CARE HOMES FOR OLDER PEOPLE
Rosebank 48 Lyons Road Sheffield South Yorkshire S4 7EL Lead Inspector
Mrs Janis Robinson Unannounced Inspection 7th February 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 Rosebank DS0000003007.V279376.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. Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Rosebank Address 48 Lyons Road Sheffield South Yorkshire S4 7EL 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) 0114 261 8618 0114 261 8618 Silver Healthcare Limited Vacant Care Home 26 Category(ies) of Dementia - over 65 years of age (21), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (21), Old age, not falling within any other category (5) Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One service user, under the age of 65, whose details are specified on the Variation to Registration application dated 12.03.03 may be resident at the home. One other service user who was under the age of 65 on 01.04.02 and who was living at the home may remain resident at the home. 10th October 2005 Date of last inspection Brief Description of the Service: Rosebank is a purpose built 26-bed home for older people. It is in a residential area of Sheffield with good access to public services and amenities. It is a twostorey building and all floors are accessed by a passenger lift. The home has 20 single and 3 double rooms. Sufficient communal space and bathing facilities are provided. The home has landscaped gardens and a car park is available. Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 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 from 8.30am to 1.30 pm. An inspection of a proportion of the environment took place, and records were sampled, including; care plans, complaints, staff training and supervision, residents finances and quality assurance. The inspector spoke with the majority of staff on duty, six residents, two visitors, and one professional visitor to the home. The manager’s post was vacant at the time of this inspection. Discussions took place with the deputy manager, who was in charge of the home. What the service does well:
All of the comments made by residents were very positive. Residents said the home was ‘very good’, ‘can’t think of anything else I need’, and ‘the staff are caring’. Visitors spoken with confirmed that they were always able to visit at any reasonable time, and the staff kept them fully informed about their relative. One professional visitor to the home said ‘the staff are very good, and are knowledgeable about individual needs’. Each resident had a care plan, which outlined all personal, social and health care needs. Access to health care professionals was supported, to maintain residents health. Residents confirmed that the staff were respectful towards them. The routines at the home were flexible, residents were able to choose how to spend their day. A range of activities were offered to residents. The home had an open visiting policy, to maintain contact with residents and their family and friends. A varied diet was provided and choices were offered. Residents said ‘the food is good, nothing is too much trouble’. The home had a complaints procedure, each resident had been provided with a copy to inform them of their rights. All of the residents spoken with said they had confidence in the homes manager, and the staff at the home, to listen to any concerns and take them seriously. An adult protection procedure was in place, to ensure safety was promoted. The environment was very well maintained. The home was very clean and free from odours. Homely touches were provided in communal areas to create a comfortable environment. Residents’ bedrooms were well decorated and individually personalised. Residents were able to bring personal possessions with them into the home. All of the residents spoken with said the home was ‘lovely and comfortable’. Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 Page 6 Agreed levels of staff were being maintained. The home had a commitment to National Vocational Qualifications (NVQ), to ensure staff had the skills needed to meet the needs of residents. Staff undertook a range of training and individual training records were kept. A quality assurance system was in operation, to obtain and act on the views of residents, relatives and professionals involved in the home. Resident’s finances were safely managed. All of the residents and staff said the management at the home was supportive and approachable. Formal staff supervision took place, to support and develop the staff team. Health and safety systems were in place at the home, fire equipment had been checked and serviced. Staff had undertaken fire training at the required frequency to ensure they had the skills to maintain safety and respond in an emergency. What has improved since the last inspection? What they could do better:
The carpet on the top floor corridor was raised in one area, posing a tripping hazard. The fire escape was covered in leaf mould, posing a possible slipping hazard. Whilst a comprehensive quality assurance system was in place, the results of questionnaires were not published or made available to residents and their representatives. A minority of staff had not received individual supervision within the recommended timescales. Several staff were qualified in first aid. However, insufficient staff had undertaken the training to ensure a qualified person was on duty at all times. Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 Page 7 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. Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 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 Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 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): Standards one to five were assessed and met at the previous inspection. EVIDENCE: Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 Page 10 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): 7,8,10 and 11. Each resident had a care plan to give staff the information needed to ensure all care needs were met. Health care was monitored, assessed and met. Staff appeared respectful towards residents. Each care plan contained information on dying and death. EVIDENCE: Two care plans were examined. The plans contained the full range of information required, and included specific information on all aspects of personal, social and health care needs. The plans included information on the staff action required to ensure assessed needs were met. The residents had signed their plans, where able. Risk assessments were undertaken. The plans were reviewed on a monthly basis. The plans contained detail of all health care contacts, appointments and treatments, and the home supported access to these to ensure health was maintained. Residents said they had regular contact with their GPs, and saw chiropodists, dentists, opticians and district nurses as required. Monthly meetings with the GPs and district nurses took place. Annual health reviews were undertaken for each resident. On the morning of this inspection, a GP, physiotherapist and district nurse visited the home. Treatment took place in
Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 Page 11 private, in residents’ rooms. One professional visitor spoken with said the staff were aware of residents health needs, and appeared very caring and professional in their approach. One relative spoken with said that the home always kept them well informed, and would telephone them if their loved one required some medical assistance. Staff were observed respecting privacy by knocking on doors before entering. The interactions between staff and residents appeared respectful and caring. Staff took time to sit and listen to residents. All of the staff displayed a high level of commitment to the residents and the home. Residents spoken to made very positive comments about their care. One resident told the inspector `this is a good home, anything you wish for is given, the staff are kind and I am very happy’. Residents said` The home is wonderful, you could not wish for more’ and `I can’t think of how I could be better cared for’. The visitors spoken with said they were `very happy’ with the care provided at the home. Each plan contained information on the residents’ wishes regarding funeral arrangements, to ensure these would be carried out. Where this information had been refused, this was also recorded. Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 Page 12 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): 12,13,14 and 15. Residents were able to make choices about how they spent their time. A range of activities was offered to residents, to improve choices and maintain interests. The home had an open visiting policy, in order to develop and maintain good relationships with residents’ representatives. The home provided a varied menu and choices were offered to respect personal preferences. EVIDENCE: Residents said they were able to get up and go to bed when they chose, and were seen to walk freely around the home. The care staff organised a range of appropriate social opportunities, such as sing-a-longs, bingo and manicures. Weekly chair-exercise classes were available and entertainers regularly visited the home. Residents were free to join in any organised activities. All of the residents spoken with said they enjoyed the range of activities offered, and said enough were provided. Residents confirmed that they were able to see their visitors in private. The visitor spoken with said they were able to visit at any time, and were `always made to feel welcome’. Residents were able to bring personal items with them into the home. All of the bedrooms were individually personalised and very homely.
Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 Page 13 All of the residents spoken with said the food at the home was very good, choices were offered on a daily basis. One resident said that `nothing was too much trouble’. Staff confirmed that they had access to food supplies at all times, to cater for residents needs. The homes dining rooms were attractively set out. Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 Page 14 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, 17and 18. The home had a clear and accessible complaints procedure, to ensure residents’ rights were protected and any concerns listened to and taken seriously. Residents’ legal rights were protected. An adult protection procedure was in place, to promote residents safety. EVIDENCE: Each resident and representative had been provided with a copy of the homes complaints procedure. This contained relevant detail and informed the reader of who to contact outside of the home to make a complaint, should they wish to do so. All of the residents said they had no concerns and could go to the managers and staff to`sort out’ any worries if they had them. The home had not received any complaints since the last inspection. Residents were able to vote at election time. Postal votes were arranged. An Adult Protection procedure was in place and all staff had undertaken training in prevention of abuse. Local multi-agency guidelines, and the Department of Health guidance ‘No Secrets’ was in place, to ensure the homes information remained up to date and promoted residents safety. Residents said they felt very safe at the home. Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 Page 15 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): 19,20,21,22,23,24,25 and 26. The home was maintained to a very high standard. The home was very clean and free from odours. Appropriate facilities were provided to meet residents needs. All areas of the home were accessible to residents. Homely touches had been provided to create a comfortable environment. Communal areas were well maintained, and residents’ bedrooms were well decorated and personalised. Two potential hazards were identified. EVIDENCE: An inspection of a proportion of the environment took place. The home was decorated to a high standard. Communal areas were attractive, comfortable and the furniture provided was of a good standard. However, the carpet on the top floor corridor was raised in one area, posing a tripping hazard. The fire escape was covered in leaf mould, posing a possible slipping hazard. All of the bedrooms were well decorated and highly individual. All bedrooms had door locks to promote residents privacy, if required. Twenty-two bedrooms were single, three rooms were double. Three bedrooms had ensuite toilet facilities.
Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 Page 16 Sufficient bathing facilities were available. Aids and adaptations were in place to assist with residents moving and handling needs. Since the last inspection corridor areas and lounges had been redecorated, and new flooring provided in two toilets, to maintain the environment. A central kitchen served the home. The laundry was sited away from all food preparation areas. Systems for the control of infection were in place and adhered to. All of the residents said that they were very happy with the accommodation provided. Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 Page 17 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 and 28. Agreed levels of staff were being maintained. Some staff undertook NVQ training. Recommended levels of NVQ trained staff had been achieved. EVIDENCE: The homes rota indicated that agreed levels of staff were being maintained to meet the needs of residents. Residents and the visitor spoken with felt that enough staff were provided. Of the 16 care staff, 8 staff had achieved NVQ level 2 in care, and two staff had achieved level 3. A further 3 staff had almost completed the training at level 2. This is over and above the recommended 50 of the care staff trained to NVQ level 2 in care by 2005. Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 Page 18 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): 33,34,35,36,37 and 38. The manager’s vacancy was being recruited to. A quality assurance system was in place. A business plan and insurance cover were provided. Residents finances were safely managed. Formal staff supervision, to develop and support staff, took place. The majority of staff had received supervision at the required frequency. The homes records were stored securely, to respect residents’ rights. Policies and procedures for the smooth running of the home and care of residents were in place and accessible to staff. Staff undertook mandatory training. Fire systems were checked and serviced. All staff had undertaken fire training at the required frequency. EVIDENCE: The manager’s post was vacant at the time of this inspection. Systems to cover this temporary absence had been put in place by the provision of an additional deputy. All of the residents and staff spoken with said the deputy managers at the home were approachable and supportive. The organisation
Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 Page 19 was in the process of recruiting a new manager, and interviews were being held the week following this inspection. A comprehensive quality assurance system was in place, to obtain the views of residents and their representatives. Questionnaires were undertaken with residents over the required frequency. Questionnaires were also undertaken with relatives and professional visitors. Whilst the results of surveys were audited, the results were not published or made available to residents, their relatives and any interested parties. Financial plans were in place and insurance cover had been provided. The certificate of insurance was in display in a communal area of the home. Two records of resident’s finances were inspected. Details of all debits and credits were recorded, and receipts were kept. Residents received interest on their accounts. Monies were stored securely. Formal staff supervision took place, to support staff and develop their skills. Whilst the majority of staff had received supervision at the required frequency, records inspected indicated that a minority of staff had not received supervision for some months. Records in the home were securely stored to protect confidential information. The home had health and safety systems in place. On the day of the inspection no fire exits were blocked and hazardous substances were securely stored. All staff undertook mandatory training and a matrix was maintained to enable training to be monitored. A rolling programme of staff mandatory training was in place. Staff had undertaken training in food hygiene, health and safety, moving and handling, emergency first aid and infection control. Five members of staff were qualified first aiders. Further staff required this training to ensure trained staff were on duty at all times. Fire fighting equipment was checked and serviced. Weekly fire alarm checks were undertaken. Staff participated in fire drills at the required frequency. Records of drills were undertaken, these records had been expanded to include the times of drills. Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 3 3 2 3 2 Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 13,23 Requirement The cause of the raised area of carpet must be investigated and the carpet made even. Leaf debris must be removed from the fire escape. The results of surveys must be published and made available to residents, their representatives and any interested parties. All staff must receive supervision a minimum of six times each year. Sufficient staff must be qualified in first aid to ensure a trained person is on duty at all times. Timescale for action 31/03/06 2. 3. OP19 OP33 13 24 31/03/06 30/04/06 4 5 OP36 OP38 18 13 30/04/06 31/05/06 Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rosebank DS0000003007.V279376.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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