CARE HOMES FOR OLDER PEOPLE
Rosebank Residential Home Rosebank 56 Pelham Road Gravesend Kent DA11 0HZ Lead Inspector
Eamonn Kelly Announced 14 July 2005 10:00am 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 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 Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Rosebank Residential Home Limited Address Rosebank 56 Pelham Road Gravesend Kent DA11 OHZ 01474 537428 01474 328569 rosebankrh@aol.com Rosebank Residential Home Limited 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) Mrs B Aujla Care Home 12 Category(ies) of Old Age (12) registration, with number of places Rosebank Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: Rosebank provides care and accommodation for up to 12 older people. Each service user has a single en-suite bedroom. Bedrooms are situated on the ground and first floors. Twenty four hour care is given with 2 members of staff on duty at night. The owner is a registered nurse who has previous experience as a hospital sister and district nurse. There is a garden at the rear which has a ramp to enable access by wheelchair users. The home is close to town centre facilities. Bus and train services are nearby. Rosebank Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection consisted of meeting with the owner/manager, 3 members of staff, and all service users. Some of the home’s records were checked including some maintenance and associated certificates. Service users and their supporters completed “comment” cards and these served to provide a further measure to comments made by service users on the day. All bedrooms and other areas were visited on this occasion. What the service does well: What has improved since the last inspection?
In the 10 weeks since the home was newly registered, the owners have made many improvements (which are continuing) to the premises, to policies and procedures and to staff training and development for all members of staff. Significant new office facilities have been added to the 2nd floor (to complement existing office facilities on the ground floor at the rear of the premises). A new concrete ramp is under construction to enable better access by wheelchair users to the rear garden. Improved safety measures in the garden are being incorporated in this development. The external of the building has been repainted and redecorated. The roof has been repaired. All policies and procedures are being re-written and new care plan records have been begun. On taking over the business, it was found that most of the previous records had been taken away.
Rosebank Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 Page 6 New records for each service user have been prepared in case of emergency hospital admission. New menus have been put into operation. A training consultant has been employed. Members of staff have, for the first time, received contracts of employment. Safety issues such as fire safety checks have been reviewed and new procedures put into place. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rosebank Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Rosebank Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 and 3 Prospective service users and their supporters receive good assistance and information about the home’s services and facilities. EVIDENCE: The home makes available to prospective service users a comprehensive booklet about services and facilities. This contains all the information requested by current care home regulations and national minimum standards. This report is based to a large extent on assessing how closely the home is meeting the claims made in the service users information pack. All service users receive a personal contract: this contract is the one used by the previous owners and, whilst it is a useful document in its current form, the owner has undertaken to review and amend it so that it more fully covers the rights and responsibilities of the home and the service user. A pre-admission record indicated that a full assessment had been carried out. This record leads to the service user’s individual care plan. At this stage in the admission process, a special hospital information pack is produced. As described by the owner, a good system is in place for enabling service users to
Rosebank Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 Page 9 feel confident about the ability of the home to meet personal and healthcare requirements. The pre-admission information pack contains a detailed statement about the stages for admission to the home. In the case discussed during the inspection, these stages had been followed. Rosebank Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 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 standard(s) 7, 9 and 10 Service user’s health and personal needs are being met. EVIDENCE: The owner/manager is creating a new individual care plan for each service user. In the 2 sets of records seen during the inspection visit, there was good information about the service users personal and healthcare requirements and about how these are met. The new records were very clear and precise. Care plan records indicated that service users have access to social and healthcare services. The information pack also describes this care provision in some detail. Observations made during the inspection visit indicated that service users are treated with respect. Close consideration is given to preserving their rights to privacy. An example of this is that a separate record is kept by the manager of personal information relating to service users which does not need to be known to all care staff. MAR (medication administration record) sheets were up-to-date and medication is stored securely. The owner has carried out a review of
Rosebank Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 Page 11 medication administration and storage and made changes to the system inherited from the previous owners. It was agreed that the CSCI pharmacy inspector would review medication procedures around the time of the next inspection visit. Rosebank Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 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 standard(s) 12, 13 and 15 Service users are able to avail of a range of activities and opportunities for physical and mental stimulation. They now benefit from the availability of meals that offer choice and variety and cater for special diets. EVIDENCE: The new information pack outlines the arrangements in place for helping service users maintain contact with friends and relatives and for enabling them with social and recreational activities. The section in this regard is quite comprehensive and the owner stated that she has recognised the need for improvement as previously service users received little