Inspection on 25/07/07 for Rosedale Residential Home

This inspection was carried out on 25th July 2007.

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 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 Residential Home 08/11/07

Rosedale Residential Home 25/04/07

Similar services:

Hillside

Applegarth

122 Scorer Street

Byars Care Home

St Marys Nursing Home

Jubilee Villa Care Home

Bramble Lodge

Parkmanor Residential Home

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

CARE HOMES FOR OLDER PEOPLE Rosedale Residential Home 68 Rockingham Road Kettering Northants NN16 8JU Lead Inspector Kathy Jones Unannounced Inspection 25th July 2007 09:00 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 Residential Home DS0000068813.V346657.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 Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosedale Residential Home Address 68 Rockingham Road Kettering Northants NN16 8JU 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) 01536 512506 R & Z Jagroo Limited Care Home 19 Category(ies) of Dementia - over 65 years of age (7), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (19), Physical disability over 65 years of age (2) Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Rosedale will limit the service to the following service user categories: Older people (OP) 19. Older people with Physical Disabilities (PD(E)) 2. Older people with a Learning Disability (LD(E)) 1. Dementia over 65 years of age (DE(E)) 7. That Rosedale be registered to provide personal care to a maximum number of seven in the category of dementia (DE(E)) of whom one person (R.L.) is aged 64 years. The maximum number of service users that can be accommodated at Rosedale is 19. 25th April 2007 2. 3. Date of last inspection Brief Description of the Service: Rosedale is a privately owned care home currently registered to provide personal care and accommodation for 19 Older People including 7 people with dementia and two with a physical disability. Rosedale is a large detached house situated on the outskirts of the town centre of Kettering providing good access to local amenities. At the time of the inspection all bedrooms were being used for single occupancy and ten of the rooms have en-suite facilities. Bedrooms on the first floor can be accessed by the stairs or a shaft lift. The home has two lounge areas and a dining room, all located on the ground floor. There is also a small garden and patio area leading off from one of the lounge areas. At the time of this inspection the fees charged to funding bodies were given as being £331.60 per week. In addition to these fees, residents are expected to pay a ‘top up fee’, which ranges between £6 and £20 per week. The amount of the top up fee is dependent on the care needs, the size of the room and whether it has en-suite facilities. The fees given for privately funded residents’ were £399 per week. There is no written information about the fees within the statement of purpose, however there is information which states that the fees include personal care, accommodation, meals, laundry and some toiletries. Additional charges include chiropody, hairdressing, newspapers, telephone calls, dry cleaning and some toiletries. Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 5 Information about the services provided including the complaints procedure is available in the statement of purpose and service user guide, which are located in residents’ rooms. There is a copy of the last inspection report in the manager’s office, however this is not included in the information provided to residents’ and their relatives. Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Standards identified as ‘key’ standards and highlighted through the report were inspected. The key standards are those considered by the Commission to have a particular impact on outcomes for residents. Inspection of the standards was achieved through review of existing evidence, pre-inspection planning, an unannounced inspection visit to the home and drawing together all of the evidence gathered. The pre-inspection planning was carried out over the period of a day and involved reviewing the service history, which details all contact with the home including notifications of events reported by the home, telephone calls and any complaints received. The report of the last key inspection carried out on the 25th April 2007 was reviewed, together with an improvement plan submitted by the Responsible Individual. The information gathered assisted with planning the particular areas to be inspected during the visit. This inspection was scheduled within a relatively short space of time after the April inspection due to the extent of the shortfalls identified. A key aspect of this inspection was to assess compliance with the statutory requirements set as a result of the inspection in April 2007. The unannounced inspection visit covered the morning and afternoon of a weekday. The inspection was carried out by ‘case tracking’, which involves selecting samples of residents’ records and tracking their care and experiences. Observations of the homes routines and care provided were made and inspectors spoke with residents’ and staff during the inspection to ascertain their views. The management of a sample of residents’ medication was checked. And a sample of staff files reviewed to check the adequacy of the recruitment procedures in safeguarding residents’. Communal areas and a sample of residents’ bedrooms were viewed and observations were made of residents’ general well being, daily routines and interactions between staff and residents. Some telephone discussion took place on the day of the inspection and following the inspection with the Responsible Individual about the issues identified. Verbal feedback was given to the Acting Manager throughout the inspection. Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: More accessible information about the fees and costs for residents and their families and access to the most recent inspection report would help people in making informed choices. The assessment process needs to be more thorough and take full account of residents’ needs and lifestyle to help ensure that their needs and expectations can be met if they decide to move into the home. Care plans need to be improved to ensure that they give detailed instruction to staff about how residents’ personal care, health, social and emotional needs are to be met. The care plans are important documents in helping to ensure that residents’ receive consistent and safe care according to their individual needs. Improvements are needed in the monitoring of residents’ health care, through better record keeping in relation to visits and advice given by doctors and Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 8 other health professionals. In addition through keeping records such as fluid intake records for residents’ who are poorly and at risk of dehydration. With changes of staff throughout the day this is important to get an accurate picture of the level of concern. Some improvements are still required to the management of medication such as ensuring that there is evidence that prescribed creams have been applied and proper records are in place so that a medication audit check can be carried out. More consideration needs to be given to how residents’ rights are respected in relation to the choice and control they have over their lives and of their individual needs. Advice has been given to involve health professionals in respect of the decision making about the care of a resident with dementia to protect her rights. The premises continue to show signs of being poorly maintained and while some work has been carried out the extent and specifics of the needs is not reflected in the maintenance programme. Some of the issues such as the broken window panes were identified at the inspection in April 2007 and have still not been addressed. Some areas identified by Environmental Health last year include elements of risk to staff and residents’ such as an assisted bath, which has not been serviced and contains parts that require replacement or repair. Arrangements for staff training need to be improved to ensure that residents’ and staff are not put at risk. It was necessary to make an immediate requirement to arrange movement and handling training as five staff had not had training putting residents’ at risk (confirmation was received that they had the training the day after inspection.) Training to meet the specific needs of residents at Rosedale must also be provided to include dementia care training to ensure that the needs of residents’ with dementia are fully met. Quality assurance systems and the overall management and oversight of Rosedale need to be improved so that the identification of shortfalls is not reliant on inspection. Relationships and trust between owners and staff need to be improved and staff need to feel confident that salaries will be paid on time in order that residents can receive a consistent level of care. 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 Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 9 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 Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 10 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): 1, 3, Standard 6 is not applicable as intermediate care is not provided. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The admissions process provides insufficient assurances that residents’ needs, can be fully and safely met. EVIDENCE: Since the last inspection a copy of the statement of purpose and service user guide had been placed in residents’ bedrooms. The documents provide information about the aims and objectives and the services provided. The above information is particularly important in helping prospective residents’ in choosing a care home. However to help people in deciding if the home is suitable for themselves or their relative more information is required about the range of needs that can be cared for and also the type of care provided. For example types and level of dementia and the model of dementia care used to guide staff. Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 11 A copy of the most recent inspection report is available in the managers office, however it is a requirement that this is more accessible to residents’ and their families and for those people looking for a care home. It is also important that prospective residents’ and their families have clear information about the fees provided. At present the service user guide just states that they are dependent on the type of facilities and the care package. There are lists of items included in the fees and of those excluded in the statement of purpose. A list of costs for excluded items has to be requested separately from ‘the office’. Excluded items include chiropody, dry cleaning, hairdressing, newspapers, telephone calls and some toiletries. The service user guide states that there will be a charge added for services not included as part of the standard fee to reflect “the administration and other costs associated with the specific service required”. Some activities are paid for from the residents’ fund, which comes from fund raising activities. Information about the expectations in relation to fundraising should also be included. Clearer more transparent information about the actual costs needs to be made available to help prospective residents’ and families with the decision making process. There is no information within the statement of purpose about the number and size of rooms. As Rosedale has been a registered care home for many years, some of the rooms are smaller than those required for newer homes and it is important that residents’ and their families have this information in order to make an informed choice. Care records were reviewed for a recently admitted resident to check the adequacy of the assessment process in determining if the residents’ needs could be met. This identified that an assessment of needs had been carried out before the resident was admitted. An assessment of need carried out by the funding authority was also available on the resident’s file, however some of this information did not appear to have been taken into account as part of the assessment carried out by the home. For example the resident had been identified as having lost weight prior to admission and the assessment identified the need for the prospective resident to be weighed. There was no evidence on this resident’s records that the resident had been weighed and it was identified that there were no suitable scales at the home for weighing residents’. The assessment also contained no information about an infection acquired in hospital making it difficult to ensure that this resident’s needs were fully met. Advice was also given to ensure that sufficient information was gathered in the assessment to ensure that residents’ social needs could be met. There was no information about the resident’s interests or preferred daily routines. Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 12 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): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Shortfalls in the management of medication, planning of care, instruction to staff and monitoring of residents’ changing health care needs has the potential to put residents’ at risk of their care and health needs not being met. EVIDENCE: Residents’ and a relative spoken with were very happy with the care that residents’ were receiving. Observations and discussions with staff during the inspection indicated that staff were keen to provide good care to residents’. However improvements to the assessment, planning and monitoring of residents’ care and health needs is needed to reduce the risk of residents’ needs not being fully met. Care records were well organised and clearly labelled making it easy for staff to access available information. There was also evidence that some additional care plans had been developed following the last inspection. Care plans are Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 13 important documents in guiding and instructing staff in the care to be provided. However additional work on care planning is required to ensure that the plans are based on a thorough assessment of the resident’s needs and are sufficiently detailed to ensure that staff are able to provide consistent and safe care which is based on good care practices. For example there was no guidance for staff as to how to meet the behavioural and care needs of a resident with dementia. Advice has been given to the Acting Manager to seek advice from health professionals and the funding authority about the care of a particular resident. Advice was given to include information with resident’s personal care plans about what they can do independently to reduce the risk of limiting residents’ independence. Pressure relieving cushions and mattresses were in place for two residents’ whose care was sample checked reducing the risk of pressure sores. However there was no risk assessment or care plan in place identifying the level of risk or actions to be taken by staff to reduce the risk. It was also identified that there was no record on the medication administration record of prescribed creams being applied for a resident who was identified as being at risk of pressure ulcers. Advice was given to implement pressure ulcer risk assessments to ensure that all residents’ who may be at risk were identified and care plans implemented which detail the actions required of staff to reduce the risk. This should include the use of any pressure relieving equipment and application of any prescribed creams following discussion and advice from the General Practitioner or District Nurse. While discussion with staff and some records confirmed the involvement of General Practitioners, District Nurses and a Community Psychiatric Nurse, there was no clear record of visits by health professional to help with monitoring the health of residents’. Some of the health care professional visits are recorded within residents’ daily records however this is not consistent, making it difficult to track residents’ health care. Records prior to a resident’s admission to hospital were reviewed and in spite of information that would indicate the resident was at risk of dehydration there was no evidence of monitoring of their fluid intake. Requirements relating to the management of residents’ prescribed medication were made following the last inspection. Since that inspection seven staff have received medication training and there was some evidence that polices and procedures were being implemented. Information about residents’ current medication and the reasons for the medication has been added to residents’ care files which helps staff to have a better understanding of any risks. Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 14 While there were some improvements in the management of medication as detailed below there continues to be some shortfalls, which may put residents at risk. Medication was stored securely in a locked trolley which safeguards residents’ medication. However if residents’ were to require any controlled drugs more secure storage arrangements would need to be in place to meet legislative requirements. Records of medication received and administered to residents’ are kept. However there is no record of medication carried forward from one cycle to the next making it difficult to carry out an accurate audit of residents’ medication. A sample check of medication administration records and medication stored confirmed that residents’ prescribed medication was available and staff are signing the record to confirm the medications has been given. However in the case of prescribed creams there is no evidence that they have been applied. The prescription label and the medication administration record for one resident’s medication did not give any instructions for administration it just stated “follow directions given to you by your doctor”. There was a handwritten entry “two tabs” which staff advised had been the instruction of the General Practitioner however this could not be verified in the records. The lack of clear instruction puts the resident at risk of not receiving medication as the prescriber intended. There was evidence that residents’ were being given medication (lactulose) which had been prescribed for other residents’. The Acting Manager advised that one resident administers her own lactulose, however although this was seen in the resident’s bedroom there was no record to show that it had been handed over to the resident or risk assessment for self administration of medication. Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the meals is good however due to the lack of individual assessment and planning some residents’ rights and choices and preferred lifestyles may be restricted. EVIDENCE: Insufficient information is gathered about prospective residents’ daily routines, social, cultural, religious and recreational needs as part of the assessment to determine if their needs can be met. This was particularly evident through review of a residents’ care file where it was identified that their lifestyle had been restricted due to the staffing arrangements operated in the home. A requirement was made at the last inspection for research into residents’ pastimes to be carried out. The purpose of this was to help to ensure that activities are based on residents’ individual needs and preferences. An improvement plan submitted by the registered provider identified that the Acting Manager was to meet with the activities organiser to review it and discuss any improvements. The plan was not available at the time of the Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 16 inspection therefore it was not possible to assess the adequacy of the arrangements for making improvements. Discussion with residents’ confirmed that activities do take place and two spoken with were happy with the activities provided. A resident said that their birthday was coming up and that there would be a party. Staff said the range of activities was very good and appropriate for residents’ needs. However this was difficult to evidence without a proper assessment of individual needs and preferences. Staff were observed to be welcoming towards visitors. A visitor confirmed that they can visit their relative as often and when they wish. They said that they had agreed with staff when to contact them if there was any change in their relatives condition. They had confidence in the staff team and were complimentary about staff and the care provided. Discussion with staff identified that a residents choices and control in relation to their hygiene routine were restricted by the resident’s capacity to make informed decisions in their own best interest. However there was no information within the care plan about the agreed care and how the decisions made by staff on the resident’s behalf, had been agreed and who had been involved in the decision making. It would be expected that health professionals, relatives, staff and if applicable social services were fully involved. Discussion with staff about the bathing routine for a resident has also identified that there is an element of restraint involved and advice has been given to consult with health professionals as a matter of urgency regarding appropriate care. Currently residents are at risk of their rights and choices not being respected and staff vulnerable to allegations of abuse. Residents’ spoken with were very happy with the meals provided and said that staff were aware of their likes and dislikes. The cook was aware of residents’ individual dietary needs. The lunch time meal on the day of the inspection looked and smelt appetising and portions were plentiful. The meal was braised steak, potatoes and fresh vegetables. Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 17 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): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are procedures for dealing with complaints and staff are aware that they have a responsibility for safeguarding residents. However additional information and staff training would provide additional protection for residents’. EVIDENCE: The Commission for Social Care Inspection have received no complaints about the home since the last inspection. The Acting Manager advised that no complaints had been received directly by the home. Residents’ spoken with said that if they had a concern that they would raise it with staff and they felt that they would be listened to. Information about how to make a complaint is contained in the statement of purpose, a copy of which is available in residents’ rooms. In addition to the information given it may be helpful to residents’ and their relatives to have contact details for the responsible individual in the event that they are not satisfied with the response given by staff. It would also be helpful for residents’ to be informed of their right to raise any concerns about their care with social services. Discussion with staff identified that they were aware that they have a responsibility for safeguarding the residents’ in their care. However there was no evidence that staff have received any training to help ensure that they have Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 18 a full understanding of the types of abuse and the actions that they should take if they suspect abuse. The Acting Manager said that they have a video to give to staff to look at and there is a quiz, which checks their understanding, however this has not been completed to date. There is a safeguarding adults policy, however advice was given to add a simple and clear procedure with contact numbers to be followed in the event of an allegation of abuse. This would help to ensure senior staff had the necessary information to act swiftly and appropriately to safeguard residents’. Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 19 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): 19, 21, 22, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The premises are clean but poorly maintained with some areas of risk to residents’. EVIDENCE: Concerns were raised about the maintenance of the premises at the inspection carried out in April 2007. A sample check of the premises identified that the standard of the environment continues to be of concern. There were some improvements in that items stored outside the home awaiting disposal in a fire escape route had been removed reducing the risk in the event of a fire. However continuing concerns about the maintenance of the environment include: two broken window panes in the front lounge (these were broken at the time of the inspection in April), stained carpet in the front lounge, large Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 20 ridges in a bedroom carpet causing a tripping hazard, a call bell which was out of the reach of a resident who sits in a chair in her