Inspection on 06/11/08 for Rosedale Retirement Home

This inspection was carried out on 6th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosedale Retirement Home 03/06/08

Rosedale Retirement Home 26/06/07

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rosedale Retirement Home Ashfield Crescent Ross on Wye Herefordshire HR9 5PH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Denise Reynolds     Date: 1 2 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Rosedale Retirement Home Ashfield Crescent Ross on Wye Herefordshire HR9 5PH 01989565851 F/P01989765851 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Julie Scotford Type of registration: Number of places registered: Autumn Days Care Ltd care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 24 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 24 Old age, not falling within any other category (OP) 24 Date of last inspection Brief description of the care home Rosedale is situated in a residential area on the edge of the town of Ross-on-Wye. A purpose built extension to the existing home was completed in 2004. This has created an inner courtyard garden and some of the bedrooms have a door that opens into the garden so that people can enjoy the garden from their room. Most of the rooms in the home are singles and some of these have ensuites so that people have the privacy of their own toilet facilities. There are steps which have to be negotiated to reach a few of Care Homes for Older People Page 4 of 33 Over 65 0 24 24 0 Brief description of the care home the bedrooms, although there is an internal lift and a wooden ramp to help people 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 type illness. The home has a contractual arrangement with Herefordshire County Council to use 5 places for respite care. The home provides written information about the service it provides in a Statement of Purpose and Service User Guide. This information is required so that people have the information they need when they are choosing a care home that is going to suit them. Anyone thinking of moving to the home should receive a copy of a Service User Guide and the Statement of Purpose should be available to read at the home. People who want information about how much it costs to stay or live at Rosedale should ask the owners for this information. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a full inspection of Rosedale to look at the quality of the outcomes for people who live in the home. We call this a key inspection. We, the Commission, made two visits to the home for this inspection. The first of these was done without staff at the home expecting us. We arranged the day for the second visit with the owners because we needed them to be there to discuss things. Our first visit lasted about seven hours and our second visit lasted about 13 hours. This was because we have had lots of concerns about the home this year and we needed to cover a lot of things during our visits. We started our second visit at 6:50am because we wanted to find out how early people get up and see a handover from the night staff to the day staff. Care Homes for Older People Page 6 of 33 The home completed an Annual Quality Assurance Assessment (AQAA) earlier this year and we used information in this to help us plan our inspection. This is a document that care services are required to fill in which they describe what they believe they do well, what they need to improve and how they are planning to do this. We also took into account information from our last key inspection in June 2008 and a follow up inspection in July 2008. When we did our inspection in June we rated the home as 0 star; this was because we identified lots of issues at the home which meant people were receiving a poor quality of service overall. We went back to the home in July to check if work was being done to put some of the problems right and found that the owners had made progress in the right direction. Since the last key inspection we had received two complaints. We referred both of these to be investigated under the local multi-agency safeguarding procedures. Enquiries about one of these have not been concluded. When planning our inspection we also took into account the findings of work done with the home by staff from Herefordshire Council; this involved inspecting records, interviewing the owners and staff and speaking privately with several people who live in the home. They have told us that their overall view following this work is that there have been improvements in the care provided at Rosedale. During the inspection we interviewed four staff and spoke privately with two people who live at the home. We also had general conversations with other people during the course of the two days. We met a relative and friend of one person and spoke briefly with the son of a person who was having a short stay. During the course of the two days we saw parts of the building and looked at various records such as care and medication records, staffing records and information about finance and the premises. What the care home does well: What has improved since the last inspection? We were told by relatives we spoke to and by most of the staff we interviewed that the standard of care at the home has improved, staff are more friendly and there is better teamwork. This is also what the staff from Herefordshire Council found when they did their inspection. The owners have begun to improve the written information about the care people at the home need and are working towards making sure everyones care records are up to date and accurate. The owners have made some improvements in the building and have done some work to identify some risks in the building and put these right. They have also done the work that Hereford and Worcester Fire and Rescue Service told them had to be done. More staff have been on training courses and other