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Inspection on 22/02/06 for Rose Lawn

Also see our care home review for Rose Lawn for more information

This inspection was carried out on 22nd February 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Roselawn is decorated and maintained to a very high standard whilst managing to maintain a homely quality. The home has a number of well-furnished communal areas including a large reception hall with seating, two lounges, a conservatory, dining room and quiet room. There has been extensive building work at Roselawn which has been managed exceptionally well with minimal disruption to residents. Staff are described as `lovely`, `warm`, `marvellous`, `excellent`, `very caring` and `professional`. In general they demonstrate excellent interpersonal skills and a desire to make the lives of the residents at Roselawn the best they can be. Staff receive a sound induction and on going training, including training in the Protection of Vulnerable Adults, is provided. The food is described as `delicious` and each meal is an event or social occasion which residents are invited to participate in, but equally have the choice to opt out of if they so wish. Prior to admission, all prospective residents undergo an assessment to ensure that their needs can be met. The moving in process is well managed to ensure that residents feel welcome and valued and that this is their home. Some residents prefer the home to manage their monies and the system in place ensures that this is handled safely and is easily auditable. Residents are accompanied to carry out shopping if needed or staff will do this for them. Residents also benefit from `Lill`s Till`, the in-house mobile shop. All residents are happy living at Roselawn and one said `I wouldn`t leave here for all the rice in China`.

What has improved since the last inspection?

At the last inspection no recommendations or requirements were made to improve the service. The building work has been completed together with decoration and the addition of furnishings. The completed works have enhanced the appearance and overall comfort of the home.

What the care home could do better:

Documented care planning and risk assessments need improving to ensure that appropriate actions are taken to assess and meet needs. Some minor alterations to practice in relation to the management of medication need to be undertaken. The home should continue to aim to have 50% of staff trained to NVQ Level 2 or above and to carry out formal quality assurance. Recruitment procedures must be adhered to.