room during the day and a broken downspout from guttering outside held together with bits of wire. There is a bathroom and a shower room on the ground floor and a bathroom on the first floor. On the day of the inspection the bathroom on the first floor was out of action as it had been in April 2007. The bath was a domestic type bath unsuitable for the needs of the majority of residents. The bath was in poor condition and the hot tap had been removed to reduce the risk of scalding, as there was no temperature regulator. The shower room was full of washing that could not be tumble dried as staff say they have nowhere else to dry washing. The bathroom on the ground floor contains a medi-bath. There is no evidence of this bath being serviced and a report by Environmental Health of a visit in November 2006 refers to a fault with this equipment. A sample check of other issues raised in this report identifies that they have not been addressed. This report was produced prior to the current ownership however this report and inspectors findings from a sample check highlight an urgent need to carry out a full review of the action required to bring each area of the home up to an acceptable standard and reduce the risk to residents’ and staff. The Commission for Social Care Inspection (CSCI) has received written confirmation of some work carried out such as decoration and small electrical equipment testing in a document titled ‘maintenance programme’. Written confirmation of commencement of external re-decoration and refurbishment of a bathroom at the end of September 2007 has also been received. However the information received by CSCI does not reflect the extent of the maintenance requirements identified through this sample check of the premises during inspection. A requirement was made at the last inspection that all lights must be working. Written confirmation was received that some bulbs had been replaced following the inspection and a sample check during this inspection indicated that lights were working. It was identified at the inspection carried out in April 2007 that the front door, which is the main entrance and exit, is locked with a “star” type deadlock. Concern was raised about the fact that residents’ and visitors were not able to leave the home without a staff member unlocking the door. No changes had been made to this system since the April inspection and there was no information within the statement of purpose to demonstrate how residents’ rights are protected. Advice was also given to consult the Fire Officer about the location of the key, which at the time of the inspection was located in the kitchen and only accessible to staff. It is important for the safety of residents’, staff and visitors to consider the number, location and availability of staff throughout the twenty four hour period as part of the risk assessment. Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 21 Following discussion with the Fire Officer advice was given to review the fire risk assessment and the fire evacuation plan as one of the fire exits identified on the evacuation plan was through a residents’ bedroom. The door to the bedroom had a typed notice on it stating that it was not a fire exit and a chair blocked the door to the exit. Areas of the home viewed were all clean and residents’ were satisfied with the cleanliness. However storage and practice in relation to the use of creams, toiletries and hairbrushes needs to be reviewed to ensure that residents’ are not put at risk of infection through the shared use of these items. Several tubes of steradent tablets were also stored in this unlocked bathroom cupboard. The risks of people with dementia mistakenly swallowing these was discussed and advice given to store them more securely. Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and staff training are not planned based on the needs of the residents’. EVIDENCE: Many of the staff have worked at Rosedale for a number of years. Care staff, housekeeping and catering staff were observed to work together as a whole team and all had knowledge of individual residents’ and their needs. Discussion with them identified that they were keen to ensure that residents’ needs are met. Residents’ and a relative spoken with were happy with the staff team and had no concerns about the way they are treated or spoken to by staff. Observations indicated that good relationships exist between staff and residents’. Observations indicated that there were enough staff on duty at the time of the inspection to meet residents’ needs. However reference was made in the daily life and activity section of incidents where a resident’s rights were restricted by the night staffing arrangements. There is no evidence of ongoing review or assessment of residents’ needs and preferences in relation to the staffing levels. Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 23 A very small percentage of staff currently hold a qualification such as a National Vocational Qualification (NVQ) in care. It is considered important that at least 50 of staff have this training in basic care practices to help in understanding and meeting the needs of residents. However positive progress has been made in that since the last inspection the Acting Manager advised that five more staff have enrolled on a course. Review of the staff training plan and a sample check of some certificates of attendance identified that seven staff had done medication training since the last inspection. However there were serious shortfalls in staff training and some staff had not received the necessary training to meet residents’ needs. Four staff had not received any movement and handling training and the training for a fifth was out of date (This is also covered in the management section of this report under safe working practices). Written confirmation has been received that staff received the movement and handling training the day after the inspection. Given that residents’ with dementia are cared for it is of concern that only a small number of staff have received any kind of training in dementia and no-one since 2005 making it difficult for them to have a full understanding of up to date care practices in relation to dementia care. A requirement was made at the last inspection relating to staff recruitment. No new staff have been recruited since the last inspection therefore it was difficult to evidence any improvements to the practice. However expectations in relation to references and criminal record bureau were discussed with the Acting Manager. A staff members file discussed contained a reference from a family member, which would not be considered independent. A new application form has been introduced which includes asking for a full employment history, which is a requirement to help safeguard residents’. Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health and welfare of residents is not been properly protected by the management arrangements and quality assurance systems. EVIDENCE: Standard 31 relates specifically to the registered manager and their experience and qualifications. At the time of the inspection there was no registered manager in post. However it is considered from the perspective of the adequacy of the management arrangements, as this is considered a key aspect of ensuring that residents receive appropriate care. In the absence of a registered manager, responsibility for the management of the service lies with the organisation. Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 25 At the time of the inspection the day to day management of Rosedale was being carried out by an Acting Manager who has worked at Rosedale for many years and therefore has experience of the client group. The Acting Manager presented as very caring and committed towards residents’, however acknowledged that she has not received management training or guidance in the responsibilities of a care home manager. The current owner has been registered since 29 January 2007 and the first key inspection took place in April 2007. The April inspection identified a range of concerns and resulted in thirty one statutory requirements being made. There was evidence that action has been taken to address some of the issues raised. However this inspection has identified further shortfalls, which raises concerns about the adequacy of the systems in place to maintain safe standards of care. There were some indications of elements of a quality assurance system in that some questionnaires had been received from residents prior to the inspection in April 2007, however these have still not been collated. There was a record in a diary of visits by the responsible individual, which also contained some information about the visit. However the systems in place appear insufficient in that the shortfalls appear to be identified through the inspection process rather than the homes own systems. It is important that robust systems are in place to monitor the quality of care provided to protect residents’. It was identified at the last inspection that there was a very small petty cash balance available and there was some concern as to whether it would adequately cover financial expenditure at times of emergencies or when the Registered Person does not visit regularly. The Acting Manager advised that although there had been no change to the amount held this had not presented a problem to date as alternative payment methods were used for purchases. Residents’ and staff confirmed that there was enough food and the Acting Manager advised that they had contacts for any emergency repairs that would send invoices rather than need a cash payment. However advice was given to review the arrangements for ensuring that there is enough money available regularly to ensure that there is no risk to residents’. Concerns about the business and financial management were identified during the inspection in that staff had not been paid as expected. Discussion with staff identified that there have been changes to the payment system and payment date, which had resulted in them having to wait an additional week to be paid. The new date given happened to be the day of inspection and staff reported that they had not been paid. The Acting Manager confirmed in a telephone call that staff had been paid the following day. It is important that there are good and trusting relationships between owners and staff in order to maintain consistency of care for residents’. Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 26 As identified in the staffing section of this report several staff were identified as not having received training in movement and handling. Given that there are residents’ currently at Rosedale who need assistance with movement and handling this puts residents’ and staff at risk of injury. Due to the immediate concerns an immediate requirement was made and the matter was discussed with the responsible individual on the telephone. The Responsible Individual dealt with the matter very promptly and training was arranged for the following day. The Environmental Health report referred to in the environment section of this report also identifies concerns about safe working practices and compliance with health and safety legislation. While it is acknowledged that the current owner may not have been aware of the report identifying breaches of legislation a review of the premises would have highlighted the problems and risk to residents and staff. Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X 1 2 X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 2 X X X 1 Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 4 Requirement Timescale for action 30/09/07 2. OP1 5 3. OP3 14 The Statement of Purpose must include all information required by regulations including the range of needs that Rosedale intends to meet and information about room sizes. This would help prospective residents and their families make a decision about moving in and provide clarity for the management of the service. (A previous requirement with a timescale for compliance of 01/06/07 has been partially met) 30/09/07 A Service User Guide must contain all information detailed in Regulation 5 including clear information about all charges and a copy of the recent inspection report. This would help prospective and current residents and their families make decisions. (A previous requirement with a timescale for compliance of 01/06/07 has been partially met) People must not be admitted to 30/08/07 Rosedale unless their needs can be met based on a full assessment. This would ensure DS0000068813.V346657.R01.S.doc Version 5.2 Rosedale Residential Home Page 29 4. OP7 12 (1) residents’ needs were met. (A previous requirement with a timescale for compliance of 01/06/07 has not been met. The requirement has been re-worded for greater clarity of expectations) All care plans must be 30/09/07 sufficiently detailed to enable staff to meet residents’ individual personal, social, emotional and health needs. (Two similar worded requirements with timescales for compliance of 15/06/07 have not been met) Assessments to identify 30/09/07 residents’ at risk of pressure ulcers must be carried out and where applicable care plans implemented detailing the actions to be taken to reduce the risk. Systems must be put in place to 30/09/07 ensure that residents’ health care needs must be monitored. 