Inspection on 23/05/06 for Rosedale Manor Care Centre

This inspection was carried out on 23rd May 2006.

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 but made no statutory requirements on the home.

Other inspections for this house

Rosedale Manor Care Centre 23/04/08

Rosedale Manor Care Centre 23/04/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Rosedale Manor Care Centre Sherborne Road Crewe Cheshire CW1 4LB Lead Inspector Wendy Smith Key Unannounced Inspection 9 am 23rd and 31st May 2006 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.V289668.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 Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 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) Judith Barton Care Home 80 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (24), Mental disorder, excluding learning of places disability or dementia (1), Old age, not falling within any other category (56), Physical disability (10) Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 80 service users to include: * Up to 56 service users in the category OP (old age not falling within any other category) may be accommodated. * Within the 56, 1 named service user in the MD(E) (mental disorder over 65 years of age) category may be accommodated. * Up to 10 service users in the PD (physical disability) category may be accommodated. * Up to 24 service users in the category DE(E) (dementia over 65 years of age) on the Woodlands Unit. * Within the 24, 1 named service user in the category DE (dementia under the age of 65 years) may be accommodated until 7th August 2008. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection. 6th January 2006 2. 3. Date of last inspection Brief Description of the Service: Rosedale Manor care centre is a detached 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. Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was carried out by two regulatory inspectors on 23rd and 31st May 2006. The home had 66 residents, of whom nine are under 65 years of age, and ten service users were receiving intermediate care. Feedback was given to the manager on 20th June 2006. Time was spent in conversation with the manager, the deputy manager and a number of staff. Residents and visitors were also spoken with and, in general, all were satisfied with the care that they were receiving. A sample of care plans was looked at, arrangements for medicines were inspected, and management records were looked at. Comments cards were sent to GP’s and social workers, and comments cards were also left at the home for relatives/visitors to complete. The home’s fees are from £329 to £800 per week. What the service does well: What has improved since the last inspection? There is a wider range of social activities available for residents. Staff working on the Woodlands unit had a better understanding of issues regarding the use of physical interventions. Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 6 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 Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 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.V289668.R01.S.doc Version 5.1 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 the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are assessed prior to admission to ensure that their care needs can be met at Rosedale Manor. Service users admitted for intermediate care are supported to regain their independence. EVIDENCE: Care plans of residents on Willows and Woodlands units showed that they had been assessed by the home manager before admission to Rosedale Manor. The residents spoken with during the visit were appropriately placed at the home. The home provides twelve places for intermediate care contracted to the local Primary Care Trust. The manager informed the inspectors that intermediate care will continue to be provided at Rosedale Manor for the next three years. Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 9 Service users are usually admitted from hospital but sometimes from their own home. Before admission, a needs assessment is carried out by a nurse and a social worker. Initially, information is given to the home by telephone but a social worker said that she tries to ensure that a care file is taken to the home before the service user arrives there. The social worker said that between 80 and 90 of service users are able to return home, usually with a care package. They may have a home visit with an occupational therapist before discharge. Intermediate care is intended to be provided for up to six weeks but is sometimes extended for a longer period. The intermediate care team, including doctor, social workers, therapy staff, and a nurse from the home, meets every Tuesday morning at the home to review all service users. One of the inspectors was able to attend the meeting held on 23rd May 2006. The information provided for service users in their rooms could be improved. There was an old Bettercare service user guide and a folder provided by the Primary Care Trust. Neither of these was particularly ‘user friendly’ and if intermediate care placements are to continue for a further three years then a single service user guide, that is informative and easy to read, should be made available. Recommendation made. Rosedale Manor Care Centre DS0000018738.V289668.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): 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some care plans are completed to a satisfactory standard, but others are not and therefore do not show that the health needs of residents are met. EVIDENCE: Service users admitted for intermediate care have a file that contains a ‘Nursing Care Plan’ but had been written by a social worker. The care plans were not evaluated. Home staff write only in the daily progress report and it is unclear who is directing the care. For example, a service user who was admitted in January 2006 had made slow progress and still had the same care plan as in January. Whilst the records may be effective for service users who have a short and uncomplicated stay, they did not appear appropriate for those requiring a longer stay and with more complex nursing needs. It may be necessary for the home’s nursing staff to add to these documents, for example a bedrail risk assessment, to ensure that they are consistent with those in use in the rest of the home. Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 11 All residents have a care plan and the care plan looked at for a resident on Willows unit had been completed to a good standard. The resident was aware that he had a care plan and said that he could look at it whenever he wished to. One care plan looked at for a resident admitted to Meadows in March 2006 was of poor quality. There was no information sheet at the front, the social assessment had not been filled in at all and a chart to record baseline observations of temperature, pulse and blood pressure was blank. On admission the resident’s Waterlow pressure risk score was 23, very high risk. A care plan had been written but did not prescribe the use of any pressurerelieving mattress or any repositioning when in bed. However her daily records say that she is turned two to three hourly. A review on 3rd May 2006 said that her skin was very fragile, but still no prevention was mentioned. Breakdown of skin on both legs and an elbow was recorded 17th May 2006 and wound assessment charts filled in. A care plan for personal hygiene was not evaluated. A nutritional risk assessment on 1st April 2006 had a score of 13. It had not been reviewed since, and no weight or BMI was recorded in the care plan. A care plan for continence had not been evaluated. A general risk assessment was not signed. There was a brief care plan for ‘Alzheimer’s’ which was very poor in content. A handling plan said that a hoist and sling should be used but did not detail what hoist or what type or size of sling. A care plan is in place for the use of restraint, ie wheelchair lap strap and bedrails. The risk assessment for bedrails says that a medical practitioner has been consulted, it does not state that the risks have been explained to the relative who gave consent. The use of restraint had not been reviewed. A resident in the dining room had great difficulty in managing her meal. Her care plan was looked at. This showed that her weight was monitored monthly and although her weight was very low it was stable. An entry in the care plan in November 2005 indicated that she was awaiting assessment by the speech and language therapist but it appeared that this had not taken place. There was no indication that she was receiving any nutritional supplements, or had been assessed by a dietician. A resident on Woodlands unit had been seen by her GP due to an increase in epileptic fits. Rectal diazepam is prescribed to control these, but there is no care plan to indicate under what circumstances it should be used. The manager has confirmed that care plan training is to be provided for all of the home’s nurses within the next month. On Woodlands unit a resident had severe facial bruising to the right eye and forehead. The nurse in charge confirmed that an unwitnessed accident had Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 12 occurred during the night of 22nd May. Night staff reported that the resident had been checked upon twice during the night as she had got out of bed and on one occasion was found sitting in an armchair. The nurse in charge said the resident had been getting in and out of bed during the night for the past month but normally slept very well. There had been two previous falls in April and May. An injury had resulted in April. Staff had not put any different safety measures in place such as more regular checks or the use of a pressure mat linked to the call system, to alert them to the resident getting out of bed. The manager provided the information that 34 residents had bedrails in place, which is a high proportion. A service user admitted in April 2006 had developed a serious pressure sore. It was suggested that this person could not always have the care prescribed due to inadequate staff numbers and a nurse said that it was ‘chaos’ on the unit between 6 am and 7 am, when large number of service users all require assistance at the same time. This was refuted by the home manager who considered that staff were always provided in adequate numbers to meet the needs of service users, however the allocation of staff for the intermediate care unit was to be reviewed. A service user spoken with had been at the home for six weeks. She had no complaints about her care. She said that the food was good and she prefers to have her meals in her own room. She said that she sometimes has to wait quite a while for the call-bell to be answered. An unoccupied bedroom on the first floor had clothes and continence pads in the wardrobe. There were a lot of notices sellotaped to furniture both in bedrooms and in dining rooms, some of which contained personal information about residents. This did not look homely and does not show respect for the privacy and dignity of residents. Folders containing personal information about residents were found in the small lounge on the first floor. Requirement and recommendation made. The medicine room on the first floor has little space to accommodate two medicine trolleys, a controlled drugs cupboard and a fridge. The trolleys are several years old and a nurse said that they are hard to push. The temperatures of the room, and of the fridge, are recorded daily. They are often above safe limits but no action is taken. A nurse said that the room temperature is sometimes in excess of 30 degrees and was recorded as 28 degrees on 12th May 2006. This is above the safe limit for the storage of some medicines. Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 13 The record of signatures for staff administering medicines contains the names of staff who left the home some while ago and needs to be updated. Drugs received were signed in on the MAR sheets but for items carried over from the previous month, no stock balance was recorded. The storage and recording of controlled drugs appeared to be satisfactory. A medicines storage room on the ground floor is shared with Willows unit. As well as medicines there were cigarettes, CDs, clothes and other items stored in this room. Medicines on Woodlands unit were satisfactory apart from two missing signatures. Requirement made. Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 14 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): 11, 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Social opportunities are provided for residents, but the arrangements for mealtimes could be improved. EVIDENCE: The home has two part-time activities organisers. On the day of the visit a number of residents enjoyed a therapy afternoon in a ground floor lounge. One of the activities organisers was interviewed and was very enthusiastic about her work. She is carrying out a survey of what activities residents would like. A programme of activities is available every day from Monday to Friday and this includes one to one sessions for some residents. Good records are kept of what activities have taken place and who has participated. An individual record is also kept for each resident. A minibus is available for trips out two weeks in every six. A resident spoken with on Willows unit said that the choice of meals is very good. He was very positive about the care he receives and described the staff as ‘brilliant’. He was pleased to be able to personalise his bedroom with his own belongings and pictures, radio, TV and computer. Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 15 On the first floor, lunch is served in two sittings. First for residents who require some assistance (referred to by staff as ‘feeders’) and second for those who are more independent. The first sitting was not a pleasant experience. Pop music was playing on the radio. Residents needing help with their meal were ‘queued up’ for assistance. There were three care staff and a volunteer to help 13 residents. Other members of staff were assisting residents in their bedrooms. In general, staff spoken with seemed to be aware of good practice but did not have time to spend with each resident. Pureed food was nicely presented in individual portions. The room is very large and there is no relaxed and pleasant atmosphere conducive to enjoyment of a meal. The week’s menu was displayed in the entrance area on the ground floor but not in the dining rooms where it could be seen by residents. The main meal is at lunch time and there are two choices of main course available plus other alternatives. There is a light meal at teatime then biscuits for supper. This may not meet the nutritional needs of residents who are not able to eat very much at each meal and therefore go for a long time with just a sandwich and a biscuit. The care plans of two frail residents did not give any mention to nutritional supplements. This was discussed with the home manager who said that there was also toast and sandwiches available at supper time. No menus were available on Willows unit and the nurse in charge did not know what choices were available. She said decisions about choice were made the night before. ‘One of the staff asks the residents that can communicate what they want, fortunately we know what residents like so those who can’t communicate we choose for them.’ Details of residents’ dietary needs were displayed in the dining room and recorded if they had a pureed, soft or normal diet but did not include residents’ dietary preferences. This information was requested to be removed from public view. During meal times a qualified nurse administered medicines while residents were eating their meals. A staff member was allocated to assist those residents who were being cared for in bed. The other qualified nurse on duty and two care assistants assisted other residents. Two visitors assisted their relatives. Out of 23 residents, eight require regular assistance from staff to eat their meals. A carer was helping a resident to eat. He placed the meal in front of her without asking her what she wanted and informed her it was in front of her. She pushed the meal away. He put some of the meal on a spoon and showed it to her and said ‘ come on it will do you good, try it’. She again pushed his hand away. He again tried to encourage her by showing her food on the spoon and she persisted in pushing his hand away. He then gave up and left the spoon on the plate. The carer had very long hair in a ponytail over his left shoulder and when he leant over the resident to offer assistance his ponytail was at her eye level and close to her face. Recommendations made. Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 16 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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are investigated by the home manager and good records are kept. EVIDENCE: Complaints received are recorded and filed in a complaints file. The complaints procedure in the file was dated March 2003 and is probably not the current version. An index would be helpful. The records showed that complaints received had been addressed by the home manager and fully investigated. The last complaint filed was from 9th March 2006 and at the time of the inspection the manager was dealing with a complaint regarding the care of person who had respite care at the home. This was found not to be substantiated. Two concerns have been reported to Commission for Social Care Inspection by social services during 2006. Recent reports of money missing from two residents’ rooms have been reported to the police. All new staff receive adult protection training. Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 17 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 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 clean, safe and comfortable but some areas are looking shabby. EVIDENCE: The home is set in large grounds that are overgrown with grass and weeds. The manager explained that the lawn mower needed repair and there had been a considerable wait before the repair could be carried out. Previous reports have identified that some windows are in a poor state of repair and require painting and in some cases repair to the woodwork. This has not yet been done. There are a considerable number of blown windows, where the double glazed panels are filled with condensation. This includes some in bedrooms which means that the resident can’t see out clearly. The manager said that estimates were being obtained for the replacement of windows. Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 18 The home has a new maintenance person. He informed the inspector that he had been working at the home for three weeks and had received some induction training from the home manager. He had not been able to find records and plans needed for his work but was gradually putting these together. On Willows unit some bedrooms have sliding doors onto a patio, however there is a six-inch gap between the patio doors and the patio, and the level of the patio is higher than the patio doors so is not wheelchair accessible. A resident living in the unit could not open the patio door, as the lock was broken. There is disabled access to the outside at the front and rear entrance to the building. In one of the first floor bathrooms there are two wardrobes with continence pads, clothes and other bits and pieces stored in them. There was a toilet seat raiser in the bath, a wheelchair, a walking frame, a clinical waste bin and a linen skip. The toilet has a handrail on one side only. The wallpaper was coming loose and the mirror tarnished. The furniture in the intermediate care dining room is in a shabby condition. The home manager said that Four Seasons plans to refurbish the building in 2007. Plans are in place for a further building in the grounds and the manager said that building work is due to start in the summer. The home was clean and there were no unpleasant odours. Requirement and recommendations made. Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 19 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, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels must be reviewed to ensure that there are always enough staff on duty to provide the care needed by residents and to minimise the number of accidents. EVIDENCE: There are separate staff rotas for the Willows and Woodlands units and for the North and East wings on the first floor. East includes intermediate care service users and some residents. The staff signing in book showed that nine staff, including two registered nurses, were on duty on the first floor on the morning of 23rd May 2006. One member of staff had escorted a service user to a hospital appointment. Some service users admitted for intermediate care attend a number of hospital appointments during their stay and this can put a strain on staffing. The provision of staff escorts needs to be negotiated with the Primary Care Trust. Rotas for the first floor are difficult to follow, particularly as they are sometimes written on two sides of the paper. It appears that a thorough review of staffing is needed and the manager was considering a separate team of staff for intermediate care. If service users are being admitted with a high level of need and requiring intensive rehabilitation, then staffing numbers must reflect this. Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 20 The Woodlands unit had two qualified nurse and two care staff on duty. A care assistant had not arrived for duty. Cover for this staff member was not obtained until approximately 1300 hours. The nurse in charge said of the staffing levels at the time of the site visit ‘we are behind, we have four residents in bed, everyone has had their breakfast but we get behind with other things like taking residents to the toilet and making beds. We cannot give one to one care. It takes the trained staff over an hour to do the medicines. We cannot observe residents all the time and provide one to one supervision this is very difficult. The new lady keeps standing up is at risk of falling but we cannot stop her. With four residents in bed it’s hard to get them all up with only four staff’. Two members of care staff spoken with said that they had complained to the home manager about what they considered to be inadequate staffing levels. The manager has confirmed that disciplinary action is being implemented for staff who fail to turn up for duty. Accident records for Woodlands were examined for the period 8.1.06 to 23.5.06. During this period 54 accidents were recorded. 