Inspection on 18/12/03 for Rosedene

Care Home For Adults (Mixed Category)Rosedene141-147 Trinity Road Wandsworth Common London SW17 7HJAnnounced Inspection18th December 2003 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment Rosedene Address 141-147 Trinity Road, Wandsworth Common, London, SW17 7HJ Email Address Name of registered provider(s)/Company (if applicable) Mr T Lewis Name of registered manager (if applicable) Miss Patricia Barber Type of registration Care Home No. of places registered (if applicable) 67 Tel No: 020 8672 7969 Fax No: 020 8672 3005Category(ies) of registration, with (number of places) Dementia (67), Dementia - over 65 years of age (67), Learning disability (67), Learning disability over 65 years of age (67), Mental disorder, excluding learning disability or dementia (67), Mental Disorder, excluding learning disability or dementia - over 65 years of age (67), Old age, not falling within any other category (67) Registration number G040000367 Date First registered Date of latest registration certificate 13th May 2003 Was the home registered under the Registered Homes Act 1984 Do additional conditions of registration apply ? Date of last inspection YES NO 28.08.03 If Yes Refer to Part CRosedenePage 1 Date of Inspection Visit Time of Inspection Visit Name of Inspector Name of Inspector Name of Inspector 1 2 318th, 23rd & 24th December 2003 and 16th January 2004 10:00 am Mark Stroud Jeremy Howe Janet Pitt Adrian Gordon Elizabeth OReilly Sally MillID Code118288 071702 071708 095718 075052 097769Name of Inspector 4 Name of Lay Assessor (if applicable) Lay assessors are members of the public independent of the NCSC. They accompany inspectors on some inspections and bring a different perspective to the inspection process Name of Specialist (e.g. Interpreter/Signer) (if applicable) Name of Establishment Representative at Acting Manager: Rosie OFarrell the time of inspectionRosedenePage 2 CONTENTSIntroduction to Report and Inspection Inspection Visits and Inspection Methods used Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspection Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Findings National Minimum Standards For Adults (18 - 65) & Older People 1. Choice of Home Adults (18 - 65) & Section 1.Older People 2. Individual Needs and Choices Adults (18 - 65) & Section2. 7.1 ­ 7.6 Health and Personal Care Older People 3. Lifestyle Adults (18 - 65) & Section 3. Daily Life and Social Activities Older People 4. Personal and Healthcare support Adults (18 - 65) & Section 2. 8.1 ­ 11.12 Older People 5. Concerns, Complaints and Protection Adults (18 - 65) & Section 4. Older People 6. Environment Adults (18 - 65) * Section 5. Older People 7. Staffing Adults (18 - 65) & Section 6. Older People 8. Conduct Management of the Home Adults (18 - 65) & Section 7. Older People Part C: Part D: Part E: E.1. E.2. E.3. Compliance with additional conditions of registration (if applicable) Lay Assessors Summary (where applicable) Providers Response Providers comments Action Plan Providers AgreementRosedenePage 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the National Care Standards Commission (NCSC), is subject to inspection, to establish if the establishment/agency is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000. This document summarises the inspection findings of the NCSC in respect of Rosedene. The inspection findings relate to the National Minimum Standards (NMS) for Adults (18 ­ 65) and Older People published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the NCSC regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the standards. The report will show the following: · · · · · · · · · Inspection methods used Key findings and evidence Overall ratings in relation to the standards Compliance with the Regulations Required actions on the part of the provider Recommended good practice Summary of the findings Report of the Lay Assessor (where relevant) Providers response and proposed action plan to address findingsThis report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The report is based on the findings of the specified inspection dates.RosedenePage 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. Rosedene is a Registered care home, presently registered for 67 nursing beds, and service users over the age of 38 with a wide range of needs including adults and older people with Dementia (67), Dementia - over 65 years of age (67), Learning disability (67), Learning disability over 65 years of age (67), Mental disorder, excluding learning disability or dementia (67), Mental Disorder, excluding learning disability or dementia - over 65 years of age (67), Old age, not falling within any other category (67). The home also provides nursing care. The property is located in Wandsworth Common, close to shops, pub, the post office, bus routes, and underground and over ground rail links. The home is on a busy main road, with parking to the front. The property comprises four large three storey terraced houses that have been joined together to form one care home. There are two passenger lifts between all floors. There are 17 single bedrooms, including two with en-suite facilities; and 25 double rooms, 10 of which are being used as single rooms presently. There is a garden to the rear, to the side of which there is a building where activities are provided.RosedenePage 5 PART A SUMMARY OF INSPECTION FINDINGSINSPECTORS SUMMARY (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.)RosedenePage 6 An announced inspection was completed over a single day in December 2003 followed by a number of unannounced visits between 23.12.04 and 16.01.04 following a serious incident at the home. Eighteen immediate requirements have been made following this inspection. There are serious concerns. The National Care Standards Commission are awaiting results of the inquest process regarding two service users. Four comment cards were received from relatives, and 6 from service users, all sent by the home with the pre-inspection questionnaire. One service user said its a lovely home, one relative that `improvements can certainly be made, and another relative that they were `impressed by caring staff. There are a number of service users, unable to express their views during the days of inspection, whose care is of concern to the inspectors, a number of requirements having been made. The proprietor of the home has acknowledged risks present from the vulnerability of some service users, and the aggressive presentation of other service users. This has resulted in concern regarding one service user, which the National Care Standards Commission has investigated during this inspection, a complaint having been partially substantiated. Key requirements, first made after the unannounced inspection 20.03.03, remain outstanding and are restated. Of most concern is the poor recording of wounds and pressure sores, and the poor recording of fluid and food intake where assessed as necessary by health professionals. This is a mixed category report, combining the Younger Adults and older Peoples Standards. Requirements are set against both Standards where applicable, denoting Younger Adults Standards YA, and Older People Standards OP. Where the number of Categories are stated this relates to the number of `grouped Standards, the number met, almost met, not met, not assessed, or not applicable. Choice of Home (Standards 1-5 YA and 1-6 OP) 1 Category were met, 3 were almost met, 1 was not met, and 1 Category was not applicable The home have produced a new Statement of Purpose and Service User Guide. A Requirement has been made for the home to amend the Statement of Purpose and Service Users Guide to describe the service provided, and apply for a variation to state the specific numbers of service users in each of the categories the home is currently Registered for. The registered Manager has just returned to the home to work on a part-time basis, Monday, Wednesday and Friday. The home were seen to hold assessments completed by health and local authorities, but in one case the home did not demonstrate its ability to meet the assessed needs of a service user admitted. Individual Needs and Choices (Standards 6-10 YA and 36-37 OP) None of these 5 Categories were met, 1 was almost met, and 4 were not met Service User Plans were revised by the acting manager following a previous inspection. This work was done largely without the involvement of key workers or service users. Service user Plans were incomplete, and not systematically used by care staff, who did not demonstrate an awareness of their contents. Service User Plans contained negative language, which did not focus on strengths. Service users are not involved in the day-to-day running of the home. Risk assessments were in place for individual service users, but were mostly generic in content, referring to general good practice, and were missing for several service users who were assessed as aggressive, vulnerable, or likely to self-harm.RosedenePage 7 Lifestyle (Standards 11-17 YA and 12-15 OP) 1 of these 7 Categories was met, 4 were almost met, 1 was not met, and 1 Category was not assessed Staff said that they provide service users opportunities to play musical instruments for stimulation. This was not seen on any of the days of inspection. Information was missing in some Service User Plans regarding activities. More able service users are able to access the community but there was no evidence that service users with higher