15/09/07 There must be an accurate record of all medication received, administered and disposed of by the service including: Records confirming the application of prescribed creams. Quantity and date of any medication given to residents for self administration. Quantities of medication carried forward from the previous month to ensure there is a clear audit trail. (A similar previous requirement with a timescale for compliance of 01/06/07 has only been partially met) Residents’ must not be given medication prescribed for other residents’ For example lactulose. DS0000068813.V346657.R01.S.doc 5. OP8 12 (1) (a) 6. 7. OP8 OP9 12 (1) (a) 13 (2) 8. OP9 13 (2) 15/09/07 Rosedale Residential Home Version 5.2 Page 30 9. OP14 12 (1) (a), 12 (3) 10. OP18 13 (6) 11. OP19 23 (4) (b) 12. OP19 23 (2) (a, b, c, d) Where it is considered necessary in a resident’s best interests to make decisions, place restrictions or remove some control over their lives, there must be written evidence of how this decision has been made and who has been involved. Staff training on vulnerable adult issues must be full and encompassing. This would ensure staff have a full knowledge of adult protection issues, and so be able to protect residents in the home. (A previous requirement with a timescale for compliance of 02/07/07 has not been met) The fire risk assessments and fire evacuation plan must be reviewed to ensure they accurately identify the fire exits and escape routes. This must include review of the arrangements for escape from any locked doors such as the main front exit. This is to help reduce the risk to residents’, staff and visitors. (A previous similar requirement with a timescale for compliance of 01/06/07 has not been fully met) A full review of the condition of the premises, furnishings and equipment that identifies the maintenance and refurbishment requirements must be carried out and a detailed plan developed with individual timescales for completion based on risk. This would ensure residents lived in a well maintained home. A full review of the adequacy, condition and safety of the bathing facilities taking account DS0000068813.V346657.R01.S.doc 15/09/07 30/09/07 30/08/07 15/09/07 13. OP21 23 (2) (c, j, n) 15/09/07 Rosedale Residential Home Version 5.2 Page 31 14. OP26 23 (2) (a) 15. OP38 13 4 (c) 16. OP27 18 (1) (a) 17. OP30 18 (1) c 18. OP31 8, 12 (1) (a) 19. OP33 24 of the needs of current and prospective residents must be carried out and a detailed plan with reasonable timescales developed to ensure that all residents’ have bathing facilities, which are properly maintained, safe, accessible, and available and meet their needs. A review of the laundry facilities must be carried out and practical arrangements made to ensure that it is not necessary to dry washing in shower rooms or other spaces required for use by residents’. Steradent and other similar products must be stored securely to reduce the risk of a resident with dementia swallowing the tablet. Staffing levels and arrangements must be kept under review and if necessary revised to ensure that the needs of residents’ are fully met and their routines not restricted. Arrangements must be made for staff to receive training to meet the specific identified needs of residents’ living at Rosedale, which includes dementia care training. The Responsible Individual must inform the Commission for Social Care Inspection in writing of the plans with timescales, for the management of Rosedale. An effective quality assurance system, which identifies any shortfalls, and includes arrangements for improvements, must be implemented. This is to help ensure residents’ receive a good standard of care. (A similar previous requirement with a timescale for compliance of 02/07/07 has not been met). DS0000068813.V346657.R01.S.doc 15/09/07 15/09/07 15/09/07 30/09/07 01/09/07 30/09/07 Rosedale Residential Home Version 5.2 Page 32 20. OP36 26 21. OP38 13 (5), 18 (1) (c) The Responsible Individual must 15/09/07 prepare a written report on the conduct of the home from the findings of the monthly unannounced visit. A copy must be forwarded to the Commission for Social Care Inspection until further notice. The unannounced visits are required so that the Responsible Individual is aware of and can monitor standards of care to residents’. Make arrangements for safe 27/07/07 movement and handling of residents’, via risk assessments and booking training with a suitably qualified trainer. This was to reduce the risk of injury to residents’ and staff. (Immediate requirement left at the time of the inspection.) 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 OP26 Good Practice Recommendations Toiletries, hairbrushes and creams should be stored individually for residents’ to reduce the risk of them being used by more than one resident and the subsequent risk of infection. The programme of National Vocation Qualification training for staff should continue to help achieve a higher ration of trained staff. Arrangements should be made to ensure that staff are paid at the agreed time and efforts made to rebuild trust in the management of the business. 2. 3. OP28 OP34 Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. Extracts may not be used or reproduced without the express permission of CSCI Rosedale Residential Home DS0000068813.V346657.R01.S.doc Version 5.2 Page 34 - 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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