.uk www.keychange.org.uk Key Change 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.V363493.R01.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 15th August 2007 Date of last inspection Brief Description of the Service: ‘Rose Lawn’ provides personal care and accommodation for up to 29 people over State retirement age. It is owned by Key Change, a not-for-profit organisation, which has a Christian and spiritual ethos. It does not provide nursing care other than that which the local community nursing services can provide, and it does not provide intermediate care. The home is a few minutes’ walk from the town centre, shops, local amenities and Sidmouth seafront. But it has a hairdressing room for visiting hairdressers, and runs a trolley shop, for the benefit of those who do not go out. Communal areas include a reception area with seating, two lounges, a quiet room, conservatory, and a large dining room with open views over the local rugby ground and beyond. An area at the rear of the property is paved, with seating provided, and with some rooms having direct access onto this. Bedroom accommodation is on the ground and first floors of the home, with staff accommodation on the top floor. All bedrooms have en suite facilities, some with a bath or shower facility, although there are also adapted baths and a level access shower around the home, providing easy access to such facilities. There is level access throughout the ground floor, with a passenger lift between floors. The current level of fees is approximately £650.00 per week. Details are given by the home when an application for admission is made. Fees do not include hairdressing, private chiropody (- a free service is available at a local health centre), transport to health appointments, newspapers and alcoholic drinks for individuals (- the home takes daily papers which anyone living at the home may read, with some alcoholic drinks available free of charge at meals and as an evening ‘nightcap’). Information about the home is available direct from the home or from the Key Change website www.keychange.org.uk Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place as part of our usual inspection programme. There were 28 people living at the home on the day of our unannounced visit to the home, which took place over thirteen hours on two weekdays. Mrs Margaret Haxton, registered manager, had previously returned a CSCI questionnaire about the home (the Annual Quality Assurance Assessment, or ‘AQAA’). This included assessment of what they do well and any plans for improvement, as well as information about the people living at the home, staffing, policies in place, and maintenance of facilities. We had also sent surveys to the home for them to give to 10 people living at the home and to 10 staff. We received seven back from people living at the home (most of who had been helped by relatives or friends to complete them), and eight from staff. We received all four surveys we sent to community healthcare professionals supporting people at the home. The majority of responses were positive. We met twelve people who lived at the home, six of whom gave us their views in more detail. We spoke with two visitors, as well as someone from the ‘Friends of Rose Lawn’, a group that supports the home. We found out from them what it was like living at the home, and also did this through observations, talking with staff, and looking around the home. We looked in more depth at the care of three people living at the home. This group included people who were more physically or mentally frail than most people living at the home, people who were supported by Social Services, and people who were self funded. We did this by reading their care records and related information (personal monies records, etc.), and checking how their medication was managed. We met with them, spoke to staff about their care, and looked at the accommodation in relation to their needs. Staff recruitment and training files, quality assurance information and records relating to health and safety (such as accident and maintenance records) were seen. We ended the inspection by discussing our findings with the manager on a third day. Information included in this report is from these sources and from communication with or about the service since our last inspection. Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Staff respond to risks to peoples’ health by seeking advice from and involving other professionals, to maximise individuals’ health and wellbeing. The temperature of the medicines fridge is regularly recorded, to monitor that medications are kept at the correct temperature to maintain their effectiveness. 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. Quality assurance systems are being developed to give people living at the home the opportunity to comment on the quality of the services provided and to make their views known. The representative of the responsible individual, who visits the home monthly, uses their visits to form an opinion of the care provided and suggests action needed, although some outcomes are still awaited. There are enough raised chairs and appropriately placed seats for people with mobility problems to sit on. Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 7 There are enough female carers on duty to ensure that residents who wish to have a female carer to assist them with personal care can be assured this will be the case. 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.V363493.