Inspection on 23/04/08 for Rosedale Manor Care Centre

This inspection was carried out on 23rd April 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rosedale Manor Care Centre 23/04/07

Rosedale Manor Care Centre 23/05/06

Rosedale Manor Care Centre 06/01/06

Rosedale Manor Care Centre 19/07/05

Rosedale Manor Care Centre 23/02/05

Rosedale Manor Care Centre 18/05/04

Rosedale Manor Care Centre 02/03/04

Rosedale Manor Care Centre 03/09/03

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Rosedale Manor Care Centre Sherborne Road Crewe Cheshire CW1 4LB Lead Inspector Wendy Smith Unannounced Inspection 23rd April 2008 10:15 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 Manor Care Centre DS0000018738.V359645.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 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 Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosedale Manor Care Centre Address Sherborne Road Crewe Cheshire CW1 4LB 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) 01270 259630 01270 259640 Four Seasons 2000 Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Janet Higham Care Home 80 Category(ies) of Dementia (80), Mental disorder, excluding registration, with number learning disability or dementia (80), Old age, of places not falling within any other category (80), Physical disability (80) Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Physical disability - Code PD Mental disorder - Code MD The maximum number of service users who can be accommodated is: 80 Date of last inspection 27th September 2007 Brief Description of the Service: Rosedale Manor care centre is a two-storey purpose-built home set in its own grounds. The home is in a residential area approximately one mile from Crewe town centre. It is close to local shops and other facilities and is convenient for public transport. The home is divided into three discrete living units. On the ground floor, Willows unit provides accommodation and nursing care for ten younger adults with a physical disability, and Woodlands unit provides accommodation and nursing care for 24 people with dementia. Meadow Unit, on the first floor of the home, provides nursing and personal care for a maximum of 46 older people. 12 of these places are contracted with South Cheshire PCT to provide intermediate care. The weekly fee is from £343.34 to £743. Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. An unannounced visit by two inspectors took place on 23rd April 2008. The home had 76 residents. During the visit the inspectors spoke with residents, staff and visitors. Survey forms were sent out prior to the visit to give residents, relatives and staff the opportunity to lets us know their views about the home. A tour of the building, including all communal areas and some bedrooms, was completed. A sample of records was looked at and time was spent in conversation with the home manager. Some of the information contained in this report is taken from the Annual Quality Assurance Assessment that was completed by the home manager at the request of the Commission for Social Care Inspection. What the service does well: A number of positive comments were received from relatives who completed a questionnaire. These included: I feel that my wife receives excellent care and nothing is ever too much trouble for the nurses and carers. Before any new resident is admitted to the home, the manager or one of the senior nurses goes out to meet them and to assess their needs. Pre-admission documents looked at for a resident newly admitted to the home on the dementia care unit was detailed and had been fully completed so that staff were aware that the home could meet the person’s needs. There was evidence of input from the relatives to give a full picture of the persons needs. Some staff on the dementia care unit have completed training to carry out ‘dementia care mapping’, so that a full picture of residents’ well-being can be identified throughout the day. Staff spoken with on the unit were positive that this can help them give better care for residents who are unable to express their needs. Medication management was looked at on each of the units and the administration, storage and recording of medicines was satisfactory throughout the home. The manager has the confidence and support of the staff. Comments made by staff included: Things have improved a great deal since Janet became manager: she has made a lot of improvements: she listens to us: if we want Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 Page 6 anything we just ask: The manager is very open about issues at the home and what she has done to address them. Meetings have taken place for all staff, residents and relatives. 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. The summary of this inspection report can be made available in other formats on request. Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People interested in going to live at Rosedale Manor are assessed by a qualified person to establish whether the home will be able to meet their needs. People admitted to the home for intermediate care receive support to regain their independence. EVIDENCE: The home provides care for four different groups of people in four separate units. Each unit has a unit manager and its own team of staff, however staff may help out in other parts of the home to cover any shortage. The maximum number of people accommodated is now 78 as there are no longer any shared rooms. Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 Page 9 Before any new resident is admitted to the home, the manager or one of the senior nurses goes out to meet them and to assess their needs. Pre-admission documents looked at for a resident newly admitted to the home on the dementia care unit was detailed and had been fully completed so that staff were aware that the home could meet the person’s needs. There was evidence of input from the relatives to give a full picture of the persons needs. The preadmission assessment is used to start writing plans of care for the person. Twelve intermediate care places are run as a separate unit on the first floor. People are admitted for a maximum of six weeks for rehabilitation. Some admissions are planned, and detailed written information is provided in advance to inform the home of the person’s care needs. In other cases the admission is made as a matter of urgency and information is given by telephone, however this is followed up with a more detailed assessment and care plan as soon as possible after admission. The unit has its own lounge and dining room. Care plans are written and reviewed by social workers but the nurses can add to the care plans if new problems are identified. Therapists visit every day and provide a variety of mobility aids. People receiving intermediate care said that they were very pleased with the service and considered that the staff are very attentive to their needs. Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of residents are met to a good standard and their medicines are managed safely. EVIDENCE: Care plans were looked at on each of the units. The care plan for a resident on the physical disability unit was concise but provided good information to give guidance to staff to meet the needs of the person. Risk assessments were completed for moving and handling and the type of hoist and appropriate sling required was recorded. Pain control charts were in place and these detailed how the staff were made aware of when the resident was in pain as the person has limited communication skills. A plan of care regarding wound management had not been updated when treatment had been changed. This was recorded on the evaluation sheet. Daily records and evaluation sheets were detailed. Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 Page 11 A care plan looked at on the dementia care unit had been fully completed to enable care staff to know what to do to meet the residents needs. Care plans on the first floor have been improved to make them more person-centred. Two care plans looked at were well written to identify the needs of the residents and how their needs should be met. In the care plans looked at on the first floor, the reviews were poor and provided no evidence that the nurse had looked to see how the person had been during the last month and considered whether any change was needed to their care. For example, one resident had a care plan regarding a skin problem. It had been written on 3rd October 2007. Every month the review reported that the ‘care plan remains valid, reassess in one month’. This does not tell us whether the condition had improved, deteriorated or stayed the same and whether the prescribed treatment was effective. The manager was able to answer these questions and said that the skin problem had not improved probably because the resident did not always use the cream prescribed. This is what should be written on the review. The same person had a care plan for epilepsy but the monthly reviews did not report whether there had been any seizures during the last month. Daily records for this person were also not very informative and the word ‘settled’ was much over-used. Some staff on the dementia care unit have completed training to carry out ‘dementia care mapping’, so that a full picture of residents’ well-being can be identified throughout the day. A more person-centred care plan can be completed so that each resident is cared for in a more individualised way. Staff spoken with on the unit were positive that this can help them give better care for residents who are unable to express their needs. More profiling beds have been provided for frail residents on the first floor who spend most, or all, of their time in bed. Food and fluid intake charts, and repositioning charts were kept in the bedrooms of the most dependent people and the charts recorded the care that they had received during the week. All of the staff spoken with were knowledgeable about the needs of the people who they were caring for. Staff interactions were positive and dignity was maintained. All personal care was given in bedrooms or bathrooms with the doors shut. Medication management was looked at on each of the units and the administration, storage and recording of medicines was satisfactory throughout the home. The new medicine room on the first floor is a great improvement on previous facilities. Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A programme of social activities is provided for residents and there is a good standard of meals. EVIDENCE: The home employs two staff to provide social and recreational activities for residents. They now have a good sized room in which to keep equipment and there is space that residents can use for arts and crafts. The large lounge on the ground floor is used for entertainment. A recent film matinee, using a large screen, was very well-received. Rosedale Manor shares a minibus with another home and makes good use of this to take residents out. Two residents have been on a short holiday to Scotland. There is a shop in the home. Religious services are organised on a regular basis. Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 Page 13 On the dementia care unit staff were seen to assist residents with their meal in a manner that upheld their dignity. A staff member took a pudding to a resident who had not finished her lunch and this was taken back to the kitchen to keep warm, rather than left on the table. The very large dining room for elderly frail residents has been much improved with matching table cloths, flowers and other domestic touches to make it looks much softer and more pleasant. The manager said that she has changed some of the food suppliers as she was not satisfied with the quality. The home now uses all fresh vegetables. The menus have been changed to reflect comments made by residents and their relatives. People spoken with were very happy with their meals. Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s policies and procedures relating to complaints and abuse. EVIDENCE: Two complaints have been recorded in the last year. One of these, from a former member of staff, was dealt with by the company’s human resources department. The other, relating to intermediate care, was being dealt with by the acting regional manager. Records looked at showed that all staff have received training about adult protection and most have attended training within the last year. The training has ensured that senior staff are familiar with the trigger forms used to alert social services to any allegations of abuse and when to use them. The manager said that she has worked to encourage openness about such issues. Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is comfortable and safe for residents and all indoor areas are accessible for people with disabilities, however there are a number of areas that would benefit from refurbishment to provide more attractive environment for people to live in. EVIDENCE: The home is set in extensive grounds that are mainly grassed. The grounds have been tidied up considerably but there is scope to develop safe garden areas for the enjoyment of residents. There are a number of double glazed units that contain condensation and need to be replaced. Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 Page 16 The home was purpose built and is spacious and accessible. A number of bedrooms have been redecorated since the last inspection. New shower rooms have been fitted on the ground floor and the first floor. The manager said that she has been obtaining estimates to replace the bath in the physical disability unit with a specialist adjustable bath that can be used by more of the residents. Communal areas are looking somewhat shabby and some parts of the corridors and doorways are badly knocked and need protection from wheelchairs and other equipment. Some of the corridor ceiling tiles are stained and strip lighting does not give a homely atmosphere. The corridor carpet near to kitchen entrance is thread-bare. The home is due to have a major refurbishment starting in May 2008. The physical disability unit has a large sitting room set out well with chairs in groups and small tables in between. A conservatory is attached. There is some storage of large wheelchairs and activity equipment in the conservatory which makes it look untidy and not conducive to sitting in. A small lounge on the unit is no longer used and the manager agreed that this might be changed into a storage room for such equipment. The main lounge in the dementia care unit has been rearranged into small groups of seats to enable more contact between residents. The dining area was set out well with table clothes, condiments and napkins. This unit would benefit from having an office for the nurses, as current arrangements do not provide any privacy for staff using the phone or speaking with relatives and other visitors. Space for records and medicine storage is also very limited. All areas of the home were clean and there were no unpleasant odours. Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Enough qualified and experienced staff are provided to meet the needs of residents. EVIDENCE: Staff rotas showed that there are enough nurses and carers on duty by day and night to meet the needs of the residents. Staffing levels have been increased since the last inspection and there are no vacancies at present. There is still a problem with staff sickness absence and it is being monitored. This means that there is some use of agency carers. There are 49 care staff employed. Fifteen have a national vocational qualification in care and eight are working towards a qualification. Others are waiting to start NVQ. Personnel files for four newly appointed staff were looked at. These contained all relevant checks so that the manager was sure they were suitable to work with vulnerable people. Induction and foundation training are provided for new staff and this is recorded in training files. Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 Page 18 The training matrix showed that all staff have attended moving and handling training. Most had training during 2007 but some have not had an update since 2006. Most of the nurses and care staff, and all of the catering staff, have done food hygiene training. About half of staff have completed infection control training and others are due to attend in the near future. The records showed that all staff have attended recent fire training. Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management of the home has improved steadily over the last year to ensure that the best interests of residents are served. EVIDENCE: The manager is a registered nurse. She has almost completed a management qualification and is registered with the Commission for Social Care Inspection as manager of this service. Staff spoken with said that the manager is very supportive. Comments included: she has made a lot of improvements: she listens to us: if we want anything we just ask: she has made a difference. The Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 Page 20 manager is very open about issues at the home and what she has done to address them. Meetings have taken place for all staff, residents and relatives. Feedback from the last company satisfaction survey states: very good 20 , good 46 , fair 27 , poor 5 , very poor 1 . This information was shared at the meetings. Monthly visits required by regulation 26 of the Care Homes Regulations are carried out by the regional manager and a report is written. The manager, deputy manager and the acting regional manager have all been involved in auditing care plans to try and raise the standard. There is a comprehensive team audit which is carried out twice a year and covers all systems of the home. Small amounts of money may be left at the home by families for their relatives to buy personal items. A separate account is maintained for each person. A health and safety meeting is held every three months. The maintenance person carries out regular checks of emergency lighting, fire fighting equipment and fire call points and records these in the fire safety log. Staff training regarding fire safety and prevention had been taking place and the last fire drill was recorded on 8th April 2008. Information provided by the manager in the annual quality assurance assessment indicated that all plant and equipment had been tested and serviced as required. A monthly bed rail audit is completed by staff, and charts in residents’ rooms showed that frequent visual checks of bedrails were carried out whenever a resident requiring bedrails was in bed. All policies and procedures were reviewed in 2007 Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 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 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 3 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 Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? no 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. Standard Regulation Requirement Timescale for action 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 OP19 OP19 Good Practice Recommendations Implement the programme of refurbishment for communal areas that have become shabby. Develop and maintain safe and pleasant outdoor sitting areas for residents. Rosedale Manor Care Centre DS0000018738.V359645.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection North West Region CSCI Preston Unit 1 Tustin Court Port Way Preston, PR2 2YQ 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. 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