Inspection on 08/01/06 for Rose Lodge Care Home

This inspection was carried out on 8th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 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 Care Home 16/03/09

Rose Lodge Care Home 13/07/06

Rose Lodge Care Home 30/07/05

Rose Lodge Care Home 08/03/05

Rose Lodge Care Home 20/07/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Rose Lodge Care Home 88-90 Musters Road West Bridgford Nottingham NG2 7PS Lead Inspector Keith Williamson Unannounced Inspection 8th January 2006 09:00 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 Lodge Care Home DS0000008797.V270116.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 Lodge Care Home DS0000008797.V270116.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Rose Lodge Care Home Address 88-90 Musters Road West Bridgford Nottingham NG2 7PS 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) 0115 9455575 Old Brompton Court Limited, c/o Mr David Wheatcroft (Shrubs) Limited Vacant Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Rose Lodge Care Home DS0000008797.V270116.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 resident shall be aged 55 or over Date of last inspection 30th July 2005 Brief Description of the Service: Rose Lodge Care Home is located close to West Bridgford town centre and the main local amenities. The home offers care for up to fifteen older people in single bedrooms. All rooms have a call alarm. Communal space includes two lounges and two dining areas. There is a stair lift to the first floor and the home is well maintained throughout in terms of decoration and furnishings. There is a pleasant enclosed garden to the rear of the property with seating and shade for communal use. Rose Lodge Care Home DS0000008797.V270116.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of the inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views of the service provided. The primary method of Inspection used was ‘case tracking’ which involves selecting clients and tracking the care they received through looking at their records, talking with them where possible, and looking at their accommodation. The inspection was unannounced and took place over 6 hours one Sunday in January 2006, and was conducted by one inspector as part of the annual inspection process. A tour of the building took place and a selection of residents’ bedrooms was inspected. Residents’ records were inspected and six residents and staff on duty were spoken with. What the service does well: What has improved since the last inspection? The acting manager has commenced entering residents final wishes into the plans of care, though is yet to complete detailed information in all plans of care. Rose Lodge Care Home DS0000008797.V270116.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rose Lodge Care Home DS0000008797.V270116.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 Lodge Care Home DS0000008797.V270116.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): 2, 3, & 6. The admission process is followed consistently for all planned admissions. EVIDENCE: All service user files seen on the day included a contract, though this included conflicting information, this does not protect residents in the home, and could lead to confusion. Pre admission assessments are used by the home for all admissions. Care plans are then produced from this information. The Registered Person does not offer intermediate care in the home. Rose Lodge Care Home DS0000008797.V270116.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, 9, & 10. Residents are well looked after in respect of their personal care needs. Inconsistent care practices prevail for medication administration and health care. EVIDENCE: Individual resident care plans are in place, are detailed on a personal basis and are under regular review. It is unclear if residents or their relatives are included in the care planning process. Health care is monitored to a point with records of General Practitioner and District Nurse visits being recorded in files, however nutritional screening was not witnessed in any files and weight monitoring only in one, for a brief threemonth period. The medication process is flawed with evidence of inconsistencies and bad practice prevailing throughout the system. The administration of controlled drugs caused the inspector a great deal of concern. The inspector highlighted two immediate requirements, requiring urgent action by the acting manager, one resulting from the sub-dispensing of controlled medications. Rose Lodge Care Home DS0000008797.V270116.R01.S.doc Version 5.1 Page 10 Staff were viewed giving out medication, this was performed inappropriately, and no back-up information was available to assist in this process. Staff spoken with did not have a good understanding of the medication process, and though medication training has been offered in the past, no training plans were available to assist the inspector in ascertaining if an accredited medication training course was planned for staff in the home. Observation during the inspection showed that staff have a good awareness of how to protect residents privacy and dignity. Residents interviewed confirmed that the staff knock on doors and wait for a response before entering, and added they spoke in a respectful and friendly way. Residents spoken with said that staff were “very caring and helpful” and “its nice and peaceful here”. A number of residents have also chosen to keep a bedroom door key A requirement was made at a previous inspection regarding the need to document residents’ funeral arrangements, preferences and final wishes; this standard was not inspected on this occasion. Rose Lodge Care Home DS0000008797.V270116.