Inspection on 08/11/07 for Rosedale Residential Home

This inspection was carried out on 8th November 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 25/07/07

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 8th November 2007 08:45 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.V354125.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.V354125.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 Vacant 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.V354125.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 July 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 service user guide states that fees for privately funded residents’ are between £380 and £400 per week dependent on the room and whether ensuite facilities are available. The service user guide 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 Rosedale Residential Home DS0000068813.V354125.R01.S.doc Version 5.2 Page 5 toiletries. It also identifies that there are fund raising events to help pay for some of the activities. 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 with the statement of purpose and service user guide in the main hall, which is available to visitors. Rosedale Residential Home DS0000068813.V354125.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the third inspection carried out since April 2007. The purpose of the inspection was to check compliance with requirements that had been made in April 2007 and had not all been met by July 2007. Compliance with additional requirements made in July 2007 was also assessed. Standards identified as ‘key’ standards and highlighted through the report were inspected. The key standards are contained within the National Minimum Standards for Older People and 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, visits 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 reports of the last two key inspections carried out on the 25th April and 25th July 2007 were 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 to the home. The first visit on 8th November 2007 was unannounced and covered the morning and afternoon of a weekday. This 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 the inspector spoke with residents’ and staff during the inspection to ascertain their views. As it became evident on the first inspection visit that compliance had not been achieved in relation to the management of medication a second announced inspection visit was carried out with a pharmacy inspector on 14th November 2007. The inspection also included looking at the file of a newly recruited staff member 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. Verbal feedback was given to the Acting Manager who is also a Director of the company who owns Rosedale throughout the inspection. Rosedale Residential Home DS0000068813.V354125.R01.S.doc Version 5.2 Page 7 As identified in this inspection report there has been an ongoing failure to comply with some statutory requirements. These requirements have been made in relation to the management of medication, care planning, and the storage of dental cleansing tablets, which pose a risk to residents. As a result of the continued non compliance with requirements it has been considered necessary to issue statutory requirement notices. Compliance with the notices will be checked during a further inspection and prosecution may occur if compliance is not achieved. What the service does well: What has improved since the last inspection? More information has been added to the service user guide, which helps people to have a better understanding of what to expect. This includes information about the fees that have to be paid. It also identifies that four of the bedrooms are smaller than would be expected of a newly built care home. Again this helps people in making an informed choice about moving in. There has been an improvement in the level of information about residents needs within some of the care plans reviewed and it was clear that staff were continuing to gather further information about the needs and preferences of a recently admitted resident. Care plans and discussion with staff confirmed that staff had a better understanding of ways of meeting the needs of a resident with dementia appropriately. Residents spoken with were generally satisfied with their daily lives and one resident had enjoyed going out to the shop with a staff member, something they said they had not had the opportunity to do for years. Some maintenance issues, which had been highlighted in previous inspections, had been addressed which included repairing a broken window pane, servicing a bath and replacing worn parts and replacing a carpet which was a tripping hazard. Work was also almost complete on replacing a bathroom, which was in Rosedale Residential Home DS0000068813.V354125.R01.S.doc Version 5.2 Page 8 poor condition at the time of the last inspection and did not meet the needs of residents with a wet room. There have been improvements in the recruitment process in that references and criminal record bureau clearances had been obtained before a new member of staff started work helping to protect residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rosedale Residential Home DS0000068813.V354125.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.V354125.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process establishes the needs of people prior to admission, helping to ensure that their needs can be met. EVIDENCE: Since the last inspection the statement of purpose and service user guide have been reviewed and updated to include required information including fees. Information about fees and additional costs is particularly important in helping prospective residents’ and their families in choosing a care home and being able to plan their finances. Information has also been added to the statement of purpose about the number of rooms and identifies the fact that four of the rooms are below the National Minimum Standard of 10 square metres. As Rosedale has been a registered care home for many years, some of the rooms are smaller than Rosedale Residential Home DS0000068813.V354125.R01.S.doc Version 5.2 Page 11 those required for newer homes and it is important that residents’ and their families have this information in order to make an informed choice. A copy of the most recent inspection report is now available with the statement of purpose and service user guide in the main hall. This is now more accessible to residents’ and their families and for those people looking for a care home. 