Inspection on 01/05/08 for Rosebery House

This inspection was carried out on 1st May 2008.

CSCI found this care home to be providing an Poor service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rosebery House 27/10/08

Rosebery House 03/05/07

Rosebery House 10/04/06

Rosebery House 20/02/06

Rosebery House 14/12/05

Rosebery House 21/06/05

Rosebery House 30/11/04

Rosebery House 18/05/04

Rosebery House 02/12/03

Rosebery House 10/06/03

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Rosebery House 2 Rosebery Avenue Eastbourne East Sussex BN22 9QA Lead Inspector Gwyneth Bryant Unannounced Inspection 1st May 2008 07:15 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 Rosebery House DS0000021246.V363085.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. Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosebery House Address 2 Rosebery Avenue Eastbourne East Sussex BN22 9QA 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) 01323 501026 01323 511124 hilenshah@aol.com Spemple Limited Vacant Care Home 30 Category(ies) of Dementia - over 65 years of age (30) registration, with number of places Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) 2. Dementia (DE)(E) maximum number of places 30. The maximum number of service users to be accommodated is 30. Date of last inspection 3rd May 2007 Brief Description of the Service: Rosebery House is a large, detached property situated in a quiet residential area of Hampden Park in Eastbourne. Local shops and amenities are a short walk away. The home is registered to provide residential care to thirty older people with dementia. Single bedroom accommodation is provided on two floors. Level access is provided by way of a passenger lift. All bedrooms are equipped with a call bell and four have ensuite facilities. Communal areas consist of a large lounge, dining room and quiet seating area. A large, rear garden provides a safe and pleasant area for residents to walk in and relax. Assisted bathrooms and toilets are located on both floors of the home. The fees at Rosebery House currently range from £423.87 to £675 per week depending upon the level of assessed needs. More detailed information about the services provided at Rosebery House can be found in the home’s Statement of Purpose and Service User Guide - copies of these documents can be obtained directly from the Provider. Latest CSCI inspection reports are on display in the reception area of the home. Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced inspection and took place in just under seven hours. The purpose of the inspection was to check compliance with the requirements made at the last inspection and inspect key standards. There were twentyseven people in residence on the day of which four were spoken with. The Manager, a domestic and two staff were also spoken with. A tour of the premises was carried out and a range of documentation was viewed including care plans, personnel and medication records. One of the people living in Rosebery said they were happy in the home, one said its ‘all right’ but the other two said they were not happy. Comments included: • • • No one listens to me. They (staff) don’t care. I don’t like shepherds pie but can’t have anything else. Following the site visit the Registered Provider supplied compliments from relatives that have been received in the home. Prior to the site visit we asked the Registered Providers to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. This was provided and the information included in this report as necessary. Some of the information provided was inconsistent and this was discussed with the manager. Following the site visit the Registered Provider confirmed that the AQAA was completed as a team undertaking by the management team. However, it remains important to ensure all documents relating to the running of the home are accurate and up to date. What the service does well: People moving into Rosebery are encouraged to bring in their personal possessions to personalise their bedrooms and the home has an attractive and well-maintained garden to the rear and side of the property, which is safe and accessible during good weather. There is an open-house policy, which welcomes visitors at all reasonable times. There are processes in place for Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 6 dealing with complaints ensuring that people living in the home and their relatives feel their concerns are listened to. What has improved since the last inspection? What they could do better: The home would benefit from sustained leadership, guidance, direction and management. As a result, there are shortfalls in care planning, meeting healthcare needs, risk assessments, handling of medication and ensuring the autonomy and dignity of people living in Rosebery is protected. Care plans need to include clear direction to staff in delivering consistent care and to recognise individual preferences in respect of daily routines, meals and leisure activities. Risk assessments also need to be expanded to identify hazards and the controls to reduce risk of harm to those living in the home with particular attention to the reduction of falls and challenging behaviour. A number of health and safety shortfalls were identified in respect of manual handling and infection control, which impinge on the safety of both staff and people living in the home. All parts of the home must be kept clean and free from offensive odours as it detracts from the general attractiveness of the home. Staffing levels, need to be reviewed and be based on the needs of people living in the home, in particular for those people whose mobility is limited or have complex care needs. In particular all staff need to receive up to date training in Protection of Vulnerable Adults, Moving and Handling, infection control and dementia care to ensure they have the skills to provide appropriate care to people living in Rosebery. Quality