needs are able to access the community. There is a day service provided to the rear of the home. Restrictions on choice and freedom such as freedom of movement in the home, and the provision of cigarettes was not recorded in Service User Plans. Personal Healthcare support (Standards 18-21 YA and 8-11 OP) None of these 4 Categories were met, 3 were almost met, and 1 Category was not met The home do not respond promptly to health concerns in all cases, in one instance concerning a specialist health procedure, essential to the service users wellbeing. Several service users were seen not to be wearing footwear, and two service users were seen to have inadequate support to maintain their continence. Wound Mapping and fluid and food intake records were found to be incomplete, and lacking detail that would allow wounds to be tracked. Requirements have been made. Most medication policies were in place. A number of requirements are made regarding missed doses, lack of supply of medication, and inaccurate Medical Administration entries. Concerns, Complaints and Protection (Standards 22-23 YA and 16, 18 OP) 1 of these 2 Categories was met, and 1 was almost met The home have dealt appropriately with four complaints. The home failed to operate within a risk management framework regarding a vulnerable service user. Requirements have been made because of a complaint to the National Care Standards Commission. Environment (Standards 24-30 YA and 19, 21-26 OP) None of these 8 Categories were met and 7 were almost met The home have replaced net curtains following a requirement from the last inspection, but lighting remains poor at the home, a requirement restated. There is a high level of shared rooms at the home, and bedrooms appear institutional since hospital beds are provided as standard. Wheelchairs were seen not to be fitted with footplates, and a requirement has been made. Staffing (Standards 31-36 YA and 27-30 OP) 1 of these 7 Categories was met and 6 were almost met Staff files were well maintained and demonstrated the provision of training. Staff were not seen to stimulate service users with higher needs, and to be unsure of the specialist communication needs of service users. The proprietor has provided information suggesting dependency levels at the home have increased and a requirement has been made for information demonstrating appropriate staffing levels and expertise. Staff have not received two monthly supervision, and a requirement is made.Conduct and Management of the Home (Standards 37-43 and 31-35, 37-38 OP) Rosedene Page 8 None of these 8 Categories was met, 6 were almost met, 1 was not met, and 1 Category was not assessed Staff all wear uniforms, a recommendation made for this to cease in order to encourage the involvement of service users in the running of the home. The home must operate a quality assurance system involving all stakeholders. Records were kept securely at the home. A requirement is made following the failure of staff at the home to administer first aid to a service user who was injured.RosedenePage 9 Requirements from last Inspection visit fully actioned? If No please list belowNOSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. No. Regulation Standard Required actions Timescale for action Each service user must be provided with a 1 5 2 30/11/03 statement of terms and conditions in accordance with NMS 2.RosedenePage 10 215.1 and 15.2 (b), 12. 1 (b), and 14.2 (a)4All the requirements detailed under this Standard in the text and in the Inspectors letters following the investigation into the complaints must be fully complied with. (from the text of the report) In July 2003 an Inspector of the NCSC investigated a complaint made about the care provided to a service user of the home who was subsequently admitted to hospital. As the result the home was required by the Inspector to: a) Ensure that care records are accurate and reflect the care given; b) All entries must have a full legible signature c) When an assessment indicates that fluid or food intake needs to be monitored, then the home must ensure that this is documented accurately d) When an assessment indicates that urinary drainage requires monitoring, then this must be documented accurately. e) When a service user has broken areas on their sacrum or wounds these must be monitored and accurately documented. f) When service users temperatures are taken the documentation must reflect whether the temperature recording is orally or axilla. g) All care needs that are identified on assessment must be met, in particular oral health care and personal appearance. h) All care staff must ensure that appropriate referrals are made to other health professionals in a timely fashion. Following a separate complaint concerning a different service, the same Inspector required that; i)Care documentation must evidence actual care given and indicate details of interventions given by staff when a service user is distressed. j)All service users must be reassessed to ensure that their current care needs are being met adequately and appropriately. During this inspection, the Inspector examined records that indicated that management and staff were making efforts to improve upon their continuing reassessment of service users health needs, and the recording of it, but further improvements were required. See Standards 7 and 8.31/08/03RosedenePage 11 312(1)8The mapping of pressure sores must be done in more detail, and the recording of dressing changes must accurately reflect the true situation. The dead leaves on the roof of the conservatory must be cleared away and the roof kept clear in future. All existing staff must have Criminal Record Bureau checks submitted as soon as possible. Arrangements must be made to consult with service users about the operation of the home.30/09/03423(2)(c)2030/09/035 619 4.1 ( c ) and Schedule 1.10 21 and 2429 3231/10/03 30/11/03733There must be a quality assurance system that uses stakeholders views to produce an annual development plan. The homes supervision policy and supervision records must meet the requirements of the NMS.30/11/03818(2)3630/11/03Action is being taken by the National Care Standards Commission to ensure compliance in regard to the above requirements. RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations Standard 1 10 Those service users who are assessed as being able to have a key to their bedroom should also be able to lock the door on the inside, subject to a further assessment of their safety. All established routines within the home should be reviewed to ensure that the needs of service users take precedence over the established working practices of staff. Early wake up times in particular should be reconsidered. Service Users preferences should be recorded in their care plans.212319, 20 and The management should consider ways in which communal areas and 24 bedrooms can be made more attractive, homely and in the case of bedrooms, personalised.RosedenePage 12 CONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS).Met (Yes / No)RosedenePage 13 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements and recommendations are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report, which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001 and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. No. Regulation Standard * Requirement Timescale for action The Registered Provider must ensure that Statement of Purpose is amended to include the specific support provided to service users, and what needs the home cannot meet. The Registered Provider must summit an 30.04.04 application for the Variation of the homes Registration to the National Care Standards Commission regarding the number of service users the home can provide a service to under each of the categories of Registration. The Registered Provider must ensure that the home are able to demonstrate their capacity to meet the needs of service users admitted to the home, taking into account the needs and wishes of the service user. The Registered Provider must ensure that each service user agrees a contract/statement of terms and conditions.14 & NCSC (Registrati on) Regulation 121(Younger Adults) & 1(Older People)212(1)(a)(3)3(YA) & 4(OP)18.12.03355(YA) & 2(OP)31.05.04RosedenePage 14 414 & 152,6,41(YA) & 37(OP)The Registered Provider must ensure that every service user has a Service Users Plan which covers all aspects of personal, social, and healthcare needs and support, including current and anticipated needs, restrictions on choice and freedom (agreed with the service user), individualised procedures for service users likely to be aggressive or cause harm or self-harm, focusing on positive behaviour. 