dates for training have been booked. This means that the staff working at the home are continuing to increase their knowledge and skills so that they become more capable carers. The owners have introduced questionnaires for people who live at the home and for relatives to help them find out what people think needs to be changed or improved at the home. They have also had meetings with people who live in the home, staff, relatives and with health professionals to help them understand what they need to do better. What they could do better: The home has made improvements in the information it gathers when deciding if it can meet the needs of people who are going to be using the service. They need to continue this work so that the information is easy for staff to refer to and can be used to create a detailed plan for the care the person is going to need. The home also needs to improve the information it has about people already living at the home so that there is good written guidance for staff about peoples needs. This is particularly important when people have specialist care needs where instructions need to be very specific so that staff are aware of and understand the care they need to give. Arrangements for temporary registration with a GP practice should be made as part of the planning for someone to come to stay. This is so that if someone needs a doctor when they are staying at the home a visit can be arranged without any delay. The owners need to improve the facilities in the staff work station so that it is more Care Homes for Older People Page 8 of 33 private. This is so that staff handover meetings and other discussions about individuals who live in the home cannot be overheard by third parties. People should be provided with a choice of meals at each mealtime so that they can make choices and decisions about what they want to have to eat. More work needs to be done to find out what interests and pastimes people will enjoy so that activities are more individualised. Staffing arrangements need to take into account the importance of staff having enough time to spend with people beyond the time spent providing personal care. The owners need to review their policies and procedures to make sure they are accurate and up to date. They also need to be able to make information for people using the service (eg the complaints procedure) in the best format for each person (eg on tape or in large print). It is particularly important that information about safeguarding (adult protection) procedures is reviewed because there is more than one version in the home at the moment and this could cause confusion for staff. The home needs to look carefully at its staffing arrangements to make sure that there are enough staff on duty every day to meet the personal and social care needs of people who live at the home and that these staff do not routinely have to undertake other duties such as cooking and cleaning. Staff recruitment records need to be improved so that information is clearer and easier to find. The owners have recently been spending more time at the home to address the problems that we identified earlier this year. However, they have commitments to another care home they own and we are concerned that they are spreading their time too thinly by trying to work in both homes. We consider that it is very important that they appoint a new manager for Rosedale to take responsibility for the day to day running of the home and to help them continue with the improvements that have started. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs checked before being offered a place at the home so staff are sure the home can provide the correct care and support. Evidence: When a person is thinking of staying at Rosedale for a short break or to live there the staff check what help they need with their care first. At the moment it is the owner of the home who does this because there is no manager. The owner gets a copy of the assessment that a social worker has done and then visits the person to find out for himself what care the person needs. We looked at the care records for some of the people who have started using the service recently. We could see that people and their relatives had been spoken to because we saw that there was information about the type of help they needed care and about the daily routine they would like to have. The information was quite detailed Care Homes for Older People Page 11 of 33 Evidence: but not laid out very clearly to help staff refer to it quickly. We also saw that some of the paperwork about peoples care needs had not been signed or dated. It is important that this is done so that in future it will be clear who was involved in discussing the information and when. Staff usually write daily notes about how each person is but had not done this for one of the newest people at the home. This meant it was hard to check how the person had been getting on since they arrived. When Herefordshire Council staff did their inspection recently they looked at the arrangements for peoples care and were satisfied that the owners are working hard to improve how they deal with things when someone new arrives. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Rosedale generally have their health and personal care needs attended to. More needs to be done to ensure that this is always the case. People will benefit from further improvements planned by the owners in the way care is planned and provided. Evidence: The owners of the home have acknowledged that they need to improve the quality of the written information about peoples care needs. This is so they can plan and monitor each persons care and make sure they are receiving the correct support. We have explained the importance of having records that clearly describe the care each person needs and what staff should do to provide this safely and correctly. They have begun to make the necessary improvements with the records for people using the service for the first time. They have also begun to improve the records of people who have been at the home a while. They have introduced a form intended to describe a persons daily and weekly routines and some new forms for assessing the Care Homes for Older People Page 13 of 33 Evidence: safest way for each person to be helped if they arent independently mobile. We found that in some peoples records the information was confusing. This was because old and new paperwork is mixed together and some of the new paperwork has not been dated. This could result in staff following the old instructions instead of the more recently written ones. Some information about the care that staff should be providing was incomplete. For example, in one instance there was no information about how staff should deal with a persons specific care needs related to their diet, continence care and moving and handling requirements. In another example, guidance written by the owner about three people needing particular attention paid to how much they have to drink was not followed with records to show that this was being put into action. A folder had been set up for fluid charts and this contained charts for a different three people. There were no fluid charts for the people we had read about. We spent some time speaking with one person who was there for a short break; they were generally pleased with the home although not feeling at their best on the day we met them. This was because they were in pain due to falling over the day before. We told staff we were concerned that the person was in pain and they asked for the doctor to visit. To be able to do this staff needed to arrange a temporary registration with one of the local doctors surgeries. This was because the person was not from Ross and their own GP was too far away to cover visits at Rosedale. Staff had to check what they should do and agree with the surgery for the person to have temporary registration so that a visit could be arranged. Because Rosedale is doing a lot of short stay care they should be making these arrangements as part of the planning for someone coming to stay, not waiting until a doctors visit is needed. We have made a recommendation about this. One person was very unsettled on both the days we were at the home and we saw staff trying hard to reassure them. The care records prepared before the person arrived did not mention this aspect of their care needs and did not provide any guidance to staff about ways to deal with the problems that might arise. This showed that the plan for the persons care needed to be reviewed. During the two days we were at the home we saw that staff were working together as a team and communicating well verbally about how each person was. For example, on the second day when we arrived at 6.50am we joined staff for their handover between day and night staff. During this they showed they know the people at the home well and care about how they are. Throughout both days we noticed that on the whole staff were doing their best to make sure people had their care needs attended to. This Care Homes for Older People Page 14 of 33 Evidence: matched the findings of the recent inspection by Herefordshire Council staff. We were concerned though that the area provided for staff as their workstation is not private. It is an area that people walk through from the hall, kitchen and some bedrooms to reach the sitting room and dining room. There is no door between this area and the sitting room. This means that when staff are speaking to each other about people who live at the home or are on the phone to relatives or professionals, they can be overheard. When we spoke to staff individually they were enthusiastic about their work and showed an interest in the people they look after. When we asked about the care people need staff showed that they know most of the information they need although we needed to prompt to remind them of some things. During the inspection we observed some poor practice in respect of the way people are moved when they are not independently mobile; in particular we saw some people being supported under their armpits while walking or being helped in and out of chairs. This is an incorrect way to support people and is viewed as bad practice which can be painful for the person being moved. On one occasion we needed to point out to a carer that the footrests on a wheelchair were not in position; we did this because it is dangerous to push someone in a wheelchair without their feet on the footrests. We also needed to point out to staff that a person who had been fetched from their bedroom did not have their pressure relieving cushion put in their armchair for them. We noted that the findings of a review of a persons care by the owner had not been followed up and the owner was unsure whether the actions he had highlighted had been done. We saw some people who did not look as though much time had been spent helping them to look their best. For example we saw people with untidy hair and a person with dirty fingernails. However, we did not get the impression that this was due to lack of care on the part of staff. We consider that the problem is arising due to the way staff are deployed and the cooking, cleaning and laundry work they have to do in addition to their care duties. We say more about this in other sections of the report. Although Mr and Mrs Menon are at the home for two to three days a week we do not consider that there is sufficient time being given to the improvements needed in the way care is planned and provided. When the owners are not at the home there is a person designated as the senior on duty but these staff do not have time to spend on developing the care records and monitoring that the correct care is being given to all the people living in the home. During the inspection the owners