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. Review of the information indicated that key areas where care was required had been identified helping to ensure that the resident’s needs can be met on admission. Rosedale Residential Home DS0000068813.V354125.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’ health care needs continues to put residents’ at risk of their care and health needs not being met. EVIDENCE: A sample of residents care plans were reviewed during the inspection visits carried out on 8th and 14th November 2007. Requirements relating to care planning have been made following the inspections carried out in April and July 2007. An improvement was identified in some of the care plans reviewed, however shortfalls still remain when considered in the light of other information relating to residents health and medication needs. One of the care plans reviewed was for a newly admitted resident which included basic information about the resident’ care needs. Staff advised that it had been difficult to obtain clear information from the previous care home and Rosedale Residential Home DS0000068813.V354125.R01.S.doc Version 5.2 Page 13 that they were continuing to develop the care plan as they gained a better understanding of the residents needs and preferences. Concerns had been identified at the inspection in July 2007 about the way a residents’ personal care was being managed. There was evidence that following the inspection advice had been sought from the Community Psychiatric Nurse and that staff now had a better understanding of how to meet the needs of the resident who has dementia and was resistant to care. It had been of concern that an element of restraint was being used, however a staff member advised that they are now able to meet the resident’s personal care needs with gentle persuasion. Some risk assessments had been developed, however these were very general and did not take proper account of residents’ individual needs. For example the risk assessment for one resident who is a wheelchair user included general statements such as “ensure wheelchair is regularly serviced”. Discussion with a member of staff identified that this resident self propels his wheelchair and does not use footplates while inside the home but that they are required for outside trips. This was not incorporated within the risk assessment. Some improvements had been identified in monitoring residents changing health, in that a record had been kept of a residents’ fluid intake during a period when they had been unwell. Staff followed up a residents concern about their health promptly during the inspection, and advice was sought from the General Practitioner. However concerns still remain about the overall management of residents’ health care needs, which puts them at risk. It is important that care plans include specific detail to enable staff to meet the health needs of residents, for example those with diabetes, those who use nebulisers or oxygen equipment and those who manage their own medication and any other such specialist needs. A requirement was made following the last inspection for people to be assessed for the risk of developing pressure ulcers. A tool for identifying residents at risk of pressure ulcers had been introduced since the last inspection. However discussion with staff about this record identified that they had no guidance about how to interpret the findings and what action they were to take as a result. There is therefore a risk that residents who are at risk of developing pressure ulcers are not referred quickly enough to the Community Nursing teams for pressure relieving equipment to be put in place. Review of a sample of residents care plans and medication records identified that the management of residents’ health and medication needs, remains poor and has the potential to put people at risk. A resident who staff say manages their own medication has a care plan which instructs staff to ensure that she tests her blood sugar regularly, there is no Rosedale Residential Home DS0000068813.V354125.R01.S.doc Version 5.2 Page 14 guidance regarding how often this should be, where it is recorded and what would be the normal range for her. There is also no guidance as to what stage medical attention should be sought. Residents who look after and take their own medicines and residents who receive medication covertly are not doing so within a framework of risk assessment. For example there is an entry on the evaluation of one residents care plan which states “---- reduced her insulin slightly”. There is no reference to any referral to the General Practitioner regarding this. Medication records are in some cases inaccurate and incomplete and do not demonstrate that medication has been administered according to the prescribers instructions. For example the daily records for one resident showed that a medication that was available in the trolley had been administered but there was no record of this medication on the medication administration sheets. No record is kept of medication that is given to residents to look after themselves and an error had been made where medication was recorded twice at two different doses both of which had been given. Changes had been made to records with no explanation of the reason why. Rosedale Residential Home DS0000068813.V354125.