CARE HOME ADULTS 18-65 Roseate House Residential Care Marden Crescent Cullercoats Tyne & Wear NE26 2EE
Lead Inspector Janine Smith Unannounced 25 May 2005 10:30. 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Roseate House Residential Care Version 1.10 Page 3 SERVICE INFORMATION
Name of service Roseate House Residential Care Home Address Marden Crescent Cullercoats Tyne & Wear NE26 2EE 0191 251 8194 0191 251 8194 communityhome@roseate.fsworld.co.uk Northgate & Prudhoe NHS Trust Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Application made CRH 6 Category(ies) of LD Learning disability (5) registration, with number LD(E) Learning disability - over 65 (1) of places Roseate House Residential Care Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 18/10/04 Brief Description of the Service: Roseate House is a purpose built bungalow providing residential care for six people with severe learning disabilities. The home does not provide nursing care. The accommodation consists of six single bedrooms, two lounges and a dining room. The home has a variety of aids and adaptations to meet the individual needs of the service users who have physical disabilities. There is a large bathroom with an assisted bath and a separate large shower and a w.c. There is a large garden to the rear of the premises and ample car parking facilities. The home is situated in Cullercoats and is close to local shops, pubs and transport network systems. The centre of Whitley Bay and the sea front are in close proximity. Roseate House Residential Care Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 5 hours. A partial tour of the premises took place and a sample of care records were inspected as well as other records. All six of the residents were seen and the three staff were spoken to. The Manager was off duty on the day of this inspection and a further visit was made to discuss the inspection with her. What the service does well: What has improved since the last inspection?
The new Manager has been approved for registration under the Care Standards Act 2000 which is a recognition of her qualifications, experience and fitness for her role in the home. Since her employment, the Manager has recognised that the care records require changing to reflect the way care is provided in the home and ensure that the individual residents are fully involved in deciding how they wish to live their life in the home. To this end, she has been carrying out one to one training with staff and this process will continue until the necessary changes have been achieved. Roseate House Residential Care Version 1.10 Page 6 A significant number of the staff team are progressing with National Vocational Qualification training and this helps provide them with the knowledge and skills they need to undertake their work. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Roseate House Residential Care Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Roseate House Residential Care Version 1.10 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 & 5. Appropriate procedures are in place to ensure that prospective service users’ needs are properly assessed prior to moving into the home, which ensures that the home is able to meet their needs. EVIDENCE: The last admission took place over twelve months ago. An examination of two care records showed that assessments had been obtained from the service users’ Care Manager. Statements of terms and conditions were in place on the two care records inspected. Roseate House Residential Care Version 1.10 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 & 7. The contents and presentation of the care plans needs to be improved to ensure that the complex needs of the residents are readily identified in the records. The staff team have developed effective ways of communicating with residents to ensure that their feelings about the services provided to them are respected and taken account of. EVIDENCE: The records of two residents were looked at. They contained a great deal of detailed information about the personal, social and complex health care needs of the residents but the files needed re-organising to ensure that the most up to date information is readily accessible. A large number of records were held in a number of different files for each resident. Whilst there were sub-divisions in the files, it was difficult to locate the most current and up to date information. In particular, letters of advice from health professionals were
Roseate House Residential Care Version 1.10 Page 10 filed in different places rather than in date order and it was therefore difficult to know which piece of advice was being followed at the current time. The staff on duty said that the files were currently being re-organised but they were not fully aware of how this should be done and had difficulty finding information requested during the inspection. The care plans in place did not appear to have been updated to take into account recent changes. Discussion with a member of staff suggested that needs were being addressed but that they were not fully aware of the most recent advice from health professionals. Not all of the residents use verbal communication, however staff could describe how they offer choices to them and observe their body language, which helps the staff to know what they like and dislike and when they are happy or not. The staff team on duty were observed to do this through the day. Advocates have been found for residents where appropriate. Roseate House Residential Care Version 1.10 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15 and 16. Links with the community and opportunities to participate in social and personal development activities have been good, but of late have reduced which means residents have had few opportunities to mix with other people and participate in worthwhile activities. Where residents spend time at home, more needs to be done to engage them in purposeful and worthwhile activities both to help develop their skills and prevent boredom. EVIDENCE: Discussion with the staff and examination of records showed that residents have been supported to use a variety of facilities in the community, such as a snoozelem, swimming pool and local colleges providing music and cookery sessions. However, it also seems that there has been a significant decline in the opportunities for residents to go out to these types of activities in the weeks