CARE HOMES FOR OLDER PEOPLE Rose Lawn Rose Lawn All Saints Road Sidmouth Devon EX10 8EX Lead Inspector Teresa Anderson Announced Inspection 22nd February 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 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 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) 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.V279223.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th August 2005 Brief Description of the Service: Roselawn is situated a few minutes walk from Sidmouth town centre and the sea front. The home is owned by Key Change, a not for profit organisation and has a Christian and spiritual ethos. The home currently provides personal care together and accommodation for up to 29 older people. The home is set back from the road and has level access throughout the ground floor. Bedroom accommodation is provided on the ground and first floor of the home, and floors are linked by a passenger lift. All bedrooms have en suite facilities. Communal areas are made of a reception area with seating, two lounges, a 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 through patio doors. There are views over and secure access to the local rugby ground. Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place as part of the normal programme of annual inspection and as such this report should be read in conjunction with the report written in August 2005. During this inspection the inspector met many of the residents and spoke with five in depth. She also spoke with one visiting relative, two members of care staff, the chef, the manager and the operations controller. The majority of the communal areas in the home were seen together with some bedrooms. Records in relation to care planning, medication, recruitment and residents monies were inspected. The manager provided a pre-inspection questionnaire. CSCI received nine comments cards, five from relatives/visitors and four from residents. What the service does well: Roselawn is decorated and maintained to a very high standard whilst managing to maintain a homely quality. The home has a number of well-furnished communal areas including a large reception hall with seating, two lounges, a conservatory, dining room and quiet room. There has been extensive building work at Roselawn which has been managed exceptionally well with minimal disruption to residents. Staff are described as ‘lovely’, ‘warm’, ‘marvellous’, ‘excellent’, ‘very caring’ and ‘professional’. In general they demonstrate excellent interpersonal skills and a desire to make the lives of the residents at Roselawn the best they can be. Staff receive a sound induction and on going training, including training in the Protection of Vulnerable Adults, is provided. The food is described as ‘delicious’ and each meal is an event or social occasion which residents are invited to participate in, but equally have the choice to opt out of if they so wish. Prior to admission, all prospective residents undergo an assessment to ensure that their needs can be met. The moving in process is well managed to ensure that residents feel welcome and valued and that this is their home. Some residents prefer the home to manage their monies and the system in place ensures that this is handled safely and is easily auditable. Residents are accompanied to carry out shopping if needed or staff will do this for them. Residents also benefit from ‘Lill’s Till’, the in-house mobile shop. All residents are happy living at Roselawn and one said ‘I wouldn’t leave here for all the rice in China’. Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (3) The system in place for assessing prospective residents ensures that the home can meet residents needs. EVIDENCE: The manager assesses all prospective residents prior to admission. This includes information from health and social care professionals. Prospective service users are invited to visit the home and to have coffee or lunch with service users and staff. This assessment forms the basis of a plan of care. One comment card remarked that ‘a difficult transition (has been) made very happy’. Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (7, 8 and 9). The system in place for planning care is not being used to its full potential to ensure that staff have the information they need to meet residents’ needs consistently. The health needs of residents are well met with evidence of good multidisciplinary working taking place. Minor improvements to the system for managing medications would further ensure the safe handling of medications. EVIDENCE: The care planning system in place at Roselawn provides for the opportunity to record comprehensive information about residents. It includes sections on nutritional assessment, risk of developing pressure sores, manual-handling assessments and sections to record long term and short term care needs. The inspector looked at 5 care plans and found that many contained good descriptions regarding the daily routine preferred by each resident. However, other important information was missing from some care plans. For example, two residents assessed as being at risk of developing pressures sores do not have care plans to provide staff with directions on what actions to take to prevent pressure sores. Another resident who was very thin on admission did not undergo a nutritional assessment. Appropriate care plans are not in place Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 Page 10 for two residents who have non-insulin dependent diabetes. Care plans do not all contain manual handling plans and/or risk assessment and actions to prevent falls. Care plans do not all include plans to promote or maintain continence. The health care needs of residents are well met. Appropriate referrals are made to health care professionals and many residents report that their health and wellbeing has improved since coming to live at Roselawn. One resident was immobile on admission and is now walking short distances with assistance. There is also clear evidence that many residents have experienced improved self-confidence, self-esteem and a return of skills which some thought had been lost. All the comments cards received from visitors/relatives said that they are kept informed of important matters affecting their relative/friend. In general the system for managing medication is good. However, hand written entries on medication charts are not all being signed by two people, the medication for those people who self-medicate should be recorded when it is received into the home and the medication fridge requires a lock. Although these are relatively minor issues, the manager is keen to ensure that the medication system is as safe as it can be and has asked for an inspection to be undertaken by the Pharmacist Inspector. Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were inspected and met or exceeded at the last inspection. EVIDENCE: Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (18) Good systems and practices are in place to ensure that residents are protected and are safe. EVIDENCE: Residents at Roselawn are treated with respect and feel safe. The manager is a trainer in the Protection of Vulnerable Adults and this training is given to all staff. Staff demonstrate a good understanding of this issue and would report any concerns immediately. The home has a Whistle Blowing policy and the homes zero tolerance policy in relation to abuse is covered during induction. The manager reports that the home has a copy of the Alerter’s Guidance. Comments cards received from residents said they feel safe. Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (19 and 26) The standard of the environment within this home is very good providing residents with an attractive, clean and homely place to live. EVIDENCE: Roselawn is a large 2-storey house that has been extended, refurbished and furnished to a very high standard. There are numerous communal areas for residents to enjoy including a conservatory, two lounges and reception hall. The building complies with the requirements of the local fire service and environmental health department. The manager reports that it is important that furnishings and décor reflect in their quality what the residents deserve and feels that this has a positive impact on their self worth. Residents are very complimentary about the homes décor and the environment generally and enjoy the many areas where they can choose to sit. The laundry is well equipped and on the whole residents report that their clothes are well cared for and, in the main, appropriately returned to them. Hand washing facilities are in place and staff carry alcohol gel to help prevent the spread of infection. Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (28, 29 and 30) The arrangements for the induction and training of staff are good with staff demonstrating a good understanding of their role. The home has yet to meet the recommendation that 50 of all staff are trained to NVQ Level 2. Since the last inspection the standard of recruitment and vetting practices has declined with appropriate checks not being carried out, potentially leaving residents at risk. EVIDENCE: All staff receive a comprehensive induction which includes an introduction to complaints, equal opportunities and whistle blowing, and are offered appropriate training. Two of the care staff are trained to NVQ Level 3 and a further three are currently studying for this qualification. Two members of the care staff are Registered Nurses and one carer is studying to become an NVQ assessor. Staff say their role is to support residents in ways they prefer and to make their lives as happy and as comfortable as possible. Recruitment procedures have not been followed and as a result staff are working at the home who have not undergone Criminal Record Bureau checks and some do not have references. The manager reports that these staff are meant to work under supervision. Discussion with residents and visitors demonstrates that these staff do sometimes work unsupervised. Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 Page 15 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (33, 35 and 38) Formal systems for resident consultation are being developed and informal systems re-established to help ensure that residents’ views are sought and acted upon. Residents’ monies are well managed ensuring their safe keeping. Safe working practices protect residents from accidental harm. EVIDENCE: The manager at Roselawn is accessible and always ready to listen to residents and to make any improvements suggested at an individual level. A staff meeting was held last week and the manager plans to reintroduce residents meetings which are normally held regularly but have been postponed during this busy construction and post construction ‘settling in’ period. Three of the four comments cards received from residents said that they are involved in the running of the home as much as they want to be. Residents could not think of anything that would improve the home, although a few are finding the increase in resident numbers and introduction of new staff difficult to cope with. The Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 Page 16 Operations Controller is currently piloting a quality assurance system in another home that may be introduced into this home in the future. The system for managing residents’ monies is clearly auditable and clear records are in place. Three accounts were checked. Receipts and records are in place and monies balanced. The manager provided a preinspection questionnaire that indicates appropriate maintenance and servicing contracts are in place, that fire training and drills are carried out and that staff receive appropriate training. Appropriate fire checks are undertaken and three of the staff have successfully completed fire warden training. The manager provides moving and handling training and appropriate equipment is in place. Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 X 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 3 Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (1) Requirement Timescale for action 30/06/06 2 OP9 13 (2) 3 OP29 19 (5)(d) The registered person should ensure that each resident has a written plan as to how the service user’s needs in respect of health and welfare are to be met and that they are kept under review. 31/03/06 The registered person should ensure that arrangements are in place for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (This relates to the need to ensure that all hand written entries on the MAR charts are signed by two members of staff, that the fridge is lockable and that all medications received into the care home are recorded, including those medicines for self-medication). The registered person must 31/03/06 ensure that full and satisfactory information is available, as per Schedule 2, for each member of staff who works at the home. Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP28 OP33 Good Practice Recommendations The home should continue to try to ensure that 50 of care staff are trained to NVQ Level 2 training (or above) The home should have effective quality assurance and quality monitoring systems in place to measure success in meeting the aims, objectives and statement of purpose of the home. Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rose Lawn DS0000022020.V279223.R01.S.doc Version 5.1 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!