Inspection on 25/06/08 for Rosebery House

This inspection was carried out on 25th June 2008.

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

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

Other inspections for this house

Rosebery House 26/06/07

Rosebery House 14/06/06

Rosebery House 16/12/05

Rosebery House 03/08/05

Rosebery House 11/10/04

Rosebery House 17/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Rosebery House 1 Rosebery Avenue Harpenden Hertfordshire AL5 2QT Lead Inspector Julia Bradshaw Unannounced Inspection 25th June 2008 11.30 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.V367125.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.V367125.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 Post currently vacant Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Rosebery House DS0000019514.V367125.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. 26th June 2007 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. The home has a service user’s guide and statement of purpose that are provided to prospective service users. Copies of the latest report on the home from the Commission for Social Care Inspection (CSCI) are available in the home. The manager stated that there is a range of fee’s starting from £578 per week to £627. Rosebery House DS0000019514.V367125.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This report draws on information obtained from the recent AQAA completed by the proprietor, questionnaires completed by the people living at the home and from a full inspection visit carried out on the 25thth June 2008.The inspection process included speaking to people using the service, staff on duty and a full inspection of records relating to care planning, medication, health and safety, staff records and training and the general management of the service. Surveys from people who use the service and from staff are part of the ongoing inspection of a service and any issues arising from these surveys and other relevant information received by the Commission could then inform further regulatory visits by CSCI in respect of Rosebery house. On arrival the inspector was introduced to the current acting manager, Sarah Mills (who is also the registered proprietor of the home). The registered manager of the home resigned in October 2007.This temporary arrangement appears to be effective with regard to the management of the service. However a more permanent arrangement must be sought and therefore the current proprietor will be making an application to the regional registration team to become the registered manager of this service. Mrs Mills agreed to keep us informed of application. For the purposes of this inspection the temporary manager will be referred throughout the body of the report as the ‘manager’, although it is recognised that she is not currently the registered manager. People using the service had just finished their lunchtime meal and were either resting in their rooms, receiving visitors , or going out of the home independently. The atmosphere within this service was both welcoming and homely, with three care staff on duty plus the cook and domestic staff. The manager is supernumery to these staffing levels, but does assist with personal care and support when required and is also therefore able to monitor on how the service is being delivered and to ensure standards are maintained. Rosebery House DS0000019514.V367125.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The services policies and procedures had lapsed during the early part of last year when the registered manager was still in post and therefore the current temporary manager has been working hard to implement and update staffing and resident information. The records relating to both community meetings and staff meetings have now been implemented and are now being held more regularly. Rosebery House DS0000019514.V367125.R01.S.doc Version 5.2 Page 7 Supervisions are carried out at least six times per year and the temporary manager has also attended a supervision course. The service now completes an activity planner/record for any activity carried out within the service and has also improved the opportunities for people to take part in a variety of activities within Rosebery House. The recording of hot water temperatures has improved since the last inspection but the levels can still be inconsistent due to the age of the property/plumbing system and therefore regular monitoring should still take place. All fire doors have been re-fitted /repaired where necessary and a check during this inspection confirmed all these doors were fitted and closing as required. The fire and rescue service also visited the home in March 2008 and all recommendations from this inspection have been implemented and re-checked by the fire services. The fire services are also currently advising and supporting the manager with revising their new fire risk assessment. 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. The summary of this inspection report can be made available in other formats on request. Rosebery House DS0000019514.V367125.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.V367125.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 is not applicable to Rosebery House. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering Rosebery house, as their home can be confident that they have the necessary information to enable them to make a well informed decision. Assessments made before admission provide assurance to people considering Rosebery house as their home, or as home for someone they are responsible for, that only people whose care needs are understood and can be fully met will be admitted. EVIDENCE: A total of five-care plans were reviewed and evidence gained regarding the initial assessments that are carried out to assess if the service can meet the needs of the individual. Detailed information is held regarding the person’s history and current needs. Assessments of the prospective person’s needs and aspiration are made before they move in. Rosebery House DS0000019514.V367125.R01.S.doc Version 5.2 Page 10 The admissions procedure to the home includes trial visits in order for people to make an informed choice about where to live. The assessment process includes the gathering of information from other professionals. Rosebery House has its own internal assessment forms and reflected fully the current service provided. Rosebery House DS0000019514.V367125.