Inspection on 20/02/06 for Rosebery House

This inspection was carried out on 20th February 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 10/04/06

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 Unannounced Inspection 20th February 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.V279512.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.V279512.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.V279512.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. 13 December 2005 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. Rosebery House Residential Home DS0000021246.V279512.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 unannounced inspection took place over five hours on 20 February 2006. Due to ongoing concerns raised about the home, two Inspectors undertook this inspection. This is the third inspection of the year and therefore this report should be read in conjunction with the reports from the unannounced inspections carried out on 21 June 2005 and 14 December 2005. Since the last inspection in December 2005, the CSCI has been undertaking regular monitoring of this service. The Inspectors undertook a tour of the premises and examined medication, care and staffing records. The preparation and serving of the lunchtime meal was observed. The Inspectors met with most of the residents during the inspection and spoke with staff on duty. What the service does well: What has improved since the last inspection? Since the last formal inspection, the service has complied with many of the areas raised as issues of serious concern. The general health and safety of the home has improved and the building works have been suspended. Fire doors that were previously found to be propped open, have now been fitted with appropriate hold-open devices. As requested an additional staff member has been brought into work between the hours of 6am and 8am and this has greatly improved the morning routine. Some staff have undertaken recent training in key areas and several are now registered to commence National Vocational Qualifications. Rosebery House Residential Home DS0000021246.V279512.R01.S.doc Version 5.1 Page 6 The provision of food has significantly improved and resident choice in this area has greatly increased. It was pleasing to note that there was an increased availability of fresh fruit and vegetables. 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 Residential Home DS0000021246.V279512.R01.S.doc Version 5.1 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 Residential Home DS0000021246.V279512.R01.S.doc Version 5.1 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, 6 Current and prospective residents would benefit from the availability of up-todate information about the services provided at Rosebery House. Rosebery House does not placement for those requiring intermediate care. EVIDENCE: The home has a Statement of Purpose and Service User Guide in place. It was however identified that both these documents are in need of revision and updating. The information available to residents and their representatives is not reflective of the services, facilities or staffing currently in place at Rosebery House. The Provider voluntarily agreed at the time of the last inspection, not to accept any further admissions at that time. Consequently, it was not possible to inspect the quality of pre-admission assessments. Rosebery House Residential Home DS0000021246.V279512.R01.S.doc Version 5.1 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, 9 & 10 Residents would receive better care if care plans provided detailed information about how to meet their needs. Medication systems have improved since the last inspection. EVIDENCE: Five care plans were inspected and information included was again found to be inadequate. It was a requirement of the last inspection that care plans and associated risk assessments be addressed to provide a system that effectively monitors residents’ health, welfare and social needs and the timescale for this requirement is 01 March 2006. Despite work having been undertaken in this area, care plans still do not provide staff with support guidelines about how care should be given and behaviours managed. As part of an agreed multi-agency strategy to improve the provision of care at Rosebery, Social Services visited the home to assess the quality care plans for those residents who are funded by them. Social Services have informed the CSCI that a number of deficits in care planning were highlighted during this visit too. Rosebery House Residential Home DS0000021246.V279512.R01.S.doc Version 5.1 Page 10 Risk assessments are also still in need development. It is required that where risks are identified, they are followed through with an assessment of the controls in place to minimise those risks. Risk assessments should be linked in with the support plans to ensure a member of staff can support residents in the safest and most appropriate way. It was identified during the inspection, that one resident goes out each day in a taxi. It is positive that people have the opportunity to go out each day, but there are no risk assessments in place to demonstrate how this activity is safely managed. The requirements made at the last inspection around improving the home’s approach to care planning and risk assessing are therefore reaffirmed at this inspection. The home must also ensure that the resident and any representatives, as appropriate, are included in the care planning process that care given respects individual wishes on maintaining privacy and dignity. That being said however, staff were observed taking measures during the inspection to ensure that personal care was given in a dignified and respectful manner. The systems for managing medication have improved since the last inspection. The Medication Administration Record (MAR sheet) was found to be fully completed and there were no signature gaps on this document. The medication trolley was found to be locked and the Inspectors were informed that there were plans in process to create a designated area for medication. Rosebery House Residential Home DS0000021246.V279512.R01.S.doc Version 5.1 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): 15 Residents are