told us they were Care Homes for Older People Page 15 of 33 Evidence: considering creating a deputy post to help solve this problem. A few days later they confirmed they have done this. They told us they have given the person appointed 15 to 18 hours a week when they will be able to concentrate on overseeing the care and making sure things are followed up and acted upon and to help improve the written information staff need. We looked at how the medication at the home is being dealt with. One concern we had was the poor lighting in the area where the medication trolley is kept and where staff sign the records to confirm people have had their medication. We found some errors in the medication records; one of these may have been partly due to the poor lighting. The error was that staff had started signing the chart on the wrong date; we thought this could have been due to not being able to see the form well enough. We found one item of medication where the manufacturers blister pack was no longer in the box it would have been in when sent from the pharmacy. This meant that the instructions on the label had been lost. This could lead to the person not being given their medication correctly. One person had been seen by their doctor because staff had noticed that the antibiotic they were taking were causing a bad reaction. The doctor visited when there was no pharmacy open in Ross to collect the new medication from. The home had not been able to make arrangements to get the prescription made up. This meant that the person had one day when they did not have any antibiotics. Staff got the new tablets as early as they could on the Monday morning. The owners need to talk to local doctors and their pharmacy to decide how to make sure people always receive new medication quickly in these circumstances. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not receive a choice of menu to enable them to have a say in the food they eat. Visitors are made welcome so that people can keep in touch with the people who are important to them. Some activities take place but the range of these is limited and may not reflect some peoples preferences. Evidence: There was no cook employed when we did our inspection and on both days we were at the home one of the three care staff on duty in the morning was preparing the breakfast. This meant that there were only two staff to assist people to get up and get ready for the day. The owner told us on the first day of the inspection that this was not so much of a problem because the night staff get some people up. This information concerned us because the night staff finish their shift at 7am. We felt this might mean that people have to get up earlier than they might want to. Because of this we arrived for the second day of the inspection at 6:50am so that we could see how many people were already up and dressed. We counted ten people in the sitting room as soon as we arrived. Some of them were dozing in their chairs. We noted that a sign written by the ex manager was still displayed; this instructed night staff to get up five people each before going off duty. Care Homes for Older People Page 17 of 33 Evidence: We checked in 19 of the care records and saw that in each file there was a note saying what time people liked to get up. This showed us that seven were said to want to get up before 6am; four people between 6am and 7am and eight people after 7am. The owners told us that everyone has been asked what they want and that relatives have also been asked for their views. The information we saw did not make it clear that people have been consulted and one person said to us It is too early really to be up and Its a long day and theres nothing to do. When we spoke to staff they reassured us that they do not get people up unless they are already awake and we did see that some people were still in their rooms later in the morning. We feel that the morning routine needs to be kept under careful review by staff to make sure that people who in the past expressed a preference for an early start to the day have not changed their minds. Staff also need to take note of people who doze in their chairs as soon as they are taken to the sitting room as this may indicate that they needed longer in bed. Because there was no cook employed at the home when we did this inspection several staff and one of the owners were sharing the task between them. The home was not working to a menu and staff were deciding what to cook on the day rather than planning in advance. People are offered something different to eat if the meal is something they dont like but a regular choice is not offered. Most people we spoke to when we were at the home said they had enjoyed their meal although one person told us there are things they cant eat and some staff dont know about this. We consider that the lack of planning could lead to the overall diet provided not being varied enough and that more choice should be offered to people. The owners told us that they are hoping to appoint a new cook shortly which will help them to make the improvements needed. Staff fit in activities during the day when they can and we heard staff talking about making sure they did this on both days we were at the home. This shows that staff recognise the importance of spending time with people and providing enjoyable things to help pass the time. Most of the things they organise at the moment are for groups of people (such as having a singsong or playing a game with balloons); these types of activities might not suit everyone and it would be good if more was done to check what things individuals enjoy. This information is not covered in enough detail in the care records at the moment. Staff also need enough time to spend with people in a more personalised way. We heard some staff talking about a person who enjoys an activity they often dont have time for. Care Homes for Older People