Inspection on 07/12/05 for Rosecroft

This inspection was carried out on 7th December 2005.

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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosecroft 06/11/07

Rosecroft 06/06/06

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 Dorothy Binns Announced Inspection 7th December 2005 09:45 Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 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.V262348.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V262348.R01.S.doc Version 5.0 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) Care Management Group Limited Position Vacant Care Home 3 Category(ies) of Learning disability (3), Physical disability (3) registration, with number of places Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Three (3) people with Learning Disability may be accommodated. The total number not to exceed three (3). Three (3) people with Physical Disability may be accommodated. Date of last inspection 17th May 2005 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 user may also have a physical disability. 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, however 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. Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine announced inspection lasting six hours. During the inspection discussions were held with the manager about the progress of the home and whether requirements at the last inspection had been attended to. Records and policies were also examined. Service users were not able to talk to the inspector but they were observed as they went about their day. Two staff were interviewed in private and a tour was made of the building. Not all the national minimum standards were covered in this inspection. What the service does well: What has improved since the last inspection? What they could do better: The home must establish a stable staff group to work with the service users. The use of agency staff is excessive and is not good for the permanent staff nor the service users. Recruitment and the retention of staff must improve. The building needs to have some work. The heating in some rooms is not adequate and some radiators need to be covered to prevent burning. Some redecoration and carpeting would improve the home. The way service users’ finances are organised and accounted for is not clear enough. Nor do the service users receive interest on their accounts. More transparency is required with more local solutions to the problem. Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 Page 6 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. Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 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.V262348.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Service users are properly assessed when being admitted to the home and how they are cared for is based on that assessment. EVIDENCE: The care records were examined and all contained a full assessment of the needs and abilities of the service users. Their skills, their health needs, how they communicated and what activities they liked were all covered. There was evidence of psychological and mental health needs being assessed with information from other professionals. Any safety areas were assessed for risk and these were also reviewed regularly. Records generally on care issues are good in this home. Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 7 Service users can be sure that their needs and wishes and how staff will help them are reflected in their care plans. The service users finances are looked after well once their money reaches the home but there are flaws in the system relating to the total administration of finances. EVIDENCE: All of the service users care plans were examined. They all were very full and based on a thorough assessment of the service users needs and abilities. The care plans gave details to staff of what assistance was needed and what activities they may have to help with to give the service users a good quality of life. There were action plans on particular areas such as mobility and these were reviewed monthly. Risk assessments were also seen for risk of falling, for bus travel, for bathing and choking. These were also reviewed regularly and had details of the steps to be taken to reduce risk. Care staff wrote regular reports about how the service user was getting on. These were good records. Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 Page 10 How the home dealt with the finances of the service users was examined as this had not been satisfactory at the last inspection. The records were not detailed enough to show what the service users are receiving in benefits and what the home are taking out of that for fees. There were records showing what money is held in a company account and what happens to the disability allowance but there were no bank statements or books to cross reference these records with. Neither was any interest given on the money held on the service users’ behalf. It is acknowledged by the Commission that there is now a difficulty in establishing individual accounts for service users and company accounts may have to be used. However service users must be able to earn interest on their money. Once money actually reached the home for the service user to use, money held could be checked against the records and these were correct. Receipts are also kept and could be cross referenced against the records. There were problems in that the record kept in the home is only for one month and in order to look further back, the manager had to obtain them from the main home where they are held. The records are also complicated in that there were three purses of cash for each service user for Christmas, clothes and for normal spending. Staff were therefore filling in three records depending on what fund they were drawing on. This seems fraught with difficulties. In summary the records were better than at the last inspection when they were almost non existent but they are still not satisfactory and the home has not kept to its own action plan which stated to the Commission that action would be taken by June 2005. Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 15 and 17 Service users do not have employment skills but staff are looking at educational possibilities. Service users are supported to use the facilities in the community and this enriches their lives. Service users are supported to maintain family links and enjoy contact with their families. Service users are offered a varied and nutritious diet. Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 Page 12 EVIDENCE: Service users are not able to work or have sheltered employment because of their disabilities. Two attend the skill centre twice a week and staff report that they are looking into possibilities at a local college. There is a lot of contact with community facilities with staff reporting that service users are taken ten pin bowling, swimming, to pubs and shops and for walks in the parks. The service users all need to be accompanied but staff said they take service users out most days. They have also been to see the Christmas lights and outings are arranged to the pantomime and to Pinocchio on Ice. Overall there is good use of community facilities though it depends on the number of staff on duty. All three service users have good contact with their families with phone calls and visits. One stays with his family every third weekend, another has a holiday with her family three or four times a year. Two service users will be away at Christmas. Staff feel they have good communication with the families and encourage and facilitate contact for the service users. Friends are also encouraged and visits are made to other homes where service users know each other. Recently the male service user had a lads night out with his friends from other homes. Service users were not able to express a view about the food in the home but were observed having lunch. One late riser was also seen having her breakfast of toast and tea which she chose. The menus for the home look varied and tasty and staff felt the service users were given plenty of variety. Most food is home cooked and not processed. Lunch of cheese and pickle sandwiches was seen being prepared and it was toad in the hole with potatoes and vegetables for the main meal. Fruit and yoghurt was available for dessert. Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20 Service users receive personal support in a gentle and dignified way though may be less well supported outside. Service users are protected by the procedures in the home relating to medication and are given them appropriately. EVIDENCE: Service users need varying levels of assistance and staff were able to describe the help required. One person needs a wheelchair outside the Home but can manage inside. In terms of the personal care required, staff said they assisted the service users in private and they used the bath with adapted chair or the shower depending on the ability of the service user. Service users are helped by their key workers to buy their own clothes and the finance records showed recent shopping for clothes had been done. Service users may have been funded for extra assistance as they need to be supported by two staff when outside. This has been problematic because of staffing issues looked at in the staffing section. There was no evidence however to support anything other than service users were assisted in a dignified manner and acknowledged for their individuality. Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 Page 14 All service users have their medication looked after by the Home. A monitored dosage system is used where the pharmacist pre packs the tablets. The medication systems in the home were checked. Medication is appropriately locked away and records are kept when medicines are given out. The record was satisfactorily completed and tallied with the tablets in the packs. There are no controlled drugs in the home. Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Service users are protected from abuse by the policies of the home and the training staff have received. EVIDENCE: Policies are in place for reporting the suspicion of abuse and for staff to blow the whistle on bad practice. There is also a gifts policy to prevent financial abuse. A file is kept on how to link in to the local adult protection unit and the manager has been on a local training course. Both staff on duty confirmed that they had received training about abuse. Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Whist the building is homely and parts are comfortable, there is work to be carried out to make it safe and attractive. The home smelled fresh and hygiene matters are dealt with properly. EVIDENCE: The home is an extended detached bungalow in a residential area and is in keeping with the local neighbourhood. It is all on one level and has an adapted chair for use in the bath to allow for easier access for those with limited mobility. In terms of space, there is a comfortable lounge with dining area and a conservatory. Each service user has their own bedroom and these are comfortable and bright though one was small. Service users are able to have their own possessions in them and make them personal. The standard of maintenance was however poor and the home has several problems. 1) The conservatory is extremely cold (the temperature was 15 degrees) and only warmed up a little when the lounge door was left open (18 degrees). This meant it was too uncomfortable for anyone to use this room. One of the bedrooms was also cold. Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 Page 17 2) The hall carpet was dirty and the walls needed decoration. 3) Hot radiators were unguarded. These problems need to be addressed with some urgency and requirements have been made. The home did not have an offensive smell and hygiene matters are dealt with satisfactorily. The washing machine has a hot wash and there are procedures for infection control. Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,34,35 Service users are not supported by as effective a staff team as they should be because of the excessive use of agency staff. Service users are protected by the Home’s recruitment policies ensuring that suitable staff are working in the Home. Training is provided for staff but a more active development plan could be put in place. EVIDENCE: The rota for the inspection showed that two staff are on duty at all times during the day but that there are occasionally three. On the day of the inspection two staff were on duty throughout the day. However the information provided for the inspection showed only three permanent staff on the home’s books, the remainder of the rota being filled by staff from other homes (of the same organisation) or by agency staff. For the week of the inspection fourteen of the shifts were filled by agency staff. Information provided by the manager showed that a total 347 daytime hours and 23 sleep ins had been provided by agency staff in the last eight weeks. If a shift is approximately 7 hours long, then approximately 50 shifts