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. (The home does not provide intermediate care – St. 6) Quality in this outcome area is adequate. The home does not assess some peoples’ needs fully before they move in, with a risk that the needs of those individuals may not be met in a person-centred way if they move into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A senior carer showed us a needs assessment she had carried out recently, of a prospective resident who had visited the home for a day but who had not yet decided whether to move in. The assessment reflected the person’s individuality, care needs, routine and interests. We requested the pre-admission assessments of the three people that we case-tracked. We found information had been collected about their next-of-kin, etc. And a ‘dependency’ checklist had been completed for each, to indicate generally how much help each person might need. These were undated, so it Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 10 was not clear when the information had been obtained. There was no other, more person-centred information to reflect their unique or specific needs, such as social or faith needs, interests and preferences. The manager said everyone was admitted for a month’s trial period, and if they decided to leave during that time, they would only be charged for the length of their actual stay at the home. Care assistants that we spoke with told us that they were informed about new admissions in advance. And that when the person arrived, a member of staff was allocated to help them settle in initially and support them in the longer term. One staff survey, however, said pre-admission assessments were not always shared with key staff. Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 10. Quality in this outcome area is adequate. Most people who live at the home are generally happy with the support they receive. However, staff have insufficient information to ensure people’s current and changing needs will be met, in a person-centred way that also promotes their dignity. Although medication systems have been improved, some people would benefit from further improvements to related records and certain practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One person living at the home felt staff had the capacity and training to care for the residents, giving “a marvellous sense of comfort and security.” Another said staff were ‘happy to help’. Most said staff seemed to know what help they needed. Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 12 A new care assistant and other staff we spoke with said they had useful handovers each time they came on duty, including if they started work at a different time to their peers. We saw some staff referring peoples’ care plan files, or writing care notes about the individuals they had helped. We looked at care plans for three people. We found some of their care needs were described, but some were not – regarding their personal care, or elimination, for example. The manager told us there was a bath/shower list to guide staff on peoples’ personal care needs, and that there were systems that ensured staff knew what continence pads individuals needed. However, one person gave an example of when a personal preference relating to bathing had not been followed. Another person’s care notes said they didn’t want baths because of their sore legs, but we could not see that this had been looked into further. Peoples’ daily notes (written by care staff or visiting professionals) showed some had problems with continence or constipation. The home’s written policies stated people should have care plans relating to their continence needs. One person told us staff were not mindful of their impaired sight. Their care plan included eye care (- information dated in 2007), which staff told us they no longer gave, and otherwise simply said ‘Good’ under the heading ‘Sight’. We noted the home’s own policies stated there should be formal monthly reviews of care plans. There was no evidence of these for the people we casetracked. The most recent review was dated January 2008, with a new entry in March 2008; this had more person-centred information than other care plans we saw. A senior carer showed us updated aspects of care plans or reviews of needs for other people. We were told these were done with the individuals concerned, which is good practice. Mrs Haxton said reviews were carried out when care plans were updated and through daily reports or notes. However, one person’s particular needs relating to their diet and the health of their skin were not reflected in their daily notes, to indicate what they had eaten or the condition of their skin. Thus there was little information on which to base a review of the care plan. We had made requirements at three previous inspections that care plans be improved, and found the requirement was not fully met on subsequent inspections. We therefore issued a requirement this time that, within 28 days of our visit, the care plan for each person living at the home was to be updated and sufficiently detailed to reflect individuals’ current care needs and how they were to be met. Professionals said the home usually met peoples’ health care needs, and staff usually had the right skills, etc. to respond to peoples’ diverse needs. We discussed with the manager information available about ‘Equality and Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 13 Diversity’, which we felt might help the home develop further in this area. The AQQA indicated the home did not know some peoples’ sexual orientation, for example. Community-based health care professionals commented that the home responded