Page 18 of 33 Evidence: When we inspected the home earlier this year we commented on the television being on most of the time and also that the screen was too small for the size of the room; this meant people at the far end of the room could not see it. During this inspection we were told that a new television is being ordered. This has been partly funded by a fund raising event organised by relatives and staff. This is a good example of how some relatives and staff are building good relationships and developing a community spirit at the home. However, we would normally expect televisions to be routinely provided by the owners of the home. We also observed that the television was still being left on for most of the time without checking what programme was on and whether people were watching it. People who live at Rosedale can have visitors come to see them whenever they like so that they can keep in touch with the people who are important to them. We had a conversation with the relatives of one person who told us that they believe that the home has become a happier and much better run place in the last few months. They consider that the owners and current staff group are working very hard to improve the atmosphere and standard of care. They told us they never used to be offered refreshments when they visited but now the staff always ask them what they would like to drink. We also overheard other people arriving and being greeted at the door in a welcoming and cheerful way. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be increasingly confident that they will be safe at Rosedale as more staff receive training to give them the knowledge they need to deal with any concern about abuse or neglect correctly. Updated information will soon be available for people so that they and their relatives will know how they can raise any concerns they may have about the home. In the past the home looked after cash for some people. The owners took a decision recently not to do this any longer to avoid the risk of any financial abuse. When we did this inspection they confirmed that they had no cash in safe keeping for anyone and that all spending was dealt with by sending people or their relatives and invoice. Evidence: We have had two complaints made to us about the home since we did our last key inspection in June 2008. These were about serious matters and we referred both of these to be investigated under local multi agency safeguarding procedures. One matter related to the care of a person at the home and their condition on admission to hospital; this investigation has not been concluded. The second complaint was an allegation about lack of care and staff conduct. The investigation into this matter found evidence that the content of the allegation was untrue and that there were grounds to believe that the allegation was made with malicious intent. Care Homes for Older People Page 20 of 33 Evidence: The home has a complaints procedure and a safeguarding procedure explaining how people can make a complaint and what staff should do if they are concerned that a person has been abused or neglected. Some information in these is not up to date. We were shown two different versions of safeguarding information; this could cause confusion about the correct action to take. The provider acknowledged that this information needs to be checked and updated to make sure it is accurate and contains up to date information. Since we did our last inspection the owners have been trying to find out more about what people think about the service they provide and the relatives we spoke to told us Mr and Mrs Menon are very approachable and that they could tell them if they were not happy with something. The owners had arranged for all the staff to do safeguarding training if they had not already done so; this was due to take place soon after we did our inspection. This will provide staff with the understanding and knowledge they need to take the correct action if they are concerned about the well being of any person living in the home. Staff we spoke to assured us that they would report any concerns they had and spoke about people living in the home with respect. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are on the whole provided with homely and comfortable surroundings but housekeeping and some aspects of the environment need upgrading to make sure people are safe, and that facilities in the home are suitable. Evidence: When we did our inspection in June 2008 we had a number of concerns about the safety of the building; some of these related to fire safety and this was being dealt with by Hereford and Worcester Fire and Rescue Service. At that time the fire service were considering enforcement action to make the home correct the things that needed to be done. Other issues also related to safety, in particular the owners failure to check what hazards there were in the building and take steps to reduce the risk from these. Since June the fire safety work has been dealt with, including the installation of a new fire alarm system and Mr Menon has made an assessment of the risks in the building. Some specific faults have already been put right. For example, new carpets have been fitted on the stairs with yellow rubber hazard strips on the treads to help reduce the risk of falls. It is essential that this work is now developed and that the owners demonstrate that they are monitoring safety in the home and continuing to make improvements. During this visit we saw some other things that showed that general Care Homes for Older People Page 22 of 33 Evidence: maintenance and housekeeping still needs more attention; for example some parts of the laundry were untidy, there was no toilet roll holder in the staff toilet and no lid on a waste bin in the laundry. Mr and Mrs Menon told us that in the next few months they intend to upgrade the kitchen and the staff work station