Inspection on 29/07/09 for Rose Lodge

This inspection was carried out on 29th July 2009.

CQC 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 Lodge 16/01/10

Rose Lodge 29/07/08

Rose Lodge 07/03/08

Rose Lodge 20/06/07

Rose Lodge 12/07/06

Rose Lodge 09/12/05

Rose Lodge 08/09/05

Rose Lodge 09/06/05

Rose Lodge 31/01/05

Rose Lodge 24/08/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Rose Lodge 2 Isca Road Exmouth Devon EX8 2EZ Lead Inspector Louise Delacroix Key Unannounced Inspection 29th July 2009 10:20 DS0000059793.V377560.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rose Lodge Address 2 Isca Road Exmouth Devon EX8 2EZ 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 227071 Eminence Care Ltd Mrs Karen Bull Care Home 25 Category(ies) of Dementia (25), Dementia - over 65 years of age registration, with number (25), Mental disorder, excluding learning of places disability or dementia (25), Mental Disorder, excluding learning disability or dementia - over 65 years of age (25) Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Dementia- Code DE- maximum 25 places Dementia, over 65 years of age- Code DE(E)- maximum 25 places Mental disorder, excluding learning disability or dementia- Code MDmaximum 25 places Mental Disorder, excluding learning disability or dementia - over 65 years of age -Code MD(E)- maximum 25 places The maximum number of service users who can be accommodated is 25. 29th July 2008 2. Date of last inspection Brief Description of the Service: Rose Lodge (formerly The Mulberry) is registered to provide accommodation and personal care for up to 25 older people with a dementia type illness. They may also care for older persons with mental health problems. The property is a large detached and extended house in a secluded residential area of Exmouth. The home is approached by a private driveway, has pleasant secure gardens and parking on site. The accommodation is arranged over the first and ground floors, with a passenger lift to the first floor. The lounge and dining areas are designed in an open plan arrangement and are situated on the ground floor. The current weekly charges range from £380- £480. Items not included in the fee include chiropody, hairdressing and clothing. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk/ CSCI Inspection reports are available on request from the manager. Rose Lodge DS0000059793.V377560.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 that the people who use this service experience adequate quality outcomes. The key inspection was unannounced and took place over nine hours and was carried out by two inspectors Louise Delacroix and Teresa Anderson. Prior to the inspection, the home completed an Annual Quality Assurance Assessment (AQAA), which tells us about how the service is run, and improvements that have been made and the homes plans for the future. Information from this document has been included in the report. We also sent out surveys to people living and working at the home, and to people visiting the home, and the responses from these have been incorporated into the report. During the inspection, we spoke to people living at the home and observed their care in communal areas. During the inspection, we carried out a Short Observational Framework for Inspection (SOFI). This helps us measure the well-being of people who are unable to comment directly on the care they receive. It also enables us to make judgments about how people occupy themselves during the day and the skills of the staff who support them. What the service does well: The home has a good assessment procedure to help ensure that it is the right place for people considering moving, and helps to establish that they can meet people’s needs. This includes providing people with information and encouraging visits to the home. We saw evidence of good links with health care professionals and for some people a good oversight of their health needs. We saw that people looked well cared for and that the majority of staff practice maintained their dignity and privacy. There are some staff members who are skilled in their approach, providing individualised and person centred cared, and who are able to act as positive role models. Meals are generally provided in a calm manner and people appear to enjoy them. Friendships and social interaction between people living at the home are encouraged by supportive staff. The home responds well to concerns and complaints and seeks to address them, and staff recognise their role in safeguarding the people in their care. The home is well maintained and safety procedures are in place. Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.2 Page 7 taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 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 Lodge DS0000059793.V377560.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Rose Lodge has a good admissions procedure, which helps ensure that they can meet the needs of people before they move to the home and helps people make a decision about whether the home is right for them. EVIDENCE: We saw in care plans that people are assessed by the manager before they come to live here. Assessments identify each person’s needs to determine if those needs can be met by this service. In addition, assessments are supplemented with information from other sources such as the family and health and social care services. The manager explained how they visited people before they moved to the home, and showed us photographs of the home that they take with them to help people make a decision about whether the home is right for them. In the Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 10 home’s AQAA, it states how people are sent a sample menu and an activity schedule, and invited to lunch. The manager told us that people are encouraged to visit, and we were told this had happened on two recent occasions but that generally relatives visit on people’s behalf. We spoke with one visitor to the home who had recently supported a relative to move to Rose Lodge. They told us they had been given information about the home and that they had been shown around the home. They told us they are happy with the decision they made. The home does not provide intermediate care. Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Changes to responding to people’s health needs and recording them, as well as better management of medication would help improve the well-being of people living at the home. EVIDENCE: People living here have needs associated with dementia. Some people also have physical needs such as reduced mobility and diabetes. One person has a pressure sore (not acquired in this home) which is being treated by the district nursing service. We were told that everyone living at the home has a plan of care. These contain information about the person the plan relates to, the risks to their health and welfare, instructions on how needs are to be met and evaluations about how well the care delivered is working. Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 12 We looked closely at the records and care plans relating to three people. Each person has a folder containing risk assessments and other in depth information. From this a day to day plan of care is developed which staff use to guide the care they give. We saw from the minutes from a staff meeting how staff had contributed to these records based on their knowledge of each individual. Staff make written records relating to the care given in another folder. Each plan of care is evaluated by the person’s key worker. When we looked at the care records, we found some information is incorrect. For example, we saw in one care plan that a person has been identified as being at high risk of developing pressure sores. The plan told staff to use a type of mattress usually used for people who are at less risk of developing pressure sores. When we checked we found that this person is cared for on the appropriate mattress, and the records are inaccurate. When we looked at the records we found some information out of date. For example one care plan told staff that the person should have cream applied to a sore area. However, staff told us they no longer apply cream but that the paper work had not been updated. It is good that staff understand what to do for this person despite the inaccurate record keeping. However, as this home uses agency staff as shown by the staff rota and as the AQAA shows that there has been a high staff turnover (we were told that overall this has been a positive outcome), this inaccurate instruction does present the risk of a member of staff carrying out inappropriate care. We met one person, who cannot eat or drink independently. Records are not kept of what this person eats or what they drink, which would help to ensure that their food and intake is adequate. We did see one staff member ensuring other people in the shift knew how much the person had eaten. However, later we saw a drink left on the side in their room, which they could not reach themselves and the type of drink could not be identified when we showed it to the manager. Records do not give guidance how this risk is managed and do not promote best practice or accurate recording. We saw that care plans are reviewed at least monthly. However, we saw from one record that changes are not always then reflected in the care plans. One example of this is a person who is losing weight whose care plan has not been altered in an attempt to address this. Staff told us they don’t have time to look at plans of care very often and that the amount of information in them can be overwhelming. They say that they tend to speak with other staff to find out about each person’s needs. These examples indicate that the care plan is not the valuable document it should be but has become, to some extent, stand alone paperwork. We were told by the management company that they have plans to introduce a new care planning system in the home. Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 13 We wanted to know how people have their health and welfare needs met. We saw that the doctor is called when someone becomes unwell. We also saw evidence that people have recently seen a dentist and evidence that others have seen an optician. Social and health care professionals (including 2 GPs and a district nurse) who contacted us told us about the improvements in the home. One said, ‘it appears to care more directly with the needs of their clients. The clients appear more relaxed and content’. A GP said that the service shows a ‘good understanding of people with dementia’. We spoke with the manager about how people’s weights are monitored and she told us that the home has sitting scales and that they are building a relationship with district nurses about monitoring people’s nutrition, and that a system is in place to ensure that everyone is served their meal. A visitor told us that their relative had put on weight since the new management team had run the home and this reassured them about their relative’s care. We saw two people being encouraged to eat additional food and drinks to help maintain their weight and recognised their personal likes, such as milkshakes and chocolate. The manager also told us about how they have reduced the falls for one person by the use of appropriate footwear, which we saw and by changing the layout of the person’s new room. The AQAA also states that the home also works closely with health professionals i.e. the falls co-ordinator. A relative told us that they were very pleased with their relative’s new room and their new footwear, both of which had reduced their falls. To help us make a judgement about the service we looked at how changes in people’s health are monitored. Records show that staff observed that one person’s behaviour had changed. Staff tested this person’s urine because they are prone to urinary tract infections, and found this to be abnormal. The doctor was contacted and antibiotics were prescribed. Records show this person’s behaviour stabilised. This is a good example of how staff observe the behaviour of people who can’t communicate verbally, so that they can quickly identify health or welfare issues and take appropriate actions. We looked to see how the home supports people with diabetes. The records show that staff measure one person’s blood sugar regularly and we saw that this is recorded. We asked staff if they knew what was a normal blood sugar for this person. They told us that this person normally has a high blood sugar. We asked them what they would do if the blood sugar were higher than this or if it was very low. Staff did not know what to do. We looked in the care plan to see if there were instructions for staff about what to do, and there are not. We also looked to see if there are instructions for staff on what to do to prevent any complications associated with diabetes, and there are not. Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 14 We observed during lunch that one person choked whilst eating. Staff responded immediately helping this person to have a drink and staying with them until the choking stopped and they had settled. We heard staff say that this person is finding it hard to swallow. Another member of staff said this person had choked the day before and that she might need to see a doctor. We looked to see if the previous day’s incident been recorded, and it hadn’t. We looked later to see if that day’s incident had been recorded and it hadn’t. We asked the senior member of staff on duty in the evening if they were aware of this problem and they were not. We asked that this be recorded and reported and appropriate action taken. We looked at how medicines are managed and found that there are good systems in place for recording, ordering, receiving and storing medicines. Staff are very familiar with the procedures to be used and demonstrate an excellent understanding of what each medicine is used for. Each medicine is stored and locked away safely, including those in the fridge, and access to them is restricted. We carried out a count of three different medicines and found these to be in order. The manager told us that they carry out weekly audits of the medicines. We looked at some records relating to medicines. We found some gaps when it would appear that medicines had not been given. We also saw that two people had not received some of their prescribed medicines on seven separate and consecutive occasions. Records show this is because they were in bed or because they were offered and not required. These medicines included an antibiotic. We saw that one person is prescribed nutritional supplements to be given ‘as directed’. We asked staff about this and they say that this means they should have supplements three times each day. However, they could not find a record confirming this. When we looked at the records we saw that, according to those records, this person is not always having this supplement three times a day. When we looked at records, we noted that no one is having a sedative type medicine to be given if needed. This indicates that staff are using methods other than medication to manage behaviours that challenge the service. This is good practice. We saw that the home has a homely medicines policy which means that people can have over the counter medicines if they need or request them. We saw that doctors had agreed to the medicines that could be used, as is good practice. However, there are some minor differences between what a doctor says can be used and what the home is using. We saw from the home’s incident log that in July 2009 a staff member had reported that a person living at the home had confided that they had not taken Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 15 their medication. This was good practice to share this information. The outcome recorded on the incident log was for staff to be more vigilant. However, we observed one person with dementia being given their medicines in a drink. The drink was left on the table in front of this person who was not being supervised by staff. After twenty minutes, this person had not drunk any of the drink. We moved it and gave it to a member of staff because other people living at the home were walking around and we had read that one of these people takes other people’s food and drink. We saw during the lunchtime meal that one person constantly interfered with other people’s meals and drinks. We observed how people’s privacy and dignity is respected by staff. We saw that all personal care is given in private. We saw that rooms have locks on them, and saw staff knock on doors and wait before entering. We saw that personal clothing is marked in a discreet way so that people only wear their own clothes. We saw that people are well presented with for example clean clothing, glasses and teeth. We heard staff using each person’s preferred name and saw that this preference is recorded so that all staff are aware of this preference. We saw some staff discreetly helping people to eat, being kind and respectful. A visitor told us that the current hairdresser provides does a ‘superb job’ and had improved their relative’s dignity. We saw staff making sure that the person they were assisting to eat knew what was on the fork before they put it into their mouth and we saw them reading the person’s body language to pace the help they provided. We saw some staff clearly explaining what they were going to do before they did it and making eye contact with people when they spoke with them. We saw one staff member skilfully intervene, when people living at the home began to lose patience with each other, in a way which maintained people’s dignity and respected their frustrations. However, we saw another member of staff wipe a person’s nose without explanation and whilst having a conversation on the telephone. We saw a person being moved in their chair from behind without any warning or understanding of what was happening. We saw some staff not fully explaining their actions or involving the person when they used equipment to move them. These range of examples show there are variances in the skills that staff have in caring for people with dementia, which the home manager acknowledged during the inspection. Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The way in which people’s social needs are being met is improving and people benefit from an atmosphere that promotes choice and generally recognises the importance of a positive meal time experience. EVIDENCE: We looked at how people’s social needs are met. The home’s AQAA acknowledges that there is further work to do in this area of care but that a number of improvements had been made, which was confirmed by a relative who visits regularly. We saw that staff find out about each person’s previous social interests and how their social needs can be met. These are recorded and from this information a plan is formulated as to how people’s social needs can be met. We saw that the home arranges quizzes and that they are building a library of memory boxes. Each box contains items which are important or significant to the person to whom the box belongs. Staff use these to stimulate conversation Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 17 and to help them interact with people meaningfully, and we saw this happening. We were told that a drama therapist was due to visit on the afternoon of our inspection but we were in the office when they cancelled their visit due to sickness. We saw that in the afternoon when the person was due to visit that several people became anxious and restless but that staff did little to occupy them. However, a relative who visits regularly praised the home for improving the social occupation of people. They told us about the ‘absolutely delightful’ person who visited at least twice a week to provide meaningful activities for people, which they commented people responded very favourably too. They told us that staff try and stick to an activities schedule for people and we saw a copy of the different activities identified for people. In the morning, we saw one person sitting in a corner of the lounge listening to classical music. Staff spoke to them about the music they were listening to. We saw from their care plan how staff had observed that they seemed more relaxed if they could listen to classical music and can view what is happening in the lounge but not take an active part. The care plan of another person who is cared for in their bedroom identifies that they like classical music. When we went into this person’s room, classical music was being played, and their relative confirmed they responded well to this type of music. We saw that people living here have developed attachments with other people and we saw people chatting and appearing to enjoy being in each others company. We saw some staff helping to facilitate these interactions, and skilfully and respectfully helping to reduce any tensions that misunderstandings had caused. We saw some staff supporting people to sit with people that they enjoyed being with. However, there were times when staff were not observant when people were becoming frustrated with each other i.e. one person became cross with another person for repeatedly touching the arm of their chair. And at times, a volunteer was left to monitor the lounge rather than trained staff, which is not appropriate. We saw people walking freely around the home and helping with simple tasks such as clearing the table after lunch. This can help people to feel useful and valued, to remain active and to use energy so that they might sleep better at night. The home’s AQAA states that work is planned to make the home’s outside areas more accessible. We looked at one person’s care plan and saw that staff had recorded that this person enjoys and needs to be busy, that they need to be active and like to do things. The record states that this will relieve boredom. We saw that the activities planned for this person are largely sedentary such as reading, listening to music, watching a musical, watching TV and looking at photos. Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 18 Records also say that this person should be encouraged to sit and rest. We spoke with staff about this plan and were told that staff do this to stop this person becoming anxious. We observed that this person becoming frustrated when it was suggested they have a rest and that staff did not offer an alternative. The home has no set visiting times and we saw relatives coming and going. We saw that some staff were more confident and competent in how they interacted with visitors. One visitor spoke warmly about the staff team and the reassurance they gave them when they visited. We heard people being offered day to day choices, for example what time to get up, what to where, who might help them with their care, what to eat, how much to eat and if they would like sugar in their tea. Choices were offered in a very sensible way so that the choice was as easy as possible to make. For example, when asking one person what they would like to wear, the staff member showed them two items so that the person could see the choices and point to the one they wanted. This is good practice and shows a good understanding of how to overcome a communication problem. A relative told us that the home had made real steps to try and ascertain people’s choices and they said they saw examples of this on a regular basis. We asked people if they liked the food served here. Those who could respond said they did, that they got a lot of choice and that they had put on weight. We saw people enjoying the lunch time meal of fish pie or roast lamb. We saw that people had been offered a choice of what to eat and that photographs of food are available to help people make these choices. We saw staff discreetly and sensitively offering help to those who needed support to eat. However at teatime, we saw that practice by another staff group was not as individualised. A person was given soup and spaghetti hoops with bread. We asked if by the time this person had eaten their soup, if the spaghetti hoops would be cold. We were told that they would be. Arrangements to address this were not made. At lunchtime, tables