to individuals’ needs and provided an efficient service. The home had consulted a GP about someone’s swallowing difficulties. The person had subsequently seen other specialists, with advice on a suitable diet being followed by the home. Their care plan needed some updating to ensure staff would be clear about their present needs, since an old care plan had not been discontinued when a new care plan was written for their changed needs. We saw someone in bed on a specialist mattress also had a pressure-relieving cushion in their armchair. Their relatives confirmed the district nurse visited regularly. One person had had a hearing check recently. One person had been referred to specialist staff because of falling and poor mobility, although we found no advice had been sought about another person who had had falls more recently (- see also the last section in this report entitled ‘Management and Administration’). People who were given their medication by staff said they were satisfied with how the home managed their medication, and that they usually got it on time. Those we case-tracked had had a medication review by their GP in recent months. A senior carer told us they arranged medication reviews, in advance, if someone began new medication, to ensure its effectiveness was properly assessed before they were prescribed it for long-term use. Visitors told us one person’s medication was being monitored carefully to ensure they were painfree. We saw most medication received by the home was recorded on medication sheets, and careful records were kept of medication returned to the pharmacy for disposal. Some people were self-medicating, and the medication sheets we saw for them did not include a record of medications received by the home for them. The manager told us their medication was usually recorded as for other residents. We saw partially completed risk assessments for people who wished to selfmedicate, intended to ensure they got any support they needed to achieve this. These were dated 2007, so it was not clear what review was carried out when someone recently fractured an arm, to see if they were still able to manage their medication. One person’s care notes indicated care staff had sought advice from senior carers about problems they found the person had. The three skin creams they were subsequently advised to use had been prescribed for the individual to be Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 14 used when required. However, there was nothing in the person’s care records to guide staff clearly as to when or how each should be used. The medication policy we saw didn’t include guidance on ‘as required’ (or ‘prn’) medication. One person was prescribed a medication with a variable dose. However, staff had not recorded what dose they had given each time. We checked controlled drugs prescribed for two people. They were properly stored, with appropriate records kept, and staff described safe procedures for their administration including two staff to do this. A specific lockable fridge was used for medication needing cool storage, with daily records showing it was running at safe storage temperatures. The manager said all bedrooms had a lockable facility, with people we asked confirming they had one. We also saw bedroom doors that were lockable, and that staff used bathroom door locks when assisting people, ensuring their privacy. People living at the home said staff respected their privacy if they were bathing or in the toilet. A new staff member told us whilst they were shadowing colleagues during their induction, this was explained to people and people were asked if they minded their presence; subsequently, she had left one person, as they requested, whilst they were assisted with personal care. We saw peoples’ preference for male or female carers was recorded in their care notes, and individuals or their visitors confirmed this information was correct. Female residents said they could get assistance from female staff for personal care if they wished, although one said it wasn’t easy sometimes. However, they added they had no hesitation in declining help from male carers. One person said some care staff walked in to their bedroom without waiting for a reply after knocking. Minutes showed that this matter had been discussed at a residents’ meeting in January 2008. We also saw a staff member walk into an occupied bedroom without first knocking on the closed door. A lack of care plans relating to peoples’ personal care needs could affect their dignity, since staff may not be aware of their needs or how they are to be met, to reduce embarrassment, etc. Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 15 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 I 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 – 15. Quality in this outcome area is good. Peoples’ daily lives are improved by the choice and flexibility offered to them, as well as by links with the community outside the home. They enjoy a varied and nutritious diet that meets their individual preferences and needs. Most have their social needs met, although those with more diverse needs would benefit from more person-centred care or support to meet such needs in an individualised way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Most people told us they had enough to do with their time, or that they did not get bored. The Social / Activity programme for July 2008 included weekly ‘music and movement’ sessions, craft groups, and Holy Communion or a church service. Other events were visiting handbell ringers, a cream tea at Woodbury paid for