Inspection on 18/07/05 for Rosedale Nursing Home

This inspection was carried out on 18th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 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 Nursing Home 30/04/07

Rosedale Nursing Home 22/06/06

Rosedale Nursing Home 10/11/05

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Rosedale Nursing Home The Old Vicarage Catterick Road Catterick Garrison DL9 4DD Lead Inspector Anne Prankitt Unannounced 18 July 2005 19:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Rosedale Nursing Home Address Catterick Road Catterick Garrison North Yorkshire DL9 4DD 01748 833302 01748 834468 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Maria Mallaband Care Homes Ltd Mrs Muriel Gazzard Care home with nursing 71 Category(ies) of PD Physical disability (71) registration, with number PD(E) Physical disability - over 65 (71) of places OP Old age (71) Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 25th November 2004 Brief Description of the Service: Rosedale is a care home providing nursing care and personal care only for up to 71 service users. It is located near the centre of the garrison town of Catterick. The home comprises of two buildings. It is set in extensive grounds with protected wooded areas to the north and west, and lawn to the south facing aspect of the home. Since the last inspection, the home has been acquired by Maria Mallaband Care Homes Limited. Main Building This building was previously a vicarage. There have been several additions to the original building since being opened in 1986; one on two floors as well as a twelve-bedded single storey unit. An additional 9 beds were provided in February 2004 in the main building with an extension and internal rearrangement of the internal spaces. The Lodge This is a separate 21-bedded unit within the curtilage of the grounds. It was opened in February 2004 and is being used for service users admitted for personal care only. Access to the upper floors in both buildings is facilitated by two vertical lifts. Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was prompted by an anonymous complaint made initially to the Commission for Social Care Inspection, and before Maria Mallaband Care Homes Limited became owners of the home. The complainant alleged that they had witnessed one resident experience poor staff attitude, and that the medical attention that the resident asked for had not been sought. The matter was referred to Social Services for investigation under the multi agency vulnerable adults procedure, and an unannounced visit was made to the home by an inspector on the day that the complaint was received, to check that the residents at the home had received the medical attention that they needed. This inspection began on 18th July 2005, when Anne Prankitt and Bridgit Stockton, Regulatory Inspectors, visited the home unannounced at 7pm, and stayed for approximately one hour and fifteen minutes. Following this, a further two announced visits were made on 1st and 2nd August 2005. Pauline O’Rourke, Regulatory Inspector, accompanied Anne Prankitt and Bridgit Stockton at the announced inspections, which lasted for a total of seventeen hours. During the inspection, a care staff meeting was undertaken, service users were spoken with, the views of a visiting professional were sought and discussion took place with trained nursing staff. In addition to this, a number of records were inspected, including care plans, staff recruitment, supervision and training files, accident book, complaints book and staff rotas. The systems used for keeping medication on behalf of residents were also inspected. The majority of this inspection was spent in the Main Building. Some time was also spent in The Lodge, which will be inspected in further detail at the next inspection. The management of Maria Mallaband Care Homes Limited have assisted in full throughout this process, and they, with the registered manager, are committed to working with the Commission for Social Care Inspection in order that requirements resulting from the inspection can be addressed quickly and fully. The area manager has already produced their own action plan prior to receipt of this report, in order that any shortfalls to the standards can be improved upon quickly, and feedback has been received that action has already been taken in a number of areas. What the service does well: Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 6 The home is set in well kept gardens, which many of the bedrooms overlook. The home is well staffed. Staff carried out their duties quietly and unobtrusively. There is a choice of communal space and dining areas, some of which overlook the grounds. There is a range of equipment available to assist residents and staff. The routine in The Lodge is flexible, and residents said that they were happy with the care provided by the staff. Comments included that ‘staff are nice and gentle’. What has improved since the last inspection? What they could do better: The home must ensure that they only admit residents to the home whose needs they are equipped to meet. Care plans must be reviewed to take into account all areas of residents’ lives, and routines of the home must not take preference over the individual choices, privacy and dignity of residents. Issues which affect the vulnerability of residents must be shared with the appropriate professionals, and the views of care staff about the running of the home should be actively sought. The medication systems must be improved upon. The menu must be given attention, residents must be afforded more flexibility around meals and mealtimes, and the kitchen must be properly cleaned. Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 7 The registered manager must ensure that all areas of the home are warm, and free from unnecessary risk. This includes checking regularly that equipment used around the home is safe. They must also ensure that residents can call staff for assistance at any time. The good supply of staff provided at the home must be used effectively. One resident said that ‘staff are busy all the time’. The registered manager must ensure that all necessary checks are carried out on staff before they begin working with residents. 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 Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 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 standard(s) 3 The registered manager has permitted the admission of service users into the Main Building whose needs fall outside the categories of registration within which the service is registered to operate, which could result in a failure to effectively meet the holistic needs of those and of other people who live at the home. EVIDENCE: The Main Building The trained staff undertake a pre admission assessment prior to service users being admitted, unless admitted under the ‘rapid response’ service, when they do not. Care staff receive a handover only once or twice each week. Comment from the care staff included that they are sometimes first aware that an emergency admission has taken place during the night when they enter the room the following morning, and that they have no information prior to that about the person who has been admitted. Some assessments were basic, consisting of one or two words to describe someone’s condition. All available pre admission information was not considered when formulating the care plan, and it was evident that, in four of Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 10 the nine care plans seen, people had been admitted to the home with the diagnosis of dementia as their primary care need. The home is not registered to admit this category of service user. It does not have the facilities, resources, time or staff equipped with the necessary skills, to effectively meet their needs. The registered manager must be able to assure service users that the home is equipped to meet their needs, and to refuse the admission where the home cannot. The Lodge It appeared through observations made, and the care plans seen, that The Lodge was an appropriate placement for those service users who lived there. Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10 The care planning systems in place in the Main Building are not robust enough to ensure that service users’ needs are met safely and fully. The privacy and dignity of service users in the Main Building is compromised because of the established rigid routine. The medication policy and procedure that is currently practiced in the Main Building does not protect vulnerable service users. EVIDENCE: The Main Building Although all service users had a care plan, they were not written in sufficient detail to ensure that staff could fully understand service users’ needs. It was sometimes difficult to decipher why service users were receiving care, and what care services they were actually receiving. All care plans must be reviewed, taking the following points of particular concern into consideration: • There was no reference in any of the files about the social and psychological needs of people. This was of particular concern where a service user was being treated for depression, and where service users suffer from dementia. J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 12 Rosedale Nursing Home • • • • • • • • There was some evidence to support that the services of outside health professionals are sought. In one case this had been provided, but the action recommended had not been included within the care plan, and the treatment prescribed was not being properly implemented. Staff often have a discussion with the General Practitioner, rather than the service user being seen. One care plan revealed that a service user had asked to see the doctor and the police. The request had not been actioned, and there was no reason for this decision recorded. Nutritional needs were not adequately recorded. There was evidence that service users were being weighed on a regular basis. However, one service user had lost 28lb in weight over a period of two months. The weight loss had not been acted upon, and the care plan had not been changed in order to direct staff to give the care required. The care plans in place, which gave information about pressure sore treatment and intervention, were lacking in information. Where a service user suffered from MRSA, there was no care plan in place to instruct staff as to how this should be addressed. Whilst it is correct that care plans should be kept locked away, care staff do not have a key to access them, and stated that they ‘don’t bother with care plans’. Composite records are currently being kept. This must cease. Entries made by trained nursing staff within the daily statements sometimes used negative language, such as ‘demanding’, and stated that a service user was ‘reprimanded’. Such recording demonstrates a lack of respect for service users, and read as if the needs of people admitted with challenging behaviour were not fully understood or considered when providing care. Risk assessments