so that both are more suitable, efficient and safe. Mr Menon recognised the need to improve the lighting in the staff workstation and said this would be dealt with sooner than the planned upgrading. Access to the basement laundry and office is by steep stairs and needs to be looked at to see how it can be improved particularly in relation to staff carrying laundry up and down the stairs. We pointed out to Mr and Mrs Menon the problem of lack of privacy in the staff workstation and they agreed that they would take this into account when they upgrade this area and try to do something about it. The sitting room next to the front door is not being used much by people who live in the home and when we did our inspection was being used to store new equipment and a new carpet. The room is potentially more homely than the main sitting/dining room and efforts need to be made to make it a pleasant alternative place for people to spend their time. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff are hard working and caring which means that people feel cared for but there may not always be enough staff on duty to make sure people have all their needs attended to. People living at Rosedale are protected by recruitment procedures which minimise the chances of unsuitable people being employed. Training arrangements have improved so that staff can develop their knowledge and skills in important aspects of safety and care. Evidence: We noted an entry in the staff communication book instructing the care staff that they would each be responsible for cleaning two or three bedrooms due to the cleaner leaving. This is in addition to the laundry which the care staff also do. We consider that the present staffing arrangements take up too much care staff time in doing other work such as cooking, cleaning and laundry and that this means staff do not have the time they need to give people enough individual attention during the day. We also consider that there are risks involved in care staff having to mix these duties. For example, if a carer has been helping a person with personal care there is a risk of infection if they then go and work in the kitchen. Similarly, if someone has been Care Homes for Older People Page 24 of 33 Evidence: cleaning the toilets there may be a risk of infection if they are then going to help a person to eat a meal. It is also important that all of these duties are done by staff who have sufficient time to do them so that all of them are done well. Mr and Mrs Menon are increasing the amount of training that the staff at the home are doing and provided information that showed us that staff have either done or are booked to do training in essential safety and care related topics in the coming months. This includes first aid, moving and handling, safeguarding, medication, infection control, dementia, palliative care, person centred care and dealing with challenging behaviour. All of the staff are registered on NVQ training or have already done their NVQ level 2 or 3. A senior member of staff has started a team leaders course. New staff who have started at the home in recent months came via a recruitment agency which sends staff on a three day induction course before sending them to a service. The recruitment records we looked at showed that the required checks had been done but information about the date staff had started work and the hours they are employed for needs to be more clearly recorded. When we tried to establish if the checks were done before people started working at the home this was difficult and we had to work this out by checking the dates of their induction training. It is important that staff records provide clear evidence that recruitment procedures are being followed correctly so that people can have confidence in the process. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of this service needs to become more effective and better organised to ensure that people living at the home can rely on being safe and well cared for at all times. Evidence: When we did our last key inspection in June 2008 there was a registered manager working at the home. Following our inspection she left and at the time we did this inspection had not been replaced. Because of this the owners were spending two to three days a week at the home. This had helped to bring about some of the improvements we have referred to in our report and we acknowledge their hard work. However, we consider that there is still a lot of work to be done to ensure that the home is being run effectively and people living there can rely on getting the service they should be able to expect. As well as being the responsible person for Rosedale, Mr Menon is also the registered manager of another home owned by the company in another part of the country. We have concerns about the quality of the service being Care Homes for Older People Page 26 of 33 Evidence: provided at the other home which has a 0 star rating. We therefore have cause to question the ability of Mr and Mrs Menon to continue managing Rosedale themselves for any length of time. This is because Mr Menons role as registered manager at the other home means he should be making a full time commitment to it. During the inspection Mr and Mrs Menon explained their anxiety about appointing a new manager. They do not want to make a bad appointment which they later regret and feel that they need to be more hands on at present. They told us they were thinking about appointing a deputy manager in the interim and since the inspection have informed us that they have done this. One of the things that Mr and Mrs Menon have begun to develop is to have a more effective way to find out what people think about the home and the service they receive there. We were shown some surveys that had been filled in a week or so before our inspection. These did not identify any major concerns but did highlight some improvements