CARE HOMES FOR OLDER PEOPLE
Rosedale Care Home 36 Lansdowne Road Luton Beds LU3 1EE Lead Inspector
Sally Snelson Unannounced 10 August 2005
th 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. Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Rosedale Care Home Address 36 Lansdowne Road Luton LU3 1EE 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 481188 01582 481188 Mr Cornelius Crowley Betty Woolford Care home 20 Category(ies) of DE(E) Dementia over 65 - 20 registration, with number PD(E) Physical disabilities over 65 - 20 of places OP Old age - 20 MD(E) Mental disorder over 65 - 20 Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 03.03.05 Brief Description of the Service: Rosedale is a large three-storey home located in a residential suburb of Luton within a mile of the town centre. There are local shops, parks and churches close by. The home is registered to provide care for 20 service users; at the time of the inspection the majority of the service users had a diagnosis of dementia. Accommodation is provided on three floors linked by stairs and a passenger lift. All the bedrooms are single rooms. Communal accommodation consists of a lounge/diner on both the ground and first floor and a conservatory off the ground floor lounge. Some off-road car parking is available at the front of the home with time limited road parking available on the street outside the home. Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place from 11am on the 10th August 2005. During the inspection the registered manager, Betty Woolford, was present throughout. The inspector tracked the care and the care records for two of the service users in detail. Other service users were spoken to and aspects of their care examined. During the day the inspector also spoke to staff and visitors and would like to thank them for the time they gave to the inspection. What the service does well:
The home is relatively small and has a core group of staff that have worked there for sometime. These staff are therefore familiar with many of the service users and their families. Despite the home changing hands a year ago, staff and visitors stated that they are pleased that only beneficial changes had been made and that the staff complement has not altered under the new management structure. The staff team are particularly skilled, as much through experience as specific training, in caring for service users with a diagnosis of dementia. At the time of the inspection all the 20 bedrooms were occupied; 13 of the service users had various levels of dependency that allowed them to spend their days in the lounge and have their meals together in the dining area. The other service users, because of their dependency spent some of their day in bed or in their bedrooms. The inspector noted that staff spent one-to-one time with those service users who remained in their bedrooms. The manager reported that despite their differing degrees of immobility none of the service users had pressure sores. She also stated that the community nursing staff supported the homes as necessary with any nursing needs, providing advice and support and the provision of pressure relieving equipment as necessary. Since the inspection a community nurse had confirmed that the staff at Rosedale appropriately referred service users to them. Staffing levels allow staff to spend time with the service users either doing activities or talking. Visitors commented that they were always made welcome and felt they visited the home as a whole, and not just their relative or friend. The home benefited from being owned by the same owners as two other homes in the same street. This enabled the staff to share training sessions, the managers to support each other, and entertainers to be booked for all the homes at a reduced rate.
Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. Rosedale Care Home I51 S62137 Rosedale V235154 100805 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 Rosedale Care Home I51 S62137 Rosedale V235154 100805 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) 2,3,4,6 Sufficient information had been sought about the care needs of those recently admitted to the home to ensure that the staff had the ability to meet their care needs. The individual service users contracts did not include the number of the room that the service user had been allocated which could result in service users being moved around the home. EVIDENCE: The Statement of Purpose and the most recent inspection reports were made available within the home for service users and visitors. Those care files sampled indicated that the majority of pre-admission assessments had been completed and contained sufficient information for the manager to make the decision as to whether Rosedale could meet the needs of the particular service user. The manager stated that a recent admission had been taken following telephone discussions with the parties involved in the admission and not face-to-face contact because of the admission was from
Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 9 another area. In this case there was insufficient documentation to support how the decision to admit to Rosedale had been made. Rosedale does not offer intermediate care. Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 10 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 There were some omissions in care plans and some areas were information had been repeated. There was no evidence that these omissions compromised the standard of care provided because the staff had a good knowledge of the service users. EVIDENCE: The manager had chosen to use a system of care planning that relied on completing some pre-written formats. In one of the files sampled these documents had been fully completed; the other had a number of areas that had not been completed. The omissions were to plans that should have been in every day use, such as mobility and continence. The key–worker had not had the time to complete all the documentation although the manager believed it had been completed. This highlighted the need for the manager to audit the care plans regularly. Speaking to staff confirmed that they were aware of all the needs of the service users and there was no risk to service users at the time of the inspections because the care plans had not been fully completed. However there would be a risk if the home had to rely on agency or temporary staff who did not know the needs of the service users so well. It was also apparent that not all of the care plans had been reviewed monthly. The manager was aware that the staff did not always document the reviews they
Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 11 completed on those long-term service users who care needs had not changed for a number of months or even years. The care plans sampled included appropriate risk assessments, monthly weight monitoring and other health assessments as necessary. Some of the plans had a family tree and a pen profile of the service user. All of the care plans should include a photograph of the service user. Service users and staff described the ways in which privacy and dignity were upheld. Staff were observed to treat service users with dignity and care at all times and to offer them choices for example about their choice of meals, where they sat or what they wore. Medication records were complete. There was evidence that staff had completed the correct documentation when receiving and administrating medication. A medication trolley would benefit the home and prevent carers carrying medication in pots around in order to administer to those in their bedrooms. Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 12 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 The service was structured to meet the needs of the majority of the service users who required considerable support. EVIDENCE: Staff were observed to provide sensitive support to those with dementia and to encourage service users to take part in social activities. It was noted that staff made time to sit with the service users in the lounge and read the daily newspaper to them and discuss issues raised. During the summer the home had been invited to a strawberry tea at another home; all had enjoyed this. One member of staff had taken one service user on a day trip to Southend-on-Sea as part of an activity organised by Mencap. A number of activities and games were regularly made available. The home had long-term links with a local church who, on the day of the inspection, were visiting to provide a communion service for those who wished to participate. Staff supported the service users to take part in various ways according to their abilities and requirements. Staff also joined this activity. All of the service users were asked if they wished to participate and could be taken to another room if they choose not to join in. Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 13 The inspector noted, and visitors confirmed, that they were welcomed into the home at anytime and felt able to talk to the staff when they were visiting. Throughout the inspection service users were served with hot and cold drinks according to their wishes. Drinks were placed within the service users reach on lap tables that had been adapted with non-slip mats. Lunch was served during the inspection. The main choice was mince, mashed potatoes and green beans. Those service users who required assistance were given this help in a dignified way. All service users were offered a large apron to protect their day clothes if they wanted it. Those service users who had a pureed diet were given a meal that looked appetising and was not mixed together in a bowl. Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 14 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) 16,18 The complaints process was satisfactory and there was evidence that some staff had an awareness of the protection of vulnerable adults. EVIDENCE: A number of staff had completed Protection Of Vulnerable Adults training and had a good understanding of all the forms of abuse and how to recognise the signs and symptoms of abuse. The manager must ensure that all staff would know how to report an incident and to whom so that it could be reported immediately. This reporting must include any injury noted that could not be accounted for. The home had a robust complaints procedure that was advertised within the home and the Statement of Purpose. There had been no complaints about the home made to the home or the Commission for Social Care Inspection. Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 15 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) 19,23,25,26 The home was well-maintained and the necessary systems were in place to protect service users health and safety. EVIDENCE: Rosedale was clean, tidy and well decorated and furnished in a homely style. The home provided individual bedroom accommodation, over the three floors. The majority of the rooms did not have en-suite facilities; all had wash hand basins. Although all the bedrooms were in excess of 10sq.m, the shape and layout of some did not make them suitable for those service users who had mobility problems and needed to use of wheelchairs and hoists. The rooms that were suitable for service users in wheelchairs should be identified and this information included in the Statement of Purpose. All rooms had access to natural light and ventilation. Radiators throughout were covered and could be individually controlled.
Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 16 All lighting was of a domestic nature and there was evidence that water temperature and fire equipment checks were carried out and recorded regularly. The inspector noted the home was kept clean and free from any unpleasant odours throughout. Since the last inspection dedicated staff had been employed to keep the home clean. This had not improved the cleanliness of the home, as that had not been an issue, but had increased the amount of time that care staff could give to the needs of the service users. All the staff were responsible for the laundry and ensuring then correct items were returned to the service user. The home had a garden which was well kept and had a variety of garden furniture for the use of the service users if they chose to be outside. The inspection took place during a very hot period of the summer. The inspector noted that a number of fans were positioned throughout the home in communal rooms and in individual bedrooms. Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 17 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) 27,29,30 Robust recruitment procedures safeguarded service users. EVIDENCE: Duty rotas suggested that the manager was usually on duty with four care staff during the morning. This was in line with the figure agreed for care homes in Bedfordshire. This had been calculated to allow the manager to be supernumerary, if necessary, throughout the day. As already mentioned the home benefits from a staff team that have been relative stable for a number of years and welcome new staff to join them. A relatively new member of staff reported that she had worked in care before but was pleased with the support she had been given and the standard of care that was expected of her. Staff reported and there was evidence in individual staff files, that staff were supported and encouraged to attend a variety of training events including NVQ training. The manager ensured that as many staff as possible attended the various training offered. Files would benefit from having clearer information as to when mandatory training was due. Staff recruitment files were securely kept. They included application forms, two references and a returned Criminal Record Bureau check. In addition the files included training certificates or proof of attendance for any course that the staff member had participated in. The inspector noted that staff were
Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 18 encouraged to include certificates or proof of training of courses not directly associated with their day-to-day roles, for example alternative therapies. New staff completed an initial induction period that was documented and was also stored in their staff file. The staff files did not include a photograph of the staff member although the manager reported that there was a photo board of all staff on display in the home. Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 19 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) 31,35,36,37,38 The manager had demonstrated skill and commitment during her short time in post as manager. EVIDENCE: Since the last inspection the manager had successfully completed the registration process and was now the registered manager. She had adapted well to the role and was seeking appropriate advice. However in order to comply fully with all the requirements of a manager she would need to complete the Registered Managers Award or an equivalent. She must also spend less time ‘hands on’ to ensure that she regularly audits care files and keeps them up-to-date. All staff must receive the required six supervision sessions a year in addition to their annual appraisals. The home did not take responsibility for service users personal money although they would hold small amounts on the service users behalf, to allow them to pay for hairdressing etc.
Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 20 Staff had good access to fire training and all the required testing of systems and equipment was carried out. A staff member who, for medical reasons, needed to wear sandals had been risk assessed and the appropriate documentation completed. Records kept in the home were generally up to date and accurate and kept securely. Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 21 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 x 3 2 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x 3 x 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 x x x 3 2 3 3 Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 22 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 7 Regulation 15 Requirement Care plans must be written in sufficient detail to ensure all the care needs of a service user can be met. Care plans must be reviewed at least every four weeks. The registered manager must be working towards NVQ level 4 or equivalent. care staff must receive supervision at least six times a year. Pre-admission assessments must contain sufficient detail to demonstrate how the decision that Rosedale could meet the service users needs had been made. Timescale for action 1.11.05 2. 3. 4. 5. 7 31 36 3 15 9 18 14 1.11.05 1.10.05 1.11.05 1.11.05 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. Refer to Standard 2 29 Good Practice Recommendations Contracts should include the number of the bedroom that the service user is accommodated in. Staff files should include a photograph of the staff
I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 23 Rosedale Care Home 3. 30 member. There should be a record of the mandatory training that has completed and also that which is required for the year ahead. Rosedale Care Home I51 S62137 Rosedale V235154 100805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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