were not being used as a working document. For instance: • • One service user who was assessed as being at high risk from pressure sores had no pressure relieving equipment in place. There was no record in the assessment as to why this decision had been reached. It had been identified that a service user required full use of the hoist. However, they occupied a shared room with little space. Should the equipment be used, then the privacy and dignity of each of the service users would most definitely be compromised, as there was insufficient room to use the privacy screens whilst the hoist was in the room. Bedrails were provided on the consent of relatives. They were loose and ill fitted, and there were a number of incidents reported in the accident book relating to their use. • During the announced inspection, staff were clearly rushed, and discussion during the staff meeting confirmed that this was always the case. The routine at the home allows for little flexibility, and results in staff being able to spend little if any quality time with service users, despite good staffing levels. Some service users looked unkempt, and had not had their hair attended to. False Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 13 teeth were found lying in the bowl used for washing a service user. (The service user had already been taken to the lounge.) A service user’s spectacles had also been left behind in their room. In one of the shared rooms there was only one commode, and the privacy of the occupants could not be guaranteed. Messages to staff about intimate aspects of personal care were posted inappropriately in two bedrooms. Communal toiletries and net underwear were used throughout the home. At the unannounced inspection, one service user said they were embarrassed because they were sitting in a communal area in their nightclothes at 7pm, but explained that the routine of the home dictated the time at which they went to bed. Contrary to this, some of the more independent service users spoken with said that they could follow their own routine within the limits set by communal living, and gave times at which they chose to rise. One General Practitioner was spoken with. They were satisfied with the care provided at the home. The medication system could not be properly audited because of a poor stock control system. There were several areas of concern which were discussed with the staff at the time of the inspection: • • Prescription only medication of deceased service users was being administered to existing clients within the home. Prescribed dressings on the medication administration record did not match with the dressing documented as being used in the care plan. Neither corresponded with what the nurse said the wound was being dressed with. Drugs were being secondary dispensed. Night staff complete a medication round each morning at the end of a 12 hour shift. This involves waking service users who are still asleep, and includes the administration of drugs such as aspirin, which should not be taken on an empty stomach. The equipment in which drugs were stored was not clean. The dressings trolley was dirty, and was transferred from room to room, without being cleaned in between, and with no consideration given to the risk of cross infection. One medication was signed for but had not been given on two occasions. The stock levels of one controlled drug were correct. However, the MAR sheet and CD register had not been signed. In another case, the administration of a CD medication was signed, but not witnessed. One service user had not required their CD drugs for some time. This should be referred to the GP for consideration for discontinuation, and all stock returned to the pharmacy. Temazepam is not currently recorded in the controlled drugs register. • • • • • • • Medication is reviewed six monthly by the General Practitioner. There was a fridge for cold storage, and daily records of temperatures kept. Staff were in Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 14 the process of completing homely remedies sheets for all service users as instructed by Maria Mallaband Care Homes Limited, and following advice from the GP as to which were applicable. The Lodge Care Plans in The Lodge were of better quality. Observations made confirmed that staff consider the individual and holistic needs of service users on a daily basis. Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 and 15 Service users rights to flexibility and choice as to how they wish to live and be cared for is compromised by the rigid institutional routine that is firmly established in the Main Building. The menu is monotonous, and mealtimes are dictated by the routine of the kitchen. EVIDENCE: Main Building The care staff who work during the day explained that they are extremely busy, and that there are certain timescales that must be met, and which dictate the activity at the home. The routine of the day is currently dictated to by the tasks each group of staff have to perform and the priority appears to be given to the needs of the kitchen, and of the number of service users that need to be ready for bed when night staff arrive. Main mealtimes are condensed into an eight hour period, with the more frail service users appearing to have no choice as to how their day is structured. The staff said that deviation from the routine results in a ‘knock on effect’ for the rest of the day. Service users are assisted to bed from approximately 6pm onwards. The home employs an activities co-ordinator. There are a