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service can not be assured that care plans reflect the initial, developing and on going needs of the resident to ensure all personal and healthcare needs are provided for and met effectively and safely. People using the service are protected by an effective and robust medication process that ensures that they receive the support they need with their medication in order to maintain their wellbeing. EVIDENCE: Five care plans were inspected and a new care planning system has been partially implemented with approximately twenty five percent of all care plans being in the new format. The current practice of creating the care plan once the person has been living at the home for the two/three months is unsatisfactory in ensuring the service is meeting the needs of the person. The service needs to ensure they are providing the appropriate care and support meeting the health and welfare needs of the individual. This standard can only Rosebery House DS0000019514.V367125.R01.S.doc Version 5.2 Page 12 be fully met if there is a comprehensive care plan in place from the time of the admission. The initial assessment created by the manager is very detailed and covers every aspect of the persons needs. However the service cannot demonstrate and deliver the appropriate care without this initial care planning process in place. People spoken to on the day of the inspection and comments received by way of surveys carried out by Rosebery house were all positive about the way that care is received in terms of preserving rights and dignity. People spoken to stated “The staff are all lovely, always happy to help you “ nothing is too much trouble”. 100 of the surveys returned agreed that care staff listen and act on what people living within the service. There is community health care support from the visiting district nurse and the home has access to all other health care agencies if required. The service uses three main G.P. surgeries. Medication records were spot-checked and found to be accurate. The medication is held within a large locked cupboard in the main office, on the ground floor. The service has a rigorous medication procedure in place. The manager has responsibility for ordering and the disposal of medication. The home has a contract with a local pharmacy for supplying the monthly blister packs for this service. The service also currently holds and administers controlled medication for two people. The administration of these controlled medications was checked and all records reconciled. The manager is very knowledgeable in the administration of medication and ensures that all practices are carried out safely and accurately. There is a monthly monitoring system in place as part of their services quality assurance. One person self medicates and there is a current risk assessment in place for this. Rosebery House DS0000019514.V367125.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Rosebery House can be confident that they will be able to be involved in meaningful activities of their choice, reflecting wherever possible their personal tastes and preferences EVIDENCE: The manager/proprietor have worked hard to improve the opportunities for social ands leisure activities for the people living at Rosebery house, since the last inspection was carried out. Each person is fortunate enough to have regular support from their families and friends and therefore people have regular opportunities to go out of the home for social and family occasions. People who use the service and relatives are given information about the services procedures on visiting and maintaining contact with family and friends. People living at Rosebery house and staff members confirmed that visiting times are flexible and visitors are “very welcome” at any reasonable time. In house activities include monthly ‘music for health’ sessions; communion is held within the service, with a local vicar in attendance. Reminscence sessions are also held every two weeks. There are also a range of board games and activities for people to entertain themselves, kept within the Rosebery House DS0000019514.V367125.R01.S.doc Version 5.2 Page 14 main lounge. Bingo and domino’s are also a popular pastime for several people within the service. The cook on duty on the day of the inspection stated that the service operates a four weekly menu and this is representative of the likes and dislikes of each person. The menu seen during this inspection included a good variety and appeared nutritionally balanced. However a few of the people spoken to said they would like a little more variety and a few less casserole type meals. Care staff serve the supper, which has usually been prepared by the cook prior to going off duty. One person stated, “ You can always rely on the food to be hot and tasteful.” The manager discussed the plan to extend the lunchtime menu to offer more than one choice and hence offer people an alternative. There are no special diets except for a few people who require their meals to be puree/soft due to difficulty with swallowing. For these people there are risk assessments in place in order to ensure staff are fully informed of the risks of choking. Rosebery House DS0000019514.V367125.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures are in place to safeguard people who use the service. There is a complaints protocol in place which service users and staff appear comfortable about using to ensure their views are heard. EVIDENCE: There is an appropriate written complaints policy in place. No complaints have been received since the last inspection took place. There are written procedures in place for safeguarding adults and a whistle blowing Policy, which staff were aware of. There are also policies for handling people’s monies. The service holds personal monies for people who are unable to manage this themselves. All these monies are kept individually in a locked steel cupboard within the main office. The manager keeps individual ledgers and reconciles these monies after any transaction. Several people hold their own money within their bedrooms in a locked bedside cabinet. Rosebery House DS0000019514.V367125.