now benefiting from an improved diet and the availability of fresh fruit and vegetables. Mealtimes would be more pleasant for residents if action was taken to remove the unhygienic odour in the dining room. EVIDENCE: In compliance with the serious concerns letter issued following the last inspection on 14 December 2005, the home has made efforts to improve the provision of food at Rosebery House. On arrival for inspection, it was pleasing to observe that breakfast was being freshly prepared as and when residents were ready to get up. There was also evidence that staff had begun asking residents what their preferences were with regard to food, in order to revise the menu. Inspection of the kitchen identified that significantly greater quantities of fresh fruit and vegetables were in supply. The Cook confirmed that residents were now being offered fresh fruit salad in the afternoon to increase their daily intake of fresh produce. On the day of inspection, the lunchtime meal was steak and kidney pie, with one resident having an omelette as an alternative. Staff are also now Rosebery House Residential Home DS0000021246.V279512.R01.S.doc Version 5.1 Page 12 recording what food residents choose each day and the quantities consumed. It was however noted that where residents had eaten very little or were described as ‘playing with their food’ this was not followed up by the action taken by staff to improve intake. It is therefore required that care plans include guidance on how to support individuals at mealtimes and what action to take if someone eats very little. It was also again noted that the dining room was very malodorous. The unpleasant odour must impact upon residents’ enjoyment of their meal and therefore it is required that action be taken to remedy this situation. Rosebery House Residential Home DS0000021246.V279512.R01.S.doc Version 5.1 Page 13 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): These standards were not assessed, please refer to the report from the unannounced inspection carried out on 14 December 2005. EVIDENCE: Rosebery House Residential Home DS0000021246.V279512.R01.S.doc Version 5.1 Page 14 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, 22, 25 & 26 The safety of residents, staff and visitors has improved since the last inspection, but all parties remain at risk from the poor standard of continence management and infection control. Call bells are without purpose, if they are not accessible and responded to appropriately. An identified fault has caused parts of the home to be cold and water temperatures unregulated. EVIDENCE: Efforts have been made to improve the general safety of the home since the last inspection. The identified risks of trips and falls have been rectified and the building works have currently been suspended. It was however identified that parts of the building, especially some bedrooms on the first floor, were very cold. It was also noted that some hot water outlets were providing water higher than the recommended safe temperature, Rosebery House Residential Home DS0000021246.V279512.R01.S.doc Version 5.1 Page 15 whilst others were significantly lower. One bedroom had barely any hot water at all. Conversation with the maintenance person revealed that there was a problem with the thermostats and that a new system was scheduled to be installed this week. This must happen as agreed. Many parts of the home were found to be dimly lit and recorded feedback to the home from a relative also re-iterated this fact. Bedrooms do not contain bedside lamps or overhead lighting to enable residents to read comfortably in bed at night. It is therefore required that action is taken to provide adequate lighting to all parts of the home. Call bells are fitted in every room, except one bathroom and this needs to be rectified. The leads to call bells in some parts of the home were found wound round the system to prevent them from being used. The location of other call bells made them inaccessible. The Inspectors tested the alarm system and it took several minutes for them to be answered. If call bells are inaccessible or unanswered it negates the purpose of their installation. The home was found to be malodorous throughout, with a strong smell of urine in a number of identified bedrooms. Some bedrooms have been fitted with a laminate type floor covering and this has improved the odour in these rooms, although if they are not sealed, urine will again seep into the floor below. Infection control was again highlighted as an issue with staff moving from one task to another without changing aprons or gloves. This is a real concern, particularly as some staff have recently undertaken training in this area. The laundry floor has been sealed, although another coat is required to ensure all gaps are covered and several doors are yet to be sealed. The ramp leading from the home to the laundry also requires sealing and making non-slip. These issues again pose a risk to safety and the control of infection. The level of poor hygiene remains unacceptable and poses a danger to residents, staff and visitors to the home. Several pieces of equipment and furniture were found to be unclean and/or rusted. It is therefore required that a system of continence management, cleaning and managing infection control be implemented to appropriately addresses these issues. Rosebery House Residential Home DS0000021246.V279512.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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): 28 Residents will benefit from the home investing in staff training. EVIDENCE: The Deputy Manager reported that she is due to commence National Vocational Qualification (NVQ) Level 4 in care in the near future. She also reported that five staff would soon be commencing NVQ 2 in care. Rosebery House has not met government targets in respect of training, although it is acknowledged that steps have been taken recently to improve in this area. Staff spoken with reported that additional training has recently been made available and that staff have had the opportunity to attend sessions on; fire safety, food awareness, challenging behaviour, protection of vulnerable adults and infection control. Rosebery House Residential Home DS0000021246.V279512.