Roseate House Residential Care Version 1.10 Page 12 preceding this inspection. For instance, it was noted that one resident had gone out only four times in the home’s car in the preceding three weeks and spent the rest of the time wandering at home. A need had been identified to support this resident with outdoor walks to reduce agitation, but this was not being met. Another resident had been out in the car three times and had one lunch out and visited an art class. The rest of the time at home had been spent occupying herself at home. The staff on duty agreed that outdoor activities had reduced and that this was due to a reduction in the number of staff on duty. One stated that they had tried to get residents out but had been limited to drives in the car without actually getting out of the car to visit anywhere. This was because it was felt they needed more staff to provide the support that individual residents need and ensure their safety. This area of care therefore needs review to ensure that residents are provided with regular opportunities to take part in appropriate activities and enjoy community facilities. Where time is spent at home, the staff should be provided with additional training to enable them to support residents in constructive, purposeful activities to provide stimulation and interest to them. Two relatives of residents were spoken to during this inspection who were both very pleased with the care provided in the home. One said that their relative had ‘come on leaps and bounds’ since coming to live in the home. A nutritious menu plan is in place and residents receive appropriate support at mealtimes. Roseate House Residential Care Version 1.10 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20. 18, 19 and The staff at the home seek professional medical advice, however, the lack of clear and consistent care planning means that staff are not provided with all of the information they need to be aware of to meet residents’ needs. Steps need to be taken to ensure that eye checks and regular weighing takes place so that all aspects of residents’ physical health is closely monitored. EVIDENCE: Staff were seen to provide personal support in such a way as to promote and protect service users’ privacy, dignity and independence. There was also ample evidence that the staff team seek advice and support from relevant professionals in respect of residents’ health and wellbeing. However, the advice obtained was not recorded in a clear way on the records held and discussion with the Manager and staff indicated that there was some confusion and lack of full awareness of how some particular needs should be met. An OK Health Check form is used to monitor and review residents wellbeing but the most recent copies on file were dated 2003 and staff were not sure if these were still being used or not. It was difficult to check when residents had
Roseate House Residential Care Version 1.10 Page 14 last had their eyes tested, and the records available indicated that this was last done in 2001. Forms available to record this information at a glance had not been used. The records also indicated that residents were not being weighed often enough. The last entries seen were for over a year ago and staff said that they had had problems weighing some residents as the equipment in the home was not entirely suitable and there were a lack of facilities in the community to do this. A random sample of medication records and the system for storage and handling medication was looked at and found to be appropriate, other than:The record of medications prescribed for a service user was not up to date and staff were unclear about what could still be administered in particular circumstances; A record of receipt of one medication could not be found; Staff were also unclear about the system for the administration of homely remedies. It was recommended that photographs of residents be placed on their medication administration records as an additional security measure. Roseate House Residential Care Version 1.10 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23. The home has a satisfactory complaints system and staff have received brief training in adult protection which helps to protect residents from abuse. EVIDENCE: A complaints procedure is in place in both written and pictorial format. A member of staff recalled receiving adult protection training and was able to give a good account of the types of abuse that could occur and what she would do if she had any suspicions. Roseate House Residential Care Version 1.10 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 27, 28 and 30. The standard of the facilities and décor within this home is good providing residents with an attractive and homely place to live. EVIDENCE: The home was found to be well maintained and decorated. It is spacious with two lounges and a separate dining room. Each resident has their own bedroom which were comfortable and personalised. Radiators were fitted with protective covers. The hot water supplied to one bath was tested and found to be safe. The staff always test the water before using it. The laundry facilities were good. The home was clean and staff were aware of good hygiene practices. Protective clothing is provided. Roseate House Residential Care Version 1.10 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33. Minimum staffing levels are met, however, there has been some reduction in overall staffing levels which has led to residents having fewer opportunities to enjoy activities outside of the home. EVIDENCE: There are a minimum of three support workers on duty through the day and evening up until 8.30 p.m. but more often there are four or more staff on duty. From 8.30 p.m. to 8 am, there is one waking night carer. One member of staff had recently left to work at another home and there were two absences; one due to sickness and one due to maternity leave. These absences were being covered by staff working in this home and from other homes run by the Trust. The home previously had staff called ‘Enablers’, who assisted residents with social and other activities. These staff have now left and are to be replaced with Support Workers instead. Whilst staffing levels met the minimum requirements, the staff team believed that there has been a reduction in staffing levels, which has had a detrimental effect on their ability to support residents to enjoy activities outside of the home. This area of care should therefore be reviewed.
