Inspection on 03/06/08 for Rosedale Retirement Home

This inspection was carried out on 3rd June 2008.

CSCI found this care home to be providing an Poor service.

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 26/06/07

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Rosedale Retirement Home Ashfield Crescent Ross-on-wye Herefordshire HR9 5PH Lead Inspector Wendy Barrett Unannounced Inspection 3rd June 2008 09:15 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.V365777.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.V365777.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 F/P 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.V365777.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th June 2007 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. 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 5 places for respite care. There is a Statement of Purpose and Service User Guide that are written descriptions of the service. Every resident should receive a copy of a Service User Guide and the Statement of Purpose should be available to read at the home. The information in these documents needs further review and updating to be sure it is current and includes all the information required under regulation. 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.V365777.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This report has been written with reference to information about Rosedale that has been gathered in a number of ways. The Care Manager, Julie Scotford, submitted an annual quality assurance assessment report (AQAA) as required by us. A sample of ten survey forms was sent out to people who use the service. Mrs. Scotford agreed to ask relatives to help residents complete these where appropriate. We have undertaken two random inspections since the last key inspection. The first of these was undertaken on 13th November 2007. It followed a request from social services to help them investigate a complaint they had received from a relative of a respite client. The second random inspection was undertaken on 27th May 2008. It arose from 3 anonymous complaints alleging inadequate staffing and shortages of food stocks. We received an anonymous complaint in September 2007. This complainant expressed concerns that residents were being got up and dressed very early in the mornings and in a hurried manner. We received a complaint from a local G.P. on 27th May 2008. The complaint identified the surgery’s concerns over the number of residents who have suffered bone fractures at the home during the past 2 years. There was also concern that the staff were not handling health care issues as well as they should. The Hereford and Worcester Fire Authority have liaised with us about their regulatory work with the service to achieve satisfactory fire safety arrangements at the home. We checked our records of contacts with the service since the last key inspection in June 2007. These include things like notifications made by the home to us about accidents and incidents that have happened e.g. resident falls. Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There must be more care in making sure the home will be able to meet the needs and expectations of potential residents before arrangements to admit are agreed. In the event that emergency admissions are to be accepted at the home there must be more robust follow up arrangements to monitor the suitability of the placement and ensure the safety and wellbeing of the involved resident. There must be more care in making sure that residents who wish to self medicate are helped to do this safely. Other potential risks to residents’ health and safety must also be more effectively managed. This work should address residents’ personal activities e.g. mobility, and premises safety e.g. essential fire prevention equipment. There must be enough staff on duty at the home to provide the care the residents need and to keep them safe. Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 7 There must be a system of monitoring the quality of the care. This should include consultation with residents or their representatives so their views can be taken into account in making future plans for the service. 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.V365777.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3,4 and 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service are not receiving the written information they need to understand what service they can expect from the home. Poor planning of admissions is leading to an uncomfortable introduction to the home for people who use the service. The home is not meeting the care needs and preferences of new residents. EVIDENCE: Information literature that describes the service was in need of updating when the home was inspected in June 2007. This remains the case and people are not always receiving the information they need. A relative commented ‘no paperwork whatsoever’. It was particularly worrying that the relative was paying the home a client contribution without the benefit of a service user guide, statement of terms and conditions or written account and receipt for the required payments. This information is very important because it clarifies Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 10 exactly what the fees cover and what type of service can be expected from the home e.g. staffing arrangements, accommodation. Although Julie Scotford confirmed in June 2007 that the home was no longer receiving emergency placements, the home’s Statement of Purpose still makes reference to an ‘emergency admission policy’. There are recent examples of the home admitting people without first making sure their needs and expectations can be met by the service. The circumstances around the admission of two respite residents were checked during inspections on 27th May and 3rd June 2008. In both cases, the residents were unhappy with their admission experience. In one case, the resident described how she wasn’t expected when she arrived and her room wasn’t ready for her. She was not receiving meals to meet her dietary needs and