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 good. This judgement has been made using available evidence including a visit to this service. Residents’ are generally satisfied with their daily lives and the meals provided, however the individual planning will help to ensure that their needs and expectations are met. EVIDENCE: There was evidence that since the last inspection residents were being asked about their preferred routines and their likes and dislikes. A resident spoken with said that they were able to get up and go to bed at a time that suited them. Residents confirmed that they are able to choose whether they spend their time within their own rooms or in the shared lounges. A reminiscence session was taking place on the afternoon of the inspection, which most of the residents took part in and the activity organiser hours have been altered so that some activity takes place each afternoon. One resident spoken with said that they had recently enjoyed going out to the local shops with a member of staff, which is something they had not done in a long while. Rosedale Residential Home DS0000068813.V354125.R01.S.doc Version 5.2 Page 16 These observations together with the fact that information is being gathered about individual interests indicate that progress is being made in trying to improve the daily lives of residents. Information received from a relative and discussion with staff confirms that relatives are encouraged to visit and that staff try and support residents in maintaining family relationships. It was of concern at the last inspection that the bathing routine for a resident involved an element of restraint indicating that residents may be at risk of their rights and choices not being respected. There was evidence that the advice given at the time was acted on and that the Community Psychiatric Nurse and the General Practitioner had been consulted regarding the resident’s care. As discussed under the health and personal care section of this report, staff have reported that with a different approach and professional advice the restraint and removal of the residents rights is no longer necessary. Some training for staff on the Mental Capacity Act has been booked for December 2007. It will be important to ensure that all staff are fully aware of the legislation and to review care practices on a regular basis to ensure that residents rights are upheld. Residents’ spoken with confirmed that they had enjoyed their lunch time meal and that they had a choice. Staff were also heard to offer residents a choice for their tea time meal. Discussion with residents, a relative and staff indicated that people were generally happy with the meals; one resident was keen to have more green leafy vegetables and salad. The Acting Manager was in the process of meeting with all residents individually to identify their preferences in order to develop an agreed care plan, which will help to ensure that dietary needs and preferences are accommodated. Rosedale Residential Home DS0000068813.V354125.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 good. This judgement has been made using available evidence including a visit to this service. There are procedures for dealing with concerns and complaints, which people are aware of and staff are aware of their responsibilities for protecting the people in their care. EVIDENCE: Review of information received by the Commission for Social Care Inspection (CSCI) since the last inspection identified that no complaints had been received directly by us. The provider investigated an anonymous complaint received by Northamptonshire County Council (NCC) and no evidence was found to substantiate concerns about the way some staff spoke to residents. Residents spoken with during the inspection had no concerns about the way that staff treated them. Discussion with relatives has confirmed that they are aware of the process for raising concerns or making complaints and contact staff or the owners directly. Review of a complaint received from a relative identified that this had been investigated and action taken to address the concern raised. Records show that staff have recently attended some training about adult abuse. Discussion with staff confirmed an understanding of their responsibilities for the people in their care. Rosedale Residential Home DS0000068813.V354125.R01.S.doc Version 5.2 Page 18 Rosedale Residential Home DS0000068813.V354125.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, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Action has been taken to address some of the shortfalls identified previously by inspectors, however there is a need for ongoing review and improvement of the premises to provide a safe and comfortable home for residents. EVIDENCE: Various maintenance requirements were identified at the last inspection from a sample check of the premises; this had been of particular concern as some of them had been identified at the inspection carried out in April 2007. There was evidence that work had been done to address the specific maintenance issues raised. This included replacing a broken window pane in the front lounge, replacing a carpet that had been identified as a tripping Rosedale Residential Home DS0000068813.V354125.R01.S.doc Version 5.2 Page 20 hazard and servicing the medi-bath and replacing the seat, which was rusted and worn. Improvements to the bathing facilities were in progress in that a bathroom on the first floor, which was unsuitable for the needs of residents, was being replaced with a wet room. Some work still needed to be done in relation to the electric shower before it was fully operational. However it was not possible to easily identify the hot tap from the cold tap on the sink and there was a plumbing problem in that foul waste appeared to be coming up the drain in the shower. The Acting Manager advised on the second day of inspection that the plumber had been called back and remedied the problem. On the second day of inspection it was noted that part of the light fitting had been removed from the light outside the bathroom door on