CARE HOMES FOR OLDER PEOPLE
Rosebery House 1 Rosebery Avenue Harpenden Hertfordshire AL5 2QT Lead Inspector
Mr Neil Fernando Key Unannounced Inspection 14th June 2006 10:30 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 DS0000019514.V299858.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 DS0000019514.V299858.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Rosebery House Address 1 Rosebery Avenue Harpenden Hertfordshire AL5 2QT 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) 01582 715600 01582 765555 Fairheart Limited Mrs Anne Knight Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The manager must complete NVQ Level 4 in Management and Care within three years of the registration date. 16th December 2005 Date of last inspection Brief Description of the Service: Rosebery House is registered to accommodate 14 elderly people. The building is a converted three-storey detached house located in a quiet residential area in Harpenden. The shops and local amenities are a short distance away. There are parking areas on the road in front of the building. The ground floor consists of a spacious lounge, an administrative office, a dining room, a kitchen and a laundry room. The first and second floors are connected by a passenger lift and the bedrooms are all located on these floors. Bedrooms are all offered as single occupancy. Bathing and toilet facilities are nearby and these are wheelchair accessible. There is a conservatory at the rear of the premises and this leads on to a patio area. The conservatory is comfortably furnished and serves as an additional lounge for service users. The back garden consists of a lawn area bordered by mature plants and a flowerbed. The garden and patio areas are also accessible to wheelchair users. Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the first inspection for the inspection year 2006/7. The last inspection (Unannounced) was carried out on 16.12.05. Rosebery House is one of two residential care homes owned and operated by Fairheart Limited, in Hertfordshire. It is registered to accommodate up to 14 older people. On the day of the visit, there were 13 people in residence. This unannounced inspection took place on 14 June 2006 and lasted for a total of 5.5 hours. During this period, 8 service users 6 staff members including the Deputy Manager and one of the Registered Persons were spoken to, in order to seek their views regarding the quality of services offered to residents at Rosebery House. A number of records were examined and a tour of the premises was also undertaken. What the service does well:
The home provides a safe, comfortable environment in which service users feel secure and at home at this establishment. Service users spoken with all said that staff members are friendly and caring, and expressed a great deal of confidence in the manner they are cared for. The home’s assessment and admission process is robust thus ensuring that the residents’ needs could be met on admission to the home. Service users consistently emphasised on the welcoming approach adopted by staff members during the admission stage; “they did everything possible to get me to settle down” said 2 residents. Observations of staff at work dealing with service users clearly demonstrated their kindness and dedication, and service users were being treated with dignity and respect. During the inspection, the main meal was served and many residents echoed satisfaction - “the food was very tasty”, said many. Staff members were present in the lounges to support service users as appropriate. Service users were well presented physically and they appeared well cared for, with smart hair and fingernails. A hairdresser visits regularly and residents appeared to value this facility very much. Residents and their families maintain good contact with their family and friends. New employees have a good induction programme, thus enabling them to become confident members of an established team. All staff members have received mandatory training as appropriate, which is well valued by them. There are robust staff recruitment processes to ensure that service users are in Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 Page 6 safe hands. None of the service users spoken to during this inspection expressed any concerns about their care. A commendable strength of the staff and management teams is their openness and willingness to further improve the quality of service delivery for service users. What has improved since the last inspection? What they could do better:
There are 4 requirements and 3 recommendations arising from this report, which need addressing. The existing care plans require improvement; the kitchen and food storage room must be thoroughly cleaned. It is crucial that essential training in Adult Protection and Care Planning (all care staff including senior members) is made accessible to staff. Monthly reviews should be carried out and review notes should be in greater details to reasonably reflect the changing needs and requirements for each service user. The frequency of staff formal supervision and “Residents’ meetings” needs some attention. In terms of health and safety, fire drills must be undertaken once every three months; also, all members must participate in at least one fire drill annually.
Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 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 DS0000019514.V299858.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 DS0000019514.V299858.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5. Standard 6 is not applicable. The home’s assessment and admission process is satisfactory in order to ensure that the resident’s identified needs could be met on admission. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be good. EVIDENCE: The home has a statement of purpose and a service user’s guide to the home. Evidence available indicates that a copy of the guide is made available to the service user, their representative and professionals, as appropriate. The case files for 6 service users were examined and these include comprehensive details of the completed pre-admission assessment undertaken by a member of the home management team. Records examined and information gained from service users and staff members including the Deputy Manager and Proprietor provides good evidence that the arrangements to enable service users and their relatives/friends the opportunity to visit and make an informed decision about the facilities offered at this home is satisfactory.
Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 Page 10 The service user is offered a trial period and this assists them to decide if they want to live at this home. This process also offers staff the time to further assess the needs of the resident; a review meeting is held at the end of the trial period involving the service user, relatives and placing authority as appropriate, and the placement is then finalised. Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 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 and 10. There is a care planning process and monthly review system in operation. However, the identified needs must be comprehensively reflected in the service users’ care plans; also, the monthly review of each resident’s care plan should be regularised. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be adequate. EVIDENCE: Based upon the pre-admission assessment, a care plan is formulated. A new care plan format has been introduced following the last inspection undertaken in December 2005. Care plans for 6 service users were tracked; these reflected some aspect of the residents’ identified health, personal and social care needs. Whilst some progress has been made in this area, further action is required, in order to ensure that the identified needs of each service user are comprehensively reflected in their care plan. Each care plan should include details of how the identified needs are to be met and the action required by staff. There is good evidence to show that monthly reviews of care plans had been carried out but these have not occurred after February 2006; also, minutes of those reviews held are inadequate. Monthly reviews should be undertaken and
Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 Page 12 some improvement is needed to review minutes, in order to reasonably reflect the changing needs and requirements for health and personal care for each service user, over a month period. The Proprietor is aware that remedial action is needed. Documentary evidence is available to show that health assessments are undertaken with respect to individual service user. Visits from GPs and other health professionals are well documented. Identified health care needs are being addressed and observations are maintained, in order to respond quickly to any change, as noted from the daily record of relevant occurrences. At the time of the inspection, there was no resident self-medicating, although the home would support anyone who wishes to and is able to do so. In the main, the home operates a safe and satisfactory medication system that is understood by staff members. Consistent with the last inspection report, excellent evidence is available to demonstrate that service users are treated with dignity and respect, and their privacy upheld. Staff members spoken to, cited many examples of how residents’ privacy and dignity are respected and promoted at all times. Service users spoken with echoed a high level of satisfaction regarding the manner staff members treat and respect them. Rosebery House DS0000019514.V299858.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Service users’ interests, expectations and aspirations are being fulfilled as appropriate. Social contact with family and friends is very good. Wholesome and balanced diets are served in congenial settings and residents have a choice of menu. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be good. EVIDENCE: The home aims to create a relaxed atmosphere with a flexible approach to daily routines. An Activities Co-ordinator is available to facilitate social and recreational activities for residents. Service users spoken with confirmed that the activities co-ordinator has given them more opportunities to follow their own hobbies and interests, and her involvement has positively enhanced their social lives. There is some evidence to show that service users are also encouraged to participate in gentle exercise as well as social and recreational activities. Service users and relatives are given information about the home’s procedures on visiting and maintaining contact with family and friends. Service users and staff members confirmed that visiting times are flexible and visitors are “very welcome” at any reasonable time. All residents maintain very good contact with family and friends.
Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 Page 14 Service users spoken with assured the Inspector that they are helped to exercise control over their lives. “Residents’ meetings” are held every six months and minutes of these meetings are maintained. This is valuable as service users feel that it promotes their autonomy and enable them to influence the decision - making process regarding issues that matter to them. A recommendation is made to increase the frequency of “Residents’ meetings” to monthly. The cook explained that she meets with the service users for feedback in respect of the meals served. The four-week menu seen during this inspection included a good variety, the provision of good nutrition and choice. An additional member of care staff continues to be available during lunchtime and this is beneficial to service users and the staff team as well. During the inspection, the main meal was served and many residents were consistent in the view that “the food was very tasty”. Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 Page 15 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 and 18. Information on how to make a complaint is available and service users felt able to raise any concern they might have. The systems in place should offer adequate protection to service users against harm. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be good. EVIDENCE: The procedures on complaints are available and accessible to all staff members. Information regarding how to make a complaint is also included in the statement of purpose and service users’ guide. Service users spoken with felt able to raise any concern or complaint they may have about the services they receive. Complaints record examined indicates that there have been no complaints received by the home since the last inspection visit. The home’s procedures on Adult Protection are satisfactory. The “Whistle Blowing” policy is also available to the staff team. Staff members interviewed demonstrated some understanding of the above procedures, but they felt that they would benefit from training on this subject. An element of this is included for those members who have completed their NVQ assessment; Standard 18 is not fully met but the issue regarding essential training on Adult Protection is more appropriately dealt with under standard 30 of the report. Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 Page 16 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 and 26. The environment is safe and well maintained and service users live in comfortable surroundings. The kitchen and food storage room require a thorough clean. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be good. EVIDENCE: The communal areas and bedrooms are decorated and furnished in a style to reflect the period features of the building - the corridor areas are decorated with attractive paintings. Many of the rooms look out onto the front yard and gardens to the rear. All areas viewed are accessible and generally well maintained. Service users own rooms are comfortably furnished and meet their needs, and they are encouraged to bring in personal possessions to create ownership and additional comforts. A rolling programme of maintenance and redecoration is in place and this ensures a good standard of physical environment. Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 Page 17 A high standard of cleanliness was evident throughout those areas viewed, bar the kitchen and food storage room that require a thorough clean. There were no mal-odours present. Suitable arrangements are in place for the storage and collection of domestic and clinical waste. There were no health hazards noted during this inspection. Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 Page 18 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 and 30. The establishment continues to provide the staffing levels required by day and night, and service users’ needs are being addressed. Structured training for staff on Adult Protection and Care Planning is a priority and NVQ assessment for staff should be given a higher profile. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be satisfactory. EVIDENCE: In terms of numbers and skill mix, the staffing arrangements are consistent and remain appropriate to ensure that the needs of the service users can be met. Discussions with service users and staff including the Registered Person confirm that they consider the staffing levels to be appropriate; also, all 8 service users spoken with were very positive about the assistance they received. Staff members continue to receive ‘mandatory’ training; all care staff members are currently undertaking a course in Infection Control at a local college, which is commendable. The home has not yet achieved the 50 NVQ Level 2 for its staff. 2 staff members (15.3 ) have so far achieved their NVQ awards and another 3 members are currently undertaking this assessment. NVQ assessment should therefore be given a higher profile, in order to meet the stated standard. Other specific training identified includes i) Adult Protection and ii), training on Care Planning, which must be made accessible to all care staff, including senior members. This would improve their knowledge and skills
Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 Page 19 on protection matters, the care planning process, implementation of identified needs and review system. The recruitment records of 6 staff including the latest recruit were viewed; Evidence demonstrates that there are robust recruitment practices in the home, which means that service users are in safe hands. Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 Page 20 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, 36, 37 and 38. The home is managed and run in the best interests of service users. Record keeping is noted to be good. The health and safety of the service users is being protected; some attention is required regarding the frequency of fire drills and staff formal supervision. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be good. EVIDENCE: The Registered Manager has a good level of experience in managing Rosebery House and she runs the home in the best interests of the service users. She keeps up to date with good practice and keeps her own training up to date. It is a condition of the Manager’s registration that she completes NVQ Level 4 in Management and Care within three years of her registration date. She has successfully completed year 1 of a 2 years course and information gained suggests that she would complete her training within the agreed timescales. Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 Page 21 Staff members spoken with reported that they are well supported by the management team. Observation of care practice during the visit also demonstrates that members of staff and service users enjoy a very good relationship. Service users spoken with indicated that the home more than meets their expectations and that they are very happy, feel valued and respected in the home. A formal one to one supervision for staff is in operation and details of supervision sessions are maintained. However, supervision had not occurred regularly and within the stated frequency. The Registered Person is aware that formal supervision should occur once every two months, at minimum. Health and safety training is provided on a rolling training programme and records show that health and safety checks had been carried out; these include fire safety equipment testing and servicing and fire safety checks. Corgi registered personnel carry out gas safety checks. Fire drills have been carried out and all staff members interviewed were conversant with the evacuation points. A requirement has been made for fire drills to be carried out once every three months; also, all members must participate in at least one fire drill annually. Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 Page 22 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 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 X x 2 3 2 Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 Requirement Care plans must reflect the identified needs of each service user, details of how they are to be met and the action required by staff (outstanding recommendation from report dated 16.12.05). The kitchen and food storage room require a thorough clean. The Registered Person must ensure that all care staff (including senior members) receive structured training in: i) Adult Protection (to be met by 14.09.06). ii) Care Planning (outstanding recommendation from report dated 16.12.05). The Registered Person must ensure that fire drills are carried out once every three months; also, all members must participate in at least one fire drill annually. Timescale for action 14/07/06 2 3 OP26 OP30 16 (2) & 23 (2) 12(1)(b) 31/07/06 14/12/06 4 OP38 23 (4) (e) 14/09/06 Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 Page 24 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 OP7 Good Practice Recommendations Monthly reviews should be undertaken and review notes should be in greater details, in order to reasonably reflect the changing needs and requirements for each service user, over a month period. The frequency of “Residents’ meetings” should be increased from once every six months to monthly. Formal supervision for staff members should be regularised and frequency increased to once every 2 months, at minimum. 2 3 OP14 OP36 Rosebery House DS0000019514.V299858.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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