Inspection on 26/06/07 for Rosedale Retirement Home

This inspection was carried out on 26th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Rosedale Retirement Home 06/11/08

Rosedale Retirement Home 03/06/08

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

CARE HOMES FOR OLDER PEOPLE Rosedale Retirement Home Ashfield Crescent Ross-on-wye Herefordshire HR9 5PH Lead Inspector Wendy Barrett Key Unannounced Inspection 09:10 26th June 2007 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 Retirement Home DS0000068339.V333030.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 Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosedale Retirement Home Address Ashfield Crescent Ross-on-wye Herefordshire HR9 5PH 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) 01989 565851 01989 765851 Autumn Days Care Ltd Mrs Julie Scotford Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24), of places Physical disability over 65 years of age (9) Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Rosedale is situated in a residential area on the edge of the town of Ross-onWye. A purpose built extension to the existing home was completed in 2004 and this provides an inner courtyard garden that can be directly accessed from some bedrooms. The residents’ accommodation consists of 20 single bedrooms and 2 double bedrooms. Fifteen single bedrooms and one of the double bedrooms have ensuite facilities. Internal steps have to be negotiated to reach a few of the bedrooms, although there is an internal lift and wooden ramp to help residents who have restricted mobility. Because of this situation the home is only registered to accommodate 9 older people who have physical disability although any of the 24 places may be used to accommodate older people who have care needs arising from general ageing, or as a result of a dementia. There is a contractual arrangement with Herefordshire County Council to use 2 places for respite care. There should be various information literature available to residents, relatives, enquirers and the Commission. For example, the new provider should have produced a revised Statement of Purpose and Service User Guide that fully describe the type of service currently offered at Rosedale. This had not been done at the time of the inspection visit although a proposed Statement of Purpose has subsequently been submitted for consideration by the Commission. In May 2007 the fees ranged from £352-00p to £455-00p. Additional charges are made for hairdressing, chiropody and newspapers. Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of the service since a new Provider was registered by the Commission at the end of 2006. There has also been a new Care Manager registered since the last inspection. Information referenced in writing this report was obtained from a questionnaire completed by the Care manager, survey forms sent out to residents, relatives and visiting care professionals, an unannounced visit to the service and records about the service and held by the Commission. What the service does well: What has improved since the last inspection? This was the first inspection following a change of management. Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective and existing residents don’t have up to date information literature describing the service offered by the new Provider. Admissions only take place once the Care Manager has obtained all the information she needs to confirm that the home will be able to meet the prospective resident’s care needs and expectations. EVIDENCE: The new Provider had not produced a Statement of Purpose and Service User Guide at the time of the inspection visit. A copy was subsequently submitted to the Commission before this report was written. These information documents are very important because they give prospective residents, existing residents, relatives, placement authorities and the Commission up to date details of the service and what it offers. Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 9 Before the Care Manager agrees to admit a new resident she gathers as much information as she can to help her decide if the staff will be able to meet their needs and their expectations. Sometimes this involves getting information from other care professionals e.g. social workers, who already work with the prospective resident. A sample of records relating to this work reflected a thorough approach to this work that addressed physical health issues and social background. The assessment work would be even more useful to staff if there was more detail of the potential resident’s lifestyle preferences i.e. the way they like to spend their day. The bedrooms allocated for respite care can only be accessed via some internal steps and they may not, therefore, be suitable for people who have restricted mobility. The Care Manager explained that she has stopped the previous practice of accepting emergency referrals for admission so that she has enough time to make her own assessment and ensure the placement will actually be suitable. Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident has a written plan of care that shows how health care needs are being met. When residents have difficulty co-operating with personal care this should be covered as part of the care planning and there needs to be more consultation with residents and their families when writing and reviewing plans. The staff, and some visiting G.P’s, have some difficulty working comfortably together and should discuss ways to improve things. Residents’ medication is stored and managed safely. EVIDENCE: Each resident has a written plan of care although the plans are not being shared with residents and/or their relatives e.g. a relative who visits regularly was not aware of a written plan. The plans are much better since the arrival of the new Care Manager, although she knows there is still work to be done e.g. when residents resist staff efforts Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 11 to offer personal care this should be discussed with families and a care plan agreed. Health care needs are well covered although the comments of visiting health care professionals and staff at the home suggest that their working relationship could be improved e.g. the Care Manager had identified a resident at risk of