the ground floor making the lighting in that corridor quite poor. It could not be ascertained how long there had been no light there, however the Acting Manager undertook to make arrangements for it to be repaired/replaced. Concerns were identified about infection control. Bins used for disposal of incontinence pads had no lids, however the Acting Manager went out and purchased new bins during the inspection. It was noted in the downstairs bathroom that the soap dispenser was empty and that there were no paper towels. A staff member advised that staff usually wash their hands in the staff toilet, which is located on the landing between the ground and first floors. Advice has been given that hand washing facilities for staff and residents must be in place in all bathrooms and toilets. Advice was given to carry out the Department of Health risk assessment for infection control to ensure that appropriate measures are in place to reduce the risk of infection for residents. The Acting Manager said that infection control training had been booked for staff in November 2007 and that the trainer would also be advising on infection control measures in the home. Rosedale Residential Home DS0000068813.V354125.R01.S.doc Version 5.2 Page 21 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. The improvements in the recruitment procedures provide better protection for residents however staff training needs to be improved to adequately meet residents’ needs. EVIDENCE: Many of the staff have worked at Rosedale for a number of years. 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’. At the last inspection night staffing arrangements were discussed, as a particular residents’ lifestyle preferences were not being met. This resident is no longer in the home and the Acting Manager advised that she is in the process of reviewing with night staff the individual needs of residents through the night. Discussions with staff about the management of medication identified that they were finding it difficult at tea time to administer medication make and serve teas and assist residents with their tea time meal with only two staff on duty. Rosedale Residential Home DS0000068813.V354125.R01.S.doc Version 5.2 Page 22 The Acting Manager confirmed that she would look into this problem and address this issue to ensure that residents were not put at risk. Since the last inspection good progress has been made in arranging staff training and some training courses have been undertaken which start to address the serious shortfalls. However it is evident that there is still a lot of work to do to ensure that staff have the appropriate knowledge and skills to meet the needs of residents. At the last inspection it was identified that seven staff had received medication training since the inspection in April 2007. However in spite of this, serious shortfalls were identified in relation to the management of medication. This creates a risk to residents and highlights the need for ongoing review of staff knowledge and competence. Some in house dementia training has been organised by the Acting Manager who is also a Registered Mental Nurse (RMN) and some advice has been sought from the Community Psychiatric Nurse regarding the care of an individual. Further dementia care training has also been booked for a senior member of staff. Training to meet residents’ needs is still an issue, as staff have not received essential training in diabetes or catheter care even though they are looking after residents with these conditions. It was also difficult to fully track some staff training undertaken, needed or due as for example one group certificate of training did not detail staff who had completed the courses and another was undated. A newly recruited staff member’s file was reviewed to check the adequacy of the recruitment process. This confirmed that appropriate references and criminal record bureau clearances had been obtained as part of assessing their suitability to work with vulnerable people. Rosedale Residential Home DS0000068813.V354125.R01.S.doc Version 5.2 Page 23 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. 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. There has been no registered manager in post since the current registration in January 2007. However this standard 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.V354125.R01.S.doc Version 5.2 Page 24 It is the inspector’s judgement that the management overview of the home is not being adequately undertaken as evidenced in the lack of sufficient progress in fully meeting outstanding requirements and protecting the health and welfare of residents. The Acting Manager who was in post at the time of the inspection carried out in July 2007 has since left. Temporary arrangements were put in place by the owners, however following a meeting with CSCI in October 2007 one of the directors of the company took on the role of Acting Manager. As a result of the findings of the inspection in November 2007 which identified continued shortfalls and the need for effective leadership the current Acting Manager advised that she had decided to increase her management hours worked in the home until a suitable manager can be appointed. 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 November 2007. These included positive comments about the staff team for example “staff are very friendly and very caring”. It was however identified in the report of the inspection carried out in July 2007 that the systems in place appeared insufficient in that the shortfalls were identified through the inspection process rather than the homes own systems. This continues to be the case e.g. medication management. It is important that robust systems are in place to monitor the quality of care provided to protect residents’. Concerns were identified at the inspection in July 2007 about the storage of steradent. Advice was given about the risks of people with dementia mistakenly swallowing these, due to the risk of asphyxiation. In July, several tubes were found in an unlocked bathroom, which was accessible to residents with dementia. There were no steradent tablets in that cupboard at the time of the inspection in November, however there were some in a second cupboard in the same bathroom, which had not been checked. Three tubes were also found on an open shelf in an unlocked residents bedroom. This raises concerns about the ability to identify and act to reduce unnecessary risk to the health and safety of residents. Rosedale Residential Home DS0000068813.V354125.R01.S.doc Version 5.2 Page 25 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X X X 2 Rosedale Residential Home DS0000068813.V354125.