CARE HOMES FOR OLDER PEOPLE
Rosebery House 1 Rosebery Avenue Harpenden Hertfordshire AL5 2QT Lead Inspector
Yoke-Lan Jackson Unannounced Inspection 16th December 2005 13:00 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 DS0000019514.V273663.R01.S.doc Version 5.0 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.V273663.R01.S.doc Version 5.0 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.V273663.R01.S.doc Version 5.0 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. 3rd August 2005 Date of last inspection Brief Description of the Service: Rosebery House is registered to accommodate 14 service users in the Older People category. It is one of two residential care homes owned and operated by Fairheart Limited. 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 passenger lift and the bedrooms are all located on these floors. Bedrooms are all offered for 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. There is a flowerbed. The garden and patio areas are accessible to wheelchairs. Rosebery House DS0000019514.V273663.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on 16th December 2005. The registered manager was not on duty. The home was full with 14 service users. A tour of the premises was carried out. Some service users were interviewed. Staff performance and their interaction with service users were observed and noted. Documents, including the care plan files and the Medication Administration Record Charts were examined. The service users are cared for in a positive way. However, it is recommended that the care plan files be reviewed to reflect the care needs and plan of care of the service user in a concise manner and that all members of staff attend training in regard to writing care plans. The management must ensure that all printed instructions on the Medication Administration Record charts are in line with the instructions on the dispensed container and that all medicines in use have the date of opening written on the dispensed containers. (Please see below for details of the inspection findings). What the service does well: What has improved since the last inspection?
The home has complied with the Statutory Requirements and the Statutory Recommendation from the last unannounced inspection. The management ensures that adequate staff are provided at all times, having regard to the number and the level of needs of the service users present in the home. The staffing level has been increased by one during lunchtime since the last inspection. The management has appointed one of the carers as the activity co-ordinator to ensure that the service users’ social and recreational needs can be met in a consistent way.
Rosebery House DS0000019514.V273663.R01.S.doc Version 5.0 Page 6 The wheelchairs are serviced regularly to ensure that they are in good working order and are safe to be used. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rosebery House DS0000019514.V273663.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rosebery House DS0000019514.V273663.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Prospective service users will be given the information they need and will be given the opportunity to visit the home and assess the facilities provided. A trial period of stay is arranged for the prospective service user following a pre-admission assessment of their care needs. EVIDENCE: The home has had a number of admissions since the last inspection. Some service users have been transferred to a more appropriate care home because of their changing needs. A copy of the signed written contract is given to the service user together with the Service User Guide. One new service user interviewed said “she is very pleased with the arrangements made and is settled in her new home.” Rosebery House DS0000019514.V273663.R01.S.doc Version 5.0 Page 9 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. Service users are treated with dignity, and their wishes and preferences are respected. The care needs and the plan of care of service users are not always reflected in the written care plan. The contents of the revised care plan files were confusing. Some printed instructions on the Medication Administration Record charts are at variance with the instructions on the dispensed container. The medicines in use are not always labelled with the date of opening on the dispensed container. EVIDENCE: Each service user has a written care plan on admission to the home. However, the contents within the file itself appeared confusing. The care plan files have been revised by the registered manager since the last inspection. It is recommended that the these files be reviewed again to reflect the care needs and plan of care of the service user in a concise manner. Rosebery House DS0000019514.V273663.R01.S.doc Version 5.0 Page 10 Trained staff administer all medication. The Medicine Administration Record charts (MAR) were examined. Some printed instructions on the MAR charts are at variance with the instructions on the dispensed container. This needs attention to ensure no misadministration. There were medicines in used where the date of opening was not stated on the dispensed container. The registered manager must ensure that all the medicines in use have the date of opening written on the dispensed containers. (Please see Statutory Requirements and Recommendations). Rosebery House DS0000019514.V273663.R01.S.doc Version 5.0 Page 11 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. Service users are given the opportunity to be involved in the planned daily activity. They also have regular contact with their relatives and friends. The meals provided are balanced and nutritious. EVIDENCE: The service users interviewed gave positive feedback regarding the hot meal that was served at lunchtime. Since the last inspection, one carer has been appointed as the activity cocoordinator to ensure that the daily activity as planned is carried out. One service user interviewed informed the inspector that there was a garden party in the summer to which friends and relatives were all invited. A Christmas party is planned for the coming week. Rosebery House DS0000019514.V273663.R01.S.doc Version 5.0 Page 12 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, 17, 18. The Complaints Policy and Procedure are in place and they are available to the service users and others. The registered manager ensures that service users are protected from abuse, neglect and self-harm. EVIDENCE: The home follows the Hertfordshire Adult Protection Procedure. Staff are aware of the Whistle Blowing Policy. All complaints have been dealt with appropriately by the management. Rosebery House DS0000019514.V273663.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. The home appeared neat and clean. It provides a safe and comfortable environment for the service users. All equipment is serviced and is maintained in good working order. EVIDENCE: The premises appeared well maintained. All the bedrooms examined were neat and clean. The furniture and the items in the bedrooms reflected the individual lifestyles of the service users. The wheelchairs and other equipment were serviced recently and are in good working order. Rosebery House DS0000019514.V273663.R01.S.doc Version 5.0 Page 14 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. The staffing level has been increased from 2 to 3 at peak periods to ensure all service users are supported and safely cared for. Staff have not had training in writing care plans. EVIDENCE: The staff interacted well with the service users. Only positive remarks were received from the service users about the care given by staff. It was noted that although the key-working system is in place, the keyworkers are not responsible for the written plan of care and some staff are not familiar with writing care plans. It is recommended that further training be arranged for all staff in regards to writing care plans. Rosebery House DS0000019514.V273663.R01.S.doc Version 5.0 Page 15 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): (This section was not inspected on this occasion as the registered manager was not on duty). EVIDENCE: (Please see previous inspection dated 03/08/2005) Rosebery House DS0000019514.V273663.R01.S.doc Version 5.0 Page 16 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 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X x Rosebery House DS0000019514.V273663.R01.S.doc Version 5.0 Page 17 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 OP9 Regulation 13(2) Requirement The registered manager must ensure that : (i) Printed instructions on the Medication Administration Record charts are in line with the instructions on the dispensed container. All medicines in use have the date of opening written on the dispensed containers. Timescale for action 16/12/05 (ii) Rosebery House DS0000019514.V273663.R01.S.doc Version 5.0 Page 18 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 It is recommended that the care plan files be reviewed to reflect the care needs and plan of care of the service users in a concise manner. It is recommended that all members of staff attend training in regards to writing care plans. 2. OP30 Rosebery House DS0000019514.V273663.R01.S.doc Version 5.0 Page 19 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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