CARE HOMES FOR OLDER PEOPLE
Rosedale Care Home 36 Lansdowne Road Luton LU3 1EE Lead Inspector
Leonorah Milton Unannounced Inspection 9th February 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Rosedale Care Home Address 36 Lansdowne Road Luton LU3 1EE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01582 481188 01582 481188 Mr Cornelius Crowley Mr Stephen Giles Betty Ann Woolford Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (20), Old age, not falling within any other category (20), Physical disability over 65 years of age (20) Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Numbers of service users 20. Age over 65 years including the two named service users under the age of 65 years who are currently accommodated at Rowles House. Categories: Older people with physical disorders, mental disorders or dementia OP, PD(E), MD(E), DE(E). 10th August 2005 Date of last inspection 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 DS0000062137.V282864.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second of the statutory two inspections that the Commission for Social Care Inspection (CSCI) is required to carry out each year. This inspection was carried out in accordance with the CSCI’s procedures to assess core care standards within the two inspections as detailed on this report. This inspection therefore focussed the core standards not assessed at the first visit and reviewed the progress on requirements from that inspection. During this inspection the arrangements for the care of two service users were assessed. Their case files were reviewed, as were their private bedrooms. Conversations took place with one of these service users, the visitors of the other, two other service users and two members of staff. A partial tour of the building took place and sundry other records were assessed. Conversations took place with the service users in the lounges where the arrangements for recreation and relaxation were also assessed. The manager was present in the home throughout the inspection and received feedback as the inspection took place and by written summary at its conclusion. It is recommended that this report be read in conjunction with the report of the inspection carried out in August 2005 for a complete overview of the standard of the operation between these dates. What the service does well:
The building provided a clean, comfortable and suitably adapted environment. Service users seen in the lounges appeared relaxed and content with their accommodation. Indeed conversations with them and the two visitors showed that they were satisfied with the arrangements for their physical comfort. Four other service users had been confined to bed for sometime. Three of these rooms were seen and showed that suitable care had been taken also to ensure that these people were comfortable, safe and cared for. It was reported that despite the confinement to bed none had developed problems in relation to their skin care. Service users stated that they had no complaints about their stay in the home and praised its personnel. Comments such as “they are kind and helpful” were passed as well as appreciation for the quality of the food, recreational activities and the respect with which they had been treated. The visitors also passed positive comments about the service and expressed no concerns about their relative’s care.
Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 Page 6 The majority of care staff had worked in the home for a significant time and was well acquainted with service users’ needs and the routines of the home. Those members of staff spoken to confirmed that their understanding of service users’ needs was as shown in the records for the care of each individual. Records indicated that the care team had made good progress on achieving qualifications in care to National Vocational Standards (NVQ). The manager spoke highly of her staff. Strategies were in place to ensure that personnel were briefed about performance and the standards of care required of them. It was evident that the manager’s involvement in the day-to- day routines of the home had enabled her to maintain an overview of each service user’s progress, support and guide personnel as necessary and to be accessible to service users. Service users confirmed that they had seen the manager frequently and expressed their confidence that she would deal promptly with any concerns that might arise. What has improved since the last inspection? What they could do better:
Sufficient personnel had been scheduled to work in the home throughout the day to care for service users. A cook and cleaner were also employed. The arrangements for the care of service users at night however were concerning, there being only one waking member of the care team on duty with another on call on a sleeping in duty. Given the frailty of several service users whose assessments showed that they required the assistance of two carers for their personal needs, a report that some service users were in the habit of wandering at night, the layout of this three story building and the risks of lone working and fire safety, these arrangements were unsatisfactory. A risk assessment must be carried out to take account of these matters. Questionnaires had been given to service users and their visitors to enable them to comment on the standard of the service. There was however no consequent plan of how the few issues raised would be addressed or evidence
Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 Page 7 that these matters had been dealt with. The home’s policy stated that feedback and reports on the survey would be made available to service users. The manager agreed to deal with this. The fireboard to alert staff to the precise area of the building in which an alarm had been activated was positioned in the entry porch to the home. It was reported that the board had been sited in the porch for sometime and that previous inspections by the fire service had not raised concerns about its location. However it was concerning that in the event of a fire there would be delay to determine which area of the building was involved because the front door would have to be unlocked to access the fireboard. The current procedure was for a member of staff to go in search of the suspected site of the fire. The manager agreed to seek the advice of the fire service about this matter. 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 DS0000062137.V282864.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Sufficient information about a service user’s needs had been obtained before the decision to admit the service user to the home had been made to determine that the home had the capacity to meet assessed needs. EVIDENCE: The admission procedures for a service user who had been admitted to the home two days before this inspection showed that the placing authority had provided a comprehensive assessment of need prior to admission that had included information about a history of mental health needs that were relevant to her on-going care at Rosedale. Risks to her safety were also noted. The manager had visited the service user and her family prior to admission to add to this assessment. The home’s preadmission assessment document had not been completed in full but the inspector was satisfied that the information shown on both documents was sufficient. Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 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 the following standard(s): 3 Service users’ care plans were comprehensive so that there was sufficient written guidance about each individual to enable staff to properly care for them. EVIDENCE: The format for care planning had been revised since the previous inspection. Those reviewed at this inspection had taken account of the details laid out in standard 3 for the assessment of needs and had been devised to reflect the significant needs that were individual to each service user. Risks had been assessed and incorporated in the plans, as had nutritional needs and management of skin care. Reviews of the plans on a minimum of a monthly basis had commenced and showed that significant changes in need had been noted. The manager was advised that the plans would benefit from a little detail about service users’ abilities but overall these plans showed a methodical approach to show how the home intended to care for its service users.
Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 Page 11 Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 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 the following standard(s): These standards were not reviewed at this visit as they were assessed as met at the previous inspection. EVIDENCE: Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 Page 13 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 the following standard(s): These standards were not reviewed at this visit as they were assessed as met at the previous inspection. No complaints about the operation of the home had been made to the CSCI since the previous inspection. The manager stated that none had been made to the home. EVIDENCE: Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 19,23 The home provided clean and comfortable communal areas that were suitable for service users’ assessed needs. Whilst there were some shortfalls to the National Minimum Standards for the provision of bedrooms they did not adversely affect service users’ care or comfort. Doubts about fire safety were raised at this inspection and whether there were any increased risks to service users in the event of a fire that might result from delays to commence evacuation procedures. EVIDENCE: Areas of the building seen at this inspection were clean and orderly. The home was well decorated and furnished with many homely touches that enhanced the home-like appearance of the building. A few bedrooms still had lino flooring that had been in place when the home transferred from the previous owner. The manager was aware that there were
Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 Page 15 risks that service users might slip on this type of flooring. The reports of the proprietor’s statutory visits showed that plans were in hand to replace this flooring. Whilst it was reported that two service users held keys to their rooms, it would not be possible for some service users to be provided with keys because the door locks to their room, although they allowed the rooms to be locked from the inside, and could be overridden if there was a need for staff entry in the event of an emergency, were not designed for use with individual keys. None of the bedrooms seen were provided with a lockable facility. Fire safety issues have been detailed on the summary to this report. Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 There were risks that the response to service users care needs at night might be delayed and aspects of their safety compromised because only one sleeping in member of staff was scheduled to work at night. Progress on the achievement of NVQ qualifications meant that the service users had benefited from the knowledge personnel had gained in relation to good practice for the care of vulnerable people. EVIDENCE: The rota indicated that sufficient numbers of staff were rostered throughout the day and evenings but that only one carer was awake in the building with another sleeping in on call. A member of staff stated that the on call person would assist if summoned. This staffing arrangement appeared to be historical rather than based on good and safe practice guidelines. As detailed on the summary to this report there was no evidence to show that the staffing arrangements at night had been qualified through an assessment that included a collective and individual evaluation of service users’ care needs and safety requirements. The inspector felt that no account had been taken of a situation where the waking carer might be unable to summon help despite the mobile phone link or the inevitable delays that result when one person only is available to respond to call bells and deal with service users who wander. These factors must be included in a comprehensive analysis to justify the night staffing arrangements. This analysis must be subject to review on a frequent basis to
Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 Page 17 take account of any changes to service users’ needs, new admissions, changes within the staff team and the competencies of individual members of staff. Records indicated that of the sixteen care staff one had achieved an NVQ at level 3 and six held NVQ’s at level 2. One was working towards level 3 and two towards level 2. It was reported that the work to complete these awards was almost complete and that another member of staff was due to commence work towards a qualification at level 2 in the near future. Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38 The service users had benefited from the care of a manager who was committed to their welfare. She had shown her willingness at inspection and through her professional development to increase her knowledge base and implement changes to improve the service. EVIDENCE: The day-to-day operation of the home was well organised. It was evident that the manager had taken daily opportunities to monitor the actual delivery of the service to the residents in the home. The previous inspection had commented that the manager needed to spend more time on the administrative functions of her role. This was no longer the case. Evidence of the progress on care planning and other aspects of record keeping showed that this aspect of the manager’s role had been being carried out.
Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 Page 19 It was encouraging to note that the some supervisory and other management tasks had been appropriately delegated to members of the senior staff so that the professional management of the home was carried by a team rather than just one person, which can result in a slide in standards during a manager’s absence. There were systems in place to enable service users and their representatives to comment on the service provision but no corresponding methods to evaluate or evidence action on the outcomes. Questionnaires in relation to the quality of the service had been distributed to service users, their families and other stakeholders. Those reviewed at this inspection were mostly positive and raised only a few minor issues. The documents had a variety of dates. The manager explained this was because questionnaires were always available. She also stated that she had taken action on the issues raised. She was advised the in addition to the random feedback gained from these questionnaires the home must conduct a systematic annual quality audit, prepare an analysis of the outcomes of the exercise and prepare a report of the same that includes an action plan with timescales for achievement on any arising issues. Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 2 x x x x 2 x x STAFFING Standard No Score 27 2 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x x x x 2 Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 Page 21 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 OP27 Regulation 13(c) 18(1)(a) Requirement Timescale for action 31/03/06 2 OP33 24(1) 3 OP36 18(2) A risk assessment must be carried out to justify the night staffing arrangements. This assessment must take account of service users’ needs, any changes to them, the needs of new admissions, safety requirements, the layout of the building, staff changes and individual competencies, lone staff working. Any initial assessment must be reviewed in the light of the above. A copy of the initial risk assessment must be forwarded to the CSCI. A systematic system to audit the 31/08/06 quality of the service on at least an annual basis must be introduced. The system must include evaluation of the outcomes, a report of the same and an action plan on any arising issues. Care staff must receive 01/11/05 supervision at least six times a year. (Previous timescale of 01/11/06 had not been met in full. However good progress was noted.)
DS0000062137.V282864.R01.S.doc Version 5.1 Rosedale Care Home Page 22 4 OP38 23(4)(c) (ii) The fire service must be consulted about the location of the fireboard and the implications for delay in accessing the same. 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 Refer to Standard OP30 Good Practice Recommendations There should be a record of the mandatory training that has completed and also that which is required for the year ahead. (From 10/08/05. Not assessed in full at this inspection) Service users should be provided with keys to their bedrooms and lockable facilities unless a risk assessment identifies that the service user’s needs are such that this would not be suitable 2 OP24 Rosedale Care Home DS0000062137.V282864.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Bedfordshire & Luton Area Office 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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