31.03.04 The Plan must be drawn up with the involvement of the service user together with family, friends and/or advocate as appropriate, and relevant agencies/specialists, and evidenced by a signature. The plan must be kept under regular review, involving the service user, and the service users key worker, and other stakeholders as appropriate. The Registered Provider must ensure that staff provide service users with the information, assistance and communication support they need to make decisions about their own lives, including their day-to-day health and social needs. The Registered Provider must encourage and assist staff to maintain good personal and professional relationships with service users. Language used at the home must promote the health and welfare of service users, take into account the wishes and feelings of service users, and respect the dignity of service users.512(2)7(YA)31.03.04612(1)(a)(3) (4)(a)(5)(b)7(YA)29.02.04724(3)8(YA)The Registered Provider must ensure that service users participate in the day to day running of the home by providing service users with comprehensive, accessible and up to date information, in suitable formats, about its policies, procedures, activities and services, and appropriate communication 31.05.04 support, as well as for instance giving opportunities for service users to participate in staff meetings, select staff, and a chance to comment in user satisfaction surveys. Service users must receive feedback about the outcomes of their involvement and participation.RosedenePage 15 813(4)9(YA)The Registered Person must provide the National Care Standards Commission with an individual up to date risk assessment of all service users likely to be aggressive or cause 13.02.04 harm to others, as well as those service users who are vulnerable to aggression from other service users. The Registered Provider must ensure that action is taken to minimize identified risks and hazards, involving service users, their friends and family as appropriate, drawing on the 31.03.04 assessment and guidance of professionals, and ensuring service users are given training about their personal safety, to avoid limiting the service users preferred activity or choice. The Registered Provider must ensure that the home hold a confidentiality policy. The Registered Provider must ensure that Staff enable service users to have opportunities to maintain and develop social, emotional, communication and independent living skills. 31.05.049139(YA)101710(YA) & 36,37(OP)1112(1)(a)11(YA)31.05.041216(2)(m) (n)12, 14(YA) & 12(OP)The Registered Provider must ensure that service users can continue to take part in activities engaged in prior to entering the home, if they wish, or re-establish activities if they change localities. The Registered Provider must ensure that service users in 31.03.04 particular diagnosed with dementia, and other cognitive impairments, or physical disability, are given opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs, preferences and capacities The Registered Provider must ensure that staff time with, and support for, service users (categorised as younger adults) outside the home is flexibly provided, including evenings and weekends, and is a recognised part of staff duties. The Registered Provider must ensure that all restrictions on choice and freedom are recorded in the Service Users Plan, including rationing of cigarettes, the ability to lock bedroom doors, and freedom to move around and outside of the home.1316(2(m)13(YA)31.03.041412(2)16(YA) & 14(OP)31.03.04RosedenePage 16 1512(1)(a)18.8(YA)The Registered Provider must ensure that assessed and identified needs are responded to promptly, to agreed timescales, and to take reasonable steps to ensure that service users health and social needs are met. All care staff must ensure that appropriate referrals are made to other health professionals in a timely fashion.13.02.041623(2)(n)18(YA)The Registered Person must ensure that the service user who was seen sleeping on a portable table is assessed by a health professional for the safety and comfort of this sleeping position. The Registered Person must ensure that service users have footwear in the home, unless an assessment is made by an outside professional, assessing this as unsafe, recorded in the Service Users Plan. The Registered Person must ensure that staff support service users to eat with dignity, maintaining eye contact, and positioning themselves at the same level as the service user they are supporting, in line with good practice. The Registered Provider must ensure that service users with continence needs are assessed and supported appropriately, wet clothes promptly changed, and professional advice sought as appropriate. The Registered Provider must ensure that the health needs of service users are acted on at the earliest opportunity, and that systems are put in place to ensure that assessed needs are met, recorded in the Service Users Plan, and reviewed as necessary. Ensure that care records are accurate and reflect the care given. All care needs that are identified on assessment must be met, in particular oral health care and personal appearance.28.02.041713(2)18(YA)13.02.041812(3)18(YA)06.02.041913(1)(b) &19(YA) & 8(OP)05.02.042013(1)(b)19(YA) & 8(OP)06.02.04RosedenePage 17 2112(1)(a)19(YA) & 8(OP)The Registered Provider must ensure that wound maps detail all wounds, and that recording of wounds and wound care tracks the progress of the wound accurately. When a service user has broken areas on their sacrum or wounds these must be monitored and accurately documented. Wound charts must be individual to each wound and there must be clear evidence of wound progress. It is recommended that if advice is sought from other professionals then this be followed to ensure assessed needs of service users are met. The Registered Provider must ensure that service users at risk of consuming too little fluid or food are monitored using recording of fluid and food intake.23.01.042212(1)(a)19(YA) & 8(OP)06.02.042313(2)20(YA) & 9(OP)1. By 6pm on 23rd December 2003 the dosage of all medications administered in error must be confirmed with the GP and this confirmation faxed to the NCSC local office. 23.12.03 (this was 2. By 6pm on 23rd December 2003 a met) supply of medication must be in stock for the three services users without their medication.2413(2)20(YA) & 9(OP)From 24th December 2003 the administration of all medication must be recorded accurately.24.12.03 (this was met)2513(2)20(YA) & 9(OP)By 9th January 2003 an investigation in to why medication was administered incorrectly must be completed and the results sent to the 09.01.04 NCSC local office. By 1st March 2004 the policies and procedures must be up dated and all staff administering medication have received appropriate training in the homes policies and procedures. From 1st February 2004 all directions for administration on the administration record must agree with the directions on the label.2613(2)20(YA) & 9(OP)01.03.042713(2)20(YA) & 9(OP)01.02.04RosedenePage 18 2813(2)20(YA) & 9(OP)The Registered Provider must ensure there is an accurate record of the number of each medicine within the home and that this record is maintained. The Registered Provider must be able to account for each individual tablet or amount of liquid administered in the home.23.01.042912(3)21(YA) & 11(OP) 23(YA) & 17, 18(OP) 24(YA) & 22(OP) 28(YA) & 19(OP) 28(YA) & 19(OP) 28(YA) & 19(OP) 29(YA) & 22(OP) 29(YA) & 22(OP) 30(YA) & 26(OP)30193123(2)(p)The Registered Provider must ensure that service users wishes regarding arrangements 31.03.04 after their death are recorded in the Service Users Plan. The Registered Provider must ensure that all care staff have a current enhanced Criminal 28.02.04 Records Bureau check. The Registered Provider must ensure that lighting in the communal areas throughout the home, including the corridors, is of sufficient 30.04.04 brightness, and has a low level of glare, suitable for service users at the home. The Registered Provider must ensure that the conservatory roof is cleared of debris. The Registered Provider must ensure that eight upright armchairs in the conservatory are replaced. The Registered Provider must ensure that the 3rd floor lounge wall is made good and redecorated. The Registered Provider must ensure that service users are able to use wheelchairs safely and comfortably where there is an assessed need, including the provision of footplates. The Registered Provider must ensure that hoists and other equipment are stored appropriately and safely. The Registered Provider must ensure that the conservatory is kept clean and free from dust, particularly around and behind seating. The Registered Provider must ensure that at least one RMN trained nurse is on every shift, and a system is operated for calculating staff numbers required, in accordance with guidance recommended by the Department of Health. Details must be sent to the National Care Standards Commission. 