preferences-even though this information was clearly recorded for staff reference. She was described in a staff day report as having ‘good mobility’ but was seen to have considerable difficulty rising out of a chair and negotiating internal steps without someone to support her. The second resident said he didn’t want to be at the home and was angry about his admission the previous day. He had some walking difficulties but there was conflicting information in written records at the home so it wasn’t clear to staff how they should be supporting him. Such confusion about a crucial area of care is concerning. A general practitioner has expressed concern about the number of bone fractures at the home during the past 2 years. The Commission also wrote to Mr. Menon in December 2007 expressing concern about the number of falls being experienced on internal stairs at the home. It is essential that people who have mobility problems be carefully assessed by a competent individual so that staff can have clear instructions about the support needed to keep the individual safe. The lack of a clear plan, as described in the two admissions above, puts people at unacceptable risk. The evidence indicates an ongoing lack of attention to finding out what help each new resident will need to keep him or her safe in the home. Neither resident had been visited by the Care manager or been able to view the home prior to their admission. Some information had been obtained from social services staff but this was not detailed enough for the home to assess if the placement would be suitable. An urgent requirement was sent to the Provider about planning admissions to the home. This is repeated at the end of this report. One of the records referred to the admission as an ‘emergency respite admission’ although Julie Scotford has said that Rosedale no longer accepts emergency admissions. The home’s Statement of Purpose refers to an ‘Emergency Admission’ policy. Julie Scotford had signed this document in Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 11 March 2008. An Emergency Admission policy was seen in a folder containing all the home’s policies and procedures. This had been written in 2004. If the service is accepting emergency admissions this policy will need updating and extending. Rosedale Retirement Home DS0000068339.V365777.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 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service are being put at unnecessary risk because the staff are either not identifying potential risks to their safety, or are not making up a plan of action to address any risks that have been identified. There is some good practice to make sure staff are handling medication safely. This isn’t the case in addressing potential risks associated with residents who want to manage their own medication. Relatives appreciate the kind and caring attitude of staff even though they aren’t practicing effective person centred care. EVIDENCE: People who use the service each have a written plan of care. This is intended to advise the staff how to work with each individual to make sure they are safe and their personal preferences are respected. Ms. Scotford refers in her AQAA report to improvements she has made to the care planning since the last inspection e.g. better risk assessments, more information about the resident’s life experience and social interests. A few care records were checked and they did include care plans for things like Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 13 personal hygiene, falls prevention, mobility and social needs. However, it looked as if the plans and risk assessments were not being reviewed regularly enough to be sure they took into account changes in the resident’s condition. For instance, one falls risk assessment was last reviewed in April 2007. Accident records at the home showed that the resident was actually experiencing regular falls during the month of May 2008. This reflected a marked change since the mobility care plan was written in April 2007. This plan had been based on the risk assessment and it advised staff that -‘moving and handling needs are not needed at this present time’. This advice was clearly out of date and should have been revised to take into account the additional risks now faced by the resident. The care staff were writing day and night reports for each resident. The entries were relevant although there were indicators that the staff were probably relying too heavily on this record. For example, the care planning system provides a separate recording page for entering any contacts with care professionals. This is a good idea because the page gives an instant picture of this type of attention. Single entries about visits from care professionals can get buried in a day/night report book and make it much more difficult to monitor a resident’s overall care. In September 2007 we were made aware of a concern that residents were being got up very early in the mornings e.g. 5:45am because the home was short of staff. We were told that residents were being rushed e.g. staff were washing them in cold water because they hadn’t time to wait for the hot water to come through. We made Ms. Scotford aware and she wrote back to us following an investigation. She was satisfied that the concerns were unfounded and explained to us how she had reached this conclusion e.g. interviewing all night staff. The recent survey exercise undertaken as part of this inspection resulted in some comments from residents that suggest a lack of prompt staff attention at times -‘staff too busy’, ’would like more help getting undressed and ready for bed’. Relatives have varying views about the personal care given to residents. We wrote to Mr. Menon in December 2007 expressing concern over the number of falls being experienced by residents on internal stairs at the home. We built up this picture from written notifications of accidents that we had been receiving from the home, and from information included in previous complaints and concerns about the experiences of particular individuals. We asked Mr. Menon to send us details of