Inspection on 10/04/06 for Rosebery House

This inspection was carried out on 10th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rosebery House 27/10/08

Rosebery House 01/05/08

Rosebery House 03/05/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Rosebery House Residential Home 2 Rosebery Avenue Eastbourne East Sussex BN22 9QA Lead Inspector Lucy Green Key Unannounced Inspection 10th April 2006 08:00 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 Rosebery House Residential Home DS0000021246.V288744.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. Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Rosebery House Residential Home 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/ kellym32@hotmail.com Spemple Limited Vacant Care Home 26 Category(ies) of Dementia - over 65 years of age (26) registration, with number of places Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is twenty-six (26). Service users must be aged sixty-five (65) years or over on admission. Service users to be diagnosed with a dementia type illness. One named service user under the age of sixty-five (65) may be accommodated. 20th February 2006 Date of last inspection Brief Description of the Service: Rosebery House is a large, detached property situated in a residential area of Hampden Park, Eastbourne. Local shops and amenities are a short, level walk away. The home is registered to accommodate twenty-six older people with dementia. Single bedroom accommodation is provided on two floors. All bedrooms are equipped with a call bell and a passenger lift provides easy access to the first floor. Assisted bathrooms and toilets are located on both floors of the home. Meals are usually served in the dining room, but can be taken in the residents own room, if preferred. 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. The fees at Rosebery House currently range from £352 to £565 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 Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Rosebery House have are referred to as ‘residents’. This report reflects a key inspection based on the collation of information received since the last inspection, feedback from representatives and visiting professionals and an unannounced site visit which lasted eight hours on Monday 10 April 2006 between the hours of 8am and 4pm. The site visit included a tour of the premises and an examination of medication, care and staffing records. The Inspector joined residents for their breakfast and lunchtime meals. Throughout the inspection process, the Inspector spoke with eight of the twenty-one residents individually and observed the way other residents were supported in communal areas. Telephone conversations were held with five representatives and three professionals. Written feedback was received from three Doctors. The home is currently being overseen by the Deputy Manager and the previous Registered Manager and both these people were met with during the site visit. In addition, two Senior staff, one carer, the cleaner, cook and hairdresser were interviewed individually. What the service does well: The inspection process has identified that the home is performing adequately in all areas. Residents are supported by a team of staff who are committed to meeting their needs. During the site visit, staff were observed to be assisting residents in a sensitive and dignified manner. The atmosphere was friendly and fun. The home has worked hard to build positive relationships with residents’ relatives and this is reflected in the positive comments received by all relatives who spoke with the Inspector. One relative stated: “Rosebery House suits my (relative) excellently”. All relatives confirmed that they were kept fully informed about any changes to needs and were consulted on in respect of all decisions. Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 6 The home has developed a good system of self audit – with a consultant undertaking monthly monitoring visits and working with the Provider to produce clear action plans. What has improved since the last inspection? What they could do better: Requirements from this inspection primarily focus upon the home completing those pieces of work outstanding from the last inspection, in particular ensuring all residents have an updated care plan and associated risk assessments. These are important documents as they provide staff with the necessary guidance to enable them to meet residents’ needs. The home also needs to develop a programme of person centred and meaningful activities to ensure that residents’ social needs can be fully met. Whilst the provision of meals has improved, there is a requirement that the home ensure that residents have sufficient quantities of food and that staff remind residents of the opportunity to have snacks and choice of cooked breakfasts. Rosebery House Residential Home DS0000021246.V288744.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. Rosebery House Residential Home DS0000021246.V288744.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 Rosebery House Residential Home DS0000021246.V288744.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): 1, 3, 4 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective and current residents benefit from the provision of comprehensive information about the services provided at Rosebery House. The improved assessment systems should ensure that the home can meet the needs of the people it accommodates. There is no provision for intermediate care at Rosebery House. EVIDENCE: The home has complied with requirements of previous inspections and produced an up to date Statement of Purpose and Service User Guide. These documents now provide comprehensive information about the services offered at Rosebery House. The management team confirmed that residents and/or their relatives had been given copies of the updated documentation. One relative whose husband moved into the home at the end of 2005, confirmed that she had received a copy of the ‘home’s brochure’. This relative Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 10 also reported that she and her family had visited the home prior to her husband’s admission. Due to the concerns raised in the inspection report dated 13 December 2005, the Provider voluntarily agreed not to accept any further admissions until identified issues had been addressed. The local Contracts and Purchasing Unit of Adult Social Services also took a decision at this time to suspend placements with Rosebery House. During the last five months, the home has re-assessed the residents living at Rosebery House in line with their clarified Statement of Purpose. Consequently, more suitable placements have been found for a number of residents. The home is now able to evidence that it can meet the needs of those people accommodated. At the time of the inspection, it was observed that the atmosphere was more relaxed and that interactions between all parties were positive. All family members spoken with expressed that their relatives’ needs were being met by the home. A new assessment pro forma has been produced which will be used as the basis for future new admissions. The form covers the key areas outlined in the National Minimum Standards, but until it has been used it is not possible to assess the outcome of this new tool. Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The introduction of a new system of care planning ensures that residents health and personal care needs can be fully met. EVIDENCE: There was documentary evidence that the home has undertaken a lot of work over recent months to introduce a system of care planning that is both comprehensive and accessible. The management team have tried a variety of tools and sought input from a range of professionals to assist them in this task. A new format has now been agreed and care plans for ten residents have been produced on the new system. As part of a case tracking exercise, the Inspector viewed five care plans, three of which had been updated using the new tool. It was pleasing to note that all updated care plans viewed, contained detailed information about how to support the resident in a person centred way. The Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 12 plans focused on the strengths of the individual and provided holistic information about the person. The inclusion of a life history evidenced that consultation had taken place with the resident and/or their representatives. The management team confirmed that wherever possible, the resident and relatives had been involved in compiling the care plan. During telephone conversations with the Inspector, three relatives reported that they had recently attended care plan reviews at the home. One relative commented; “they are really informed about all the changes to my relative’s health”. The support given to residents throughout the inspection was seen to be provided in a sensitive and dignified manner. Five residents spoken with confirmed that they had chosen their clothes that morning and informed the Inspector that they felt it “important to look smart each day”. Personal care was observed being offered in a way that preserved privacy and choice. Three senior care staff confirmed that they had noticed a big improvement in care planning. One stated “the care plans are now seen as working documents and key-workers know it is their responsibility to review them on a monthly basis”. The management team are aware of the need to ensure all care staff are fully up-to-date with the new system and this is being addressed through individual supervision sessions. At the time of the inspection, there was evidence that written guidance was starting to be reflected in staff practice. The Inspector observed the way one resident was supported at mealtimes and noted that this was in accordance with the care plan. The requirement made in this report in respect of care planning, reiterates the need for all care plans to be updated to the new system. The management team has agreed a timescale of two months from the date of this inspection for this piece of work to be completed. As part of the inspection process, the Inspector made contact with visiting professionals to assess the ability of the home to ensure healthcare needs are fully met. At the time of this report, three Doctors had returned comment cards that indicated that the home responded appropriately to their patient’s healthcare needs. A telephone conversation with one Community Psychiatric Nurse and the local District Nursing Team did however, identify a need for some more specific training for staff about specialist healthcare needs and this is reflected in the requirement section of this report. An assessment of medication systems was conducted as part of the inspection, although the medication policy was not inspected. Improvements in the recording of medication, particularly in respect of changes to medication and controlled medication were noted. The administration of medication was Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 13 observed to be more person centred and thought was given to ensuring residents received their tablets at appropriate times. Staff were however reminded of the importance of signing the Medication Administration Records (MAR sheets) immediately subsequent to administering medication. This is again reflected as a requirement. Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 14 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 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Notwithstanding the improvements in this area, residents would benefit from greater opportunities to lead more healthy and fulfilling lives. EVIDENCE: The atmosphere on the day of inspection was noted to be calm and relaxed. Staff were observed engaging with residents in a friendly and appropriate manner. Feedback received from visitors also confirmed that they too had noted a cultural change at Rosebery House. One visitor commented “the home is definitely getting friendlier and better”, another relative stated “from what I see, people are genuinely caring and very nice”. Those residents spoken with also remarked that “people are quite nice” and “staff are friendly, no one is at loggerheads”. Staff recognised that Rosebery House is “now a much nicer place to work”. One senior staff member informed the Inspector that “it’s a nicer atmosphere, more relaxed”. Another stated; “there’s been big improvements here since January and on the whole residents are a lot happier”. One staff member said that “I’ve noticed that more people visit now and for longer periods of time”. Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 15 The Statement of Purpose states that visitors are welcome throughout the waking day at Rosbery House. This was seen to be the case at the time of the inspection, with visitors arriving at different times to see their relatives. One visitor confirmed that they “always drop in unannounced and staff are always approachable”. Despite the recent improvements, it was commented by all stakeholders that there is a real absence of meaningful activities at Rosebery House. Staff were observed spending time with residents, but they do not have the same time or expertise dedicated to activities as someone employed solely for this purpose. The management team advised the Inspector that they were looking to recruit a new activities co-ordinator who also had skills and experience of engaging with people with a dementia type illness. The Inspector spent time talking with staff and the management team about the importance of person centred activities and looking at the type of interests and hobbies people pursued before entering residential care. One resident told the Inspector that she always went to watch cricket with her husband and this may be an activity that staff could explore with her now. Individual arrangements for some residents provide the opportunity for residents to go out. For example, one resident informed that Inspector that she visits her husband at another home every day, except for Sunday when she goes to church. For the majority of residents at Rosebery House however, there is limited opportunity for community presence. The need to increase social inclusion is reflected in the requirements section of this report. The provision of meals at Rosebery House has been the subject of requirements at recent inspections. It was pleasing to note during this visit, that a lot of work has gone into improving not only the quality of meals, but also the way mealtimes are conducted. The Inspector joined residents at both breakfast and lunchtime. The first noticeable change was the length of time over which these meals are now served. At previous inspections, mealtimes were set with all residents arriving in the dining room at the same time. This generated a lot of noise and tension at these times. At the time of this visit, breakfast was served over more than two hours, with residents being offered a choice of freshly prepared food at a time suitable to them. As a consequence, the dining room was not crowded and staff had the time to individually ask residents what they wished to eat. Lunchtime was also observed to be more relaxed. The Inspector asked one staff member how they had managed to improve the atmosphere so greatly, the reply was “residents can now choose who they wish to sit with”. This simple choice has made a real difference to the way residents spend this time. Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 16 The lunchtime meal of sausage and bacon casserole, vegetables and mashed potato, was thoroughly enjoyed by the residents who the Inspector sat with. It was also noted that staff responded positively to two residents who requested an alternative meal. One resident changed their mind several times about what they wanted to eat and the staff member responded positively and appropriately to all of these requests. Conversation with the Cook identified that the food budget has increased and that he is now able to order fresh produce several times a week. The Cook also explained that in order to ensure residents ate more fresh fruit, a homemade fruit salad was being served in the afternoons four days each week. All parties spoken with agreed that meals had greatly improved at Rosebery House, however there are two areas that still need to be improved. The first issue was raised by three relatives, who all felt the food portions were quite small. Another relative reported “the only thing I would say, is that my relative always seems hungry”. It was observed at the inspection, that the portions were not large, however some staff were seen to offer the option of a second helping. The issue was raised with the management team who stated that when larger portions were served, residents ‘were put off and ate very little’. It is therefore required that all staff ensure they offer a second serving as a matter of routine. The second issue which home needs to address is ensuring that residents are aware of the availability of snacks throughout the day and that they can request a cooked breakfast if they wish. Staff spoken with, including the Cook, confirmed that residents could have whatever they wanted to in respect of food. The food records indicated however that residents’ eating habits had not significantly altered since the changes had been implemented. The Statement of Purpose also identifies that the home could do more to ‘advertise the choices available’ and this is something which needs to be addressed. Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The systems now in place protect residents from abuse, however more work is needed to ensure residents feel that their complaints are taken seriously and acted upon. EVIDENCE: Neither the Commission for Social Care Inspection nor the home have received any formal complaints about the services provided at Rosebery House since the last inspection in February 2006. Feedback from relatives and visitors indicated that they advise the management team if they have any concerns or issues that require addressing. Staff spoken with were clear about what to do if a relative or visitor complained. During the inspection however, it was observed that complaints made by residents may not always be considered to be a ‘complaint’ as per the policy. Some work is needed to assist staff in dealing with situations where residents are negative about the home or service. At the time of the inspection, one resident became quite angry and frustrated. Whilst the staff member dealt sensitively and appropriately with the resident, the content of the ‘complaint’ was not acknowledged and was dismissed as part of the person’s dementia. It is therefore recommended that the home consider ways of ensuring residents’ views are carefully listened to. Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 18 The training plan identified that thirteen of the eighteen care staff and two ancillary staff have attended training in the protection of vulnerable adults in the last twelve months. The training schedule also confirms that refresher training has been arranged for May and September 2006. Conversation with staff and observation of practice confirmed that recent learning was being reflected in staff practice. The updated care plans also provide detailed guidance as to how to support residents in an appropriate way that reflects choice and preserves dignity. Similarly, the work undertaken to assess compatibility of residents with each other has significantly reduced the risk of residents abusing each other. Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 19 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, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents, visitors and staff are better protected by the improvements to safety, hygiene and cleanliness of the home. EVIDENCE: The Inspector toured the home at various intervals throughout the day and it was pleasing to note a significant improvement to the environment. The biggest impact has been made by the introduction of an odour-control system. In addition, the flooring in five bedrooms has been replaced with a good quality laminate covering that has enabled the cleaning processes in these rooms to be more effective. Discussion with one relative highlighted that families had been consulted with before such changes to rooms had been made. A discussion with the cleaner revealed that a second domestic person had been employed to clean the home at weekends. This is reported to have made a big Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 20 difference and ensures that standards can be maintained across the whole week. It was commented by one staff member that the Provider “has really worked hard at improving the cleanliness and hygiene at the home”. This sentiment was re-iterated by the visitors and relatives spoken with. The training plan confirms that seven care staff and three domestic staff attended infection control training in January 2006. The yearly schedule identifies that refresher training has been arranged for September 2006. Staff spoken with reported that a lengthy discussion about how to improve infection control in the home was had at a recent staff meeting. Throughout the inspection, staff were observed to be more vigilant about changing gloves and aprons. Building works at the home are currently suspended and the management team confirmed that efforts were being focused on improving the existing premises. This comment was found to be substantiated during the tour of the home, where it was noted that one bathroom was being upgraded and the laundry floor has recently been re-sealed. The lighting in bedrooms and communal areas has been improved. The previous issue with the thermostats has been addressed and rooms were now adequately heated and water temperatures appropriately regulated. Call bells were also found to be accessible and no call bell was left unanswered during the eight hours of inspection. The maintenance plan for the home was found to be on-going and whilst some parts of the home still looked tired, there was evidence of a rolling schedule for improvements. Three relatives and three professionals expressed that they had concerns when the building works were ongoing, but stated that the environment had become much safer and more inviting since they had ceased. One relative said that they would like “to see the garden used more and that it would be nice to see some seats and things to brighten it up”. The requirement section of the report identifies the need to continue upgrading the environment and as rooms are re-decorated to seek professional advice about how to make the environment as suitable as possible for people with a dementia type illness. Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported by a team of staff who are committed to meeting their needs. Greater protection would be afforded to residents if recruitment systems were more robust. EVIDENCE: Throughout the inspection, the Inspector observed a real difference in staff attitude towards residents than noted during previous visits. The interaction between staff and residents was positive and quality time was spent supporting residents in an appropriate and sensitive way. Discussion with five staff members revealed that the team felt more valued and listened and that “Rosebery House has become a nice place to work”. One senior member of staff informed the Inspector that the introduction of proper supervision sessions and regular staff meetings “has really made people realise what their job is and that the home needs to be run for the residents”. Feedback from relatives was also positive about staff. One relative said “my (relative) gets on really well with staff”. Another visited commented that “staff are always respectful to the residents and I find them very approachable”. Staffing levels have improved and all staff spoken with stated that current levels were adequate. The rota indicates that the home is staffed by a Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 22 minimum of four staff during the waking day, of which one person is always a Senior. At night, there are two waking staff. All meal preparation and domestic tasks are undertaken by a team of ancillary staff. The deputy manager works in a supernumerary capacity. These were the staffing levels in place on the day of inspection and they appeared to be adequate to meet the needs of residents. As previously identified however, social needs would be better met with an additional activities co-ordinator. In line with a requirement made at the inspection conducted on 13 December 2005, one of the day staff commences work at 6am each day to support the night staff. There has been some discussion with the management team as to whether this could be moved to a 7am start. However, at the time of the inspection, the consensus of opinion from care staff was that the 6am start had made a really positive impact and that it relieved any need to rush. This was certainly the observation at the time of the inspection and also ensures that one member of staff is available downstairs to supervise and make drinks for those residents who have chosen to get up early. The recruitment files for four care staff were inspected. There was evidence that the files had been updated in line with a requirement at the last inspection, however, there were still some gaps in the information required to be in place. One staff member only had one written reference and for two staff a full employment history had not been supplied. There was also a query for one individual as to whether a work permit was necessary. The management team, were again advised of the importance of ensuring all documentation was in place prior to the staff member commencing work. This is reflected as a requirement. Staff training has greatly improved since the last inspection and there is now a training matrix in place which identifies staff and the dates of training attended. A schedule for the year has been devised that indicates when refresher courses have been arranged. Staff confirmed that recent training had been useful, especially the dementia training that has been provided with input from the Alzheimers Society. It was identified that not all new staff had commenced an induction in line with Skills for Care and the management team reported that this matter was in hand. This is not reflected as a requirement, but is expected to have been addressed as discussed. The home has made a real effort now to provide staff with the opportunity to obtain National Vocational Qualifications (NVQ). Two staff already hold NVQ level 2 and two are currently working towards this qualification. The management team also confirmed that a date had been set for a further nine staff to commence this training. Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home has improved greatly since the last inspection and it is anticipated that once the newly appointed Manager commences work the team will be further strengthened. EVIDENCE: There has been no Registered Manager at Rosebery House since August 2005 and the last two inspection reports reflect the negative impact the lack of management has had on the home. The Provider has recently put systems in place to ensure that the home is being managed until the new Manager commences work. As such a consultant has been employed to assist the Provider in auditing the home and conducting the Regulation 26 visits. The recent correspondence Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 24 received by the CSCI from the home has been of improved quality and demonstrated evidence of clear action planning. It was pleasing to note at the inspection, that the information was an accurate reflection of the reality in the home. On a day to day basis, the home is being overseen by the Deputy Manager with the support of the previous Registered Manager who has been providing 20 hours each week of management support. The improvements to the home and the feedback received from relatives, visitors and staff indicated that the management of the home has recently become a lot more effective. The home has recently introduced a revised system of quality assurance. As such a meeting for relatives was held to discuss the service and gather suggestions for feedback. Satisfaction questionnaires have been given out to residents, relatives and professionals. At the time of inspection, feedback was still in the process of being collated and therefore not possible to analyse, but it is a positive step that this has been conducted. A system of supervising staff has been put in place and the previous Registered Manager has been undertaking the first session. Similarly, regular staff meetings are being held and staff commented on how valuable these had been, especially since the Provider has attended. The home has a policy that it does not get involved with residents’ finances or hold valuable items for residents. This was confirmed by the management team at the time of the inspection. Residents are supported with their finances by either relatives of appointed solicitors. Where it is necessary to make purchases on behalf of residents, the home makes the initial payment and invoices are sent to the nominated representative. There was evidence that a number of health and safety issues have been addressed and the service is safer as a result of this action. In particular, the improvements to infection control and fire safety have made a big impact. Hot water outlets were found to be delivering water at appropriate temperatures and windows above ground floor restricted. One radiator in a ground floor bathroom was not covered, this is again highlighted and requires action to be taken. Records were not inspected on this occasion, but the management team confirmed that training and fire drills are up to date. Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 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 3 X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 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 3 2 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 2 Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 26 YES 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 OP7 Regulation 13(4) Requirement Comprehensive risk assessments must be carried out in respect of all areas of service users lives and the controls in place evaluated. (Previous timescales of 01 September 2005 and 01 January 2006 extended). That the homes care planning system must effectively monitor residents health, welfare and social needs. Care plans must provide support guidelines which outline how care should be given. Care plans must be regularly updated. (Previous timescales of 01 September 2005, 01/03/06 and 01 January 2006 extended). All staff must receive training to enable them to meet any specialist needs of people accommodated, e.g. diabetes. T Medication must be dispensed, administered and recorded appropriately. The Registered Person must consult with service users about DS0000021246.V288744.R01.S.doc Timescale for action 10/05/06 2. OP7 15 10/05/06 3 3. 4. 5. 5 OP8 OP30 OP9 OP12 OP14 18(1) 18(1) 13(2) 16(2)(m) 16(2)(m) 01/07/06 01/07/06 10/04/06 01/06/06 01/06/06 Page 27 Rosebery House Residential Home Version 5.1 &(n) 6. OP15 16(2) 7. OP19 23(1)(a) 8. OP29 19&Sch2 (as amended) 13(4) 9. OP38 providing a programme of meaningful and person centred activities. This should include the opportunity for increased social inclusion. Ensure service users are provided with sufficient quantities of nutritious and wholesome meals that meet their needs and expectations. The process of redecoration and refurbishment must continue, with consideration being given as to how the environment can best meet the needs of people with a dementia type illness. The home must follow correct recruitment procedures to ensure the safety and protection of residents. Ensure that all parts of the home are kept safe, secure and free from hazard at all times, this to include the guarding of radiators. 10/04/06 01/07/06 10/04/06 10/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP16 Good Practice Recommendations The home consider how residents’ views are listened to and respected. Rosebery House Residential Home DS0000021246.V288744.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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