30.04.04 31.05.04 31.05.0432 33 3423(2)(p) 23(2)(c) 23(2)(b)3523(2)(n)06.02.0436 3723(2)(m) 23(2)(d)31.03.04 31.03.043818(1)(a)32, 33(YA) & 27(OP)28.02.04RosedenePage 19 39Schedule 3 32(YA) & (3)(l) 27(OP)4019(1)(c)34(YA) & 29(OP)4120(3)35(OP)4220(1)(a)35(OP)4312(5) &18(2)36 (YA & OP) 39(YA) & 33(OP)44244513(4)(c)42(YA) & 38(OP)The Registered Provider must ensure that staff working at the home are aware of the details of any specialist communications needs of individual service users and methods of communication that may be appropriate to the service user. The Registered Provider must provide staff with training appropriate to the communication needs of service users. The Registered Provider must ensure that reference requests prompt referees to state their relationship to the applicant. The Registered Provider must ensure that, as far as practicable, persons working at the care home, including members of the partnership, do not act as the agent of a service user. The Registered Provider must ensure that money belonging to any service user is not paid into a bank account unless the account is in the name of the service user, or any of the service users, to which the money belongs. The Registered Provider must ensure that all staff receive 2 monthly supervision and an annual appraisal. The Registered Provider must ensure that there is a quality assurance system that uses stakeholders views to produce an annual development plan, demonstrating the improvement in quality at the home. The Registered Provider must ensure that an Appointed Person qualified to administer first aid is on duty at all times, and that first aid is administered where necessary.30.04.0431.03.0431.03.0431.03.0430.04.0431.05.0406.02.04RECOMMENDATIONS Identified below are areas addressed in the main body of the report, which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s)RosedenePage 20 No.Refer to Standard * 14(Young Adults 19, 31(YA) & 8(Older People) 25(OP)Good Practice Recommendations1The Registered Provider should ensure that a seven-day holiday is included in the contract price for any younger adults at the home. The Registered Provider should ensure that wound maps currently held in the treatment room are included in the service users file with the Service Users Plan. The Registered Provider should ensure that the high level of shared occupancy rooms should be reduced as soon as practicable, in line with good practice The Registered Provider should ensure that service user rooms are homely, and that ordinary beds are provided, and only hospital beds where there is an assessed need. The Registered Provider should ensure that bathrooms are made more homely, involving service users in their redecoration. The Registered Provider should ensure that service users are actively supported to be involved in staff selection, and are supported through the process of joining and departure of staff. The Registered Provider should ensure that the Registered Manager has overall responsibility, set out in a job description, to ensure that: i. Written aims and objectives of the home are achieved; ii. Policies and procedures are implemented; iii. The homes budget is properly managed; iv. Certificates and licenses are obtained and displayed; v. Each service user has a written contract/statement of terms and conditions and that the terms of the contract/statement are fulfilled; and The home complies with the Care Standards Act and Regulations, General Social Care Council codes of practice and other legal requirements.23426(YA) & 24(OP) 27(YA) & 21(OP) 34(YA) & 29(OP)56737(YA) & 31(OP)8 938 40(YA)The Registered Provider should ensure that the practice of all care staff wearing uniforms ends, so as to increase the inclusion of service users in the running of the home. The Registered Provider should ensure that policies and procedures held at the home are reviewed annually, in line with good practice, and any changes inside or outside the care home.RosedenePage 21 PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct Observation Indirect Observation Sampling · Pre-inspection Questionnaire · Records · Care Plans / Care Pathways · Meals · Activities · Other (Specify) `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Relatives/significant others survey/feedback Service user survey Visiting Professionals survey / feedback Tour of Premises Formal Interviews Document reading Additional Inspection Information: Number of service users spoken to at time of inspection Number of relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the Responsible Individual seen CRB check for the Manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total number of care staff employed (excluding managers) Total number of staff with nursing qualifications employed Date of Inspection Time of Inspection Duration Of Inspection (hrs) YES NO YES YES YES NO NO NO YES NO YES NO YES YES YES YES NO YES NO YES13 1 0 NO NO YES NO 27 11 18.12.03 10 20RosedenePage 22 As this establishment accommodates residents who are both over and under 65 years, the report format reflects the likely differing needs by drawing together the National Minimum Standards for Care Homes for Older People and for Adults (18 ­65). Both sets of Standards are broadly similar, but where there are differences these have been highlighted in italics. The following pages summarise the key findings and evidence from this inspection, together with the NCSC assessment of the extent to which the National Minimum Standards for Care homes for older persons have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No shortfalls) (Minor shortfalls) (Major shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.RosedenePage 23 Choice of HomeThe intended outcomes for the following set of standards are: · · · Prospective service users have the information they need to make an informed choice about where to live. Prospective service users individual aspirations and needs are assessed. Prospective service users know that the home they choose will meet their needs and aspirations · Prospective service users have an opportunity to visit and to `test drive the home. This process will also involve the service users relatives and friends. Each service user has an individual written Contract or statement of terms and conditions with the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home.· ·Standard 1 (1.1 ­ 1.4) Y.A & Standard 1 (1.1 ­ 1.3) O.P The registered person produces and makes available to service users an up to date statement of purpose setting out the aims, objectives, philosophy of the home, its services and facilities and terms and conditions; and provides prospective and current service users with a service users guide to the home. The statement of purpose clearly sets out the physical environmental standards met by the home in relation to standards 24.2, 24.9, 25.3, 25.5, 27.2, 27.4 and 28.2 (Y.A), 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10 (O.P): a summary of this information appears in the homes service users guide. Range of fees charged From (£) 496 To (£) 1600Any charges for extras If yes please state what the extras are:YESPERSONAL ITEMS, TRANSPORT AND TRIPS OUT 2 Key findings/Evidence Standard met? The home has produced a new Statement of Purpose and Service User Guide. The inspector discussed the Categories of Registration with the acting manager and proprietor, as well as the Registered Manager who came into the home during leave on the day of inspection. The proprietor agreed with the inspector that the home is not currently able to meet the needs of all service users at the home. The proprietor said that the home cannot manage the needs of service users who are aggressive. The Registered Provider must make this clear in the Statement of Purpose, and apply for a Variation of Registration to the National Care Standards Commission reducing the numbers of beds Registered for particular needs, and amending the Statement of Purpose accordingly. This was agreeable to all parties during the inspection, with the aim of making the nature of the service provided at the home clearer to purchasers, staff, service users, family, and other stakeholders.RosedenePage 24 Standard 2 (2.1 ­ 2.8) Y.A. & Standard 3 (3.1 ­ 3.5) O.P. New service users are admitted only on the basis of a full assessment undertaken by people competent/trained to do so, involving the prospective service user, his/her representatives (if any) and relevant professionals using an appropriate communication method and with an independent advocate as appropriate. 2 Key findings/Evidence Standard met? A service user had been admitted to the home in the last few days. The home were seen to hold a comprehensive community care assessment by the funding authority and other multidisciplinary assessment, and letters transferring the service users health care. Of the six Service User Plans inspected two did not cover specific assessed vulnerability, five did not include assessed aggressive behaviour, and three did not include other assessed needs. Standard 3 (3.1 - 3.10) Y.A. & Standard 4 (4.1 ­ 4.4) O.P. The registered person can demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 1 Key findings/Evidence Standard met? There was no clear evidence that the home had assessed the most recent service user to be admitted in good time to decide whether the home could meet the service users needs. A hand written sheet was found referring to the service users previous placement, but this was not signed or dated. A `patient lifestyle questionnaire was seen, dated two days before the date of admission. The second page was not completed, and the assessment identified a range of health and social needs requiring a range of support from within the home and from specialist health services. These needs were not all identified in the Service Users Plan. Standard 4 (4.1 ­ 4.5) Y.A. & Standard 5 (5.1 ­ 5.3) O.P. The registered manager invites prospective service users to visit the home and to move in on a trial basis, before they and/or their representatives make a decision to move there, and unplanned admissions are avoided where possible. 3 Key findings/Evidence Standard met? The placing social worker of the last service user to be admitted was contacted after the inspection and confirmed that the service user had visited the home prior to placement, communicating that they wanted to be placed at the home. Because of the health needs of the service user the visit was kept to approximately one hour, but the service user had a chance to look round the home and talk to staff. Standard 5 (5.1 ­ 5.5) Y.A. & Standard 2 (2.1 ­ 2.2) O.P. The registered manager develops and agrees with each prospective service user a written and costed contract/statement of terms and conditions between the home and the service user at the point of moving into the home (or contract if purchasing their care privately). 