his plans to reduce the risks to people who use the service but we did not receive any reply. Immediately prior to this inspection a local G.P. expressed concern about the ability of staff to deal effectively with health care matters. There was reference to the tendency of staff to make unnecessary requests for visits. On one occasion, the G.P. had been into Rosedale and hadn’t even got back to the surgery before another request for a visit had been received. When asked Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 14 about this type of incident Julie Scotford referred to the residents’ right to have access to their G.P. A resident had apparently seen the G.P. in the home on that day and had been unhappy that the doctor had not spoken to them. The residents’ right to G.P. access is not denied but sometimes there does need to be negotiation and consultation with all interested parties when this type of situation is experienced. This is a part of the care management task. The G.P. also expressed concern about the number of bone fractures experienced at the home during the past 2 years. The G.P. pointed out that the above concerns arose from the surgery’s experience of a number of similar care services in the area where the working relationship is more comfortable and mutually supportive. There were examples of a lack of attention to high-risk aspects of care that we identified during a random inspection on 27th May 2008, and this inspection. Two respite residents had been admitted to the home and there was information describing potential risks such as difficulty walking, risk of malnutrition. The staff had no written guidance in a care plan to tell them how to work with each resident to reduce these risks. One of the individuals was already experiencing the home’s failure to provide her with a high fibre diet. A long-term resident’s day and night reports contained regular entries throughout the month of May 2008 describing increasing mobility problems, falls and staff clearly struggling to cope. Despite this, written guidance e.g. risk assessments and care plans intended to address these problems had not been reviewed since April 2007 and did not reflect the current situation. An urgent requirement was made in response to the above evidence. This is repeated at the end of this report. A sample of medication stock and records showed a generally satisfactory situation at the home. Handwritten records were being checked for accuracy by two staff and administration records were complete. Most allergy boxes were completed-one or two were not and it was pointed out to Julie Scotford that these should be filled. The staff were appropriately dating the containers of new stock when they were brought into use. The controlled drugs were being stored in a suitable, purpose designed cupboard and the controlled drugs register was fully completed. Checks of actual stock showed no discrepancies in the recorded stock totals. The safety and whereabouts of the medication cupboard keys was well monitored. The staff sign a record sheet to show exactly who has control of the keys at any time of day or night. This is a very good practice and the record was completely up to date. A self-medicating respite resident was met during the random inspection on 27th May 2008. The list of medication in the care record did not correspond with the medication seen in the resident’s bedroom. The medication was not being stored in a lockable facility and the bedroom door was wide open. There was no evidence of a self-medicating risk assessment having been completed. Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 15 The resident alleged that a care assistant had brought her a tablet and she had to point out to the care assistant that she had her own medication. An immediate requirement was made in response to the above evidence. We received a written response to this requirement from Mr. Menon and from Ms. Scotford. Ms. Scotford confirmed that she had completed a self-medicating risk assessment report immediately after the random inspection on the 27th May 2008. The resident was also offered guidance and a key so that she could keep her medication safe. She had subsequently chosen to hand over her medication and allow staff to manage it on her behalf. Her medication record had been completed and counter-signed by a second staff member to confirm its accuracy. Ms. Scotford had interviewed two staff about the resident’s allegation that a staff member had tried to give her a tablet though she had all her own medication. Both staff on duty at the time denied that this had occurred. Mr. Menon confirmed in his written response to the immediate requirement that he had discussed care planning arrangements with Ms. Scotford on several occasions. He had given her a ‘medication profile’ form for use in this work. Relatives’ comments refer to kind, caring staff-‘the girls are nice to him’. One relative felt that the staff ‘do their best’ but also felt that they have too much work. The next section of this report describes a 2 hour observation exercise we undertook in the residents’ main lounge. It was noted that there was little ‘social’ conversation going on between many residents and the staff. Any dialogue seemed to relate to a practical task that was being addressed e.g. collecting drinking mugs, walking through the room on the way to a practical task elsewhere in the building. One resident spoke to us about a care assistant who had asked him to use a commode ‘in her time’ and he had answered that he would and could only use it in his own time. The cook spoke about a care assistant who had been asked to give a resident brown bread but had given the resident white. We spoke to this resident and she had not felt able to raise the issue with any staff. These examples may reflect a home where there are too few staff to offer person centred care because they are so busy moving from one practical task to the next. It may be that staff do not know how to practice person centred care and need more guidance and support. This is an essential approach if there is to be due regard to respect and dignity. Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 16 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 poor. This judgement has been made using available evidence including a visit to this service. There is not enough attention to running the home in a flexible way that takes into account the preferred lifestyles of individual residents. This is leading to residents missing out on the social opportunities that would make their days enjoyable. The quality of the food stock is satisfactory and the menus are varied and interesting. There isn’t enough care to be sure the meals served meet individual dietary needs and preferences. Food stocks are not being well managed to avoid running out of basic, everyday provisions and ingredients that are needed to follow the planned menu choices. EVIDENCE: A random inspection was undertaken on 27th May 2008 because we received 3 concerns that food supplies were running short at the home. We found that there were a few shortages on the day. One resident did say she had to wait for her breakfast toast until someone had been out to buy butter. The cook had to alter the menu due to a shortage of eggs. Generally there were good food stocks of a satisfactory quality. Julie Scotford acknowledged that there had been some shortfalls but that these had probably arisen because there had Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 17 been a change of suppliers and ordering arrangements. She was confident the problem was a one-off situation. At the time of this key inspection the cook said that she didn’t always have the ingredients she needed to make the type of food specified on the menu. For example, she had no glace cherries or cooking chocolate for baking cakes. She was also short of bananas and couldn’t serve the banana custard that was on the standard menu for the day. She had made a rice pudding as an alternative. Mr. Menon had recently decided to use more frozen vegetables to avoid waste. Although this decision may not affect the nutritional quality of the meals the residents should have been consulted because they may prefer fresh vegetables. A respite resident was met during the random inspection on 27th May. She explained that she needed a high fibre diet and that she did not like red meat. This information was recorded in the care records but the she hadn’t received her preferred brown bread since arriving at the home. On the day of the inspection she had been offered a choice of beef burger or meat pie for lunch. This was clearly not suitable for someone who does not eat red meat. An immediate requirement was made to ensure the provision of a suitable diet. Mr. Menon and Julie Scotford sent a written response to this immediate requirement. Julie Scotford confirmed that she had supplied kitchen staff with information about high fibre diets. She had identified a number of alternative foods that could be offered as part of this special diet and told the staff what these were. She had also given the resident some dietary information to take home at the end of her respite stay. Mr. Menon referred to Nutritional Risk assessments that staff had been given to use in care planning work. He also stated that there had been no decision to reduce/replace fresh vegetables. The intention was to better co-ordinate fresh produce deliveries and to improve the variety of vegetables provided. He had introduced a more varied and interesting menu because he felt that the previous meals ‘were very boring’. The new menus were seen at the home and they were varied and appealing. A record of food actually served to residents showed that residents were getting some choice. It was noted that there had been quite a lot of convenience type food served during the previous few days e.g. burgers, bought meat pies, fish cakes, waffles. This will need monitoring and is another reason why it is essential the cook has the ingredients she needs to prepare home made dishes and not rely too heavily on convenience foods. Care staff should not be expected to routinely combine catering tasks and care tasks. This is because the availability of care staff for providing direct care is limited when the also have to prepare a teatime meal and clear away afterwards. There may also be implications for food hygiene due to the likelihood that the two staff on duty in the afternoon may have to move between food preparation and care tasks. This situation arises every weekend Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 18 afternoon and evening period. During weekday afternoons and evenings Julie Scotford provides some care support. However, she cannot always be available if she has management tasks to perform e.g. pre-admission assessment visits. Some residents also need staff support to be able to enjoy their meals. Relatives commented on weekend afternoons when two staff are the only staff on duty at the home. The relatives noticed that the residents are left alone in the main lounge for long periods while the two staff go off to deal with one of the residents who need two staff to work with them. The relatives sometimes have to wait a long time to either be let into the home or to exit the home because no staff are around to unlock the door for them. A care assistant also expressed her embarrassment about the same situation. We spent two hours during an afternoon period observing life in the main communal lounge at the home. Although some residents were involved in a Bingo activity for some of the 2-hour period, many other residents were left alone except all the time except to be given a drink, and to be asked if they wanted sauce on their tea. The staff had little engagement with the residents-a care assistant only spoke to one resident while collecting used mugs-‘Can I take that?’