monitoring and quality assurance systems need to be more robust to ensure all aspects of the service are closely monitored and shortfalls are quickly identified and addressed. On 31 October 2007, a Regulation Manager, Regulatory Inspector and Pharmacist Inspector from the CSCI visited Rosebery House and met with the previous Registered Manager and the Provider. This visit was prompted by the CSCI receiving a series of complaints about the running of the service and notification that the turnover of staff, particularly senior staff had been high. As a result of that visit it was discussed and agreed that staffing levels, both care and domestic needed to be increased, the induction training for new staff needed to be improved and that medication should be managed more closely. It is therefore disappointing that despite correspondence from the Provider Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 7 indicating that these shortfalls had been addressed, that all of these areas are subject to requirements at this inspection. The two good practice recommendations in the last inspection report in respect of reviewing staffing levels and the Manager liaising with the cook to ensure a nutritional menu is devised had not been addressed. 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. The summary of this inspection report can be made available in other formats on request. Rosebery House DS0000021246.V363085.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 Rosebery House DS0000021246.V363085.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Improvements need to be made to the admission assessment to demonstrate the needs of people moving into the home can be met. EVIDENCE: The pre-admission assessments for the last three people admitted to the home were viewed and while they identified needs they did not include information as to how the home will meet those needs. One assessment had not been completed therefore not all needs had been identified for the person concerned. Information in the AQAA stated that the home encourages people to continue with their religion, however pre-admission assessments do not include this aspect of need, nor do the assessments clearly identify individual preferences in respect of daily routines. The AQAA also states that during the one month trial period a continuous assessment takes place but there was no evidence to show this happens in practice. Intermediate care is not provided. Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. All aspects of service users health, welfare and care must be identified and planned for, in order to clearly direct staff in the delivery of appropriate care and improvements in the administration in medication need to be made to ensure people living in the home are not at risk. EVIDENCE: Five care plans were viewed and in the main were found to include most aspects of care needs. However, some parts were inconsistent or contradictory and this needs to be addressed to ensure staff are directed in the delivery of consistent care. Daily notes identified care issues such as people having falls or being attacked by other residents but there was no evidence that this was followed up to ensure needs are met or action taken to reduce incidents. It was of great concern to note that the night notes for one person had been written up as ‘(name) had a quiet night and slept well and no problems to report’. The notes had been subsequently crossed out but the person written about had been in hospital for a number of days so was not in the home and Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 11 this suggests that staff are writing notes without relating them to the person concerned. One note stated that a lady had repeatedly hit another person with a walking stick but this note was not dated or signed. It is crucial for records to be accurate and facilitate an audit trail should it be necessary. Although basic risk assessments had been carried out for those at risk of tissue breakdown or of falls, they were inadequate as they did not clearly identify the hazards nor include sufficient detail for the management of these risks, this was the case even for those people identified as being at high risk. Risk assessments must be expanded to provide staff with clear direction on the management of the risk. A number of people living in Rosebery are aggressive towards other people and staff and although incidents are recorded there was no information on how triggers could be avoided or how staff should deal with the issues effectively. A turning chart was maintained for one person who needed it, as were fluid charts, however this person was moved to their right side despite a clear instruction on the chart not to do so. In addition the chart did not include entries from 4.00 am until almost 11am when it was pointed out to the manager. Subsequently the manager spoke to day staff who added an entry to the chart showing the care delivered at 08:30am. It is important to maintain these charts regularly to ensure people are not at risk of either tissue breakdown or dehydration. One care plan indicated that an individual needed to be weighed weekly, in practice this did not happen and this needs to be addressed to ensure those people whose nutritional intake need particular monitoring are not at risk. Weight charts showed that some people had lost weight but there was no information to demonstrate what action is to be taken to deal with this. Not all staff have received up to date training in the safe handling of medication and this needs to be addressed as a number of shortfalls were found in the medication administration records. These included signatures being overwritten which suggests that medication has been signed for prior to administration. There were gaps in the medication charts and in one instance medication charts did not correspond with the entries in the controlled drugs register. A number of people living in Rosebery are prescribed medication to be taken as required, however care plans did not included the triggers to indicate a need such as pain or being anxious. This is particularly important for those people who are unable to communicate their needs. A senior carer was seen to leave medication with an individual but did not wait to see if he took it. This practice puts people at risk as there was no evidence that the person took the medication, in addition the carer signed that it was administered but she could not know if it was actually swallowed as she did not witness it. Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 12 Information in the AQAA stated that there are monthly reviews of care plans and a 24 hour care summary is carried out, however there was no evidence to show this happens in practice. Rosebery House DS0000021246.V363085.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The lifestyle experience by people living in the home does not match their expectations, choice or preferences. EVIDENCE: Care plans did not include full details of preferred leisure interests and daily routines therefore it was not possible to ascertain whether or not activities provided were based on individual preferences. In addition it was not clear if people got up at times of their choosing as when asked about getting people up a carer said that people are got up and dressed if they have a wet bed. Discussion with the manager found that the carer spoken with does not have sufficient command of the English language to clearly explain what happens in practice. The manager added that people are only dressed when and if they choose to do so. The home continues to operate an open house policy for visitors who are welcome at all reasonable times. Some care plans indicated that some people go out for walks either with carers or family and this shows that individual preferences are met in some instances. Menus showed that a choice is given for each meal and although a food log is maintained for each individual there were a number of gaps in the records Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 14 therefore it was not possible to determine exactly what meals people consumed. The AQAA showed that people are offered five portions of fruit and vegetables each day however menus showed that this is not always achieved. It is good that the home tries to achieve this and the manager said they will continue to explore ways to do so. It was disappointing to note that although three different vegetables were served with the lunchtime meal they were pureed together for those people who need a pureed diet. It is important to puree foodstuffs separately to ensure they are attractively presented. In addition the AQAA stated that people are offered a second helping at meal times but this did not happen in practice on the day. One person refused her lunch and it was good to note that three members of staff all tried to persuade her to try a small amount, however this lady was not offered an alternative as staff did not ask if she actually liked the given meal. One person has been assessed by a dietician and the home has made progress on maintaining a satisfactory weight. As part of the dietary advice there was a sheet pinned up in the kitchen listing the type of high calorie foods that will help maintain weight, however only one of the foodstuffs listed had been served during the last month. Again the manager agreed to review menus with the cook to ensure these items are included on the menu. At the start of the site visit 9 people were up, dressed and sitting in the communal areas. When asked one person said they had not had a cup of tea or breakfast. Discussion with a carer found that people are given a cup of tea on waking but they are not given breakfast as the carer who prepares breakfast does not come on duty until 8am although daily notes showed that some people get up at 5am. The carer said that people would be given a biscuit if they ask. Both the carer and the senior carer were dealing with laundry at the start of the visit and when the senior was asked when people would be given a cup of tea the response was ‘Give me a chance’. This suggests a task orientated approach as it was clear the senior carer felt there was a need to deal with the laundry before providing tea to residents. Discussion with the manager found that there is a task list for night staff and this list comprised 12 tasks of which just four related to care of people in the home with the others being domestic tasks, including laundry and cleaning. While the manager was clear that tasks should be completed after the needs of people living in Rosebery have been met but in practice it seems that staff have a different view. A hot drink and biscuits were served at 12 noon but lunch was served less than an hour later. This needs to be reviewed to ensure gaps between meals and snacks is more spaced to ensure people living in Rosebery are hungry enough to eat a substantial lunch. One individual was seen to be sitting in a wheelchair in the lounge while tea and biscuits were served and they remained in the chair throughout lunch. Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 15 Wheelchairs should be used for transfers only as they are not designed for long term use and do not provide the required comfort and support to individuals. It was of concern to note that the store cupboards contained out of date foods, some as much as two years out of date. The manager disposed of these items on the day and agreed there is a need to carry out a food audit and devise a stock control system for the kitchen. Rosebery House DS0000021246.V363085.