2 Key findings/Evidence Standard met? A contract was not seen on service user files. Two service users spoken to were not aware of a contract/statement of terms and conditions. The room number was seen recorded on all care planning and assessment information completed by the home for each service user file inspected. A requirement is restated for a copy to be given to the service user, and its contents explained to the service user, and a copy placed on each service users file.RosedenePage 25 Standard 6 (6.1 ­ 6.5) O.P. Where service users are admitted only for intermediate care, dedicated accommodation is provided, together with specialised facilities, equipment and staff, to deliver short term intensive rehabilitation and enable service users to return home. 9 Key findings/Evidence Standard met? No intermediate care is provided.RosedenePage 26 Individual Needs and Choices· · · · · Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept.Standard 6 (6.1 ­ 6.10) Y.A. The registered manager develops and agrees with each service user an individual Plan generated from a comprehensive assessment, which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals 1 Key findings/Evidence Standard met? The inspector was satisfied that the acting manager understood the principle of good care planning. Good care planning was noted in one Service Users Plan. One Service Users Plan contained no care plan regarding diet or fluid intake despite these being identified as needs within assessment information completed by the home, and in assessments provided to the home by health professionals. One service user was seen to become incontinent in the main dining area on the first day of inspection. One staff member said that the service user was prompted to go to the toilet two hourly, and that the service user did not want to be spoken to or approached often. The Service Users Plan was seen not to contain clear strategies, for instance the consistent use of prompting, to maintain the service users continence. Older peoples Service User Plans were seen to be reviewed three monthly, evidenced by a written review summary. These should be reviewed monthly. The inspector did not see evidence of service users accessing their files; none of the six Service User Plans inspected having been signed by the service user, friend or relative. Standard 7 (7.1 ­ 7.7) Y.A. & O.P. general good practice Staff respect service users rights to make decisions and that right is limited only through the assessment process, involving the service user, and as recorded in the individual Service User Plan 1 Key findings/Evidence Standard met? The care plans of two service users were seen not to have been signed by the service user or a relative or friend. Care plans were seen to contain negative language without qualification, commenting `cannot, or `unable regarding independent activities, without evidencing discussion with the service user as to how the service user wished to be supported, or how the home could maximise the service users strengths. Other comments found included remains over demanding regarding another service users needs on readmission. One service user was identified by two members of staff as difficult to communicate with, but could not describe what the Service Users Plan contained regarding communication.RosedenePage 27 Standard 8 (8.1 ­ 8.5) Y.A. specific & O.P general good practice The registered manager ensures that service users are offered opportunities to participate in the day to day running of the home and to contribute to the development and review of policies, procedures and services. 1 Key findings/Evidence Standard Met? No evidence was found regarding opportunities for service users to participate in the day-today running of the home and to contribute to the development and review of policies, procedures and services.Standard 9 (9.1 ­ 9.4) Y.A. Specific & O.P general good practice Staff enable service users to take responsible risks, ensuring they have good information on which to base decisions, within the context of the service users individual Plan and of the homes risk assessment and risk management strategies. 2 Key findings/Evidence Standard met? Risk assessments were seen to be generic in the six Service User Plans inspected, referring to general risks across service users, and general strategies to minimise these risks. Risk assessments were seen not to signed by the service user, or a friend or relative. Of the six service user files inspected risk assessments regarding identified risks in assessments including three service users identified as aggressive, one service user likely to refuse food, and two service users likely to self harm, were missing. The inspector could not find evidence of individualised procedures for service users likely to be aggressive or cause harm or self-harm, focusing on positive behaviour, ability and willingness, or risk assessments. The acting manager agreed to complete these risk assessments within four weeks of the inspection. Standard 10 (10.1 ­ 10.6) Y.A. & Standards 36 & 37 O.P. Staff respect information given by service users in confidence, and handle information about service users, in accordance with the homes written policies and procedures and the Data Protection Act 1998, and in the best interests of the service user. 1 Key findings/Evidence Standard met? A code of conduct policy was seen dated 9/03 but the home do not hold a confidentiality policy that covers action in the event of a breach of confidentiality, and what constitutes a breach of confidentiality. Service user files were seen to be kept safe and securely in the office, which was locked at times when the manager or proprietor was not present.RosedenePage 28 Lifestyle· · · · · · · Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes.Standard 11 (11.1 ­ 11.4) Y.A. specific & O.P. general good practice Staff enable service users to have opportunities to maintain and develop social, emotional, communication and independent living skills. 1 Key findings/Evidence Standard met? The inspector did not see evidence of service users having opportunities to use practical life skills such as making hot drinks or snacks, or the provision of assertion or confidence training. One staff member spoken to in the 1st floor lounge said that staff encourage service users to play musical instruments to provide stimulation and entertainment for the service users on the 1st floor. This was not observed during this inspection.Standard 12 (12.1 ­ 12.6) Y.A. specific & O.P. general good practice Staff help service users to find and keep appropriate jobs, continue their education or training, and / or take part in valued and fulfilling activities. 2 Key findings/Evidence Standard met? The acting manager said none of the service users work. Two service users files inspected had no entries regarding `activities of daily living.Standard 13 (13.1 ­ 13.5) Y.A. & Standard 13 (13.1 ­ 13.6) O.P. Staff support service users to become part of, and participate in, the local community in accordance with assessed needs and the individual Plans and service users preferences. 2 Key findings/Evidence Standard met? The acting manager and proprietor said that four service users go into the community independently, going to local shops. The inspector could not find evidence that service users categorised as younger adults, with higher needs, were systematically supported to go into the community flexibly, including evenings and weekends. Four of the six Service User Plans inspected contained a `life history providing good information for care staff to work with service users around their preferences. The acting manager expressed concern that members of staff were reluctant to access service user information kept in the office, so that this information is likely not to have been seen by many staff members.RosedenePage 29 Standard 14 (14.1 ­ 14.6) Y.A. & Standard 12 (12.1 ­ 14.6) O.P. Staff ensure that service users have access to, and choose from a range of, appropriate leisure activities. 2 Key findings/Evidence Standard met? The inspector could not find evidence of a seven-day holiday being included in the contract price for any younger adults at the home. Activities are provided from a day service to the rear of the home, which does not currently need to be registered and was therefore not inspected. Service users were seen to sit through the day in the main lounge and four lounges on the 1st and 2nd floors. Five service users in the larger 1st floor lounge were seen on two occasions during the last day of inspection to be left unsupervised and unstimulated, except for a radio. The orientation board in this lounge has been marked with a permanent maker, and gives misleading information. Standard 15 (15.1 ­ 15.5) Y.A. & Standard 13 (13.1 ­ 13.6) O.P. Staff support service users to maintain family links and friendships inside and outside the home, subject to restrictions agreed in the individual Plan and Contract (subject to standards 2 and 6 if necessary) service users are able to have visitors at any reasonable time. 3 Key findings/Evidence Standard met? One relative was spoken to on the first day of inspection, and expressed satisfaction at the friendliness of the home and other service users. The service user most recently admitted to the home was seen on the first day of inspection with their family.Standard 16 (16.1 ­ 16.11) Y.A. & Standard 14 (14.1 ­ 14.5) O.P. The daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in the individual Plan and Contract (subject to Standards 2 and 6 if necessary) 2 Key findings/Evidence Standard met? The six Service User Plans inspected did not contain clear restrictions on choice and freedom. However there are restrictions within the home, due to the environment, and the general routine of the home. These include, as stated in the last inspection report, bedroom doors cannot be locked from the inside, and inevitable constraints around support for service users to leave the home. Service users in the main lounge were seen to receive cigarettes from a member of staff at specified intervals. On the last day of inspection, a service user was seen to be prevented from remaining in the garden. All restrictions should be recognised and agreed in the Service User Plan, and individual strategies put in place to ameliorate there affects, and promote individual choice and freedom.RosedenePage 30 Standard 17 (17.1 ­ 17.9) Y.A. & Standard 15 (15.1 ­ 15.9) O.P. The registered person promotes service users health and wellbeing by ensuring the supply of nutritious, varied, balanced and attractively presented meals in a congenial setting and at flexible times. 