. Julie Scotford was observed passing through the room without acknowledging any of the residents. A television was on although nobody was watching it most of the time. Residents were observed practising benign activities e.g. looking at fingernails, picking ear, scratching head, looking at watch, picking feet off floor. One resident commented - ‘sitting here for hours. If there was a bit of music it wouldn’t be so bad’. Another resident wanted to go home and another said ‘we all want that’. The above observations indicate a lack of staff support in helping each resident enjoy their days, although there were records kept of individual participation in activities e.g. ‘ball’, ‘one to one’, ‘family’. Some people who use the service have problems with confusion and shortterm memory loss. They require a particular type of social care that reflects their special needs and limitations. There was no evidence to show how these special needs were being addressed. Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 19 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 poor. This judgement has been made using available evidence including a visit to this service. Although some concerns are looked into when they are received, the home’s complaints procedure is not being adhered to all the time. There isn’t enough effort to develop good communications between the managers and people who use the service. Good information sharing would strengthen the safety of the residents. The staff have written guidance to help them recognise and report any potentially abusive situations at the home but they need more training to keep their knowledge up to date. EVIDENCE: A complaints procedure was displayed in the main entrance to the home. This needed updating e.g. it still referred to the Commission by its previous name of National Care Standards Commission. People expressing concerns about the service have contacted the Commission on a number of occasions since the last inspection. Some of these contacts have been anonymous. Two relatives have commented that they have raised their concerns with the home and have not received a reply. This indicates that Mr. Menon and Julie Scotford are not following the home’s complaints procedure. There was a record seen at the home of a complaint about the laundry and what action had been taken to put this right. Julie Scotford had also responded Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 20 to our request for information regarding concerns raised in an anonymous contact. The response to peoples’ experience of complaints is mixed, but it is important for all concerns to be listened to and acted upon because this approach helps keep residents safe. A relative said she had not received any information at all about the home and two relatives commented that Mr. Menon hadn’t contacted them at all since he took over the home. This situation doesn’t help residents and relatives ask questions, make suggestions and discuss any concerns they have about their experience of the home. Eight staff received training in abuse awareness in April 2007, and there is written guidance to advise staff about adult protection and how they can report any related concerns they may have. It would be advisable to repeat training to be sure that the staff understand the home’s related procedures e.g. whistleblowing policy, and are also made aware of current local arrangements for safeguarding adults. Residents rely heavily on staff to keep them safe so it’s very important the staff feel confident in this area of their work. Our recent contact with and concerning the service at Rosedale has identified a number of areas where people using the service are at unnecessary risk of harm. The personal activities of residents are not being robustly managed through the care planning procedures. Mr. Menon has failed to respond promptly to essential fire safety work on the premises. Staffing levels do not allow staff to meet individual residents’ care needs in a timely manner. Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 21 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 poor. This judgement has been made using available evidence including a visit to this service. The accommodation is generally well kept and odour free. There is ongoing work to maintain and improve the quality of the environment. People who use the service are put at unnecessary risk because important premises work isn’t addressed quickly enough. EVIDENCE: People who use the service have different views about the quality of the environment-’we were impressed by how light and clean it was’, ’my family has to complain to get them to clean my room on time’. It was clean and tidy when this unannounced inspection took place and there was no mal-odour anywhere in the home. During the past year the home has been fitted with new carpeting and many areas have been decorated. A new freezer and food mixer have been Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 22 purchased. A ramp has been fitted to improve resident access and trees have been cut down due to health and safety requirements. This has improved the lighting and the views for the people who use the service. There are future plans to upgrade the kitchen and update lighting in some areas. We have been in contact with the local fire authority as part of inspection planning work. The fire officer confirmed that Mr. Menon had failed to complete fire safety work within required timescales and this was being pursued with him at the point of this inspection. It is very worrying that Mr. Menon had failed to address work that is so important in keeping residents safe. The staff station is in an open area that is the corridor access from the front door to the main lounge and dining room. This isn’t an ideal situation because this is where confidential information is stored for staff reference. It was concerning that there were examples of temporarily mislaid resident care records during this and the previous inspection. Staff had not locked the records away in the metal cabinet and they were eventually found left out on the top of the work station. It would be preferable to identify a more secure area for the staff station although this has been a long standing problem and may not be easy to sort out. Meanwhile, staff must be reminded how to safely handle confidential records. Residents are being encouraged to make more use of a front lounge-two ladies were observed sitting