Inspection on 06/11/07 for Rosecroft

This inspection was carried out on 6th November 2007.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosecroft 06/06/06

Rosecroft 07/12/05

Rosecroft 17/05/05

Rosecroft 16/12/04

Rosecroft 15/04/04

Rosecroft 16/09/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Rosecroft 39 Carter Road Drayton Norwich Norfolk NR8 6DY Lead Inspector Mrs Judith Last Unannounced Inspection 6th November 2007 03:10 Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 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 Rosecroft DS0000027626.V354408.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 Adults 18-65. 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. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosecroft Address 39 Carter Road Drayton Norwich Norfolk NR8 6DY 01603 861356 01603 864449 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) www.caremanagementgroup.com Care Management Group Ltd (trading as CMG Homes Ltd) Position Vacant Care Home 3 Category(ies) of Learning disability (3), Physical disability (3) registration, with number of places Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th June 2006 Brief Description of the Service: Rosecroft is a care home providing personal care and accommodation for up to 3 younger adults with a learning disability. The service users may also have a physical disability. The Care Management Group Limited, whose registered office is located in London, owns Rosecroft and four other small homes in Norfolk There is quite a lot of sharing of procedures and records and service users in each home visit each other. The home is located in a residential area on the outskirts of Drayton and close to the city of Norwich. Local amenities, shops and pubs are also close by. The home consists of an adapted bungalow. All bedrooms offer single occupation, although one of the bedrooms is below 9.3 sq. metres. None of the bedrooms have en-suite facilities. There is ample communal space. Limited off-road parking is available. The inspection report was seen in the office/sleeping-in room and staff said it was available to the public or relatives. The fees for this organisation are based on the amount of care the service users need. This is currently £729.00 to 1345.89 weekly. However, there is no up to date information in the Service Users’ Guide, as the law requires, about amounts and arrangements for paying these. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We visited the home unannounced and spent just over four hours there. We chatted to all of the residents. One did not want to speak to us in detail and one did not communicate at all. Because of this we also needed to get information from others. We spoke to two staff and the acting manager and had written comments from three other people. We also spent some time listening to what was going on. We got other information from the “self-assessment” the manager sent to us before we visited as well as from records and from policies. We used this information to judge the home against outcome groups and see how well the service meets the needs of people living there. We have rules that tell us how to do this. Overall these say that people are receiving an adequate service at the moment. If the management and administration section were improved a little, the service would be good. What the service does well: What has improved since the last inspection? There has been continuing redecoration of the home to make sure it is maintained to a good standard. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 6 The way people can make complaints has been presented in symbols. Although people would still need help with this it shows that the staff are trying to make information more accessible. Records of the use of people’s money have improved and systems are in place to check this regularly so that people are protected from mismanagement or misuse. 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. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvement is needed in the information available to service users’ representatives, (given the cognitive abilities of people living at the home), so they can make a more informed choice about using the service. However, assessments are sufficiently detailed to show that people who did decide to use the service could be confident their needs and aspirations had been taken into account. EVIDENCE: The service users’ guide does not have information about fees in line with revised regulations. See requirement. There are good formats for assessing people’s needs. One person has recently been admitted from another home in the company. The person came with all the necessary information in the “company format”. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans reflect the needs and abilities of each person, but more work is needed to make information accessible and to reflect efforts to involve people in the process so far as they are able. Some work is needed to ensure that measures are put in place promptly to control risks when situations change. EVIDENCE: The manager’s self assessment did not refer to the standards in this outcome group so we were not able to gather appropriate information from that about what the service thought of its own performance in this area. Two staff who wrote to us say that they are ‘usually’ given up to date information, (e.g. in the care plan), and a relative told us they felt that the service usually met the needs of the person living there. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 10 There were relevant assessments and files contained a list of priorities with their relative importance. These are used to develop individual action plans to support work towards goals. This is good practice. Goals are reviewed regularly. However, these repeatedly show “no change” over prolonged periods of time so do not properly show how people are to be supported to attain these goals. See recommendations. Information is not presented in a simplified form or pictures/symbols, and does not clearly show how service users were involved. However, we did see and hear people being encouraged to participate in activities such as preparing meals and drinks, subject to their abilities and risks. We heard staff talking to residents about what they had done and what they wanted to do, also what kind of drinks or food they would like. People’s abilities to make decisions could be increased if alternative methods of communication were used. See recommendations. There are risk assessments covering a range of relevant issues. However, as in common with other homes under the same ownership, these have been added to with apparently little thought as to how they could be combined to reflect one activity, for example one for “food and drinks” refers to risks from hot temperatures, and another for “eating” refers to the risk of choking. Likewise there are two assessments about someone bathing – one reflects the risk of allegation of abuse and another about temperature, (but does not make reference to epilepsy or the risk of slipping on a wet floor). See recommendation. There are two risk assessments for one person to do with travelling in a car. An additional piece of equipment had to be found to stop the person opening their seat belt and a second risk assessment was documented rather than an update to the original. This seat belt adaptation no longer works as staff and records confirm the person can undo it. The manager and staff told us other things were being looked at and staff are clearly aware of the risks. However, there is no interim guidance about managing the changed level of risk it pending alternative or additional equipment in order for the service not to appear negligent. See requirement. However, staff spoken to know people well and anticipate where they may be vulnerable. There has been an increase in incidents of aggression from one person following a change in the resident group. This is shown in incident records and reported by staff. The risk assessments need to reflect this and what interim measures are being put in place, (e.g. additional staffing or increased supervision), in the interests of protecting other service users and staff or members of the public if when out. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 11 People are helped with their finances by staff and these are checked regularly by staff and by the person who carries out monthly visits on behalf of the registered providers. This is good practice. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are offered a variety of opportunities to ensure their lifestyles are as fulfilling as possible. As with other areas of the service, outcomes would be further enhanced if alternative methods of communication were in use to increase people’s abilities to make decisions and choices about what they wanted to do or eat. EVIDENCE: We saw staff making efforts to engage people in activities. One person has more severe communication problems and there are no alternative methods in use as yet to help encourage this person to make choices about their activities. However, there are lots of games available with lights, colours and noises that provide some sensory stimulation. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 13 The manager recognises in the self assessment, that the service could do better by providing evening activities for the other people living at the home and in looking at ways to staff this. (However, the plans for improvement in the next 12 months do not reflect a review of staffing and exploration of possible issues in this area). One person likes to go to the pub according to the staff and records and is sometimes not able to do this because of staffing needs, other people’s preferred routines and behavioural constraints from others. Comments from four staff show they recognise they may not always meet people’s social needs because of these difficulties. See partially outstanding requirement. Photographs and discussion with one person and staff shows that holidays are arranged for people. Records show that opportunities for education are arranged where this suits someone’s wishes and abilities, but a college placement has broken down due to behaviour. Staff told us of the efforts and progress they were making to arrange an alternative. We also saw that one person has a library card. Staff made efforts to talk to people rather than just to each other all the time we were there. Records show that people are helped to keep in contact their families and staff work hard to make sure visits are arranged where appropriate and necessary, including to relatives in London. A relative confirms that they are always kept up to date with important issues affecting the person and helps them keep in touch. The menus are available and staff told us that these have recently been revised with the people living at the home. People said they liked their food and we heard them being offered choices about drinks. One person was helping with the meal preparation with the support of staff. Staff keep records of what people eat including when they go out for lunch, and so can make sure that people have a balanced diet. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive personal care in a private and dignified way and their health care needs are properly monitored. There is some need to improve the way medication and associated guidance is recorded and, given the change in need of people living at the home, to make sure associated training is up to date for everyone. EVIDENCE: Records show what support people need to manage their personal care. We have commented elsewhere about breaking goals down into smaller steps so that people could progress for example from physical assistance to gestural prompts to verbal prompts etc. There are opportunities, for people to be assisted with intimate personal care by someone of the same gender some of the time, depending on the duty roster. We saw that people were comfortably dressed and their clothes were clean. However, we had comments from a relative that sometimes a person wore clothing that had fastenings which made it difficult for the person to be as independent as they may be otherwise. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 15 Records show that people can go to bed when they like, and that one person likes to go early. Times for getting up vary, based on records, depending on daytime commitments, (such as attendance at the activities centre or other appointments). There is a bath seat to help people who need it to get in and out of the bath properly. People have keyworkers and one person told us who their keyworker was. Discussion with staff, and looking at records show that someone occasionally displays “behaviours”. Staff know the person well, but this recording is neither clear nor specific and does not relate to what was actually seen. See recommendation. Health action plans have recently been introduced in conjunction with other health professionals. These are, as yet, not fully complete although work has started. In one case it has been inaccurately completed, (under “important information about my eyes” it has been completed to show that “I visit the dentist every year”). The “action plans” in these folders for each person are not all complete. A relative commented that one person’s feet could do with slightly better care. We acknowledge that this is a system newly introduced. See recommendation. Health appointments and their outcomes are recorded so it can be seen that people receive the treatment they need to keep them well. There is a monitored dosage system in place for most medicines. We saw that the person responsible checked both the medication administration record, (MAR) chart and the labels on the pack before preparing this for administration to service users. The record was signed following administration. The cupboard was locked when it was left unattended. We found omissions of signatures for 9pm medications for one person on 26th October. See requirements. There are sample signatures on file for people who administer medicines. This is good practice and means staff responsible can be easily identified. There was guidance about the administration of PRN, (when needed), medicines for one person that referred to a process of escalating from one medicine to another if there were no effect. Administration records verify this. However, on one occasion it appeared that the second medicine was used as a first resort. The acting manager says that the consultant has advised once it has been given that another dose should follow, but the arrangement is not clear from written guidance. See requirement. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 16 Medication for occasional use is habitually signed and coded by staff when there is no need to do this unless it is actually administered. This would make monitoring of its administration easier and more immediately visible from the MAR chart. See recommendation. One person has epilepsy and a letter from the consultant indicates rectal diazepam should be reinstated. Not all staff training in this area is up to date based on staff training files. See requirement. There are separate records of epileptic seizures so that the way medication helps to control this can be monitored. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people have some communication difficulties that would make it hard for them to complain and advocate on their own behalf, staff are clear in their obligations to speak up for people and protect their interests. They have training to help them do this. EVIDENCE: There is a clear complaints procedure in the service users guide and the address of the Commission is provided. It is not clear that people living at the home would understand who they would complain to given their cognitive abilities. However, the procedure is now available in symbol form to help simplify it for people. A relative told us they know how to complain and says that the service has always responded appropriately if they have needed to raise issues of concern. The home has received no complaints since the last inspection. Two staff spoken to are clear about their obligations to speak up on behalf of service users should they have concerns about their care and the way they are treated. They know the signs that people might show if they are distressed, if they are people who are not able to say. Guidance about “cross gender” care could be strengthened in line with risk assessments and known issues. See recommendations. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 18 Staff have training in protecting vulnerable adults promptly when they are recruited and there is guidance about their responsibilities to report. Policy files include the guidance that registered homes in Norfolk are expected to abide by. The company that owns the home provides regular training in the “Dignified Management of Conflict” so that staff have an awareness of how to deal with difficult behaviour in a manner that respects the people they work with. Staff need this training as they have to intervene on occasions, (as we saw), to keep people safe. There are “body charts” available to record any bruising etc, but it would be appropriate, in the interests of protecting people, to ensure one of these is completed after each incident where staff need to intervene physically, if this involves “safe holding” techniques, showing how and where the person was held. See recommendations. The senior management of the company that owns the home have co-operated well with other agencies when working to protect people using their services. However, concerns were raised as part of the complaint that issues may not have been picked up promptly and one staff member considers in comments that concerns are not always responded to appropriately. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a homely and comfortable environment with the adaptations they need. Staff work hard to keep it clean and could bolster the process by seeking specific advice given client changes, to make sure laundry arrangements do not compromise food safety. EVIDENCE: We looked at communal areas and at two bedrooms. These were pleasantly decorated and one person confirmed that their room was a colour they really liked. People had their own belongings around them and there were no immediate safety concerns. Radiators seen were covered to help prevent people being at risk from hot surfaces. There are aids in the bathroom, (grab rails and a bath seat), to help support people who need them. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 20 The paintwork to window frames and ledges at the front of the home is peeling and not generally in good condition, but the self assessment sent to us shows that there are plans to improve in the next 12 months that include the provision of new windows and doors. We have not therefore made a requirement at this point. When we visited first time people were away on holiday so we did not complete a fieldwork visit, though we noticed the grass in the front of the home was long and untidy. This had improved when we went back. There were no unpleasant odours noted. There are aids to continence where these are required and disposal arrangements are in place. Staff have access to protective gloves and aprons as required. The home does not have a separate laundry, as there are only three service users. The washing machine is in the kitchen. At the last inspection, staff reported that there is very little soiled linen and the machine has a high temperature facility if required. However, the service user group has changed since our last visit and this situation needs to be kept under review such that washing is not carried out when people are using the kitchen to prepare meals or eating at the nearby table. See recommendations. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are concerns about staffing levels. These need review to show evidence that they are adequate to meet people’s needs in a manner that promotes their safety and welfare and provides for their social and recreational needs outside the home. Although staff show a good understanding of people’s needs they are not yet supported by the underpinning qualifications they need and do not receive adequate supervision. EVIDENCE: The manager’s self assessment shows that there are four people employed at the home but that only one has achieved the required national vocational qualification, (NVQ, level 2 or above). However, two other staff are working towards this so no requirement is made at this point. Training files show that people have access to a range of opportunities for training, and staff comment cards confirm that people feel they have access to the training they need to do their jobs. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 22 Staffing levels compromise people’s abilities to go out during the evening. The manager identifies this as something the service could do better in the selfassessment of the service. Staff are clearly worried about the opportunities they can safely provide to people to make use of local facilities as they might wish given the needs of all three people living at the home. One experienced staff member has recently been involved with an incident and needed to request assistance. We note that staffing has improved in that there are generally two staff on duty until 10pm based on the roster, rather than 7.30pm when the last fieldwork visit was made. For some time there have been two staff on duty at the home when there were two people living there. There are now three people living at the home. Observation and records shows that one person takes considerable effort to stimulate, involve and engage with. Records and discussion show that another person likes to go to bed early and since the third person has moved in is showing considerably more behaviour that challenges and can lead to assaults on a third service user or staff. We saw evidence of this in that staff on duty were not able to take themselves away to do tasks elsewhere because the person concerned, if not receiving attention at all times, would initiate aggression against other people living there. Staff have a “baby” monitor, which is designed to alert them to problems while they are sleeping in for one person who has regular seizures. The person concerned had 6 seizures recorded during October, some of these taking place during the night. The home does not have waking night staff although this was in place at the person’s former residence. However, there is no risk assessment about the change in night staffing arrangements for this person, backed up by any analysis of the frequency, nature and timing of seizures which may mean the person does not get the support they need. Assessment is needed to show that sleep-in staff are not being disturbed on a regular basis when they should just be there for occasional emergencies. This is needed to show that staffing levels at night are adequate. See requirement. We were pleased to hear and see the efforts that staff made to engage people, whether or not they could communicate verbally. They asked questions, encouraged people and made good eye contact. Where people could respond verbally they were encouraged to do so. There is regular use of agency staff and the person we spoke to has been there since August. The duty roster shows that efforts are made to keep this consistent rather than to making frequent changes of personnel, so that people get to know the staff who are working there. We were informed during our visit, that a permanent member of staff would be starting at the home during the following week. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 23 We checked the staff file for one person recruited since we last visited. This showed that all checks and references were obtained before the person started work. However, it would be good practice to make sure that, where references are professional rather than personal, these are obtained on headed notepaper from the organisation/individual providing them to help support the capacity in which they do so, or that the organisation “stamps” the place available on the standard reference form the company uses and this is followed up if missing. See recommendation. Induction is delivered promptly. The acting manager is new to post and will need to demonstrate that she adheres to these standards at future visits. Staff are not being properly supervised. One person has received two supervisions from a manager since February based on notes. One senior member of staff has received only two supervisions since January and has concerns about being able to deliver this to others given current issues on shift. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is no registered manager for the service and progress needs to be made to ensure that someone is in place who can accept this responsibility and work towards the qualifications they need to show they can operate the service effectively and in the interests of people using it. There are minor improvements needed to help monitor and improve the quality of the service. EVIDENCE: An acting manager is currently running the service with responsibility for two of the small homes operated by the company. This person has taken over from the former manager who is seconded elsewhere and who completed the self-assessment of the service for us. The person is not registered and has not Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 25 undertaken the required qualifications or training, although they have considerable experience with the organisation. The person does participate in the training opportunities the organisation offers. See requirement. Improvements are needed in the way whoever is responsible for the completion of the self-assessment of service carries this out. It needs to reflect the individual standards within outcome groups in order to ensure that evidence identified and improvements made or needed, properly reflect the way the home meets standards within each group. The acting manager was unable to locate reports of visits made on behalf of the registered provider to comment on service quality that were more recent than July 2007. These are needed in order to ensure matters commented on are properly addressed. We know that these visits are carried out regularly as they are supplied to us. See requirement. Safety records show regular maintenance and testing of equipment, including that related to fire safety and raise no immediate concerns. However the last health and safety checklist completed, marked for monthly completion and available on file was in July. See recommendation. The bath seat needs removal from the bath when people who do not need it are using the bath. This is a heavy piece of equipment in the interests of stability in use and has to be picked up from inside the bath. There is no manual handling assessment showing that the safety of this activity has been properly assessed and to protect staff from back injury by giving clear guidance as to how it is to be handled. See recommendation. There is a company assessment by the manager of how well they feel the service is being delivered. The last staff questionnaire was carried out in May 2006 and the last analysis of service users questionnaires, (across this area), was in 2006, although another survey has been done this year. Analysis and an action plan for the service is not yet available. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 x x LIFESTYLES Standard No Score 11 x 12 3 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 2 x x 3 x Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES 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 YA1 Regulation 5 Requirement People who live at the home or who are thinking about moving there, must have the information the law says they need. This is so they or their representatives can make an informed choice about moving into the home. It is also so they can be sure of the arrangements for charges or increases in these. Action must be taken to ensure that behaviour which challenges is met in a consistent manner with interventions set out that may help to minimise problems. This is so staff do not inadvertently increase the likelihood of the behaviour happening and so affect the opportunities open to the person concerned. Where risks have changed or increased, there must be a prompt assessment (with evidence in records) of the measures staff need to take to minimise these. If this does not happen then people living at the home, staff and others may be DS0000027626.V354408.R01.S.doc Timescale for action 31/01/08 2. YA6 13(1)(b) 31/03/08 3. YA9 13(4) 30/12/07 Rosecroft Version 5.2 Page 28 harmed. 