by the home, bowling, and new books from the local library. Other recent events included trips to a garden centre and to a particular store at The Willows shopping centre in Torquay, requested by people living at the home, and a themed evening. The ‘Friends of Rose Lawn’ support the home by Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 16 fundraising for the residents’ benefit, paying for some outings, and help to provide spiritual care by leading the weekly services, etc. Someone, who needed help to go out, said although the home arranged outings, they would like more spontaneous outings (to their bank or local coffee shops, for example). Another person said staff did offer to take people out. The manager told us that days varied - on one day during the inspection week, someone had been taken to the shops for something they wanted and another had been taken to the seafront as they wished. Codes were used to record social activities in peoples’ care notes. The same few codes were used in the records we saw, usually the ones showing they had had visitors. Two people – one of whom had impaired sight and hearing - said sometimes there were activities they could join in with, one adding that more had been provided recently. A staff member reflected this, saying some people had sight problems so did not join in with certain organised activities. The manager said a care staff member had asked everyone about their interests, but this information was not in care records we saw. There were no care plans for supporting individuals’ interests, for providing positive ways of spending their time, or records showing how they enjoyed activities they attended. Someone told us they were a ‘loner’, saying this caused some difficulties for staff, who made efforts to include them in activities. Their care plan, dated 2007, said they liked to socialise. People told us their visitors were made to feel welcome. We saw posters about a forthcoming ‘Sausage sizzle’, to which visitors were also invited. One person was unable to go to the church they used to attend, but friends from the church visited them regularly. Visitors told us that senior staff looked after them as much as the person living at the home. Recent staff meeting minutes said visitors were not charged for meals, a donation being requested instead. People living at the home told us they had enough choice and control of their lives generally. They had their own furniture or other possessions in their rooms. Staff do not act as appointee for anyone, leaving people free to choose who helps them manage their affairs. One person thought staff fitted in with the people living at the home, so people could have their preferred routine. When asked about this, one staff member told us staff took breaks separately so as not to affect the care people got or their routine. A survey from someone living at the home said, “I really enjoy the meals.” Another said, “Excellent meals, variety, nourishing, fresh fruit and vegetables daily, etc.” The sweet trolley we saw at lunchtime had 10 different desserts on it, including fresh fruit dishes, homemade hot puddings and egg custard. The chef said he managed to speak with most people living at the home each day, and told us about peoples’ preferences or special diets. The components Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 17 of pureed meals were served separately on the individual’s plate, to improve the appearance and experience of the meal for people needing pureed food. One person told us there was a rolling menu, repeated monthly, so they got to know what the next meals would be. People we spoke with generally liked the food; one person said suppers weren’t ‘so good’, but couldn’t clarify what they would prefer. When we asked someone about the evening meal, discussed at the January residents’ meeting, they said the food was very good but service was still very slow. They said they were told this was due to staff shortages, but felt this should be addressed if that were the case. Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 18 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 & 18. Quality in this outcome area is good. People’s complaints are heard and acted upon. One matter needs attention to ensure individuals and their rights are fully protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Surveys and people we spoke with told us they felt able to make a suggestion or a complaint. Staff told us that they would report any complaints made to them to senior staff or the manager. The AQAA said the home has not received any complaints in the last year. Since our last inspection, the commission has received one anonymous complaint about the home, expressing general concern about care, care planning, staffing levels, and management. This was still being investigated by the Responsible Individual at the time of our inspection. The majority of people told us they felt safe at the home and with staff. However, one said some staff were ‘a bit bossy’, adding, ‘But I need that.’ And two people – who both said they felt the manager would listen if they complained - commented one or two staff could be ‘short’ with them, or were brusque in manner. See also the section under ‘Staffing’, where some people thought staffing shortages were affecting some staff. Staff appeared polite and Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 19 helpful during our visit, and we did not hear any inappropriate communication. However, we reported such comments to the manager, who said she would speak individually with residents, as a matter of urgency, to find out if they had any problems with staff. Staff were able to tell us to whom they could report any concerns or abuse if they witnessed it, and knew where relevant phone numbers were. We saw inventories of peoples’ property, which would help safeguard their personal interests. Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 20 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 & 26. Quality in this outcome area is good. People have a homely, well-kept and clean place to live, which is adapted to suit their needs and promote their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People we spoke with had some of their own furniture and possessions in their bedroom; bedrooms looked homely and individualised. The great majority of people we asked were happy with their facilities (hot water supplies, lighting in the evenings, etc.). Décor throughout the home looked pleasant and was of a good standard. We saw a cupboard was full of new towels and pillows. The manager said completely new bed linen, pillows and towels were provided for new people, even if they were only having a short stay. Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 21 One person had spoken with staff about difficulty moving around their room because of their own mobility needs and its layout, and staff were trying to address this. People told us they knew they could move bedrooms when one they preferred became available. At our last inspection, we said more specialist equipment, to promote independence and mobility, would further enhance the lives of people living at the home. On this visit, people told us they appreciated that new chairs of different heights had been obtained. And staff said new adapted baths were very helpful when assisting less able people. They and people we asked thought currently there were sufficient aids or adaptations. There were handrails in corridors, though only on one side of the corridor in places. En suites and shared facilities had raised toilet bases, with grab rails fitted in bathrooms and toilets. There was a level access shower. It did not have anywhere for people to put their toiletries. The manager said no-one used it independently at present but, if someone wanted to, a shelf would be put up, positioned according to their needs. People living at the home and staff told us that repairs were addressed quickly. One person told us, “There’s a man that does nothing else!” We saw a list for reporting repairs was kept in the care office, with dates kept of when the problem was attended to. Mrs Haxton, the manager, told us vacant rooms were checked for repairs and safety before a new occupant moved in. At our last inspection, we said additional training in fire procedures for staff would further enhance the safety of the home. On this visit, staff were able to describe appropriate procedures, in the event of the fire alarms sounding People told us they were satisfied with the usual level of cleanliness. Visitors said there were never any unpleasant odours around the home when they visited, and that their relative’s bathroom was always clean. The home looked clean and very well kept; one room had a malodour, not masked by an air freshener provided. The laundry room looked orderly. Staff said they managed with the one washing machine and one tumble drier. They confirmed there were special bags available for transporting soiled laundry. Disposable gloves and aprons were available around the home. People living at the home told us they saw staff used these regularly. Staff explained appropriate procedures for reducing risks of cross infection. Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30. Quality in this outcome area is adequate. People are supported by a core of caring, committed staff, who are suitable for work in a care setting. They would benefit from further staff recruitment and training, with development of staffing arrangements, to ensure there is a care team able to consistently meet their current and changing needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A survey from someone living at the home said staff were very kind and gave high quality of care day and night. People we spoke with said the ‘regular staff’ were lovely, and loyal. Visitors described staff as ‘patient’. When we arrived on our first day, we were told there were seven care staff on duty, with a chef, housekeeper and handyman, as well as the manager, to look after 28 people. In the afternoon, there were five care staff - including two agency staff. The chef was on duty until after tea. Three care staff were on duty in the evening, with a new staff member. We found that one of the seven care staff was helping in the kitchen for the shift. One staff survey had said there were not enough staff to meet peoples’ diverse needs, with frequent shortages in all departments leading to ‘Robbing Peter to pay Paul’. Others commented on the home’s difficulties in recruiting Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 23 and retaining suitable staff, and that there were some difficulties because the agencies couldn’t always provide staff. Comments on surveys from people living at the home or from visitors included that there were “quite a few agency (staff) who don’t know needs as well as usual staff”, that the high use of agency staff affected continuity of care and it affected the family atmosphere of the home. One of these respondents had impaired sight and hearing, and said the use of agency staff was confusing. A visitor felt continuity of care was made possible by a core of long-serving, committed staff. The home’s