together in this room during part of the inspection. However, an external training assessor was also seen to conduct an appointment with a member of staff in this room so it isn’t exclusively available for residents’ use. The environment would be improved if lampshades were fitted to light fittings in the main lounge. This would make the lighting less harsh and give a more domestic feel to the area. We also noted that there is a slight change in floor level right across the middle of the main lounge. Apparently the possibility of fitting some kind of visual warning had been considered but it wasn’t possible. This could present a risk to people with reduced mobility and sensory impairments and there should be careful monitoring of any falls that may arise as a result of this. The laundry was clean and tidy. It is a spacious room and is well equipped. There had been a recent delivery of disposable products and cleaning materials so the home was well stocked. It was good to see that staff were being offered a choice of vinyl and latex gloves to accommodate individual staff skin sensitivity. There were supplies of liquid soaps and paper towels around the home. Ten staff received training in infection control in April 2007. Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 23 A complaint received by the Commission towards the end of 2007 referred to patio doors from residents’ bedrooms that stick and can’t be opened. The situation wasn’t reviewed at this inspection. The complainant also referred to problems with hot water supplies in some areas of the home, with the result that some residents were being washed in cold water. Julie Scotford confirmed at the time that she had ensured this practice was not happening. During this inspection two staff spoke about continuing problems with hot water supplies in some areas of the home- ‘We have to get water from the bathroom next door-it’s a bit quicker’. This information indicates an ongoing problem that needs further attention because all bedrooms should have a supply of hot water. Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 24 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, and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staffing levels don’t meet the needs of the people using the service and their health and welfare are being put at risk. There are relevant training opportunities being arranged but there should be more attention to individual staff training programmes, and refresher sessions, to be sure they all receive the training they need to work effectively with the residents. EVIDENCE: There was information to indicate inadequate staffing levels at the home. Staff described four residents who require 2 staff to assist them with their personal care. Most other residents require a care assistant to assist them with various aspects of their care e.g. toileting. A relative expressed concern about the length of time when residents were left unsupervised in the communal lounge while the only two staff at work were busy in another part of the home dealing with one of the higher dependency residents. A staff member said she felt embarrassed when visitors were angry because they had been waiting so long to be let in or out of the building because the only 2 staff on duty had been busy caring for a high dependency resident. Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 25 The Commission has received complaints about a recent reduction in staffing levels at the home and the potential risk to people who use the service as a result of this. Two care assistants were on duty at the home after 1.30pm on the day of this inspection. The Care Manager was at work but was engaged in urgent discussions with a resident and relative. She was also involved with the inspection. A resident had to be intercepted by staff as she went to leave the building having called herself a taxi to take her shopping. The staff had to negotiate with the taxi driver and reassure the resident that she may be at risk if she went out alone. Two other residents were observed trying to help each other find their way around until one of the care assistants arrived to help them. The two care assistants were expected to prepare, serve and clear away a tea of cheese on toast, issue medication and respond to the care needs of the resident group. We observed a large section of the resident group over a period of 2 hours during the afternoon. Remaining residents were participating in an activity with a care assistant in the dining area during part of this time. The only staff attention offered to the first group of residents was when they were given a hot drink and asked which sauce they wanted on their tea. One resident was heard to say ‘sitting here for hours. If there was a bit of music it wouldn’t be so bad’. The television was switched on although residents were not watching it for most of the time. An urgent requirement was sent to the Provider about staffing levels at the home. This is repeated at the end of this report. Mr. Menon contacted us in October 2007 regarding the possible appointment of two new staff prior to receiving the required checks of their suitability e.g. criminal records bureau and Protection of Vulnerable Adults (POVA) register. This indicates his awareness of the importance of these checks before starting staff at work in the home. It is, however, a decision that he must take within a recorded risk assessment framework. It may be advisable, if not already done, to look up the most recent regulation amendments under the Care Homes Regulations 2001 relating to staff fitness. This would ensure that recruitment procedures always comply with this and subsequently add to the provision of a safe environment for the people who use the service. Two care assistants were interviewed at the home. One had worked at Rosedale for 3 years, the other for 6 years. They were, therefore, experienced. Both had received various training in the past year e.g. manual handling, fire safety, first aid, infection control. One of the staff was doing a health and safety training course at the time of this inspection. She