small number of communal activities available to service users, such as bingo and beetle drive. There was no evidence from either documentation or observation to suggest that individual activities take place. The care assistants intimated that they Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 16 have little time to chat with service users, as they were always too busy, and that they would be frowned upon by their colleagues should they break from their routine to do so. There were plenty of visitors and the policy has been amended by Maria Mallaband Care Homes Limited to reflect that visitors are welcomed at the home at any time. The kitchen provides meals for up to 71 service users and any staff who require a meal. It is small, and on the days of inspection, was dirty. The equipment provided is not adequate for the proper storage of prepared food. A hot trolley is provided to allow meals to be taken across to The Lodge. The same trolley is used to transport meals to the lounge when those service users who require assistance have finished their meal. There is no hot plate to store the food once it is ready to serve and food was ‘plated up’ prior to staff taking it to the service users. Staff were late taking meals to service users on the first day of the inspection, when there was a choice between chicken or pork chop. There had been no allowance made for this by the kitchen staff, and subsequently the meal was cold and the meat tough. Some service users found the meat difficult to chew. Two service users who eat in their room said that the meals are always cold. Service users said that there was always a choice but they were reluctant to request an alternative if they did not like either of the choices. The meals are provided at 8-8.30am, 11.30am –12.30pm and 4.30pm-5.00pm Suppertime is at 8pm. Not all the service users sit at a dining table for their meals and several were seen to be negotiating their teatime meal, including soup, on their knee. The meal was provided in plastic plates and bowls. All the service users who require assistance were fed in their sitting chairs. One resident was observed being fed in a reclined chair. This is a very poor posture for feeding. There is no written menu, and the cook on duty stated that the meals provided were dictated by the meat left out by the previous cook. The only record kept of ‘main meals’ provided at lunch time was the temperature check of the cooked meats. This record showed that for a period of six days some form of beef was provided as one of the choices. There was therefore no evidence that a varied, wholesome and nutritious diet is provided, or that the needs of those service users requiring a specialist diet were catered for adequately. The registered manager was not aware that there was not a menu. She stated that there always used to be. The question of how those service users who require assistance and are in bed at supper time manage their supper was not answered. Care staff concluded that the kitchen would ‘go mad’ if the routine was altered. The Lodge There appears to be more opportunity in The Lodge for service users to choose how they spend their day. Rising and retiring times are more flexible, and there is a stronger emphasis on individual social activities. Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 17 Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Service users have access to a clear and transparent complaints procedure which has not yet been tested. Whilst care staff were clear with regard to their responsibilities, the failure by the registered manager to report situations where the vulnerability of service users is compromised, could potentially result in service users being subject to unnecessary risk. EVIDENCE: There was no record of any complaint having been made direct to Rosedale since 1994. The complaint made to the Commission for Social Care Inspection was not firstly directed to the home, and there was suggestion made that the registered manager may not always be open to complaints. The complaints documentation is being changed, and the policy at the home has already been amended by Maria Mallaband Care Homes Limited. The service users’ guide was also in the process of being updated, to reflect the fact that the home has changed ownership, and that a complaint may be made to the Commission for Social Care Inspection at any stage, should the complainant wish to do so. There was one matter recorded in the incident book, which occurred in May 2005. The incident should have been reported to the local authority as a vulnerable adults issue, and to the Commission for Social Care Inspection under regulation 37. There was no evidence to support that either party had been informed by the registered manager. During discussion, care staff were Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 19 clear as to their responsibilities with regard to reporting matters of suspected or alleged abuse to the correct parties. Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22 and 26 Whilst service users live in homely surroundings, full use of facilities available is not made, which has a detrimental affect on care provision. EVIDENCE: The Main Building and The Lodge are two separate buildings. The home is set in well kept grounds. Maria Mallaband Care Homes Limited initially plan to refurbish one area of the Main Building. Main Building There are two sitting areas and a dining area in the Main Building. One sitting area, which is located away from the central area of the home, is very pleasant, but not used. Some areas of the home were cold. A number of rooms had secondary portable heating which was not secured to the wall and was unguarded. This practice is unsafe. One service user said that they were cold. Assistance was provided. Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 21 There is a nurse call bell system in each area of the home. However: • • One service user was sat alone in their bedroom, with no access to the call bell. They attracted the attention of staff by shouting for help. The records of one service user explained that because they had received no response, they had repeatedly called the nurse call bell. The nurse in charge made the decision to remove the call bell from the room, and check the service user half hourly instead. This is not acceptable. In one of the shared rooms, only one service user had access to the call bell once in bed. • One service user had been assessed as requiring full assistance with a hoist for moving and handling purposes. The bedroom they occupied was shared. The bed was positioned against the wall, and there was insufficient space to ensure that this activity could be carried out safely and effectively. Screening was provided in shared rooms. However, due to the needs of one service user who occupied a shared room, it would not be possible to use the screen when care was being provided. One bedroom smelt strongly of cigarette smoke. Outside the window, which was open, was the area where staff choose to smoke. This must cease. Not all rooms are fitted with lockable facilities. It is the intention of Maria Mallaband Care Homes Limited that these will be supplied as part of the plan of refurbishment. The Lodge The Lodge provide pleasant surroundings, including a pleasant and spacious sitting area, with which service users were satisfied. Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 Insufficient consideration is given to the effective deployment of staff, who are dictated to by a strict routine, in the provision of care. The standard of vetting and recruitment of staff is not robust, which potentially leaves service users at risk. EVIDENCE: Both the Main Building and The Lodge have a good supply of staff, and staffing levels are satisfactorily maintained. In the Main Building, as well as completing care tasks, care staff take round the tea trolley, set up the plates for lunch time and clear the tables. They said that if they were relieved of some of these tasks, they would have more time to spend with service users. They stated that suggestions about changing the routine are not always received positively, and that it is the expectation that service users will be either in bed, or dressed for bed before night staff commence their shift. The staff in The Lodge appear to have more time, in a routine that is more flexible to the individual needs of service users. There was evidence in the staff files that they had all completed Moving and Handling training and some also had a current first aid certificate. Staff said that they were completing learning distance courses in ‘dementia care’, ‘safe handling of medicines’ and ‘equality’. Some were training towards NVQ Level 2 accreditation. There was no evidence in the staff files this was the case, which also evidenced that there are gaps within the recruitment process: Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 23 • • • • • • Two files contained only one written reference Criminal Record Bureau checks and/or POVA First checks are not completed prior to deployment The registered manager has accepted CRB disclosures which have been completed at a previous place of employment The registered manager does not check the Personal Identification Number (PIN) of trained nursing staff A further follow up to a written reference was not completed by the registered manager where the content of the reference should have triggered this The files did not contain a contract of employment Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,35,36,37 and 38 Maria Mallaband Care Homes Limited have a good understanding of the areas in which the home needs to improve, and have adopted plans in order that this can be actioned. There are a number of health and safety issues which have been overlooked, and which place service users at unnecessary risk. EVIDENCE: The office door was shut throughout the inspection with a note on the door saying please ‘knock and wait.’ There was no indication if anyone was in the office and a visitor was seen to wait for at least 5 minutes before discovering that no-one was in. Some care staff said that the management were approachable but felt awkward going to them with suggestions/grumbles as they felt they would be told ‘its your job’. However, staff were seen entering the room to consult privately with the registered manager. Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 25 The area manager for Maria Mallaband Care Homes Limited assisted and participated throughout the inspection. However, the registered manager was not able to assist fully during the inspection process, or with the feedback at the end of the inspection. Throughout the inspection there was little evidence that there is a strong management team in place. There is a lack of communication at the home. Whilst nursing staff receive a handover at the commencement of each shift, care staff have handovers only once or twice each week. Some staff shifts do not have a handover at all. Staffing has split in to factions to ensure the work gets done. The staff have the time to provide only basic care. The care staff group were keen, and willing to change/train in order to improve their work practice. Basic supervision is carried out, but staff are not currently receiving 6 sessions a year. Staff meetings are not held regularly. Records are kept secure. The care plans in the Main Building are locked away and inaccessible without the key, which is held by the duty manager. The accident book is properly maintained but there is no evidence that audits are carried out so that service users who do fall frequently can be re-assessed. Maria Mallaband Care Homes Limited is currently addressing the problem whereby all monies belonging to service users are pooled, and kept in a central bank account. Service users currently have no immediate access to their monies. It was not possible to reconcile the bank statement with the individual monies sheets. There were a number of concerns relating to health and safety in the environment within the Main Building: • • Bed rails were not properly fitted, and in some cases there were no protective bumpers. The management were instructed to rectify this immediately, and before the beds were occupied again. Some of the en suite areas were not properly cleaned. In one case, a soiled pad had been left on the floor, and the commode left in an unsatisfactory state. There was a red ‘dissolvobag’ containing soiled linen on the floor. There was a urine stained jug on the floor of one en suite. The door to the sluice, which contained chemicals and a hot water supply, was unlocked. The door to the boiler room was also unlocked. The extractor fan vents in some areas required to be cleaned. A television in one bedroom was on a bedside table on castors. This was deemed unsafe, and the area manager required staff to organise an alternative suitable for the service user. There were no window restrictors fitted to two upper floor bedrooms. Fire safety records confirmed that staff have fire training every six months. However, the nurse who provides fire safety training to the night staff had received no fire training herself. This situation is not acceptable. J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 26 • • • • • Rosedale Nursing Home • • • • • The electrical fixed wiring certificate included a list of works to be completed in order that the system could be deemed fully satisfactory. The area manager confirmed that all but one matter, which was addressed on the day, had been dealt with. Written confirmation has since been received that all matters had been previously addressed. The emergency lighting to one area of the building was lit constantly. The registered manager needs to check that this does not effect the safe running of the system should the lighting fail. There was a fault recorded outside of the building. The registered manager stated that this was in the process of being repaired. The fire alarm checks are carried out mainly on a two weekly basis. This must be increased to weekly. There was a cracked tile in the shower room which needs to be repaired or replaced to reduce the risk from injury or cross infection. The kitchen was dirty. Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 x 15 1 COMPLAINTS AND PROTECTION 3 x x 1 1 1 1 x STAFFING Standard No Score 27 1 28 2 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 x 1 x x 1 2 3 1 Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 28 N/A 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 3 Regulation 14 Requirement The registered manager must ensure that pre admission assessment information is used in full in order that only those service users whose needs fall within the category of registration are admitted to the home. All care plans in the Main Building must be reviewed, to include consideration to the following points: 1. The psychological and social needs of service users must be considered and recorded appropriately 2. Composite records must not be kept 3. Care staff must be encouraged to use the care plans as working documents 4. Risk assessments for the use of the hoist must take into account the layout of the room in which the equipment is to be used 5. Bed rails must only be used following a multi disciplinary decision. The resultant risk assessment must be reviewed Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 29 Timescale for action 2nd August 2005 and maintained thereafter 2. 7 13,15 30th September and maintained thereafter regularly, to include written evidence that the equipment is checked on a regular basis All bed rails must be checked immediately to ensure that they are safe and fit for use 3. 8 13 Where a decision is made that a service users wish to see a GP has been declined by staff, the reason for this decision must be clearly recorded The treatment required for the treatment and prevention of pressure sores must be clearly recorded, and clear indication provided where a decision has been made that equipment for the promotion of tissue viability is not provided where this contraindicates the findings of the risk assessment The nutritional needs of service users must be clearly recorded within the care plan in order that they are clearly understood by all staff. Unexplained weight loss must be referred to the dietician for advice Medication must only be administered to the person for whom it was prescribed Medication must not be secondary dispensed The current practice whereby night staff wake service users to administer medication which should be given with food must cease immediately Equipment used for the storage of medication must be kept clean and hygienic Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc 1st August 2005 and maintained thereafter 2nd August 2005 and maintained thereafter 17(1)(a) Schedule 3(p) 15(2)(b) 16(1) 14(1)(a),2 (a)(b) Regulation 17(1)(a) Schedule 3(o) 4. 