AQAA said agency care staff had covered 100 shifts in the previous three months. Some staff felt the same agency staff came and so were used to the home’s routines, etc. Another felt there had not been continuity in recent weeks, so people living at the home could not get to know those who were caring for them. The manager said minimum staffing levels were six care staff for morning shifts, four in the afternoon/evening, and two awake staff overnight from 9pm. She said these levels were always maintained. Of the six care staff on duty on the first day of our visit, two had worked at the home for less than a month. One of these two had no previous care experience, and was one of the staff working the evening shift, having helped in the kitchen during the afternoon. One person living at the home told us weekend staffing was ‘bad’. Rotas showed that on some weekends, no ancillary staff were rostered. This meant care staff were also responsible for cooking (covered by specific carers), cleaning or other domestic duties. One staff member felt weekend staffing was more of a problem because often there were no senior carers rostered, with agency staff employed to run the shift instead. Rotas reflected this. A new senior carer had just been employed, however, so staff hoped this would address some of these issues. Someone felt there were enough staff, or always someone about, and said staff sometimes stopped to chat. However, they also said time ‘dragged’ at weekends. One of their peers said staffing levels varied and they never knew ‘how it was going to be’. They said staff were rushed, but coped with meeting peoples’ needs. Another – who also described staff as ‘kind and generous’ – said staff were busy all day and worked very hard, and thus one or two lost their patience. New staff described their recruitment, which showed appropriate practices had been used. We checked their recruitment records, and these contained checks to help ensure their suitability for care work. This included two references and a full police check, obtained before they began their employment. Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 24 We saw an induction record for one of these staff, for the first day of their employment. Another had been assessed using a recognised process, which led the manager to decide that in view of their experience, they need not undergo a full induction. This person said they had shadowed a colleague for a day, and did not work unsupervised until they knew people. One person living at the home felt most new staff were ‘pretty qualified’ already but noted they were still directed by other longer-serving staff. We saw the newest care staff member worked with an experienced colleague during the morning on the first day of our visit. When we asked people living at the home if staff seemed sufficiently trained for the work they had to do, most felt they were capable. One thought some would benefit from training in ‘people skills’ - such as communication and their individual approach - as opposed to ‘hands on’ care skills. Staff told us about a continence nurse specialist’s involvement at the home; she was due to give a staff training session in the next week. One said they had had training on catheter care when this was relevant in the past to some people living at the home. Hospice staff had also given some training. One person with impaired sight said staff either forgot this or didn’t realise their needs. For example, interrupting them when they were listening to a talking book, or not leaving their possessions in the same place after cleaning the room. The training programme we were shown did not include visual impairment. The manager told us she had recently contacted an organisation for people with sensory impairments, and was hoping to arrange some training through them. One staff survey said there was ‘lots of training if we want it’. The manager said anyone could attend any training offered, hence training records showed the chef had attended training on medication, continence, palliative care, etc. Care staff we spoke with said they had had little training in the last year on topics specific to the needs of people living at the home or likely to use the service. This was reflected in the training records we were shown. We noted the annual budget for the home did not include staff training/development. The manager said she requested funding when she wanted it for training. She told us that the home intends that all care staff will achieve a recognised care qualification (NVQ2 in Care), and only three of the current staff were still to commence the course. The AQAA said of 21 care staff, nine already had the qualification. Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 25 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, 33, 35 & 38. Quality in this outcome area is adequate. Residents’ financial interests are safeguarded by the home’s policies and practices. Peoples’ views are being sought, so the service will be developed and run in the best interests of those living at the home. Although improvements are evident, some managerial responsibilities are not fully carried out, creating a risk to the welfare and safety of people living or working at the home at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mrs Haxton, the registered manager, trained originally as a nurse and has since undertaken and achieved the Registered Managers Award. People living Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 26 at the home, visitors and the majority of surveys spoke positively about Mrs Haxton as a