0 Key findings/Evidence Standard met? This Standard was not assessed during this inspection.RosedenePage 31 Personal and Healthcare support· · · · Service users receive personal support in the way they prefer and require. Service users physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the homes policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish.Standard 18 (18.1 ­ 18.11) Y.A. & Standard 10 (10.1 ­ 10.7) O.P. Staff provide sensitive and flexible personal support and nursing care to maximise service users privacy, dignity, independence and control over their own lives with particular regard to care giving social contact and consultation. 2 Key findings/Evidence Standard met? A relative of one service user said that the service user was awaiting a new wheelchair. On inspection of the file and from information given by the acting manager a verbal referral had been given to the GP two months previously and not acted upon. The acting manager agreed to approach the GP again. One service user was seen in the 1st floor larger lounge bent forward and apparently sleeping with their head on a pillow placed on a table on wheels in front of the chair. Eight service users were seen in the main lounge without any footwear. Risk assessments in Service Users Plans state that lack of footwear presents risk of falling for service users at the home. One staff member was seen to support a service user to eat by standing over the service user.RosedenePage 32 Standard 19 (19.1 ­ 19.5) Y.A. & Standard 8 (8.1 ­ 8.13) O.P. The registered person ensures that the healthcare needs of service users are assessed and recognised and that procedures are in place to address them. Number of incidents where service users have been taken to Accident and Emergency during last 12 months Number of service users with pressure sores at time of inspection (from information taken from care notes) 111 Key findings/Evidence Standard met? After a complaint received by the National Care Standards Commission, the home agreed to arrange for a service user to be weighed at the service users GP surgery, the day after the first day of inspection. This was not done until the lead inspector asked the home again some days later. The inspector is concerned at the delay in actioning this matter and a requirement is made. The incidents of service users taken to Accident and Emergency, and of pressure sores is taken from the pre-inspection questionnaire completed before the first day of inspection. Records were seen confirming that one service user had access to community healthcare regarding the management of an external ulcer, which the acting manager said was now healed. At the end of the first day of inspection the acting manager received a call in the inspectors presence regarding a service user who had missed an appointment for an essential specialist health procedure, the details of which were apparently unclear to the acting manager, and were absent from service users care planning information drawn up by the home. Clear details regarding this specialist health procedure were found in referrals from health professionals, held in the service users file. Wound records for two service users had not been reviewed since 17.10.03 and 10.10.03 respectively. Specialist advice given regarding one service user was seen not to have been followed by staff at the home. Wound maps are kept in the treatment room, separate from Service User Plans. One Service Users Plan was seen to contain no record of food or fluid intake on the diet chart the day before the second day of inspection. Requirements originally made following a complaint July 2003 are restated, namely a) Ensure that care records are accurate and reflect the care given; b) When an assessment indicates that fluid or food intake needs to be monitored, then the home must ensure that this is documented accurately c) When a service user has broken areas on their sacrum or wounds these must be monitored and accurately documented. d) All care needs that are identified on assessment must be met, in particular oral health care and personal appearance. e) All care staff must ensure that appropriate referrals are made to other health professionals in a timely fashion. A service user was seen with wet trousers in the main dining area.RosedenePage 33 Standard 20 (20.1 ­ 20.14) Y.A. & Standard 9 (9.1 ­ 9.11) O.P. The registered manager and staff encourage and support service users to retain, administer and control their own medication, within a risk management framework, and comply with the homes policy and procedure for the receipt, recording, storage, handling, administration and disposal of medicines 2 Key findings/Evidence Standard met? Policies covering continuous refusal of medication and medication supplied to service users on leave from the home were not in place. All other policies and procedures were in place. No service users were self-medicating on this visit. In two instances, the midday medication had been signed for in advance. In three instances, the actual quantity of medication given was not recorded for items prescribed with a variable dose. In one instance, the dosage directions on the label did not agree with dosage direction on the administration record. The medication had been signed as being given in accordance with the directions on the label and not the directions on the administration record. In two instances, a transcription error on the administration record led to two service users receiving the incorrect dosage of medication. In two other instances, two service users did not receive the correct dosage of medication. One of these has been ongoing since 20th November 2003 when the dose had been changed by the doctor but not in the home. All other necessary records were in place and accurate and up to date. All items of medication in the home were stored securely. In three instances, medication for service users was not in stock on the day of the visit. Registered nurses administer all medication within the home. On the last day of inspection one service user had a prescribed dose not signed as administered 15.01.04. Standard 21 (21.1 ­21.8) Y.A. & Standard 11 (11.1 ­ 11.12) O.P. The registered manager and staff deal with the ageing, illness and death of a service user with sensitivity and respect and their spiritual needs, rites and functions observed. 2 Key findings/Evidence Standard met? The acting manager said that one service user died at the home over the past 12 months. Service users preferences regarding death and dying were not seen to be recorded in the six Service User Plans inspected.RosedenePage 34 Concerns, Complaints and ProtectionThe intended outcomes for the following set of standards are: · · · Service users and their relatives and friends feel their views are listened and acted on. Service users are protected from abuse, neglect and self-harm. Service users legal rights are protected.Standard 22 (22.1 ­ 22.7) Y.A. & Standard 16 (16.1 ­ 16.4) O.P. The registered person ensures that there is a clear and effective complaints procedure, which includes the stages of, and times-scales, for the process, and that service users know how and to whom to complain. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to NCSC Percentage of complaints responded to within 28 days 4 1 2 0 1 2 100 3 Key findings/Evidence Standard met? The acting manager said that complaints are now all recorded. Before this inspection, a complaint was received by the NCSC regarding the home. This was investigated by The London Borough of Wandsworth and the National Care Standards Commission as part of this inspection, which resulted in the complaint being partly substantiated and a number of requirements being made.RosedenePage 35 Standard 23 (23.1 ­ 23. 