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Improvements need to be made to the recording of complaints and to the safeguarding adults systems to ensure that people are not at risk. EVIDENCE: Information provided prior to the site visit confirmed that the service has policies and procedures on both complaints and Protection of Vulnerable Adults. The complaints book showed that the last two complaints were dealt with but the records did not show what action needs to be taken to prevent similar incidents occurring. It is important to detail actions to reduce complaints as part of the quality monitoring system and to improve the service overall. The CSCI has been contacted by five different individuals in the last twelve months who have raised concerns about the provision of services at Rosebery House. These concerns raised issues about the adequacy and competency of staff, poor standards of hygiene within the home and concerns about the way medication is handled. The CSCI visited Rosebery House on 31 October 2007 to meet with the previous Registered Manager and the Provider and conduct an audit of staffing and medication records. As a result of this meeting a Regulation Manager from the CSCI wrote to the Provider requiring him to ensure a number actions were taken to improve the services. This inspection highlights that the outcomes agreed at this meeting have not been achieved. Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 17 Records in the home showed that there have been a number of incidents which resulted in some people being attacked by individuals living in the home and suffered injuries as a result. The manager reported them as part of the safeguarding adults procedures but there was no evidence to demonstrate the action that needs to be taken to prevent further incidents. During the site visit one individual was seen to threaten to punch another in the face. At this time, people in the lounge had been left unsupervised, and this needs to be addressed to ensure any potential risks are identified and eliminated to avoid people being attacked. Discussion with the manager found that staff should not leave people unsupervised but due to lack of staff it is not always possible. Not all staff have received training in Protection of Vulnerable Adults and this needs to be addressed promptly to ensure they are aware of the latest guidance and ensure they have the skills to deal with incidents in the home. Rosebery House DS0000021246.V363085.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Most parts of the home are maintained providing a homely and comfortable environment for people living in the home; improvements need to be made in respect of on-going maintenance and cleanliness to ensure all areas of the home are pleasing and safe. EVIDENCE: A tour of the premises was carried out and a number of randomly selected bedrooms inspected. Most parts of the home are well maintained and décor is generally good, with individual bedrooms being attractively decorated and comfortable. It was disappointing to note that some areas of the home need a thorough clean, especially some baths, splatters on doors, toilets and the elimination of odours. The issue of cleanliness and odours was discussed with the cleaner who pointed out that she has been given additional tasks but not additional hours. She does have a cleaning rota for carpets to reduce odours but agrees that she does not have sufficient time to ensure all parts of the Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 19 home remain clean and fresh at all times, despite an additional cleaner being employed for one day a week. As there has been recent refurbishment there is the opportunity to improve all aspects of the environment. Where doors have been replaced in bedrooms, the surrounding paint and plaster needs to be replaced. Two bedroom doors did not close fully and this needs to be addressed to ensure people are not at risk in the event of fire. As part of the refurbishment programme all rooms need to be assessed in respect of providing a bedside table and lamp as these need to be provided unless a risk assessment suggests otherwise. This was discussed with the manager who was aware of this shortfall and believes that some of the falls during the night may occur due to the lack of light. In addition to the environmental improvements mentioned earlier a new drugs trolley and cupboard have been purchased, as have various waste bins, kitchen and laundry equipment. The lounge and two bedrooms have been redecorated and the boundary fence has been painted. Two call bells, one in the dining area and one in the quiet lounge had the cords reduced to a few inches long and therefore are too high to be reached in an emergency. It is important to ensure that help can be summoned at all times and therefore this needs to be addressed. Water delivery temperatures were variable with some as high as 47.40 and others down to just 27.30. Water needs to be delivered at temperatures that are comfortable for people to wash in but not so hot as to place them at risk, with the optimum temperature being 430. Wheelchairs were in a number of rooms but none had footplates and this needs to be addressed as using wheelchairs without footplates put people at risk of serious injury. The containers for gloves and aprons in one bathroom were empty and this needs to be rectified to ensure staff have access to protective clothing at all times. One senior carer was wearing a blue apron while serving food but during lunch she was seen to assist a gentleman with adjusting his trousers, but did not change the apron or wash her hands after giving this assistance. Such practice raises the risk of cross infection for everyone in the home. Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The number of staff deployed is not sufficient to meet the needs of service users and staff training needs to be improved to ensure they have the skills to meet assessed needs. Recruitment practices are such that people living in the home are safeguarded. EVIDENCE: The manager confirmed that there were five care staff on duty during the morning of which one does breakfasts and assists in the kitchen. There are two night waking carers on duty, however as mentioned earlier night staff are expected to carry out a number of domestic tasks which impinge on the time available for caring duties. Two domestics are employed in addition to a full time person to deal with laundry, however Rosebery House is a large building, especially with the recent extension and therefore produces a lot of work in respect of maintaining a constant level of cleanliness. Serious consideration needs to be given to increasing the hours of domestic staff to both ensure the home remains clean and to reduce to domestic tasks carried out by care staff which impinges on their time for caring duties. When the CSCI visited Rosebery House on 31 October 2007 to follow up on a number of concerns raised about the home, including the standard of cleanliness, it was identified that domestic staffing levels needed to be increased. This was agreed with the previous Registered Manager and the Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 21 Provider and detailed as an action point for the Provider in a letter from the CSCI on 7 November 2007. It was recommended at the last inspection and required at the meeting on 31 October 2007, that care staffing levels be reviewed and increased, especially in the morning and at supper time. Given the number of hostile incidents between people living in the home and the high number of falls, staffing levels are insufficient and need to be reviewed urgently to ensure people are not left unsupervised whilst in the communal areas. The manager has compiled a staff training matrix in order to facilitate a training programme, a copy of which was supplied. These records show that a number of staff have not received up to date mandatory training in moving and handling and fire safety each of which poses a risk both to themselves and people living in the home if not addressed promptly. Minutes of the staff meetings were viewed and from these it was ascertained that there is the intention to delegate additional responsibilities to senior carers. However, as three senior carers were seen to be ignoring good practice in respect of moving and handling, medication and treating individuals as priority over tasks it is important to ensure they are competent to handle additional responsibility. There are currently 19 care staff employed. It was queried that one person did not seem to have done any up to date training and the manager explained that they were on long term sick leave, however following the site visit the Registered Provider said this was not the case and confirmed that no staff are on long term sick leave. Of the 19 care staff, 7 have achieved at least National Vocational Qualification at level 2 with a further 3 due to sign up to this course in the near future. Therefore, the home is on target to ensure at least 50 of care staff have this qualification. Recruitment records for the last three people to be employed were viewed and all had provided the required documentation prior to starting work. One person did not have a Criminal Record Bureau check but the manager said they do not work alone on any shifts. The induction process could be improved as currently records show that it is completed in one day and this is not sufficient time for new staff to become familiar with the practices in the home. Additional staff training needs to be provided in respect of moving and handling as one senior carer was seen to push an individual closer to the table whilst they were sitting in a dining chair. This practice puts both the carer and the individual at risk and needs to be addressed without delay as the chairs are designed to facilitate individuals moving themselves to the table, not to be used as wheelchairs. Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 22 Only 9 care staff have been trained in dementia care and this needs to be rectified given that the home is registered to provide care for those with this disorder. Rosebery House DS0000021246.V363085.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff need to be provided with sustained leadership and direction and systems need to be put in place to ensure all aspects of service users health, welfare and safety are protected and promoted. EVIDENCE: The information in the AQAA was discussed with the manager who agreed that some of the information provided was inaccurate. For example, it states that monthly care meetings take place with family and advocates to discuss care plans but this has yet to be implemented. In addition the AQAA says there is a Registered Manager in place but the manager has yet to register with the Commission although she did confirm that she has the relevant qualifications and experience to competently manage the home. It is essential that all information supplied to the CSCI provides an accurate and up-to-date record of Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 24 what is going on within the home. It is equally important to ensure it is clear who supplied the information to enable the CSCI to discuss with them any queries resulting from these records. Although the manager has been in post since February 2008 she said that she was unaware of poor care practice and the lack of a deputy manager magnifies the problem. However, following the site visit the Registered Provider confirmed that the manager was aware of poor practice within the home four weeks prior to the site visit and an action plan had been developed. The management structure, as a whole, should be working together to identify and address shortfalls in the service that result in poor outcomes for people living in Rosebery. In order to ensure that a good service it is crucial to scrutinize day-to-day care practices and ensure that senior staff are sufficiently competent to supervise more junior staff. All aspects of the service was discussed with the manager who has begun to formulate plans to improve