person, and were complimentary about all the senior staff at the home. One commented, “We have an excellent manager and deputy to whom we can talk to confidentially.” The AQAA provided was detailed and generally comprehensive (- one area being less informative). It was also very positive to find that some of the requirements and recommendations made at our last inspection had been addressed. However, others had not been met. Two requirements were issued during this inspection for urgent attention. People told us through conversations and surveys that there were residents’ meetings, which is a positive development since our last inspection. They told us they could say what they liked at these meetings. One person’s survey said, “Residents’ meetings are held periodically for discussion, and open debates.” We saw minutes from a meeting in January 2008 (- Mrs Haxton said minutes from a more recent meeting were still to be produced). One person told us action was usually taken about most of what was discussed. Two people thought it took a long time for anything to happen regarding suggestions made - one felt nothing happened because the manager was very busy. When we asked someone about specific issues raised at the January 2008 meeting, they said the issues were still occurring. We saw reports by senior managers external to the home who have legal responsibilities for the home’s running and who carry out their own unannounced visits. These visits had included speaking with people living at the home. Some areas for improvement of the service had been identified (such as care planning and recruitment/staff retention), with suggestions for action to address them included in the reports given to the manager. At our last inspection we recommended the home should have a development plan based on specific considerations. When we asked the manager if a development plan had been produced, we were shown the annual budget for the home, which did not specify any goals for the home, actions to achieve them, etc. We saw minutes from a staff meeting in June 2008. These indicated it was an opportunity for discussion and shared problem-solving, with staff confirming the meetings were ‘two way’ between senior staff and other staff, and that they bore results - a positive development since our last inspection. Staff said they did not have formal, recorded, one-to-one supervision with senior staff, but were generally positive - saying senior staff or the manager were always available if staff had any queries, a meeting could be requested, etc. One (anonymous) staff survey, in relation to meetings with their manager, Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 27 said they had never had the opportunity to discuss their role, only receiving instructions. On the first day of our visit, we saw some upper windows that were open wide, which we brought to the attention of Mrs Haxton. When we returned for a second day, we found two still opened wide, without the risk of falling from them having been assessed. We therefore issued an immediate requirement notice that risk assessments be carried out and action be taken to manage any risks. Although we have not yet had written confirmation of action taken or intended, we were informed verbally by Mrs Haxton that short-term action has been taken to promote peoples’ safety whilst a more suitable long-term solution is found. Two of the three people we casetracked had fallen in recent weeks, although one of them had already been referred to relevant professionals for help with their mobility. One person we met had a notable bruise on their left hand, which neither they nor staff could explain, and which was not reflected in their care notes. One person told us they felt safe at the home, and that they hadn’t had any falls since moving in, unlike when they lived at home. We looked at accident forms completed in recent months. One person had had nine falls in recent weeks, the most recent one necessitating a hospital stay. The manager said these were mainly slips from the edge of their bed, but we discussed that this should have been addressed nevertheless. The person’s care plan did not reflect the issue properly, although a manual handling assessment had been reviewed in May 2008. The manager said she would begin to audit accidents formally. Staff did not feel there were any environmental hazards contributing to falls, but training records we saw did not include falls prevention. The manager told us three staff had done an extended first aid course, and one would usually be on duty. She confirmed no risk assessment had been carried out to assess the actual level of need for first aid cover, but said she was due to review the home’s training needs at a management meeting that week. Records of regular safety checks by the handyman had been commenced in May 2008. We were shown checklists completed twice a month, which included action taken to address any problems identified. The headings and related information were quite general, and had not led to identification of the unrestricted windows. We discussed whether it would thus be prudent to have more detail. Care staff we spoke with confirmed they had had ‘mandatory training’ i.e. on health and safety matters or safe working practices. Staff we spoke with described, consistently, procedures to be taken in the event of the fire alarm sounding. We were shown the home’s fire safety risk assessment, with a review date in 2006; Mrs Haxton thought bi-annual reviews were required. We Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 28 have since spoken with a local