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12 (1) (a), 15 (1) Requirement Care plans must be sufficiently detailed to enable staff to meet residents’ individual personal, social, emotional and health needs. This must include clear instructions on how needs are to be met and action to be taken when/if residents needs change. (Previous requirements with timescales for compliance of 15/06/07 and 30/09/07 have not been met) A statutory requirement notice has been issued separately as a result of non compliance with this requirement. Systems must be put in place to ensure that residents’ health care needs are monitored and met. (A previous requirements with a timescale for compliance of 30/09/07 has not been met) Assessments to identify 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 DS0000068813.V354125.R01.S.doc Timescale for action 24/01/08 2. OP8 12 (1) (a) 24/01/08 3. OP8 12 (1) (a) 24/01/08 Rosedale Residential Home Version 5.2 Page 27 4. OP9 13 (2) risk. (A previous requirement with a timescale for compliance of 30/09/07 has not been met) Effective arrangements must be 19/12/07 in place to ensure that people who self administer medication do so within a risk assessment and care planning process to ensure that medication is taken correctly, safely and according to the prescriber’s instructions. (Previous requirements relating to the management of medication with timescales for compliance of 01/06/07 and 15/09/07 have not been met.) A statutory requirement notice has been issued separately as a result of non compliance with this requirement. 19/12/07 Effective arrangements must be in place to ensure that covert administration of medication only takes place within the context of existing legal and best practice frameworks to protect the person receiving the medication and ensure that medication is not being used inappropriately. (Previous requirements relating to the management of medication with timescales for compliance of 01/06/07 and 15/09/07 have not been met.) A statutory requirement notice relating to this requirement has been issued separatley. 5. OP9 13 (2) 6. OP9 13 (2) Effective arrangements must be in place to ensure that people who use the service have their medicines promptly obtained at all times and given to them according to prescriber’s instructions. DS0000068813.V354125.R01.S.doc 19/12/07 Rosedale Residential Home Version 5.2 Page 28 (Previous requirements relating to the management of medication with timescales for compliance of 01/06/07 and 15/09/07 have not been met.) A statutory requirement notice relating to this requirement has been issued separately. Effective arrangements must be 19/12/07 in place to ensure that people living at the home have records of medicines received on their behalf fully and accurately recorded at all times. There must be an audit trail to demonstrate the receipt, administration and disposal/return for each prescribed medication. (Previous requirements relating to the management of medication with timescales for compliance of 01/06/07 and 15/09/07 have not been met.) A statutory requirement notice relating to this requirement has been issued separately. Effective arrangements must be in place to ensure that accurate, complete and up to date medication administration records are kept. (Previous requirements relating to the management of medication with timescales for compliance of 01/06/07 and 15/09/07 have not been met.) A statutory requirement notice relating to this requirement has been issued separately. 9. OP9 17 (1) (a) (b) Effective arrangements must be in place to ensure that any DS0000068813.V354125.R01.S.doc 7. OP9 17 (1) (a) (b) schedule 3 (i) 8. OP9 17 (1) (a) (b) schedule 3 (i) 19/12/07 19/12/07 Rosedale Residential Home Version 5.2 Page 29 schedule 3 (i) changes to the dosage and or administration of medication are recorded. (Previous requirements relating to the management of medication with timescales for compliance of 01/06/07 and 15/09/07 have not been met.) A statutory requirement notice relating to this requirement has been issued separately. 10. OP30 18 (1) (c) Arrangements must be made for staff to receive training to meet the specific identified needs of residents’ living at Rosedale, which includes diabetes and catheter care training. (A previous requirement with a timescale for compliance of 15/09/07 has not been met) 24/01/08 11. OP33 24 An effective quality assurance 24/01/08 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. (Previous requirements with timescales for compliance of 02/07/07 and 30/09/07 have not been met). Dental cleansing tablets must be 12/12/07 stored securely to reduce the risk of a resident swallowing them and becoming asphyxiated. (A previous requirement with a timescale for compliance of 15/09/07 has not been met) A statutory requirement notice relating to compliance with this requirement has been issued separately. 12. OP38 13 4 (c) Rosedale Residential Home DS0000068813.V354125.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rosedale Residential Home DS0000068813.V354125.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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.V354125.R01.S.doc Version 5.2 Page 32 - 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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