people wanted. Nothing had been done at the time we did the inspection to collate this information or use it to create an action plan. This is a good illustration of Mr and Mrs Menon not having the time to address everything that needs doing on their own when they have other commitments. Since being at the home on a regular basis each week Mr and Mrs Menon have not been doing the monthly reports they are required to complete about the conduct of the home. When we explained that this is required even if they are there every week Mr Menon said he would arrange to start doing this again. During the inspection we had lengthy discussions with both Mr and Mrs Menon about the problems at the home during 2008 and the possible reasons for this. We reminded them that they are responsible for making sure that the home is run in a way that means the people living there get a good service and complies with legislation. The reports required under Regulation 26 are one means for them to monitor that this is happening. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Regulation 15(2)(b) When a persons care needs develop or change you must make sure that the written plans about their care are reviewed and updated. This is so that staff all know about the changes and about how this affects the care they need to provide. 31/12/2008 2 7 15 Regulation 15(1) When a 31/01/2009 person has specific and/or specialist care needs the home must ensure that their written care plan gives clear information about the care to be given by staff in these areas. This is to make sure that staff are aware of and understand the care they need to give to each person and the correct way to do this. Care Homes for Older People Page 29 of 33 3 8 12 Regulation 12(1)(a) and (b) You must ensure that staff do not use incorrect methods of moving people. This is to make sure that people are moved in a way that is as safe and comfortable for them as possible. 31/12/2008 4 19 12 Regulation 12(4)(a) 31/01/2009 You must make arrangements to ensure that staff are able to have conversations about the care of people who live in the home in private. So that the privacy of people living in the home is protected. 5 27 18 Regulation 18(1)(a) You must ensure that the staffing arrangements ensure that there are enough staff on duty every day to meet the personal and social care needs of people who live at the home and that these staff do not routinely have to undertake other duties. So that people who live in the home are cared for by staff who are able to spend the time they need providing personal and social care. 31/03/2009 6 29 17 Regulation 17(2), Schedule 31/12/2008 4, para 6 Recruitment records must include all of the information required. Care Homes for Older People Page 30 of 33 So that your staff recruitment records provide evidence that safe recruitment practices that minimise the risk of unsuitable staff being employed is followed at all times. 7 33 26 Regulation 26 (2) 31/12/2008 You must visit the home at least once a month and this visit must be unannounced. You must write a report detailing the findings of your visit and ensure that copies are available at the home for inspection. This is because these reports are an important tool for you to use in monitoring the service and checking that the home is being run in the best interests of the people who live there. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 You should continue to develop the work started on improving the information you gather about people who are going to be using the service. You should also consider improving your paperwork for this so that the information is easier to refer to for staff. It is important that staff keep an account of how a person settles in when they arrive at the home to help make sure that people are ahving their needs attended to correctly. Arrangements for temporary registration with a GP practice should be made as part of the planning for someone to come to stay. This is so that if someone needs a doctor Page 31 of 33 2 3 3 8 Care Homes for Older People when they are staying at the home a visit can be arranged without any delay. 4 9 You need to make sure that you have adequate arrangements in place for obtaining medication when this is required out of hours. You need to take steps to ensure that arrangements are made so that staff handover meetings and other discussions about individuals who live in the home cannot be overheard by third parties. More work needs to be done to find out what interests and pastimes people will enjoy so that activities are more individualised. Staffing arrangements need to take into account the importance of staff having enough time to spend with people beyond the time spent providing personal care. You should monitor and keep under review the arrangements for what time each person gets up in the morning. This is so that people have the opportunity to be flexible about their routine and feel they can change their mind if they want to. People should be provided with a choice of meals at each mealtime so that they can make choices and decisions about what they want to have to eat. The complaints procedure needs to be updated to make sure it contains the correct information and should be made available in formats suited to individual people (eg large print). The safeguarding information available in the home needs to be reviewed and updated to make sure that it contains the correct information and is compatible with local multiagency safeguarding procedures. You need to appoint a suitable qualified and competent manager as soon as possible so that there is a person working full time at the home who is able to take charge of the improvements and developments that are needed. 5 10 6 12 7 12 8 15 9 16 10 18 11 31 Care Homes for Older People Page 32 of 33 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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