22 of these accidents occurred during the night, which were not witnessed when residents were found on the floor. Accidents records were kept in each residents file but did not record a reference number to comply with the Data Protection Act. Two accidents were attributed to a resident when the residents’ wheelchair tipped backwards with the resident in it. The nurse in charge said ‘the accidents happened when he was waiting for us to take him to the toilet. We have now stopped the practice of leaving him unsupervised. We don’t know how it happened he just tipped himself backwards’. The Four Seasons care plan documentation includes a ‘dependency rating’ for each resident, however there was no evidence to suggest that this was utilised to indicate appropriate staffing levels for the dependency. Concerns regarding staffing were discussed with the home manager. She confirmed that staffing for the intermediate care unit is to be increased, and she will also carry out, as a matter of urgency, a review of staffing levels on the Woodlands and Meadows units to determine whether staff numbers are appropriate to the dependency needs of residents. There did not appear to be any difficulties with staffing on the Willows unit. The recruitment record for a member of care staff who started working at the home in April 2006 contained an application form, one written and one verbal reference (written confirmation of the verbal reference was being pursued) a satisfactory Criminal Records Bureau disclosure, a contract of employment. He had almost completed induction training, including health and safety topics. The recruitment records for a registered nurse, employed at the home since February 2006, were all in order. Staff spoken with confirmed that they had received induction training. Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 21 The home employs 47 care staff of whom 26 have NVQ or equivalent. The deputy manager takes lead responsibility for staff training. A training matrix showed that all staff have received statutory training for safe working, but most are overdue for training updates. The deputy manager said that in order to keep these up to date he would need to have more hours allocated for training. The manager said that all of the nurses will be required to attend a full day training, to include care planning and adult protection, within the next month. Requirements made. Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 22 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, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an experienced manager who is taking action to address identified shortcomings with regard to care planning and staffing. EVIDENCE: The home manager is a registered nurse who has previous management experience and has almost completed the Registered manager Award. The home also has a deputy manager and Willows and Woodlands units have their own unit manager. Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 23 The home has two part-time administrators who look after the day to day finances of the home. The administrators look after small amounts of personal spending money for residents. Both electronic and written records are kept. A number of residents have their financial affairs looked after by social services or by a solicitor, and three are able to look after their own finances. The majority have a family member who looks after their finances. A meeting for the nurses was held on 18th May 2006 and the minutes of this were looked at. These showed that there were a number of items put forward for discussion by the manager and that staff were also able to raise any issues that they wished to discuss. A health and safety meeting was held in February and this was minuted. Residents and relatives are invited to attend coffee mornings where they can meet with the home manager and discuss any concerns or suggestions. A weekly report prepared for head office includes details of any accidents, incidents, pressure damage, weight loss, infections, POVA issues and complaints. Monthly monitoring visits, required by regulation 26 of the Care Homes Regulations, are carried out by the area manager. The home manager said that she would personally be carrying out an audit of all care plans. The manager provided evidence that plant and equipment in the home are regularly serviced and maintained. There had been a significant number of accidents occurring to residents and there is a high use of bedrails in all parts of the home. These need to be investigated. Records showed that all staff have received training regarding safe working practices but most staff had not received updates for a considerable length of time. Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 24 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 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 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 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Timescale for action Care plans should provide 19/06/06 information about the needs of residents and service users admitted for intermediate care. They should instruct staff how to carry out the care for each individual, and should be reviewed and evaluated regularly to determine whether the service provided is meeting the individual’s needs. (Timescale 31/8/05 not met) Medicines must always be stored 19/06/06 at a safe temperature. External woodwork must be painted and repaired as needed. (Timescale 30/09/05 not met) Sufficiently experienced and qualified staff must be provided in adequate numbers at all times to meet the needs of residents. (Timescale of 06/01/06 not met) 19/06/06 Requirement 2 3 OP9 OP19 13 23 4 OP27 18 19/06/06 Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 26 5 OP30 18 Staff must receive regular 30/09/06 updates of statutory training. 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 OP6 Good Practice Recommendations Service users admitted for intermediate care should receive information about the home and the service provided in an easy to read form. Personal information about residents should not be on display. Arrangements for assisting residents with their meals need to be reviewed to ensure that mealtimes are pleasant for residents and that they receive food of their choice. Double-glazed window panels containing condensation should be replaced. There should be a programme of refurbishment for areas that have become shabby. 2 3 OP10 OP15 4 5 OP19 OP19 Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Rosedale Manor Care Centre DS0000018738.V289668.R01.S.doc Version 5.1 Page 28 - 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. 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