malnutrition but was finding it difficult to get the G.P. to prescribe a food supplement. Visiting G.P’s feel that staff who receive them at the home aren’t always aware why the doctor has been called and staff may call a doctor unnecessarily sometimes-‘frequently have no idea why doctor called’, ‘low threshold for calling the doctor’. Residents and relatives are happy with the way staff treat them-‘the staff are always nice to us’. A relative felt that personal care was well attended and another mentioned that staff had recently been on training courses in dementia care. A new medication trolley has been purchased so staff can store drugs more tidily and securely. The Care Manager has been reviewing staff competencies in handling medication. This involves written questions and observations of practice to be sure medication is managed safely on behalf of the residents. Medication records indicate that good procedures are being followed and stock is also being well managed because there is no sign of over stocking and the records show clearly how medication is received, administered and disposed of. Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff work hard to help residents enjoy their days as they wish, and families and friends are welcomed into the home as part of this work. Residents may benefit if the current layout and use of the communal space was reviewed. Meals are planned so that they will please the residents and will provide them with a good nutritional balance. EVIDENCE: Relatives and residents are particularly happy with the recreational opportunities provided at the home –‘excellent recreation’, ‘encourage us to be active’. There are displays of craftwork and a chart of activities offered each month that reflect this positive picture. Residents were observed at the home playing cards and painting. One lady was knitting a child’s cardigan and was very pleased with her work. A Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 13 gentleman had been allocated a patch of garden so that he can pursue his interest in gardening. The lounge where most residents sit is a long, narrow room that only allows armchairs to be arranged in a row. This does not help residents interact with each other. It might be a good idea to consider if the communal areas could be re-arranged to improve the current layout. A front lounge doesn’t seem to be used very much at the moment. New sit-on weighing scales were delivered during the inspection visit. These will also measure body mass index and will help staff identify any residents who may be at risk of malnutrition. The care planning process includes assessment of each resident’s dietary needs and preferences and there is an example described in this report of the Care Manager’s attention to this aspect of care. There is a choice of menu and special diets are catered for. The dining area is very attractively presented although residents may choose to have their meal in the privacy of their bedroom. A staff member was observed helping a resident to eat her meal. This was done in an unhurried manner with good attention to the dignity and comfort of the resident. Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and things are put right when shortfalls are identified. Residents are protected from abuse by staff who understand about adult protection EVIDENCE: There are records kept at the home of all complaints received and how they have been dealt with. These confirmed a thorough response to complaints. Residents felt their concerns are handled appropriately and a complaints procedure is displayed at the home. Two complaints had been received at the home since the last inspection. The Commission has received three contacts and the main area of concern has been in respect of the personal care provided. Most of this has originated from admissions that have been short term and/or emergencies, and the new Care Manager has already taken action to avoid hurried admissions so she can undertake a full assessment of care needs before any admission is agreed. Sometimes residents have less serious concerns that are quite easy for staff to deal with. It would be a good idea to keep a record of these minor issues as well so that any re-occurring issues can be looked into. Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 15 Staff received training in adult protection in April of this year. They also have written guidance to help them in protecting the residents from abuse. This guidance was recently updated in March 2007. Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 16 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The accommodation is well cared for and there are plans to continue upgrading facilities at the home to suit the residents. The layout of the building is not ideal although things are changed and improved when this is possible. The residents are very pleased with the cleanliness of their accommodation and the staff understand how to work hygienically. EVIDENCE: The residents’ accommodation is well cared for and there is no sign of any mal odour. A resident commented ‘the home is always very clean’. There are some aspects of the premises that are not ideal although there is Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 17 a commitment to do whatever is possible to improve the situation. There are a high number of residents who have dementia related needs and the special needs of these people need to be considered in future premises work. The Care Manager showed a good awareness of what this involved although the layout of the building may limit the opportunities for very much change. A staff ‘station’ is in the communal area of the home and does not provide good security or privacy. The Care Manager has installed a hand wash basin and re-arranged furniture to try and improve the situation. An unused utility room is due to be converted into a wet room because the residents tend to prefer shower facilities. The Provider has also consulted the Care Manager and the cook about proposals to upgrade the kitchen. Unfortunately, the main lounge is long and narrow so that residents have to sit in a line rather than in smaller groups that may encourage them to chat to each other. A second lounge doesn’t appear to be much used by residents at the moment so perhaps this could be better utilised. The access to a few bedrooms includes a small flight of stairs for residents to negotiate. Staff received training in infection control procedures in April of this year and they have associated written guidance and procedures. The laundry is well equipped with adequate sluicing facilities. Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 18 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff to look after the residents and they receive the training they need to meet the residents’ needs. Their training opportunities have been improved and developed by the new management. New staff are generally carefully recruited to be sure they will be suitable to work with vulnerable adults but occasionally not all the checks are fully implemented. EVIDENCE: There were a satisfactory number of competent staff on duty when the inspection visit took place and duty rotas are kept to record the cover each day and night. The residents feel comfortable with the staff –‘the staff are always nice to us’, and they were observed chatting and laughing with staff during the visit. There is a good percentage of care staff working at the home who have achieved a national vocational qualification in care – over fifty percent. All staff are receiving health and safety instruction so that they know how to work safely with the residents, and the Care Manager has introduced Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 19 additional training and guidance in respect of dementia care e.g. training courses, workshop, literature. When staff are selected for work at the home they are subject to checks of their suitability. The recruitment process is generally satisfactory but occasionally this is not being quite thorough enough e.g. two records only showed one reference obtained instead of two, one long term staff member had not been checked by the Criminal Records Bureau, and one sampled staff record did not include a full employment history. Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 20 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): 31,32,33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered people understand their responsibilities and have a commitment to developing the service in the best interest of the residents. More work needs to be done to help residents and relatives get to know the new management team and what type of service they want to offer. Residents are protected by regular attention given to health and safety aspects of the service. EVIDENCE: Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 21 The Commission has recently registered a new provider and a new Care Manager in respect of the service at Rosedale. This means they have recently been confirmed as fit people to carry out their responsibilities and have not yet had enough time to fully demonstrate their management practice at the home. The evidence at this first inspection was encouraging. The Care manager felt that the home was being well supported by the Provider’s representative who visits regularly. They have already discussed various proposals for developing the service and residents are being encouraged to contribute to this e.g. being asked to select colour schemes. During these visits the Provider’s representative meets staff, residents and any visiting relatives and he also checks records at the home and the premises. However, reports of these visits should be available for inspection at the home but were not yet in place. There were examples to suggest that residents’ views are welcomed and encouraged at the home e.g. two residents recently joined a staff meeting and were invited to stay and offer their comments on the service. Survey forms were sent out earlier this year to gain feedback from professionals and residents. It was noted that health care professionals described the same type of difficulties as described in the current inspection survey responses, but it was unclear if anything had been done at the time to address the issues raised. A relative said she hadn’t been given any information about the new Provider and would have liked to receive an introductory letter or an opportunity to meet. The home does not get involved in helping residents with financial affairs if there are family members to offer this support. This is good practice. When this is not possible, savings are kept in individual bank or post office accounts. There is only one resident who relies on the manager to act as appointee and records are kept to show how personal money is looked after by the home. Health and safety procedures have been well addressed. A new health and safety policy had been written in March of this year and there were comprehensive records of regular audits e.g. maintenance work required, history of resident falls, health and safety reports completed by senior staff at the end of each shift. Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 22 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 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 x 3 x x 3 Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard OP1 OP7 OP8 OP19 OP29 OP37 OP32 Good Practice Recommendations All residents should be given a Service User Guide that describes the current service, and a copy of a Statement of Purpose should be made available at the home. Residents and/or their representatives should be encouraged to participate more in care planning work. Any difficulties in working well with health care professionals should be addressed so that residents are not disadvantaged. Review the current use of communal space and consider ways of re-organising it to encourage better resident interaction. Fully apply the recruitment procedure on every occasion. A monthly report of visits by the Provider’s representative should be available at the home to describe the work covered in monitoring the service. Residents and relatives may appreciate more opportunity DS0000068339.V333030.R01.S.doc Version 5.2 Page 24 Rosedale Retirement Home to meet the new management and discuss the future plans for the service. Rosedale Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Retirement Home DS0000068339.V333030.R01.S.doc Version 5.2 Page 26 - 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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