on the quality of care provided such as the purchase of commercial size thermos flasks so people living in Rosebery can be given drinks at any time without the risks associated with kettles and teapots. While it is good that the manager is aware of some shortfalls, her workload is such that she does not always have time to monitor day-to-day practice. Thus, the poor care practice was brought to her attention on the day, in particular that related to medication, record keeping and moving and handling. There were documents available confirming that audits are carried out as part of the quality monitoring system, however they lacked the follow up details to ensure that action is taken to address identified shortfalls. This is also evidenced by the high number of shortfalls identified during the site visit. The home does not manage the finances of people living in Rosebery, their families or solicitors do so on their behalf. It was of concern to note that there were 23 accident records for the month of April most of which were related to people living in Rosebery having a fall or being found on the floor. This was discussed with the manager who agreed it needed to be monitored but she has yet to carry out a review of this matter. Until this review is carried out people living in the home remain at risk. It is also of concern that one report was poorly written as the recorder did not have a good command of written English. The manager had added to this record and it was pointed out that she needed to sign the part that she had added and she agreed to do so. Information in the AQAA demonstrated that all policies and procedures are updated annually and all safety checks are carried out on gas and electrical appliances and systems. However, as mentioned earlier not all staff have received up to date fire safety training and this needs to be addressed as lack of such training puts both staff and people living in Rosebery at risk in the event of fire. Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 25 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 2 2 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X x X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 2 Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 26 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 OP4 Regulation 14 (1) (d) Requirement Timescale for action 01/07/08 2 OP7 3 OP7 4 5 OP7 OP7 6 7 OP8 OP9 That the pre-admission document be expanded to include information as to how the home will meet assessed needs. 13 (4) (b) Risk assessments undertaken for (c) those at risk of falls and tissue breakdown must include the management of the risk and be regularly reviewed. 15(1) That care plans are fully and (2)(b)(c) regularly reviewed and accurately reflect service users current care needs. 15 (1) That daily notes accurately reflect the current condition of service users. Sch3(o)13 Food intake records must be (4)(b)(c) maintained for all service users that require them as under Regulation 17 (1) (a) and records of action taken when service users are noted to have lost weight. 13 (1) (b) That turning charts be maintained and any instructions closely followed 13(2)18 All staff who administer (1)(a)(c) medication must receive DS0000021246.V363085.R01.S.doc 01/07/08 01/07/08 01/07/08 01/07/08 01/07/08 01/07/08 Rosebery House Version 5.2 Page 27 (i)(ii) 8 9 OP9 OP10 13 (2) 12 (4) (a) 10 OP14 12 (2)(3) 11 12 13 14 15 OP15 OP18 OP18 OP19 OP26 16 (2) (i) 13(3) (6)(7)(8) 13(3) (6)(7)(8) 23 (2) (n) 23(1)(d) 16(2)(j) (k) 18 (1) (a) 16 OP27 17 OP27 18 (1) (a) 18 19 OP30 OP30 18(1ac) (i)(ii) 18 (1) (a) (c) (i) (ii) satisfactory training and that all medication administration records are clear accurate and up to date. That service users are observed to take medication unless the care plan directs otherwise. That the home is conducted to ensure the dignity, choice and autonomy of service users is protected and promoted at all times. That service users preferred daily routines including rising and bed times are recorded and staff adhere to them as required. That a food stock control system is introduced and out of date foodstuffs destroyed. That all staff be trained in adult protection. That risk assessments be carried out for those people who present challenging behaviour That all call bell cords are of a length that makes them accessible. That high standards of cleanliness are maintained throughout the home, including the elimination of offensive odours. Staffing levels need to be reviewed to ensure service users needs are met throughout the day and night hours. To increase the hours of domestic staff to ensure the home remains clean and free from offensive odours. That induction is carried out in accordance with the Care Skills Sector guidance. That all staff are trained in dementia care to ensure they have the skills to deliver good care. DS0000021246.V363085.R01.S.doc 01/07/08 01/07/08 01/07/08 01/07/08 01/07/08 01/07/08 01/07/08 01/07/08 01/07/08 01/07/08 01/07/08 01/07/08 Rosebery House Version 5.2 Page 28 20 21 OP38 OP38 13(5) 23 (4) (a)(b)(c) (iii) (d)(e) 23 (2) (n) 17 (1) 22 23 OP38 OP38 That all staff have up to date training in manual handling. That fire drills are carried out regularly and records maintained and that all staff receive regular fire safety training. That all wheelchairs have footplates fitted. That accident records are maintained in line with the latest guidance. 01/07/08 01/07/08 01/07/08 01/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP15 OP31 Good Practice Recommendations The Registered Person to work with the Cook to ensure that meals are being prepared according to a nutritionally balanced menu. That the appointed manager is given sufficient time to satisfactorily monitor care practice within the home. Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Rosebery House DS0000021246.V363085.R01.S.doc Version 5.2 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!