are laid for each meal with cloths, serviettes, cutlery, condiments, drinks and flowers. This helps people to recognise that it is a meal time and helps to make meals a social event. During lunch we saw people talking with each other and helping each other by passing the salt for example. Staff told us they encourage people with a similar level of ability to sit together so that they can enjoy lunch as a social event. We spoke with the cook who told us that the home operates a 4 week rota for the menus. She says she knows who needs special diets and who needs their food pureed. Foods are pureed separately so that people can taste those separate foods (although one person living here chooses to have their food Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 19 pureed together). The cook told us that there are no vegetarians living at the home at the moment but that she would cater for this if needed. The cook is told if someone is not well and told us they will then prepare something light for them to eat. Staff have given them a list of those people who are at risk of malnutrition and who need extra calories. This is achieved for example by putting extra cream in their mashed potato. The manager also told us about people who had food prepared in the way they like to encourage them to eat, such as milkshakes or chocolate, which we saw being provided during the inspection. Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from staff who recognise their safeguarding role and where complaints are taken seriously, although the recording of them could be improved. EVIDENCE: The Commission has not received any complaints about the home since the last inspection. A relative told us that they felt listened to by the home when they had raised a concern, and told us that the home had addressed the situation. They told us the manager was approachable and that they had a good relationship with them. A district nurse told us that the home always responds appropriately to concerns. The office has been brought to the front of the home, and the manager said this made them more accessible for people to talk to, and we saw this to be the case during the inspection. The home’s AQAA records that the service has received six complaints and one was upheld. It states that ‘all/any accidents are logged appropriately’. The service provided us with a log of their complaints and incidents. From the recording, it was unclear why only one had been upheld, and for two incidents it was unclear about the action taken and why the incident had happened. We spoke with the manager about the poor quality of the recording of complaints, Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 21 and clarified the outcomes for people and how many complaints had been upheld. Records show that staff receive training in safeguarding adults from abuse. We spoke with staff about how they do this. They told us what abuse is and what the signs of abuse might be. They told us they feel confident that if they reported an incident that this would be dealt with effectively. They also say that if it were not dealt with that they would contact an outside agency such as the commission. This is good practice. We observed staff being respectful, patient and caring with the people who live here. One person can grab and hold on to staff which might result in staff being hurt. Staff described what they do to prevent this person grabbing and what they do to loosen this person’s grip. The actions are appropriate, although they are not documented in the care plan as they should be. We saw one staff member reacting less professionally than others when this happened. We noted in one care plan that one person had made an allegation that someone had shouted at them. We spoke with the manager who explained the steps they had taken and who they had consulted with to ensure that they were taking the correct steps. Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been noticeable environmental improvements to Rose Lodge, and the general appearance of the home which benefits the people living there. EVIDENCE: We found this home to be clean and odour free throughout. We were told that areas have been deep cleaned and staff have been involved in choosing priority areas. We spoke with a visitor who said it was always clean. They told us that lots of people spill things or ‘have accidents’ and that staff really quickly clear the spillage up. A health professional told us ‘I have been pleasantly surprised on my recent visits to Rose Lodge. It feels more homely and is a pleasant, relaxed place to visit’. In the home’s AQAA, it states that areas of the home have been divided to create smaller seating areas to reduce the noise. We saw people responding positively to this change of layout. Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 23 The home is decorated in a homely fashion with for example pictures on the walls and lots of vases of flowers. The seating is comfortable and well placed for multiple uses. We saw that there are points of reference to help people with dementia to find their way around the home such as green toilet doors, personal photographs on bedroom doors and photographs showing what the room is used for, such as the dining room. We saw that the laundry and kitchen are clean, tidy and well organised. Foods are stored appropriately and fridge and freezer temperatures are checked frequently. Upstairs windows are restricted to help prevent falls We looked at the majority of bedrooms in use and found them to be well decorated, clean and personalised for the person whose room it is. The home’s AQAA states that several of the rooms have been refurbished to a higher standard, and that one bedroom by the front door has been made into an office while the office has been made into a bedroom, which we saw. We spoke to the management team about how the home is kept warm. The management team told us that they are currently getting quotes to replace one of the home’s three boilers, which they told us was inefficient. They told us that all staff once shown could operate the heating system and that all areas of the home could be kept warm. When we visited people’s rooms, all but one was warm. The one bedroom that wasn’t warm has four windows, and although none of these were open it was a cool and rainy day. We spoke to the person to whom this room belongs and they told us they are warm and cosy at night. We saw staff helping to prevent the spread of infection by using appropriate protection such as gloves and aprons. We saw staff washing their own hands and using wipes to help the people living here to clean their hands. Washing facilities are available throughout the home, as is alcohol gel rub. Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff group is varied in their skills and understanding of people with dementia but they generally have access to training and have their performance monitored. However, the current recruitment procedure at Rose Lodge is not robust and has the potential therefore to put people at risk. EVIDENCE: We observed that staff have variable skills in relation to working with people with dementia. Some staff consistently and confidently display positive regard for the people living here. They show warmth and provide support at a level that encourages independence and encourages a sense of belonging and inclusion. Staff and people living here were seen sharing mutual jokes and relaxed relationships. We saw that these staff are able to prevent or diffuse any developing tensions. From our observation, we could see that the majority of people showed a positive sense of well-being and responded well to appropriate staff intervention. We saw other staff who are less skilled, which we have highlighted in other areas of the report. We spoke to the manager about this, who agreed with this observation. The manager explained that she tries to design the rota so that there is a mix of skills on duty and so that skilled staff can act as positive role Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 25 models and mentors for those who have training needs. However, she also said that sometimes, due to sickness for example, this is not possible and we saw from rotas that there are occasions that staff who have been identified by the management team as needing strong role models are working together on a regular basis, which the manager said they would endeavour to address. The home’s AQAA shows that half of the care staff group currently hold an NVQ 2 in care. We looked at the current recruitment practice of the home and spot checked three staff members who have been employed since the last inspection. From looking at these files, we saw that the current practice is not robust and has the potential to put people living at the home at risk. For examples, there were unexplained gaps on people’s employment histories, and the layout of the home’s application form only allowed for a history of two jobs (we have been informed that this has since been rectified). Job references for one person were undated and their start date is not clearly recorded making it hard to judge if necessary information was in place before they began working at the home. One person’s application form was incomplete and did not provide pertinent details, and there was no clear record of why they had been thought suitable for a care position given information on their CRB (police check). However, we saw that the home had been diligent in ensuring that police checks had been completed before people start work. We looked at records relating to training. We saw that all staff receive mandatory training and updates. We also saw that staff receive training in caring for people with dementia. The manager explained that this training involves watching a DVD and then answering questions about what they had learnt. The manager is trying to find other training and has approached the Devon Training Consortium. However, this organisation is not yet providing this training. We saw from records and demonstrated in discussion with the manager that staff performance is monitored and addressed individually and in meetings. However, we saw from one staff member’s records that they had received a low score as part of their dementia awareness but there was no record to address this training need. According to the three recruitment and training records we looked at, one staff member had not fully completed their induction from April 2009. Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from an experienced manager who has shown a commitment to improvement. Generally, the home is safe place to live, but recruitment practices do potentially put people at risk. EVIDENCE: The home now has an experienced registered manager, whose registration showed a commitment to maintaining their training and updating their practice. The manager is pro-active and responds well to challenges. Staff minutes and written information provided to staff show a clear expectation from the management team about the level and quality of care expected from the staff group. Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 27 The information in the home’s AQAA highlights the importance of good quality communication within the management team and a strong focus on improvement for the lives of people living at the home, which we saw demonstrated during the inspection and in our contact with the home prior to the inspection. A relative told us that there has been a ‘big shake up’ since the current management team have run the home, which has been positive. We could see a number of improvements since the new management organisation has become involved in the running of the home. However, there are still some areas that need further improvement. Since the inspection, the manager has advised us that concerns raised by us have been addressed. The management team ensures that the home has a robust quality assurance system in place to monitor the progress of the home since they have become involved in the running of the home. These systems are well recorded and were explained to us in detail. We saw written records