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service provides a safe, clean and well-maintained environment for those who live and work there. People who live in the home can be assured that they can personalise their rooms to reflect their own tastes and personalities. EVIDENCE: There is a very welcoming atmosphere at Rosebery house and people clearly take great pride in their home and have created their own rooms to reflect their personal interests and lifetime interests. All areas of this service are maintained to a high standard except for a leak that has occurred above the kitchen ceiling, which has caused some plaster to fall off. This has now dried out and is waiting to be re-plastered. The manager is hopeful that this will be completed by the end of the month. Rosebery House DS0000019514.V367125.R01.S.doc Version 5.2 Page 17 The service has had all faulty fire doors re-fitted and has received a recent visit form the fire and rescue services who made three recommendations, which have all been rectified. Several areas of this service have been re-decorated since the last inspection took place including, three bedrooms, new bedrooms carpets have been fitted; a new freezer has been purchased as have new linen and curtains. Hot water temperature temperatures should be monitored regularly due to some inconsistent levels, on occasions. This is due primarily to the age of the property. The service has a reliable plumber that calls regularly to assist in maintaining safe water temperatures. There were certificates for the servicing of the hoists, the gas. portable electrical equipment testing and also the latest report from the last environmental health visit. All areas of this service were clean and no mal odours were present. However there were some communal toilet areas that did not have adequate hand washing facilities, which is essential for the prevention of cross infection and therefore this requires rectifying urgently. Rosebery House DS0000019514.V367125.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 18, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has effective management systems in place to support staff by providing the necessary supervision and training to ensure an effective staff team are able to support people living within the service to lead safe and fulfilling lives. EVIDENCE: The proprietor/ manager is providing good support to the staff team and ensuring that regular supervisions and staff meetings are taking place. The previous management support had been inadequate in ensuring that staff had received the appropriate supervision and guidance. The current staff team spoke very positively about the change in management support and felt the current manager was both approachable and inclusive. The temporary manager has enrolled on NVQ level 4 and is hopeful that this will be completed by July 2008. The manager is committed to providing all the training necessary to ensure that all staff are provided with the knowledge and training they need to carry out their role effectively and efficiently. Rosebery House DS0000019514.V367125.R01.S.doc Version 5.2 Page 19 The levels of staffing within this service are adequate and provide the appropriate cover and support during the day and nightime, with two waking night care per night. The manager also does one late shift per month, which also provides supervision for the night staff and involves working through to the night until the early hours of the next morning. This ensures that the manager has a good insight into both the day and night time routines of the service. Three staff files were checked on the day of this inspection and all contained the required information. The manager is in the process of applying to the Commission to become the registered manager of this service. Rosebery House DS0000019514.V367125.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Rosebery House can feel confident that they are living in a home that is well managed, is run with their best interest and they are safeguarded from harm by effective policies, procedures and accurate record keeping. EVIDENCE: The manager in post who is also the proprietor of the service has worked hard to improve the standards since the registered manager resigned in October 2007. There has been a complete review of all care planning within the service and this now part way through completion. Policies and procedures are in the process of being reviewed and updated and staff supervision and staff meetings are now taking place on a regular basis. Rosebery House DS0000019514.V367125.R01.S.doc Version 5.2 Page 21 Staff training is has also improved and the manager has a variety of courses that staff will have the opportunity to attend within the coming months. The proprietor has enrolled on the NVQ level 4 and is hopeful that this will be completed by the end of July 2008. People are safeguarded from harm by the services recruitment procedures and the complaints procedure. People spoken to stated “The manager is always a round to talk to and her door is always open”. People using the service were aware of the complaints procedure and staff spoken to also confirm that they were aware of the whistle blowing policies. People living at Rosebery house have a lockable space in their room for holding their monies and medication, where required. All records relating to health and safety standards are maintained and carried out effectively by the manager and senior staff. The service should monitor the hot water temperatures closely as there is a tendency in the records for the some temperatures to fluctuate. Quality assurance systems are in place and carried out by the manager. However the manager intends to improve on the current quality assurance systems and produce checklists for monthly monitoring for all aspects of the service. Rosebery House DS0000019514.V367125.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 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 4 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 x 18 3 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Rosebery House DS0000019514.V367125.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(2) Requirement So that service users can be assured that their needs will be meet appropriately all the required information must be contained in the service users care plan, including any current risk assessments. These care plans must be reviewed on a regular basis. All areas of the service must provide effective hand washing facilities in order to protect both service users and staff by preventing the spread of infection. Timescale for action 31/08/08 2. OP26 16 (2) (J) 25/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations There should be a review of the current menu in order to incorporate all the views, likes and dislikes of the people using the service. DS0000019514.V367125.R01.S.doc Version 5.2 Page 24 Rosebery House Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rosebery House DS0000019514.V367125.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!