opportunities to keep adequately active. Some of these improvements were seen during the inspection visit. As part of this process, the home has employed an occupational therapist. The information pack states that this person will “work with staff to teach them how to carry out gentle activities to motivate keep service users active”. Members of staff had an understanding of some service users previous occupations and lifestyles. In the new care plan records, this information will be included and kept up-to-date. Rosebank Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 Page 13 Service users receive a commitment towards receiving assistance to attend religious services. They also are encouraged to maintain contact with their friends and relatives. New menus have been produced. These are displayed on each dining area table. Specific improvements have been made in the range of food provided and in its presentation. This was confirmed by members of staff and service users. Rosebank Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 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 standard(s) 16 Service users and their families/friends are encouraged to express their views in the knowledge that their comments will receive proper consideration. EVIDENCE: Many “comment” cards were returned to the Commission by service users and their supporters. These contained additional handwritten comments from service users outlining their likes and dislikes. Some “comment” cards were returned by service user’s families (who included their telephone numbers). These were contacted by phone and very positive feedback was received. The home has a good complaints procedure and a very good précis of this procedure is included in information packs. Meetings with service users indicated that their comments are taken into consideration by the manager and members of staff and that they are now encouraged to make their views known. Rosebank Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 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 standard(s) 19, 21, 22, 24 and 26 The premises are suitable for the needs of service users. EVIDENCE: Each service user has a single en-suite bedroom. Each bedroom is well furnished, including in some cases with personal possessions of service users. Bedrooms and communal areas are safe and comfortable. Since the home was newly registered, many improvements have been made and these are continuing (please refer to Page 6). In addition, the owner is considering the need for installing a stair-lift. The home was clean, tidy (apart from inevitable issues connected with ongoing redecoration and improvement) and hygienic. Rosebank Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Service users have the benefit of being in the care of staff whose training needs are being actively addressed. EVIDENCE: Service users are in the care of the full-time manager and care assistants supported by an activities organiser, domestic staff and handyman/gardener. At night, there are currently 2 members of staff on duty (one awake and one on “sleep-in duty). The owner/manager has employed a training consultant to enable members of staff to reflect on their levels of competence and gain new skills and insights into the care needs of frail older people. This programme has now begun and an initial outline was provided by the owner. Named members of staff are attending first aid study days in July and August and moving & handling training in July 2005. Dates are being finalised for care staff to begin NVQ Level 2 in Care. An Introduction to Caring course has been arranged for 8 members of staff in September 2005. Rosebank Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36 and 38 Service users benefit from a well managed home and from the maintenance of safe working practices. EVIDENCE: The owner/manager is a registered nurse with previous experience as a hospital sister and district nurse. The home’s information pack outlines the manager’s other medical training and skills. She is giving consideration to achieving the registered manager’s award. In the 3 months since acquiring the home, the manager has identified a range of operational defects and is well on the way to addressing them. The emphasis is on changing procedures and attitudes so that the home is run for the more complete benefit and interests of service users. There was evidence that improved leadership is of direct benefit to service users: for example,
Rosebank Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 Page 18 members of staff are receiving personal development opportunities to take responsibility for intervening to help service users, new systems and procedures are being implemented, a developmental programme extending to the end of the year is in place and a quality assurance system is underway. The progress by the home in encouraging service users and their friends to express their views about how the home is run is referred to elsewhere in this report (please refer to Standard 16). A staff supervision and appraisal system has been implemented. The supervision system is currently being used primarily to address the training needs of staff. Some of the home’s maintenance and associated certificates were seen on this occasion. A fire safety officer visit was due soon after the inspection visit. The owner found that important declarations made in the fire safety logbook maintained by the previous owners were not valid and a new system has been put in place. Copies of risk assessments (relating to individuals) were seen. The programme of training (some of which has been implemented) includes relevant aspects associated with health and safety and general aspects of care provision. Rosebank Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 x 3 3 x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 4 x x 3 3 3 x x 3 x 3 Rosebank Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 Page 20 NA 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 Regulation Requirement Timescale for action 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 2 Good Practice Recommendations The personal contract for all service users would benefit from improvement in that the rights and responsibilities of the home and service user could be more accurately described. The owners consideration as to whether a stair lift is necessary is acknowledged. The good progress towards identifying the competences of members of staff and addressing them (see also Standard 36) is acknowledged and encouraged. 2. 3. 4. 22 27 Rosebank Residential Home H56-H06 S63433 Rosebank V229739 140705 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone, Kent ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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