6) Y.A. & Standard 18 (18.1 ­ 18.6) O.P. The registered person ensures that service users are safeguarded from physical, financial, or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, inhuman or degrading treatment through deliberate intent, negligence or ignorance in accordance with written policies. Standard 17 (17.1 ­ 17.3) O.P. specific Y.A. general good practice Service users have their legal rights protected, are enabled to exercise their legal rights directly and participate in the civic process if they wish The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets No. of staff referred for inclusion on POCA/ POVA lists YES 02 Key findings/Evidence Standard met? The proprietor states in the pre-inspection questionnaire that three care staff do not have active applications for a Criminal Records Bureau (CRB) check. These must be submitted and completed by the end of February 2004. The staff files inspected all contained a current CRB check. The home were seen to hold the Wandsworth Borough Protection of Vulnerable Adults policy, and were seen to have involved an officer from Wandsworth in a recent complaint. The home were also seen to have contacted the police appropriately following a recent incident at the home. Concern regarding injuries to a service user resulted in a complaint to the National Care Standards Commission. The complaint was upheld since, despite injuries having been recorded at the home as resulting from aggression from another service user on at least one occasion the home did not make a recorded assessment of the risks. The home have agreed to provide risk assessments regarding all service users who they identify as vulnerable, as well as those who pose a risk to others, or themselves. A Requirement is made under Standard 9.RosedenePage 36 EnvironmentThe intended outcomes for the following set of standards are: Service users live in a homely, comfortable and safe environment with indoor and outdoor communal facilities. · Service users bedrooms suit their needs and lifestyles are comfortable with their own possessions around them. · Service users bedrooms promote their independence. · Service users toilets and bathrooms provide sufficient privacy and meet their individual needs · Shared spaces complement and supplement service users individual rooms. · Service users have the specialist equipment they require to maximise their independence. · The home is clean pleasant and hygienic. Standard 24 (24.1 ­ 24.13) Y.P. & Standard 22 (22.1 ­ 22.8) O.P. The homes premises are suitable for its stated purpose; accessible, safe and wellmaintained; meets service users individual and collective needs in a comfortable and homely way; and have been designed with reference to relevant guidance. The registered person demonstrates that an assessment of the premises and facilities has been made by suitably qualified persons, including a qualified occupational therapist, with specialist knowledge of the client groups catered for, and provides evidence that the recommended disability equipment has been secured or provided and environmental adaptations made to meet the needs of service users. 2 Key findings/Evidence Standard met? Lighting in the hallways was seen to be poor, bulbs shaded to produce a high level of downward glare, and a low level of general light. The acting manager said that net curtains were changed following the last inspection. ·RosedenePage 37 Standard 25 (25.1 ­ 25.8) Y.A. & Standard 23 (23.1 ­ 23.10) O.P. The registered person provides each service user with a bedroom which has useable floor space sufficient to meet individual needs and lifestyles which meets minimum space as follows: Total number of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1 April 2003) - single bedrooms below 10 sq.m usable space or additional compensatory space Total number of rooms accommodating wheelchair users with at least 12sq.m of space Total number of rooms accommodating wheelchair users with less than 12sq.m of space Total number of shared rooms at least 16 sq.m Total number shared rooms less than 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total number of single bedrooms Total number of single rooms with en suite Total number of double rooms Total number of double rooms with en suite NO NO YES 15 0 25 2 1701 3 25 02 Key findings/Evidence Standard met? The high level of shared occupancy rooms should be reduced as soon as practicable, in line with good practice. Risk assessments must be completed as a matter of urgency for service users in shared rooms where they are assessed as vulnerable, or assessed as posing a risk to other service users or themselves (see Standard 9). Rosedene Page 38 Standard 26 (26.1 ­ 26.4) Y.A. & Standard 24 (24.1 ­ 24.8) O.P. The registered person provides each service user with a bedroom that has furniture and fittings sufficient and suitable to meet individual needs and lifestyles. 1 Key findings/Evidence Standard met? Service users bedrooms doors were seen to have labels fitted, five inspected displaying the name of the current service user. The acting manager said that bedrooms have locked storage and this was seen in one service users room. One service user was seen to have a door lock, for which they held a key. The five bedrooms inspected were again not homely in appearance, as noted in the last inspection, for instance all having hospital beds. Standard 27 (27.1 ­ 27.6) Y.A. & Standard 21 (21.1 ­ 21.9) O.P. The registered person provides service users with toilet and bathroom facilities which meet their assessed needs and offer sufficient personal privacy. 2 Key findings/Evidence Standard met? The acting manager said that taps were changed following the last inspection. All taps seen in the six bathrooms and toilets inspected had well maintained taps, showing hot or cold water. All wash hand basins seen were fitted with a plug. The acting manager said that some service users call bells are deactivated, and that this is recorded in the service users plan. Three of the bathroom inspected, which the acting manager said are the same throughout the building, were seen not to be homely, lacking any individual decoration. The home should involve service users in personalising, and redecorating as appropriate the bathrooms. Standard 28 (28.1 ­ 28.3) Y.A. & Standard 19 (19.1 ­ 19.6) O.P. A range of comfortable, safe and fully accessible shared spaces is provided both for shared activities and for private use. 2 Key findings/Evidence Standard met? The inspector found lighting in the conservatory area to be dark, and a restated requirement is made. A service user commented that the chairs were worn, and not pleasant to sit in. The inspector noted eight easy chairs in the conservatory that have worn arms and seating, and must be replaced, or appropriately re-upholstered. The rear wall to the top floor lounge was found to be damp, and the wallpaper peeling away. Standard 29 (29.1 ­ 29.8) Y.A. & Standard 22 (22.1 ­ 22.8) O.P. The registered person ensures the provision of the environmental adaptations and disability equipment necessary to meet the homes stated purpose and the individually assessed needs of all service users. 2 Key findings/Evidence Standard met? One service user in a wheelchair did not have footplates, and was seen to have a dressing to their foot. A hoist was seen in a corridor next to a 2nd floor lounge. The hoist must be kept in appropriate storage, to avoid unnecessary risk to the health and welfare of service users.RosedenePage 39 Standard 30 (30.1 ­ 30.9) Y.A. & Standard 26 (26.1 ­ 26.9) O.P. The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation, published professional guidance and the purpose of the home. 2 Key findings/Evidence Standard met? The home employs three cleaning staff. On the last day of inspection, the carpets in the hallways on all floors were seen to be cleaned, and most areas were seen to be free from dust. The exception was in the seating area of the conservatory where an area behind chairs was seen to be dirty, and apparently not cleaned for some time. Since this area if used for service users to be able to smoke dust and rubbish can cause an additional fire risk, and this are must be cleaned. Standard 25 (25.1 ­ 25.8) O.P. specific & Y.A. general good practice The heating, lighting, water supply and ventilation of service users accommodation meet the relevant environmental health and safety requirements and the needs of individual service users. 2 Key findings/Evidence Standard met? The majority of service users at the home are accommodated in shared bedrooms. Given that most service users share a room, it would be difficult to conclude that they share because they have made a positive choice. None of the eight service users spoken to expressed dissatisfaction with their current living arrangements.RosedenePage 40 StaffingThe intended outcomes for the following set of standards are: · · · · · · Service users benefit from clarity of staff roles and responsibilities Y.A. specific & O.P. advice Service users are supported by competent and qualified staff. Service users are supported by an effective staff team with appropriate numbers and skill mix. Service users are supported and protected by the homes recruitment policy and practices. Service users individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff Y.A. specific & O.P. advice.Standard 31 (31.1 ­ 31.7) Y.A. specific & O.P. general good practice The registered manager ensures that staff have clearly defined job descriptions and understand their own and others roles and responsibilities. 