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): 13, 14 & 15. Residents are assisted to exercise choice and control over their lives, and are offered a balanced diet in line with dietary requirements and plans of care. EVIDENCE: A variety of “in house” activities are offered to residents, though these are yet to be consistently recorded on a daily basis by staff, these are culturally appropriate, and meet residents’ personal abilities. A limited amount of activities are offered outside the home, mostly based around residents’ religious preferences, and enabling a number to continue their community and spiritual contacts. One resident interviewed stated, “it would be nice to go out now and again”. Of the residents interviewed all indicated visiting was not restricted at any time. Personal choice is offered throughout the home, and evidence is in place to suggest the homes’ practices are flexible, promoting resident’s individuality and independence. The menu system offers a well-balanced diet, and is provided to residents at a time to suit them, however there is no recognised choice to the main meal at lunch time, one resident indicating, “not having a choice doesn’t bother me, I eat everything”, where another indicated, “it would be nice to have a choice”. Residents were witnessed enjoying a pre-lunch sherry. Rose Lodge Care Home DS0000008797.V270116.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. Staff do not have the appropriate information and knowledge on adult protection issues to protect residents. EVIDENCE: At the point of the last inspection staff were unaware of the Adult Protection policies, procedures and terminology. An Immediate Requirement was made that this be addressed with the staff group, the current situation remains with no evidence of any Protection of Vulnerable Adults policy (pova) training having taken place. Rose Lodge Care Home DS0000008797.V270116.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. Residents live in a homely environment. EVIDENCE: There was no evidence of a plan of routine maintenance. There is some outstanding work required to carpets in some area of the home, where one residents bedroom carpet has “risen up” and requires making safe, another area is at the end of a corridor, and fire exit, the area is very worn and could cause anyone using the exit to slip, therefore this requires attending to. The latest report by the Environmental Health Officer was viewed and the outstanding work has been completed. The last visit from the Fire Officer was satisfactory with no outstanding work. Rose Lodge Care Home DS0000008797.V270116.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): 29 & 30. It is unclear if residents are protected by the homes recruitment policies. EVIDENCE: No access to the staff files or staffing information was possible on this visit. This is unacceptable and access to Inspectors must be made available at all times. A requirement was made at the last inspection for a training plan to be formulated for the staff in the home and forwarded to the commission for social care inspection, it is unclear if this has been sent, and if it has is up to date with training offered in the home. Rose Lodge Care Home DS0000008797.V270116.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 & 38. The management approach does not promote effective protection for residents’. EVIDENCE: Quality assurance questionnaires are apparent in the foyer of the home, situated above the signing in book; visitors are also prompted to indicate how long staff took to answer the front door. It would be advantageous for questionnaire results to be made public in the Statement of Purpose and Service User Guide or brochure of the home. The records of residents financial balances, were not available at this inspection to ensure the appropriate protection of residents in the home, it is essential for such information to be available at inspections. One resident indicated a close relative assisted with personal finances and stated “ I always have plenty money”, the inspector could not ascertain what availability of Rose Lodge Care Home DS0000008797.V270116.R01.S.doc Version 5.1 Page 16 personal finances residents had available at the weekend, again availability of finances is essential for residents who’s monies are held on their behalf. After viewing a number of documents regarding the recording of issues pertaining to Health and Safety in the home, it was not possible to ascertain if issues requiring reporting on to the Health and Safety executive had been followed through as no copy documents could be found. Other records viewed such as those for the testing of fire alarms and emergency lighting, were not completed on a consistent basis, and left gaps in testing periods. Rose Lodge Care Home DS0000008797.V270116.