Roseate House Residential Care Version 1.10 Page 18 The staff team were observed to be kind and caring towards residents and to enjoy their work in the home. Roseate House Residential Care Version 1.10 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42. Further guidance and direction is needed to ensure that the health and safety of residents and the staff team are safeguarded at all times. EVIDENCE: The home was found to be generally well maintained and safe apart from the following matters:A lot of items were stored in a cupboard, which meant a suitcase was touching the light bulb, which could be a potential fire risk. An incident had occurred with a bed side rail resulting in a minor injury to a resident and a member of staff. This had occurred due to a lack of training. There were two risk assessments in place regarding the use of these bed side rails but there was no evidence to show that they had been reviewed in the light of this incident or at routine intervals. The risk assessments did not take into account all of the potential areas of risk in using bed side rails, which are dangerous if not used properly.
Roseate House Residential Care Version 1.10 Page 20 A letter was left with the home with regard to the above matters. It was also noted that a resident’s television was plugged into a socket close by the wash hand basin and the television placed in front of the basin with the electric cable stretched across. This could be potentially hazardous and should be reviewed. SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9
Roseate House Residential Care Score 2 3 x x Standard No 24 25 26 27 28 29 30 Score 3 3 3 3 3 x 3
Page 21 Version 1.10 10
LIFESTYLES x
Score STAFFING Standard No 11 12 13 14 15 16 17 2 2 2 2 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 x x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x Roseate House Residential Care Version 1.10 Page 22 No Are there any outstanding requirements from the last inspection? 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 6 Regulation 15 Requirement Timescale for action 31/8/05 2. 11, 12, 13 14 12(1) 18(1) Ensure care plans include full up to date details of how care needs are being met in a format, which provides easy access to the information. Residents must be provided with 31/8/05 the support necessary to enable them to participate in leisure and community activities to provide enjoyment, stimulation and opportunities for personal development. Staff should engage in purposeful, constructive activities with residents when at home to provide enjoyment, stimulation and opportunities for personal development. Training for staff should be provided as necessary. 3 19 12(1) Ensure that residents’ health care needs are clearly recorded in their plan of care and that staff are fully aware of how
Version 1.10 31/8/05 Roseate House Residential Care Page 23 these needs are to be addressed. 4 20 13(2) Medication administration records must be kept up to date. All medications must be checked on receipt and a record made of this. All staff handling medication must be clear about the system followed and about what is prescribed. Review staffing levels to ensure that these are adequate to provide support to residents with social activities. Ensure items are stored safely within cupboards housing electrical fitments. Ensure television is placed safely in bedroom. Review safety of bed side rails in use using the guidance issued by the Medical Devices Agency. Ensure these risk assessments are reviewed at appropriate intervals. 28/5/05 5 33 18(1) 31/8/05 6 42 13(4)(a) 28/5/05 7 42 13(4)(c) 28/5/05 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 20 Good Practice Recommendations Medication administration records should include a photograph of the resident to assist in correct identification. Roseate House Residential Care Version 1.10 Page 24 Commission for Social Care Inspection Northumbria House Manor Walks, Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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