or 25 a month have been provided by agency staff. This has major implications for the service users, the main one being that they are not supported by a consistent staff group who knows them well and how best to help and communicate with them. Permanent staff also spend Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 Page 19 part of their time instructing the agency staff on what to do. One staff told the inspector that she had not worked with another permanent member of staff for over three weeks and that there are times when the two staff on duty are agency staff. Another implication is that one service user who is commissioned to have extra hours and can only go outside if two staff accompany her, has her activities curtailed because of lack of staffing. Staff felt they did not provide as much social activities as they should be because of staffing. Clearly this is a poor state of affairs and drastic action must be taken. The manager reported that she is trying to use the same agency staff so that they are familiar with the service users and that staff are currently being recruited. She hopes the situation will be stabilised in the new year. This gives some hope that things will improve but the turnover of staff also needs to be examined to see why staff are leaving. Some turbulence is usual with a change of manager but this level of difficulty gives the Commission cause for concern. A further visit will be made in the New Year to check the staffing situation. Two staff records were examined to see what the home’s recruitment procedures were and to see whether the requirement for better records at the last inspection had been dealt with. The records showed that references, identity checks and criminal record checks had been carried out and that staff had been issued with contracts and with the General Social Care Council code of practice. The records showed that both staff had undergone induction training and had received training on medication, abuse and food hygiene. More individual training assessments were not in evidence. Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38 and 39 The current manager is not yet registered but is working hard to meet the home’s objectives. There are troubles in this home that need to be rectified before it can run well and the new manager will have to use all her skills to turn things around. The quality assurance system is partially in place but needs to be strengthened to be more robust. Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 Page 21 EVIDENCE: The manager is still new and is responsible for five small homes. She is not yet registered. The home is part of a national organisation and the Commission has reminded them of the need to have a registered manager. They have not yet submitted an application despite assurances that they would. The manager relates to and receives support from a hierarchy of management at regional and national level. The head office is slow to respond to problems and the manager who may well be able to find local solutions is hampered by the need to wait for action from head office. The manager is trying to turn the home around and ensure the standards are complied with and that efficient systems run in the home. There have been tensions and staff have left but there is also support for what she is doing. There is a clear sense of direction from the manager though staff may need more time to voice their worries before they can affect the way the service is delivered. The quality assurance system is not fully completed though has some good components. There is a residents’ charter which sets the standard for quality, and a conference is arranged annually for the organisation’s service users to have a say. Residents meetings and the complaints procedure are part of the tools of the quality process. Staff reported that they completed a survey but this was a national one sent to head office and not just dealing with local issues. No outcome has been communicated. Staff said they had never seen or assisted service users to complete a questionnaire though there was a blank one in the file. A relatives form was also only shown in blank form. Clearly the quality system does need more coordination, with clear standards that are being judged. It also needs to show an analysis of the findings and an action plan for the next year to demonstrate that the home is able to identify the problems and set about dealing with them. Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 Score x 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 2 x x x Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score x x 1 3 2 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Rosecroft Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score 2 2 2 x x x x DS0000027626.V262348.R01.S.doc Version 5.0 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA7 Regulation 17 Requirement A record must be kept of all the money received on the service user’s behalf including records of any money deposited on their behalf in the bank and the interest received. Previous timescale 30/06/05 Suitable heating must be provided in all parts of the care home which are used by service users. In this instance the conservatory is too cold. Unnecessary risks to the health and safety of the service users must be identified and so far as possible eliminated. In this instance, risk assessments must be carried out and acted upon inn relation to hot radiators. The registered person must at all times ensure that suitably qualified, competent and experienced staff are working in the care home and that the employment of staff on a temporary basis will not prevent service users from receiving continuity of care. The registered person must submit an application for the DS0000027626.V262348.R01.S.doc Timescale for action 31/01/06 2 YA24 23(2)(p) 28/02/06 3 YA24 13(4) 31/01/06 4 YA33 18(a) and (b) 31/01/06 5 YA37 8 13/01/06 Rosecroft Version 5.0 Page 24 registration of the manager. 6 YA39 24 A system for reviewing and improving the quality of care provided at the home must be established and maintained. 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA24 YA24 YA35 Good Practice Recommendations It is recommended that all radiators are covered to prevent burning by service users It is recommended that parts of the home are redecorated and recarpeted. It is recommended that there is a staff training and development plan. Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rosecroft DS0000027626.V262348.R01.S.doc Version 5.0 Page 26 - 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!