fire safety officer, who confirmed the local fire authority expect evidence of annual reviews as a minimum. We saw a very positive 2008 report from an Environmental Health Officer’s inspection of the kitchen. The area looked clean and organised. The chef told us that since our last visit, arrangements have been made for regular cleaning of ventilation ducts to avoid risks from build-up of airborne materials. No staff act as appointee for anyone living at the home. One person who had some personal spending money held by the home on their behalf said they were satisfied with how this was managed. We checked the records of three people whom the home held monies for. These were well kept, with two signatures, receipts or other evidence to verify the transactions shown, and cash balances held matching the records we saw. Mrs Haxton said a copy of these record sheets was sent to those responsible for supporting residents with their finances, on request or when the sheet was full. Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 29 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 1 Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 30 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 OP3 Regulation 14 Requirement Timescale for action 25/07/08 2 OP7 15 (1) You must not accommodate anyone at the care home unless their needs (physical, social, etc.) have been fully assessed by a suitably trained person, and you have a copy of that assessment. All the people living at the home 21/08/08 must have an up to date and detailed plan of care. This will ensure that their health, social and welfare needs are met in a person-centred and consistent way. (This requirement is outstanding from 30.06.06, 30.01.07, & 15.08.07) 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. (This requirement is outstanding from 31.10.07) You must make arrangements DS0000022020.V363493.R01.S.doc 3 OP7 15 (2) 21/08/08 4 OP9 13(2) 21/08/08 Page 31 Rose Lawn Version 5.2 for the recording, safekeeping and safe administration of medicines in the home. This is to include Maintaining records of medication received by the home, including for people who subsequently self medicate. Supporting people who wish to self medicate, within a risk management framework, to ensure they receive any help they need to achieve this safely. Ensuring that there are clear directions available to staff on how and when medicines prescribed to be used “when required” are to be used, considering both general guidance available to staff as well as individuals’ care records. Ensuring that it is clear what dose an individual has been given, when they are prescribed a medication with a variable dose, on each occasion that they are given such medication. 5 OP38 13(4) You must ensure 24/07/08 (a) All parts of the home to which people have access are so far as reasonably practicable free from hazards to their safety, And (c) Unnecessary risks to the health or safety of people at the home are identified and so far as possible eliminated. Including provision and maintenance of window restrictors, based on assessment of vulnerability of and risk to people at the home. Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 32 To ensure as far as is reasonably practicable the health, safety and welfare of people at the home. 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 OP10 Good Practice Recommendations Staff should have particular regard for arrangements for entering individuals’ bedrooms, to ensure each person feels they are treated with respect and their right to privacy is upheld. Each individual’s social needs and interests should be recorded, with this information then used by staff to support them to meet these needs in a way that suits the individual. You should ensure that people living at the home are spoken to respectfully, so they are safeguarded from psychological abuse, discriminatory abuse, degrading treatment, etc. through deliberate intent, negligence or ignorance. With consideration of factors such as new staff (for example, those on induction and agency staff, who are less familiar with the people who live at the home), you should ensure that staff numbers and skill mix of qualified/unqualified staff are appropriate to peoples’ assessed needs, the layout and purpose of the home, at all times, to ensure peoples’ needs are met. 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, with a staff training and development programme that ensures staff can fulfil the aims of the home and meet the changing needs of people living there. The registered manager should develop a more proactive management approach, ensuring they carry out their management responsibilities fully, so that people benefit DS0000022020.V363493.R01.S.doc Version 5.2 Page 33 2 OP12 3 OP18 4 OP27 5 6 OP28 OP30 7 OP31 Rose Lawn 8 OP33 9 OP33 10 OP38 from a well run home. You should draw up 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. The representatives of the registered provider should develop a more proactive management approach, with regard to their unannounced monthly visits and acting on their subsequent findings, to ensure that people live in a well run home. You should audit accidents, & carry out a risk assessment to inform provision of first aiders at the home, so the health, safety and welfare of everyone at the home is promoted and protected. Rose Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 © 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 Lawn DS0000022020.V363493.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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