about how the quality of care is monitored and saw how feedback had been responded to. For example, comments made by a relative, which were listened to and responded to. We saw that staff meetings are well attended and that there is a strong focus on improvement. We saw a record of positive comments from a range of people visiting the home including relatives and health and social care professionals who comment on an improved and welcoming atmosphere. As written in the staffing section, recruitment practices are not robust and have the real potential to place people at risk. A representative of the management company said that the service is not yet where they want it to be but they do know where they are going. This reflects our findings. The home does not hold people’s personal allowances and instead relatives are billed on a regular basis for additional expenses. We saw that the manager has systems in place to help with managing the safety of this home and the people who live here. Regular fire drills take place and the home has recently improved the fire safety in the home through the provision of an extra fire door and an improvement in fire evacuation arrangements. Staff receive the mandatory training they need including training in moving and handling, and the home has a member of staff who is qualified to provide this type of training. We saw staff using appropriate moving and handling techniques. Some staff have received first aid training and demonstrate a good understanding of what to do if for example someone chokes or collapses. Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 28 The water system has recently been checked for Legionella and there are thermostatic valves in place to control the temperature of hot water. We checked one bath and found the temperature of the water to be 48C which is too hot. The manager said she would address this. The home’s AQAA records that maintenance checks are up to date, and shows that the majority of care staff have had training in food hygiene and monitoring people’s nutritional intake. We also saw in records that one person who has bed rails on their bed to prevent them falling out. On two occasions they have been found to be caught in these rails. On one occasion their head had been caught in the rails. The plan relating to the use of bed rails has not been changed, and their use continues. However, we did see that the home checks the position of the bedrails on a regular basis. Care plans contain numerous risk assessments and demonstrate that generally actions are taken to reduce risks to the people living here. The manager has kept us informed of incidents in the home, both in writing and verbally. Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 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 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 2 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x N/A x x 1 Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 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 OP7 Regulation 15 (2)(b) Requirement Timescale for action 30/10/09 2. OP8 12 (1) (a) 3. OP9 13 (2) 4. OP9 13 (2) Each person should have a plan of care that is accurate and sets out in detail how that person’s health, welfare and social needs are to be met. This will help to ensure that each person receives the appropriate care in a consistent and person centred way. Each person must have their 30/10/09 health and welfare needs met. This includes people who have diabetes and swallowing difficulties receive appropriate care to help prevent complications. This will help to keep people healthy for as long as possible. People must receive the 01/10/09 medicines they are prescribed and must receive these in a way that is safe. This will help to ensure that people stay healthy and are kept safe. Records relating to medicines 01/10/09 must be kept up to date and be accurate. This will ensure that people receive the medicines they are prescribed to keep them DS0000059793.V377560.R01.S.doc Version 5.3 Rose Lodge Page 31 5. OP29 17 Schedule 2 6. OP30 18 1(c)(i) 7. OP38 13 (4) (c) healthy. Staff recruitment files must contain dated and appropriate written references, gaps in employment history must be explained, and contain completed application forms. This is to ensure that staff are suitable to work with vulnerable adults. You must ensure all staff receive a structured induction to skills for Care standards.(Previous date of 1/12/08 not met) There must be a system in place to ensure that the risk to service users from very hot bathing water is controlled. This will help to ensure that people are kept safe. 01/10/09 30/10/09 01/10/09 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 OP7 Good Practice Recommendations Each person should have their plan of care reviewed in a way that uses all the available and pertinent information. This will help to ensure that all care given is the most appropriate for that person’s needs. On–going observation should take place by appropriate role models to ensure all staff practice in a way which supports people’s dignity and is person centred in its approach. Staff should ensure that people’s restlessness or anxiety is responded to appropriately rather than being task orientated in their approach. Complaints should be recorded in a more robust manner to ensure they reflect the outcomes for people living at the home. The detail of decisions to recruit people with Police information on their CRB should be recorded to explain DS0000059793.V377560.R01.S.doc Version 5.3 Page 32 2. OP10 3. 4. 5. OP12 OP16 OP29 Rose Lodge 6. 6. OP30 OP38 how risks were assessed. There should be clear records as to how training needs will be met when a problem had been identified. There should be a more robust system to ensure that bed rails are appropriate, and that care planning evidences how risks have been measured and the actions taken. Rose Lodge DS0000059793.V377560.R01.S.doc Version 5.3 Page 33 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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