9 13 2nd August 2005 and maintained thereafter Version 1.40 Page 30 Regulation Record of the administratrion of 17(1)(a) medication, including controlled Schedule drugs, must be kept up to date 3(k) The administration of controlled drugs must be witnessed and countersigned Regulation Where service users no longer 14(2)(a) require medication, referral must (b) be made to the General Practitioner in oder that it can be discontinued, and the drugs returned to pharmacy 5. 10 12(4)(a) Service users must be treated with respect, and the daily records written in such a way which reflects that this is the case The registered manager must ensure that service users privacy is not compromised where they occupy a shared room Staff must be afforded sufficient time to ensure that assistance with personal grooming for service users can be completed properly The individual preferences with regad to rising and retiring times for service users must be given full consideration The registered manager must explore ways in which the routine at the home can be made more flexible, in order that individual choice can be better considered The registered manager must devise a written menu plan, which must incorporate choice, flexibility and variety and which 2nd August 2005 and maintained thereafter 6. 12 12(2)(3) 30th September 2005 7. 15 12(2) 30th September 2005 Page 31 Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 is offered to service users in written or other suitable format 16(2) Meals must be served to service users at a suitable temperature Service users must be seated in a suitable position when being assisted with their meals 8. 18 12(1) and 37 All vulnerable adult issues must be referred to the local authority for investigation, and reported to the Commission for Social Care Inspection The registered manager must ensure that service user have access to a call bell facility at all times The registered manager must ensure that the layout of bedrooms allows for the safe moving and handling of service users The registered manager must ensure that screening can be used effectively where rooms are shared, in order that the privacy of service users is not compromised All areas of the home must be adequately heated Secondary heating must be secured to the wall and guarded, within a risk assessment framework The practice whereby staff smoke outside the premises, but next to a service users open window, must cease Staff hours must be deployed in order that the needs of the service users do not come secondary to the routine of the home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc 2nd August 2005 and maintained thereafter 2nd August 2005 2nd August 2005 9. 22 16 10. 23 12 11. 24 12 2nd August 2005 12. 25 23 2nd August 2005 13. 27 18 31st August 2005 Rosedale Nursing Home Version 1.40 Page 32 14. 29 19 Staff must not be deployed to work at the home prior to: 1. Receipt of two satisfactory written references. Unsatisfactory references having been followed up. 2. Receipt of a satisfactory Criminal Records Bureau check completed by the home. 3. Confirmation from the Nursing and Midwifery Council that trained staff continue to be registered with them. 2nd August 2005 15. 32 10,12 The registered manager must make provision in order that the viewpoints of the full staff team can be considered with regard to the delivery of care. 2nd August 2005 16. 38 13,16 Staff handovers must take place at the commencement of each shift, to include all staff providing care. Soiled items must be attended to 2nd August appropriately and immediately. 2005 The door to the sluice and boiler room must be kept locked. The television identified at the time of the inspection must be placed on a secure surface. Window restrictors must be fitted to the rooms identified following an assessment of risk. Service users must be kept safe in the interim. All staff must receive fire training from a suitably qualified person at the following rates: Night staff - three monthly Day staff - six monthly New recruits - twice within the first month of employment Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 33 The registered person must seek confirmation that the emergency lighting will continue to operate should the lighting fail. The fault to the emergency lighting to the outside of the building must be repaired The cracked tile to the shower room must be repaired or replaced The kitchen must be cleaned and kept clean The extractor fans must be cleaned and kept clean 31st August 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 9 15 36 Good Practice Recommendations A record of the administration of Temazepam should be kept in the controlled drugs register The interval between supper and breakfast the following day should be no longer than 12 hours Supervision should be provided to all staff a minimum of six times each year Rosedale Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 34 Commission for Social Care Inspection Unit 4, Triune Court Monks Cross York YO32 9GZ 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 Nursing Home J53-J04 S64332 Rosedale V238778 180705 Stage 4.doc Version 1.40 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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