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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 2 X X X X X X X STAFFING Standard No Score 27 X 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 3 Rose Lodge Care Home DS0000008797.V270116.R01.S.doc Version 5.1 Page 18 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 OP8 Regulation 12 Requirement The Registered Person must ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of residents. Care plans must include more information regarding residents’ wishes should health deteriorate. The timescale of 31/12/05 has not been met. The Registered Person must ensure that no “sub-dispensing” of any medication is allowed to happen in the course of medication administration. The Registered Person must ensure that medication administered and treated, as a “controlled drug” is the strength prescribed by the General Practitioner, and issued by the pharmacist. The Registered Person must ensure that medication is adequately receipted in the home, and that medication supplied in its original containers or packages is periodically checked to ensure appropriate administration by staff. Timescale for action 08/02/06 2. OP9 12 08/01/06 3. OP9 12 08/01/06 4. OP9 12 23/01/06 Rose Lodge Care Home DS0000008797.V270116.R01.S.doc Version 5.1 Page 19 5. OP9 12 6. OP9 12 7. OP9 12 8. OP18 12, 13 9. OP19 13 10. OP30 12,18 The Registered Person must ensure that all medication is signed for appropriately at the time of administration. The Registered Person must ensure that all excess (including “controlled medication”) and out of date medication is disposed off appropriately. The Registered Person must ensure that all staff are aware of the circumstances in which to follow up and how to record, residents refusing medication in the home. Arrangements must be made to train all staff in preventing service users being harmed or suffering abuse, following the introduction of the homes own procedures for the protection of vulnerable adults. This is an outstanding immediate requirement from the previous inspection, and the timescale of 30/07/05 has not been met, this remains and Immediate Requirement. The Registered Person must ensure that all covered floor areas are done so safely, and any carpeted areas requiring replacement due to worn areas, or relaying due to being raised are done so promptly. The registered person must ensure all staff receive updated training to fulfil the aims of the home and to meet the changing needs of service users. A training plan is required to address this for all staff a copy of which must be sent to the Commission as part of the action plan. The timescale of 01/09/05 has not been met. 23/01/06 23/01/06 23/01/06 08/01/06 23/01/06 23/02/06 Rose Lodge Care Home DS0000008797.V270116.R01.S.doc Version 5.1 Page 20 11. OP31 9 12. OP38 13 The Registered Person must 23/02/06 appoint a registered manager and inform the Commission for Social Care Inspection. This is an outstanding requirement from the previous two inspections. The timescale of 30/07/05 has not been met. The Registered Person must 23/01/06 ensure that the regular testing of fire alarms and emergency lights takes place. 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. 3. 4. 5. Refer to Standard OP2 OP7 OP7 OP9 OP9 Good Practice Recommendations It is recommended that when residents move rooms that the terms and conditions of stay (contract) is re-issued with the appropriate details being in place. It is recommended that daily records are not changed by overwriting, rather the original record crossed out and the correct information written in at the time. It is recommended that risk assessments are reviewed at the period specified, in the risk assessment information or dates changed accordingly. It is recommended that all staff being trained to administer medication in the home are offered the benefit of an “accredited” medication course. It is recommended that any medication tablets that require to be “halved” are done so either by the administering pharmacist, or staff are provided with appropriate equipment to complete the task. It is recommended that all staff have access to the current medication policy and procedures. It is recommended that medication is secured appropriately within the locked medication cupboard. It is recommended that a risk assessment is entered into the plan of care for residents refusing medications. 6. 7. 8. OP9 OP9 OP9 Rose Lodge Care Home DS0000008797.V270116.R01.S.doc Version 5.1 Page 21 9. 10. 11. 12. 13. OP15 OP19 OP19 OP27 OP33 14. 15. OP35 OP38 It is recommended the staff should record all meals consumed by each resident. It is recommended the acting manager should ensure that the cracked wall tiles and worn work surfaces do not compromise the hygiene in the kitchen. It is recommended that any areas of planned work or improvement be entered into the maintenance records for the home. It is recommended the acting manager should ensure that there is sufficient staff on duty to meet the residents needs. It is recommended that the returned information from the quality assurance questionnaires are made available for current and prospective residents in a revised Statement of Purpose and Service User Guide. It is recommended that residents are able to gain access to personal finances at all times in the home. It is recommended that copies of forms to the Health and Safety executive be kept for future inspections in the home. Rose Lodge Care Home DS0000008797.V270116.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Lodge Care Home DS0000008797.V270116.R01.S.doc Version 5.1 Page 23 - 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. 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