had been on a dementia care awareness day last year but had not had any formal training in adult protection and abuse awareness. However, the second care assistant had been shown the adult protection policy by Julie Scotford and familiarised with Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 26 the various type of abuse. She had not received any training in dementia care. She was working towards her National Vocational Qualification (NVQ) in care. This is the relevant qualification for care staff and all care staff have either obtained an NVQ award or are working towards one. Training records were well kept - certificates were available to show details of each course e.g. the name of the trainer, the content or level of training, the date etc. The records indicated that there are regular training opportunities being arranged and these include the statutory health and safety aspects. The development of an individual training record for each member of staff would help to target future training and ensure all staff receive essential training at the necessary intervals. Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 27 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. An experienced and suitably qualified person is managing the service but there is little evidence of improving quality of life for residents as a result of the everyday care management work. There is little understanding of person centred care provision. The people who use the service aren’t given the information they need or the opportunities they need to communicate effectively with the management staff. This means decisions are being made that aren’t necessarily in the best interests of the residents. There is some work being done to keep the premises safe and to train staff to work safely with the residents. However, this isn’t managed effectively enough to avoid unnecessary risks and keep residents safe and comfortable. EVIDENCE: Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 28 Julie Scotford was appointed as the Care Manager at Rosedale in June 2006. She had several years experience in care homes and has completed her Registered Manager’s Award. This is the recognised qualification for care managers. We subsequently approved her fitness for registration in the care manager role at Rosedale under the Care Standards Act 2000. At this point a recommendation was made that Julie should undertake further training in dementia care, risk assessment and an NVQ level 4 in care management to broaden her knowledge and skill. A recommendation offers advice and is not compulsory but it would be a good idea to re-consider this recommendation if it hasn’t been addressed. Julie Scotford submitted an Annual Quality Assurance Assessment (AQAA) report when we asked for it. Some of the information in the report described things that are apparently happening in the home to make it a good place for the residents to live e.g. ‘seniors giving more attention to making sure assessment information is kept up to date for respite clients’, ‘ range of activities to suit individuals (including simple household chores if wanted)’. The inspection findings don’t actually show that this description is an accurate picture of the service. A number of recommendations were made following an inspection in July 2007. Although these are guidance rather than statutory requirements it is disappointing that little attention has been given to them. For instance, a recommendation was made for work to be done to improve the home’s relationship with local doctors’ surgeries. Nothing appears to have been done to make sure residents aren’t disadvantaged by this problem. The AQAA refers to an intention to do some work in the next year. This reflects a very slow response to such an important working relationship. A local doctor’s surgery is currently expressing a lack of confidence in the service. Relatives have spoken to us about a lack of response when they have tried to communicate with the service. One of them said she had received no written information at all since her relative was admitted. Neither relative had any contact from the owners of the service at all although both had raised concerns and queries that needed a response. This suggests that there is little commitment to developing an open management approach in the best interests of the residents. Information in the AQAA refers to an implemented quality assurance system and receipt of positive feedback from residents and their families as a result of the home’s surveys and comments. The AQAA also identifies a need to set out an annual development plan and ‘establish a system for giving service users and families opportunities to express opinions by means of anonymous questionnaires’. The current situation regarding consultation and quality monitoring is, therefore, unclear. Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 29 Some of the home’s policies and procedures have been revised this year. Many others are currently being updated. It may be advisable to increase the frequency of reviewing exercises so that staff always have up to date guidance. The policies folder at the home included an Emergency Admission policy that had been written in 2004. This document should either have been removed (if emergency admissions are no longer accepted) or updated. The Provider representative does visit the home regularly and has a chat with the staff and with residents or visitors. Although there were apparently electronic records of these monitoring visits they were not readily accessible on the day of inspection. This is an example of the lack of response to previous inspection recommendations. The telephone line to the main office and the e.mail system had not been working since the day before the inspection. This had been reported to the Provider but Julie Scotford was using her personal laptop at the home in the meanwhile. This was creating difficulties because the home communicates with social service staff and the Provider through e.mails. There has been a recent reduction in the staffing levels at the home and the registered persons have