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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 & 38 Rosebery House needs a skilled and effective Manager with the knowledge and experience in supporting people with a dementia type illness, to take the service forward. The home needs to introduce formal systems of gaining feedback from residents and enable their views to develop and shape the running of the home. Supervision systems are currently inadequate. The identified matters of health and safety present real hazards for people, who live, work and visit Rosebery House. EVIDENCE: Rosebery House is still without a Registered Manager and this management vacancy is noticeable within the provision of service. That being said, the Rosebery House Residential Home DS0000021246.V279512.R01.S.doc Version 5.1 Page 18 Provider has responded to the lack of management identified at the last inspection and interim measures have been put in place. The service is currently being run by a team of people including a Deputy Manager who is being supported by the Previous Registered Manager and a Consultant. The rotas have also been revised to ensure senior staff are on duty on each shift. Whilst immediate issues of serious concern that were raised by the CSCI in December 2005, have been addressed, there is a lot of work needed to take the service forward. Rosebery House needs to recruit a competent Manager with the skills and experience gained from working in a residential setting for people with a dementia type illness. The issues identified during the inspection highlight the need for someone with these specialist skills to lead the service. In order to monitor quality assurance, the Provider has appointed a Consultant to undertake the Regulation 26 monitoring visits each month. This person has also recently conducted an audit of the home and set timescales for key pieces of work to be completed. Questionnaires were sent to relatives at the end of last year, requesting feedback about the service. It was disappointing that some of the issues raised by relatives had not been acted upon or taken forward to improve the service. At the current time, there are limited ways for the home to obtain feedback from residents. This area needs to be explored to ensure that Rosebery House is run for the benefit of the people who live there. The supervision records for four staff were viewed and it was identified that staff had not received supervision for almost twelve months. One member of staff who had been employed for six months, has never had supervision. Since the last inspection, some staff have received a formal appraisal with the previous Registered Manager. A greater commitment to supervising staff is required. There is evidence that a number of health and safety issues have been addressed and the service is safer as a result of this action. It was pleasing to note that those fire doors previously found propped open, have now been fitted with appropriate hold-open devices. Similarly, the suspension of building works and the action taken to remedy the identified risks to trips and falls have all contributed to improvements in this area. There is however, a real need to improve infection control within the home, as it this time this is the greatest area of risk. Rosebery House Residential Home DS0000021246.V279512.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X 2 X X 2 1 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X 1 X 2 Rosebery House Residential Home DS0000021246.V279512.R01.S.doc Version 5.1 Page 20 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. 2. Standard OP1 OP4 Regulation 4&5 14(1) Requirement The Statement of Purpose and Service User Guide are updated and copies sent to the CSCI. A review of all service users’ needs to ensure the suitability of the placement is undertaken, involving all relevant parties. That the homes care planning system to effectively monitor residents health, welfare and social needs. Care plans should provide support guidelines which outline how care should be given. Care plans to be regularly updated. (Previous timescale of 01 September 2005 not met and timescale of 01/03/06 extended). Comprehensive risk assessments are to be carried out in respect of all areas of service users lives and the controls in place evaluated. (Previous timescale of 01 September 2005 not met and timescale of 01/01/06 extended). The home review the way service users are supported at mealtimes and care plans include DS0000021246.V279512.R01.S.doc Timescale for action 01/03/06 01/04/06 3. OP7 15 01/04/06 4. OP7 13(4) 01/04/06 5. OP15 16(2) 27/02/06 Rosebery House Residential Home Version 5.1 Page 21 6. 7. OP18 OP19 18(1)(c) 23(2)(c) 8. OP25 13(4) 9. OP26 16(2)(j) & (k) 10. OP31 8&9 11. OP33 24 12. OP36 18(2) action to take if intake is poor. Staff receive training in managing challenging behaviour Ensure that all calls bells are accessible to residents and that staff respond to their use appropriately. (Previous timescale of 06/01/06 not met) The Provider to ensure that the ventilation, heating and lighting is suitable and provided in all parts of the care home which are used by service users. (Previous timescale of 20/01/06 not met) A system of continence management, cleaning and managing infection control that ensures the home is hygienic and free from odour. (Previous timescales of 01 August 2005 and 14 December 2005 not met). A competent Manager to be recruited who has skills and experience in supporting people with a dementia type illness in a residential setting. A formal system of monitoring quality assurance and gaining feedback from service users to be put in place. Staff to receive regular, recorded supervision with an appropriate person. 01/04/06 21/02/06 27/02/06 27/02/06 01/04/06 01/05/06 01/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rosebery House Residential Home DS0000021246.V279512.R01.S.doc Version 5.1 Page 22 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. Extracts may not be used or reproduced without the express permission of CSCI Rosebery House Residential Home DS0000021246.V279512.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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