4. YA13 YA33 16(2)(m) Partially outstanding requirement The registered person shall consult service users about their social interests and make arrangements for them to engage in social and community activities. In this instance the provision of staff and increases in challenging behaviour are compromising the opportunities available to others living at the home so their needs may not be met. There must be accurate and complete records showing when people’s medication has been administered and what they have been given. This is so people are not at risk of error and to show they receive the treatment that has been prescribed to keep them well. Guidance about the use of medicines needed occasionally to help someone be calm must be clear about the arrangements for the use of the two different medicines. This is so that the risk to people of mistakes being made with their medicine are kept to a minimum. All staff must have up to date training in the administration of emergency medication considered necessary to control epilepsy. This is risks are minimised and so people can be helped to keep well. Outstanding requirement There must be evidence that that the numbers of staff on duty are appropriate for promoting the welfare of the service users. This is so that people’s health, safety, welfare, emotional and social needs are promoted. DS0000027626.V354408.R01.S.doc 31/12/07 5. YA20 17(1)(a) Sched 3 no.3(i) 31/12/07 6. YA20 13(2) 31/12/07 7. YA20 13(2) 31/12/07 8. YA33 18(1)(a) 31/01/08 Rosecroft Version 5.2 Page 29 9. YA36 18(2) 10. YA37 8 11. YA39 17(2) Schedule 4, no.5 Staff must be supervised with 31/01/08 the agenda and frequency set out in national minimum standards. This is so staff receive adequate supervision and support to ensure they understand and can fulfil their roles properly, can support people in line with the home’s philosophy and so that any initial problems with staff performance can be addressed. There must be a registered 31/03/08 manager in charge of the service, working towards the required qualifications. This is so the service can show it is being run effectively, within the law and with the best interests of service users at heart. There must be copies of reports 31/12/07 into service quality compiled on behalf of the registered providers kept at the home. This is so any identified improvements can be made promptly in the best interests of people living and working at the home. 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 YA6 Good Practice Recommendations Goals should be broken down into smaller steps to be concentrated on in stages. This would mean that the progress of people towards goals would be more easily identified and their achievements recognised. Alternative methods of communication should be explored to make information more accessible to people and to show how they are involved in planning their care or making decisions. There should be a review of all documentation associated DS0000027626.V354408.R01.S.doc Version 5.2 Page 30 2. YA6 YA7 3. Rosecroft YA9 4. YA18 5. YA19 6. YA20 7. 8. YA23 YA23 9. 10. YA24 YA30 11. YA34 12. YA42 with risks to avoid repetition or duplication and increase how comprehensive these are. If there are lots of separate pieces of paper that are not linked, crossreferenced or otherwise clear, staff may not be able to remember all the concerns they set out and may inadvertently place people at risk. Records should always show the behaviour that is observed. This is so it is easier to monitor any patterns and so that other professionals who may be consulted can be clear about what actually happened in particular environments. This is in the interests of good recording practice and to minimise the possibility that someone’s needs could be overlooked. The management team should review the content of people’s health action plans to ensure these are completed fully and accurately. This is so people’s health care needs are fully and properly set out and they can be sure these will be met. Staff should only sign medication administration records for PRN medication when this is actually given. This will make it easier to track the dates and times when it has been needed. There should be clearer guidance about cross-gender care, linked with assessments of known risks. This would help to protect both people living in and working at the home. “Body” charts available should be used to record when and how people have been held if staff need to intervene physically to protect people living at the home. This would help provide clearer evidence that intervention is at an appropriate level and a trail of evidence should there be any subsequent problems. As at the last inspection, renovations need to continue in a timely manner and the garden needs to be regularly maintained. Practices for managing laundry should be kept under review given the change in client group. If soiled laundry is now an issue advice needs to be taken from environmental health officers. This is so the risk of infection to people is kept to a minimum. Professional references (rather than personal ones) not supplied on headed notepaper or without official stamps should be followed up to verify their origins. This will help to show that they are genuine and enhance the protection offered to people by recruitment procedures. Monthly health and safety audits should be completed regularly. This is so any issues are identified promptly and can be dealt with to promote the safety and welfare of people living and working at the home. DS0000027626.V354408.R01.S.doc Version 5.2 Page 31 Rosecroft 13. YA42 There should be a manual handling assessment completed by someone competent to do so, for staff lifting and moving the bath seat. This is so staff are protected from avoidable accidents. Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Rosecroft DS0000027626.V354408.R01.S.doc Version 5.2 Page 33 - 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. 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