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Inspection on 10/08/06 for Roseacres Residential Care Home

Also see our care home review for Roseacres Residential Care Home for more information

This inspection was carried out on 10th August 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Prior to this inspection, many residents and/or their representatives sent written comments to the Commission for Social Care Inspection about their experience of the service. These reflected a good level of satisfaction and were generally complimentary about the staff. There is a core group of staff who have worked at the home for a long time, which provides continuity of care. All new residents are given contracts that detail what is covered or excluded in the fees charged for the service, and comprehensive assessments of their needs are carried out prior to being admitted to the home. Appropriate stimulating activities are provided for groups of residents. There are good systems in place for recruiting staff, which ensure that residents` welfare is protected.

What has improved since the last inspection?

Some improvements have taken place since the last inspection in residents` personal care and in the administration of medicines. The provider was in the process of improving the ventilation in the kitchen. Two new hoists have been provided to assist staff in safely transferring residents. Better facilities have been provided for staff when they take breaks and staff meetings are now held at various times to facilitate their attendance. A budget and financial plan is now available for inspection at the home. Fridge and freezer temperatures are being better monitored to ensure food safety.

What the care home could do better:

Two requirements made at the last inspection have not yet been met and have been restated in this report, with a new timescale for compliance. In the "Timescale for Action" column, the date in ordinary type relates to the timescale given at the last inspection. The date in bold type relates to the new timescale. Further information about unmet requirements can be found in the relevant standard. Unmet requirements can impact upon the welfare and safety of residents. Failure to comply by the revised timescale may lead to the Commission for Social Care Inspection considering action to secure compliance. The provider has not complied with several environmental standards, or has failed to address requirements within set timescales. There are serious concerns about the amount of space available in the home, particularly where bedrooms are shared by people with physical disabilities. There is also a lack of space for storing chair tables when not in use. Care plans are not always regularly reviewed to ensure that residents` current needs are being met. Some residents are not able to be weighed because sit-on scales are not available for those with physical disabilities. Residents or their representatives administration of medicines. consent must be obtained for theIt is not good practice for male staff to provide personal care for female residents. Otherwise, residents` written consent must also be obtained.Several requirements have been made regarding maintenance and repair to individual and communal areas of the home. The provider must give serious consideration to the use of the downstairs toilet, which is unsuitable for protecting residents` privacy and dignity, and the downstairs bathroom, which cannot be accessed when hoists are required. Staffing levels need to be increased at peak times to ensure that residents do not have to spend inordinate periods of time in bed, and chair tables must be removed when not in use so that residents` movements are not restricted.

CARE HOMES FOR OLDER PEOPLE Roseacres Residential Care Home 80-84 Chandos Avenue Whetstone London N20 9DZ Lead Inspector Tom McKervey Key Unannounced Inspection 09:30 10 & 11th August 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roseacres Residential Care Home Address 80-84 Chandos Avenue Whetstone London N20 9DZ 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) 020 8445 5554 020 8445 5589 www.aermid.com Aermid Health Care Limited Mrs Nena Adams Care Home 43 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One specified service user who is under 65 years of age may remain accommodated in the home. The home must advise the registering authority at such times as the specified service user either attains 65 years of age or vacates the home. 28th February 2006 Date of last inspection Brief Description of the Service: Roseacres is a care home registered to provide care for 43 older people, some of whom may be experiencing symptoms of dementia. Residents’ bedrooms are located on both the ground and first floors with a passenger lift and chair lift providing access to the first floor. There are 27 single bedrooms and eight doubles. Communal rooms, which are on the ground floor, include interconnecting lounges and the dining area. There is a large, attractive garden to the rear of the property. Roseacres is owned by a company called Aermid Health Care. owns other care homes as well as a domiciliary care service. The company Roseacres is situated in a pleasant residential area close to shops and other amenities in the area of Whetstone in North London. The fees for the service range from £450 to £650 per week, depending on whether bedrooms are shared or single with en-suite. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over two days in a period of ten hours. The inspection was carried out as part of the Commission’s inspection programme and to check compliance with the key standards. The registered manager was present throughout the inspection and fully cooperated in the process. The inspection process included a tour of the premises, reading residents’ case files, and discussing with them about their experiences of living and in the home. Visitors to the home were also spoken to during the inspection. The staff were observed interacting with the residents and providing care and support. Several staff were interviewed and their records were also examined. Prior to the inspection, several concerns were communicated to the Commission for Social Care Inspection in an anonymous complaint. These issues were examined in the course of this inspection and are referred to in the following report. What the service does well: What has improved since the last inspection? Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 6 Some improvements have taken place since the last inspection in residents’ personal care and in the administration of medicines. The provider was in the process of improving the ventilation in the kitchen. Two new hoists have been provided to assist staff in safely transferring residents. Better facilities have been provided for staff when they take breaks and staff meetings are now held at various times to facilitate their attendance. A budget and financial plan is now available for inspection at the home. Fridge and freezer temperatures are being better monitored to ensure food safety. What they could do better: Two requirements made at the last inspection have not yet been met and have been restated in this report, with a new timescale for compliance. In the “Timescale for Action” column, the date in ordinary type relates to the timescale given at the last inspection. The date in bold type relates to the new timescale. Further information about unmet requirements can be found in the relevant standard. Unmet requirements can impact upon the welfare and safety of residents. Failure to comply by the revised timescale may lead to the Commission for Social Care Inspection considering action to secure compliance. The provider has not complied with several environmental standards, or has failed to address requirements within set timescales. There are serious concerns about the amount of space available in the home, particularly where bedrooms are shared by people with physical disabilities. There is also a lack of space for storing chair tables when not in use. Care plans are not always regularly reviewed to ensure that residents’ current needs are being met. Some residents are not able to be weighed because sit-on scales are not available for those with physical disabilities. Residents or their representatives administration of medicines. consent must be obtained for the It is not good practice for male staff to provide personal care for female residents. Otherwise, residents’ written consent must also be obtained. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 7 Several requirements have been made regarding maintenance and repair to individual and communal areas of the home. The provider must give serious consideration to the use of the downstairs toilet, which is unsuitable for protecting residents’ privacy and dignity, and the downstairs bathroom, which cannot be accessed when hoists are required. Staffing levels need to be increased at peak times to ensure that residents do not have to spend inordinate periods of time in bed, and chair tables must be removed when not in use so that residents’ movements are not restricted. 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. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 & 3. Standard 6 does not apply. The quality in this outcome group is good. This judgement has been made from evidence gathered both during and before the visit to this service. Comprehensive assessments of service users’ needs are undertaken prior to admission. Contracts of the terms and conditions of the service are issued to residents and their representatives when they are admitted to the home. Residents or their representatives say the home meets their expectations. EVIDENCE: The case files of four new residents were sampled. Two of these service users were self-funding and they had contracts stating the terms and conditions of the service and the fees charged. The contracts were signed on behalf of the home and the resident or their representatives. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 10 There were documented assessments of service users’ needs by local authority care managers and senior staff from the home. During the inspection, a resident was having an annual care review by a reviewing officer from the local authority. Prior to the inspection, questionnaires from the Commission were sent to residents and their representatives, of which twenty-five were returned. The response indicated that the service met peoples’ expectations. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The quality in this outcome group is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Residents’ care plans are not being reviewed on a monthly basis. This could lead to staff being unaware of changes in residents’ needs. The weights of some residents are not being monitored because of a lack of sit-in weighing scales. There is no evidence that residents or their representatives have given permission for medicines to be administered. Male staff should not provide personal care to female residents without their written consent to ensure that their dignity is safeguarded. EVIDENCE: A sample of five care plans was examined. They contained good assessments of residents’ needs. There were appropriate goals set and there were risk assessments documented about mobility and the risk of pressure ulcers. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 12 However, some care plans had not been reviewed for some time and there was no evidence that service users or their representatives had been involved in the process. A requirement is made to address these issues. Three residents had pressure ulcers that were being treated by district nurses. Pressure relieving mattresses and pads were being used to improve their comfort. In addition, there were charts used to monitor frequent turning to aid recovery. The weights of residents who were able to weight bear, were being monitored. However, a sit-on weighing machine was not available for those residents who were unable to support themselves and their weight was not being monitored. A requirement is made about this matter. There were records in the accident book of some residents frequently falling. None of these persons had been referred to the falls clinic and there were no charts being used to monitor the frequency and incidence of these falls. A requirement is made to address these issues. With the above exceptions, the residents generally looked well cared for, clean and appropriately dressed. Those who were able to express an opinion were very satisfied with the service. The medication standards were examined. There is an appropriate procedure for the safe administration of medicines. Staffs’ signatures were recorded in the administration of medicines, (MAR) sheets, but there was no record of residents’ consent for medication to be administered which is a requirement. The inspector observed the staff providing care and support for the residents. This was generally carried out in a courteous and friendly manner. A relative of a resident who was visiting during the inspection, said they were very satisfied with how the staff supported all the residents. The inspector was concerned to see a female resident being supported in their personal care by a male member of staff on his own. The resident had dementia and there was no record of their consent being sought about this. This is not good practice and could cause offence and compromise the resident’s dignity. The manager also expressed concern about this when informed by the inspector. A requirement is made about this issue. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 13 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): 12, 14, & 15 The quality in this outcome group is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Appropriate activities are available for the majority of the residents, but several residents’ freedom of movement is restricted by the way in which they are confined for long periods in their armchairs. The residents are able to choose alternative meals to the planned menu, but the arrangement of the furniture makes it difficult for staff to properly support some residents who need help to eat, EVIDENCE: There are regular activities provided during the week, which include two art and crafts sessions, one of which was taking place during the inspection. There was an attractive display of the residents’ artwork on the wall of the dining room. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 14 A reminiscence and a keep fit session are also provided twice a week by an occupational therapist. There is a communal television in two areas of the large lounge. During the afternoon, staff were seen engaging some residents in throwing a ball. An outside entertainer comes to the home three times a month and the manager said it was planned to make this a weekly event. There is a large communal garden and decked area where residents can go when the weather is good. The inspector was concerned to see several residents seated in rows of armchairs for long periods, including mealtimes. Because there were no spaces between the chairs and they had tables placed in front of them, it was not possible for these residents to get up if they wished to move around. This limits the choices available to them and a requirement is made about this issue. Staff told the inspector that there was nowhere to store the tables when not in use. This appeared to be a form of restraint and a requirement is made for this practice to cease. The inspector was concerned about a resident who was virtually confined to their room. The reason given was that this resident either refused, or was unable to sit properly in a chair and might annoy the other residents. A requirement is made for an assessment of this person’s needs by an occupational therapist and for any recommendations to be implemented. The dining room had recently been decorated and looked attractive. It is not large enough to accommodate all the residents at one sitting, and as noted above, several residents eat in their armchairs. The arrangement of the furniture also makes it difficult to properly support residents who need help to eat, with staff having to stand in front of them rather than be seated beside them. A requirement is made to address this issue. Although there was a typed menu for the week, on both days of the inspection, this menu was not followed but the actual menu for the day was put on the notice board. However, a record was kept of the food actually eaten by the residents that showed they had a good variety of nutritious food. Two residents stated that they liked the food and they could ask for an alternative choice if necessary. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 15 Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The quality in this outcome group is good. This judgement has been made from evidence gathered both during and before the visit to this service. There is a complaints procedure in place and complaints are properly investigated. There are systems in place to protect residents from possible risk of abuse and staff are being trained in adult protection procedures. EVIDENCE: Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 17 Prior to this inspection, an anonymous complaint was sent to the Commission for Social Care Inspection. The complaint consisted of allegations about poor personal care, residents’ bedrooms and the bed linen, and issues about staff recruitment. These matters were referred to the proprietor to investigate. The proprietor responded to this complaint and found some of the issues raised were substantiated and some were unfounded. The inspector was satisfied that the investigatory procedure was satisfactory. These matters were also followed up during the course of this inspection, and where appropriate, requirements have been made for actions to be taken. Residents, who were able to give an opinion, and relatives who provided written comments, said they were satisfied with the service and had no complaints. There are Adult Protection and Whistle-blowing procedures in place. Care staff who were spoken to, demonstrated an awareness of elder abuse issues and knew how to report concerns. Staff records showed that several staff had attended training in adult protection and training was booked for August 06 to ensure that all staff had received this training. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22, 23, 24 & 26 The quality in this outcome group is poor. This judgement has been made from evidence gathered both during and before the visit to this service. There are serious concerns about space relating to shared bedrooms in this home storage and access to a bathroom and toilet. Some previous requirements about repair and maintenance issues have not been complied with, resulting in residents not having a well-maintained and safe home to live in. There is a good standard of cleanliness and there are no offensive odours. EVIDENCE: A tour of the interior and exterior of the premises was carried out. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 19 The garden was looking particularly attractive and well maintained and there was a good selection of comfortable garden furniture. One of the complaints referred to in the Complaints section of this report alleged that the furniture in residents’ bedrooms was broken. However, the inspector visited a large number of bedrooms and found no evidence of this. The inspector also noted that a large stock of new bed linen and towels had been purchased recently. (This was one of the complaints referred to above). A requirement from several previous inspections regarding the poor ventilation in the kitchen was in the process of being addressed, as was the provision of changing facilities for staff. The standard of décor in the lounge was good and the carpets were clean. However, the following requirements from the last inspection relating to environmental issues had not been complied with. These include: • • • Improving the access to the downstairs toilet and bathroom for residents who have mobility problems, so that their privacy and dignity is safeguarded. Reviewing and improving the laundry space. Repairing the broken windowpanes at the front of the home. These requirements are restated and the registered person is required to submit an improvement plan to address these and all other requirements in this report. In addition to the above, requirements are made in relation to the following: Room 6: The net curtain is torn and must be replaced. Room 8: The door to the toilet needs repair. Room 26: The window frame was broken. (The manager attended to this immediately). Room 31: This room needs redecorating. The bathroom next to Rooms 26/27 needs a new floor cover. The door closure in the corridor by Rooms 30 to 34 was hanging off. (This door is a fire door). The plugs in several bedroom sinks were missing. The handle of the door to the communal day room was broken. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 20 Some of the “chair tables” used at meal times, were badly chipped and should be replaced. In addition, storage space must be provided for these tables when not being used by the residents. Some of the transparent panels in the cover to the entrance to the home were missing or broken and should be replaced. The inspector was informed that the downstairs bathroom in Number 84 was rarely used because the door was not wide enough to allow access for a hoist or wheelchair users. The inspector was concerned that two shared bedrooms appeared to be too small to safely accommodate the physically disabled residents who lived in them, particularly as there wasn’t enough room to use hoists to assist staff to support them. A requirement is made for an assessment to be made of these residents’ needs by an occupational therapist, vis-à-vis sharing a bedroom. A recommendation is also made for the provider to reconsider the appropriateness of using these rooms for residents who are physically dependent. At the time of the inspection, the floor of the kitchen was dirty and sticky, about which a requirement is made. Otherwise, the home was clean and tidy and there were no offensive odours. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 21 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): 27, 28, 29 & 30 The quality in this outcome group is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. There are proper systems and procedures for recruiting staff to safeguard the welfare of residents. Staff receive training that is appropriate to their roles as carers. Staff levels need to be addressed to ensure that there are always sufficient care staff available to meet all the residents’ needs. EVIDENCE: At the time of this inspection there were thirty-nine people living in the home and there were four vacancies. The staff rotas showed that there are normally eight care staff on the early shift, seven on the late shift and three staff on night duty. There are catering and cleaning staff also employed. The manager had been previously supported by a deputy, but this post is to be converted to provide more hours for the laundry worker. The inspector observed that some residents were still in bed at 11am, while waiting for care staff to help them to get up. The staff said that this was a Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 22 reflection of the increased dependency of some fourteen residents who require two staff to meet their personal needs for dressing, toileting and bathing. The inspector was informed that these residents are given breakfast in bed. The day staff are also responsible for assisting the very dependent residents to go to bed before the night staff come on duty at 8pm. This means that these people spend relatively long periods of time in bed and are unable to socialise with others. A requirement is made to ensure there is always a sufficient number of care staff available to meet all the residents’ needs. There is a significant turnover of staff in the home. The manager said that it is difficult to recruit and retain staff because of the terms and conditions of employment. This issue is also addressed under Standard 32 below. There are currently two staff with National Vocational Qualification level 3 and a further four are training for this. Six staff are studying for Level 2 NVQ. There was evidence that staff were scheduled to attend training in August 06 in the mandatory subjects of health and safety, manual handling etc., and training in infection control. Allegations were made in the anonymous complaint about staff being unable to speak English and not having work permits. The inspector spoke to all staff on duty over the two days of the inspection. While the majority of staff came from the Philippines, all care staff were able to converse in English. Staff records contained copies of passports, work permits and written evidence of permission to work from the Home Office. The records of five new staff showed that proper recruitment procedures had been carried out including references and Criminal Records Bureau checks. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 23 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): 31, 32, 33, 34, 35 & 38 The quality in this outcome group is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home is managed by an appropriately qualified and experienced manager, and there are good systems and checks to safeguard the health and safety of residents, staff and visitors. There is a good team spirit among the staff, but there is some dissatisfaction about their terms and conditions of employment, which should be addressed by the provider. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager is a qualified nurse and is experienced in caring for older people and running a care home. She is currently training towards the Registered Manager’s Award, which she hopes to complete in April 2006. One of the elements in the anonymous complaint alleged that the manager spent too much time in the office and was “not very visible” in the home. While the location of the office could result in the manager being distant from the main areas of activity, the staff assured the inspector that the manager was very visible in all areas of the home and attended staff handovers. It was obvious to the inspector that the manager knew each resident and staff member by name, and residents and relatives who were spoken to, confirmed they had direct and frequent contact with her. During the inspection, the atmosphere in the home was cheerful and relaxed. Staff said they enjoyed their work and there was a good team spirit among them. The inspector was shown an out-building that was being refurbished to provide break and changing facilities for staff. The staff also said that they were unhappy with their terms and conditions of employment and gave this as the reason why many staff were leaving this service. This is a contractual matter between staff and employer. However, poor staff morale could have an impact on the service provided to residents, and a recommendation is made for the provider to address staffs’ concerns and to review their terms and conditions of employment. The inspector saw a copy of the financial plan and budget for the home, which confirmed that it was a viable business. Copies of the monthly reports of visits by a senior manager are sent to The Commission for Social Care Inspection. The reports show how the service is monitored. The manager said that questionnaires had recently been sent to service users or their representatives as part of a quality assurance audit. The manager stated that normally, residents manage their own personal finances or is the responsibility of their representatives. Money that was held in the home for one resident, and the records and cash balance were examined and found to be in order. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 25 There were current certificates of safety for fire, electrical, gas and water systems and lifts and hoists had been serviced. COSHH materials were stored securely and the fire log showed that the alarms had been tested weekly and drills were carried out. There was an up to date fire risk assessment. There were no gaps in the record of the temperatures of fridge and freezers, and all food was dated and labelled, (another issue raised in the complaint). However there were some out of date eggs being stored, which were disposed of immediately. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 26 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 4 X 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 3 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 2 2 3 2 2 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 X X 3 Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 27 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) Timescale for action The registered person must 30/09/06 ensure that care plans are reviewed at least monthly to ensure that any changes in residents’ needs are recorded. The registered person must 30/11/06 ensure that residents or their representatives are involved in the writing and review of care plans. The registered person must 31/10/06 provide sit-on weighing scales to monitor residents who have physical disabilities. The registered person must seek 31/10/06 advice from health professionals about the care and welfare of those residents who have a history of frequent falls. The registered person must 31/10/06 ensure that a specific resident is referred to an occupational therapist for assessment and advice about appropriate care. The registered person must 31/10/06 obtain the written consent of residents or their representatives for the administration of medicines. DS0000010509.V303555.R01.S.doc Version 5.2 Page 28 Requirement 2. OP7 15(2)(b) 3. OP8 14(2)(a)( b) 13(1)(b) 4. OP8 5. OP8 13(1)(b) 6. OP9 13(2) Roseacres Residential Care Home 7. OP10 12(4) 8. OP14 12(2)(3) 9. OP19 23(2)(b) 10. OP19 23(2)(b) 11. OP19 23(2)(b) 12. OP21 23(2) The registered person must ensure that male staff do not provide personal care for female residents without their written consent. The registered person must ensure that chair tables are removed when not in use so that residents’ are able to get up and move around if they choose. The registered person must repair the broken windowpanes at the front of the home. This requirement is restated from the previous inspection. The previous timescale was 31/03/06. The registered person must ensure that the missing and broken transparent panels in the cover to the entrance to the home are replaced. The registered person must ensure that: • The net curtain in Room 6 is replaced. • Room 31 is redecorated. • Room 8: The door to the toilet is repaired. • The floor cover in the bathroom next to Rooms 26/27 is replaced. • All bedroom washbasins have plugs fitted. • The “chair tables” used at meal times that are chipped, are replaced. • The door handle in the day room is replaced. The registered person must improve the access to the downstairs toilet and the bathroom for residents who have mobility problems. This requirement is restated from the previous inspection. The previous timescale was 31/05/06. DS0000010509.V303555.R01.S.doc 30/09/06 30/09/06 31/10/06 30/11/06 31/10/06 31/12/06 Roseacres Residential Care Home Version 5.2 Page 29 13. OP19 23(2)(a) 14. 15. OP19 OP23 23(2)(b) 23(2)(e)(f ) OP24 16. 17. OP26 OP27 16(2)(j) 18(1) The registered person must review the laundry space and inform the CSCI of the plans to improve this area. This requirement is restated from the previous inspection. The previous timescale was 31/05/06. The registered person must repair the door closure in the corridor between Rooms 30/34. The registered person must refer those physically disabled residents who share a bedroom, to an occupational therapist regarding the suitability of the room to meet their needs. The registered person must ensure that the kitchen floor is thoroughly cleaned. The registered person must ensure that staffing levels are sufficient at peak times of the day, so that residents are helped to get up and go to bed at a reasonable time. 30/11/06 31/10/06 31/10/06 31/10/06 31/10/06 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 OP32 Good Practice Recommendations The registered provider should hold meetings with staff to address their concerns about their terms and conditions of employment. Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Roseacres Residential Care Home DS0000010509.V303555.R01.S.doc Version 5.2 Page 31 - 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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