given us differing explanations of the reasons for this, and the way the decision was reached. Changes in food supplies have also been initiated without any evidence that people who use the service have been consulted. Accident records were being well maintained but may be more useful if they were audited more frequently. Many reports made in April and May 2008 related to a specific resident. This pattern should have led to more robust and earlier action to try and reduce the risks to the individual. Essential services and equipment at the home are being regularly serviced and tested. For example, the lift, portable electrical appliances, fire safety equipment and heating system have all been serviced in the last year. There wasn’t any information to say when premises electrical circuits were last tested and it may be worth checking when this should next be done. This report includes evidence to indicate a failure to comply with other relevant legislation e.g. Data Protection Act 1998, Regulatory Reform (Fire Safety) Order 2005. There is a system at the home for assessing risks associated with potentially hazardous materials e.g. cleaning liquids so that handling and storage arrangements keep residents and staff safe. There is a programme of health and safety training to help staff work in a safe and hygienic manner. The records are well kept to give an overall view Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 30 (certificates of completion kept), but it isn’t easy to see if each staff member is receiving the training they need at the required intervals. A matrix recording tool would provide this individualised view and help target future training where most needed. Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 31 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 1 1 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 1 x x x x x x 3 STAFFING Standard No Score 27 1 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x x x x 1 Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? No 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 OP3 Regulation 14(1) Requirement People must not be admitted to Rosedale until the home has the information it needs to meet the individual’s health and personal care needs safely. This work should include consultation with the proposed resident (or representative) so that personal preferences and lifestyle choices can be taken into account to try and make the admission a comfortable experience for everyone involved. Timescale for action 13/06/08 2. OP8 OP7 13(4)c Urgent requirement made in letter to Provider dated 5th June 2008. Risks to the health and safety of 30/06/08 people using the service must be identified and assessed. Plans for their care must address these areas of risk so that the staff know how to work in a way that is most likely to keep the resident safe. Urgent requirement made in letter to Provider dated 5th June 2008. Potential risks associated with DS0000068339.V365777.R01.S.doc 3. OP19 13(4)a. 30/06/08 Page 33 Rosedale Retirement Home Version 5.2 4. OP27 18(1)a the premises must be assessed and reduced as far as is practicable. There must be sufficient staff on duty at all times to provide each person using the service with the care they need and to minimise risks to their safety. Urgent requirement made in letter to Provider dated 5th June 2008. A system for evaluating the quality of the services provided must be established and maintained. The system should include consultation with people who use the service or their representatives. The requirements of the Regulatory Reform (Fire Safety) Order 2005, as specified by the Fire Safety Officer, must be complied with in order to protect the people who use the service from the risk of fire. 20/06/08 5. OP33 24(1) 31/08/08 6. OP38 23(4A) 30/06/08 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 OP1 Good Practice Recommendations Arrangements should be made for every person who uses the service to have a copy of the Service User Guide, as required by regulation. The Guide should include all the required information. The Service User Guide should include a copy of the Statement of Terms and Conditions, as required by regulations. If emergency admissions are accepted at the home there should be a related policy and procedure that addresses the particular difficulties of receiving people into the home DS0000068339.V365777.R01.S.doc Version 5.2 Page 34 2. 3. OP2 OP3 Rosedale Retirement Home 4. 5. 6. OP8 OP12 OP15 7. OP16 8. OP27 9. OP30 10. OP37 without the benefit of a full needs assessment. G.P. surgeries should be consulted about their working relationships with the service so that any difficulties can be addressed for the future benefit of the residents. There should be a review of the way in which suitable opportunities are provided for people to participate in activities. Food ordering systems should be strengthened to be sure there is always enough stock to serve the meals shown on the standard menu and respond to any special dietary needs and preferences. The home’s complaints policy and procedure should be updated, and all residents or representatives given a copy, as required by regulation. Staff should be told how to respond to concerns and complaints in line with the procedure. When assessing the number of staff required at the home there should be recognition that care and catering tasks must be clearly separated to maintain hygienic practices. There should also be consideration of the additional staff time involved in dealing with a respite service. Individual staff training programmes should be developed so that arrangements can be made to ensure each staff member receives the training they need, or refreshed as necessary, to work effectively with the residents. 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. Rosedale Retirement Home DS0000068339.V365777.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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.V365777.R01.S.doc Version 5.2 Page 36 - 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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