CARE HOMES FOR OLDER PEOPLE
Rosebery House 1 Rosebery Avenue Harpenden Hertfordshire AL5 2QT Lead Inspector
Yoke-Lan Jackson Unannounced 3 August 2005 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 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 I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Rosebery House Address 1 Rosebery Avenue, Harpenden, Hertfordshire, AL5 2QT Telephone number Fax number Email 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 CRH Care Home 14 Category(ies) of OP-14 registration, with number of places Rosebery House I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 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. Date of last inspection 11 October 2004 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 I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the first inspection (unannounced) for the year 2005. The registered manager was present. There were 14 service users. The inspection began with a tour of the premises. The inspector spent time chatting to the service users who were in the main lounge. The afternoon was spent observing the lunchtime routine and the staff performance and staff interaction with service users. The inspection has identified areas of concern. On the day of the inspection, the staffing level was reduced from 3 to 2 by 1.00 pm. There were only 2 staff on duty for the rest of the day, namely, the manager and 1 care worker (or 2 care workers from 5.00 pm). There were no activities or social interaction between the staff and service users as the staff were busy attending to the individual service users whose personal needs were a priority. (Please see below for further details of the inspection findings). What the service does well: What has improved since the last inspection?
The home manager has completed her registration with the Commission for Social Care Inspection (CSCI). The home has installed the drug cupboard that is required for the storage of controlled drugs. Instead of borrowing or renting a hoist, the home has purchased one. The service users’ files are currently being revised and updated. Rosebery House I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 Page 6 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 I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Rosebery House I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 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 standard(s) 1, 2, 3, 4, 5. New service users are admitted only on the basis of a full assessment. The prospective service user and their relatives are able to visit the home to assess the facilities and suitability of the home. EVIDENCE: The registered provider assessed the needs of the prospective service user. Relatives and other professionals may be involved in drawing up the contract and the terms of condition prior to admission into the home. A trial period is arranged for the prospective service user before a permanent contract is drawn up. Rosebery House I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9, 10. Service users are treated with respect and their right to privacy is upheld. A plan of care is drawn up with each individual service user and is reviewed regularly. The healthcare needs of one service user need urgent review to ensure that the home is meeting all his needs. EVIDENCE: Each service user has a care plan drawn up at the point of admission and the care plan is reviewed regularly. The service user files are currently being revised and updated. It was noted that the health care needs of one service user may have to be reassess to ensure that the home is able to meet all his needs. The registered manager agreed to contact the General Practitioner to review the service user’s condition and medication immediately. Rosebery House I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 Page 10 (Following the medical assessment on 05/08/05, the plan of care of the respective service user was changed accordingly. The registered manager assured the inspector that the home is currently able to meet his needs). Rosebery House I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14.15. Service users have links with their relatives and friends. They are given choices and control over their lives. The meals provided are nutritious and wholesome. However the activities provided are not adequate. EVIDENCE: There were three service users with their visitors on the day of the inspection. However, for those without visitors, there is very little stimulation. The service users were either sitting in their bedrooms (as of choice) or in the lounges with little or no stimulating activity. After lunch, the manager and one member of staff were busy assisting those service users who required personal care. There was no other carer around to lend a hand. This seemed to be the daily routine. The registered manager must ensure that there is adequate staffing at all times and that the provision of stimulating activities is also a priority in the routine management of services. It is recommended that the home employ an activity coordinator. (Please see Statutory Recommendations).
Rosebery House I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 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 standard(s) 16, 17, 18. Service users and their relatives are aware of the complaints policy and procedure. All complaints are dealt with appropriately. EVIDENCE: The home has had 2 complaints that were dealt with within the stipulated timescale. A copy of the Hertfordshire Vulnerable Adult Protection Procedure is available in the office. Staff are aware of the Whistle-Blowing Policy and Procedures. Rosebery House I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 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 standard(s) 19, 20, 21, 22, 23, 24, 26. The home is generally clean and comfortable. The wheelchairs have not been serviced regularly. EVIDENCE: The interior of the home is tidy and comfortable. All the bedrooms are clean and in good decorative order. The service users interviewed are pleased with their bedrooms. There were personal items on display that reflected their individual lifestyles. It was noted that the wheelchairs that were in use had not been serviced. One wheelchair was unsafe for use on the day of the inspection. The registered manager must ensure that equipment provided for use by service users, including wheelchairs, is maintained and in good working order. (Please see Statutory Requirements).
Rosebery House I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 30. The home has operated the key-working system since May 2005. Staff have relevant training to provide a good standard of care. The home is not providing a sufficient number of staff at all times to cater for the current needs of the service users. EVIDENCE: Staff undertook refresher courses and planned training includes Food hygiene, Moving and Handling and other relevant topics. On the day of the inspection, there were 14 service users in the home. There were 4 service users with high needs, 5 with medium needs and 5 with low needs. The manager and one carer (apart from the chef) were the only staff present to serve lunch to these service users. Not all the service users were in the dining room. After lunch, the two staff had to attend to the personal needs of the respective service users, some of whom needed two staff to assist them. Other service users were left unattended in the dining room for some time. The registered manager confirmed that she has no autonomy to increase the staffing level. The registered provider is away for another week. In this care home, the registered provider assists in the day to day administration and management of the home. The registered manager has
Rosebery House I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 Page 15 assured the inspector that an urgent meeting will be held with the provider (as soon as they returned) to rectify the staffing situation and other issues. (Please see Statutory Requirements and Recommendations). Rosebery House I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36, 37, 38. Staff have a range of policies and procedures available for guidance. Relevant service maintenance and associated records have been maintained and updated, except for equipment such as wheelchairs. Appropriate records are kept as required by legislation. EVIDENCE: In this care home, the registered manager is mainly responsible for the day to day management of staff and the practical aspects of care and service provision. The registered provider (proprietors) is actively involved in the general administration and management of services in the home including the budget. ‘Where the registered provider is in day-to-day control of the home, he/she meets all the standards applying to the registered manager’ (Standard 31.8). Rosebery House I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 Page 17 All the service maintenance and associated records were dated between January and July 2005. Individual records are kept secured and used in accordance with the Data Protection Act 1998. Rosebery House I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 x x x x 3 3 2 Rosebery House I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 Page 19 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 12.3 Regulation 16(2)(n) Requirement The registered person must ensure that service users are given opportunities for stimulation through leisure and recreational activities which suit their needs, preferences and capacities. The wheelchairs must be serviced regularly to ensure that they are in good working order and are safe to be used. The registered person must ensure that the staffing level is adequate at all times having regard to the number and level of needs of the service users in the home. Timescale for action By 30 September 2005 2. 22.1 23(2)(c) By 30 September 2005 03/08/08 & Henceforth 3. 27.3 18(1)(a) 4. 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 12 Good Practice Recommendations It is recommended that the home employs an activity coordinator.
I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 Page 20 Rosebery House Rosebery House I52 s19514 Rosebery House v243043 030805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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