2 Key findings/Evidence Standard met? Of the four staff spoken to one said that they ensure service users receive regular drinks, and another that close supervision is important for vulnerable service users. The acting manager said that staff are reluctant to use service users care plans as a daily tool, and that there is a tendency amongst nursing staff to maintain records including wound maps, separately to the care plans, held in the office. As stated in Standard 12(YA) &12(OP), where a requirement is made, five service users in the larger 1st floor lounge were seen on two occasion during the last day of inspection to be left unsupervised and unstimulated, except for a radio.RosedenePage 41 Standard 32 (32.1 ­ 32.6) Y.A. & Standard 27 (27.1 ­ 27.7) O.P. Staff have the competencies and qualities required to meet service users needs and achieve Sector Skills Council workforce strategy targets within the required timescales. Number of staff /hours in respect of service user needs based on guidance recommended by Department of Health. Personal Nursing Care No. service users High No. staff hours 24 X X needs allocated No. service users Medium needs No. service users Low needs Total No. of staff hours required No. of staff with NVQ level 2 or above 26 8 X X X No. staff hours allocated No. staff hours allocated Total No. of staff hours provided X X X X XNo. of trainees registered on Sector Skills Council training programme No. of staff with nursing qualifications (where applicable)112 Key findings/Evidence Standard met? The information above is taken from the pre-inspection questionnaire completed by the proprietor. Dependency levels quoted show a marked increase since the last inspection. The inspector is not aware of any increase in staffing to reflect this increase in needs. The home must provide details of staffing, and the way in which staffing is allocated on an individual basis to meet these needs. Staff appeared relaxed with service users. While not engaged with staff, service users appeared relaxed. Staff were not seen to systematically provide stimulation to service users, for instance ensuring they spent 1:1 time with each service user, or providing any specific activities to service users unable to access the activities room to the rear of the home. Staff were seen to talk to service users from a standing position, particularly in the conservatory area, not sitting next to service users and engaging with them in a way that would be likely to meet specific communication needs and build a significant relationship.RosedenePage 42 Standard 28 (28.1 ­ 28.3) O.P. specific A minimum ratio of 50 trained members of staff (NVQ Level 2 or equivalent) is achieved by 2005, excluding the registered manager and/or care manager, and in care homes providing nursing, excluding those members of care staff who are registered nurses. No. care staff (excluding registered nurses) with NVQ level 2 or equivalent of care staff with NVQ level 2 12 44 2 Key findings/Evidence Standard met? The number of qualified staff has been assessed from the statement of the proprietor in the pre-inspection questionnaire.Standard 33 (33.1 ­ 33.11) Y.A. specific & O.P. general good practice The home has an effective staff team, with sufficient numbers and complementary skills to support service users assessed needs at all times. 2 Key findings/Evidence Standard met? The proprietor states in the pre-inspection questionnaire that three staff members left the home in a three and a half month period, one of which was dismissed, and one of which retired. Due to the lack of supervision found on one day of inspection, in particular the larger lounge on the 1st floor, a requirement is made that the home provide details regarding the calculation of staffing levels at the home against the dependency of service users. Standard 34 (34.1 ­ 34. 8) Y.A. & Standard 29 (29.1 ­ 29.6) O.P. The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 2 Key findings/Evidence Standard met? One staff member explained the induction process, identifying peer support, supervision, and an induction checklist involving the identification of training needs. The six staff files inspected contained evidence of CRB checks, two references, and proof of identification, and a copy of the staff member terms and conditions of employment. References were seen not to provide a prompt for referees to state their relationship to the applicant, and this must be added. There was no evidence at the home that service users are involved in the selection of staff.RosedenePage 43 Standard 35 (35.1 - 35.8) Y.A. & Standard 30 (30.1 ­ 30.4) O.P. The registered person ensures that there is a staff training and development programme which meets Sector Skills Council workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 3 Key findings/Evidence Standard met? Staff training records were seen to contain health and safety training including fire precautions, and manual handling. Training targeted at service users needs included training in dementia care, vulnerable adults, and training in identifying abuse.Standard 36 (36.1 ­ 36.8) Y.A specific & O.P. general good practice Staff receive the support and supervision they need to carry out their jobs. 2 Key findings/Evidence Standard met? The acting manager has instituted a system of staff supervision, allocating nursing staff to supervise named care staff. The acting manager recognised that recorded supervision is still not taking place at the required intervals. The inspector did not see evidence of the appraisal of staff at the home. The five staff files inspected contained some supervision records, some of which were not complete. Recorded supervision was seen to be given less than 2 monthly to four staff.RosedenePage 44 Conduct and Management of the HomeThe intended outcomes for the following set of standards are: · Service users benefit from a well run home. · Service users benefit from the ethos, leadership and management approach of the home. · Service users are confident their views underpin all self monitoring, review and development by the home. · Service users rights and best interests are safeguarded by the homes policies and procedures. · Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. · The health, safety and welfare of service users are promoted and protected. · Service users benefit from competent and accountable management of the service. Standard 37 (37.1 ­ 37.4) Y.A. & Standard 31 (31.1 ­ 31.8) O.P. The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Registered manager qualified to level 4 NVQ in Management and care or equivalent? YES2 Key findings/Evidence Standard met? The Registered Manager returned from leave before the last day of inspection, now working on a part-time basis. The Registered Manager said that she intends to return to full-time employment as the Registered Manager in the coming months. Before her return, and until she is full-time, an acting manager is providing cover. The Registered Manager has managed the home for more than two years. The inspector did not see the Registered Managers job description. Standard 38 (38.1 ­ 38.6) Y.A. & Standard 32 (32.1 ­ 32.7) O.P. The management approach of the home creates an open, positive and inclusive atmosphere. 2 Key findings/Evidence Standard met? Staff at the home wear uniforms, and this is felt by the proprietor and Registered Manager to be essential to the running of the home. The inspector suggested to both that uniforms are likely to detract from the inclusion of service users in the running of the home. This was felt by the inspectors to be the case.RosedenePage 45 Standard 39 (39.1 ­ 39. 10) Y.A. & Standard 33 (33.1 ­ 33.10) O.P. Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in achieving the aims, objectives and statement of purpose of the home. 2 Key findings/Evidence Standard met? The acting manager said that she had no knowledge of a quality assurance system at the home, and that this was operated independently by the proprietor.Standards 40 (40.1 ­ 40. 6) Y.A. specific The homes written policies and procedures comply with current legislation and recognised professional standards, covering the topics set out in Appendix 2 of the National Minimum Standards for Younger Adults. 2 Key findings/Evidence Standard met? The proprietor states in the pre-inspection questionnaire that the home hold policies on all areas listed in the pre-inspection questionnaire with the exception of policies relating to emergency admission and guardianship treatment under the Mental Health Act 1983, all other policies dated 11/02. Policies should be reviewed annually.Standard 41 (41.1 ­ 41. 3) Y.A. & Standard 37 (37.1 ­ 37.3 ) O.P. Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 2 Key findings/Evidence Standard met? Records held at the home were safe and secure. Service Users Plans were seen not to be kept up to date and complete. There was no evidence found that service users had regular access to their Service User Plans, or access to other documentation held about them at the care home.Standard 42 (42.1 ­ 42 . 9) Y.A. & Standard 38 (38.1 ­ 38.9) O.P. The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 1 Key findings/Evidence Standard met? On the third day of inspection nursing staff who found a service user injured were questioned regarding the provision of first aid, and replied that they had not made basic attempts to apply first aid, instead relying on contact with the health authorities emergency services. The acting and Registered Manager were not clear whether an Appointed Person was on shift to administer first aid. The acting manager said that all taps at the home are fitted with pre set valves to ensure temperatures close to 43°C. Gas safety certificate was seen dated 2/12/03, portable appliance test 15/12/03, fire equipment tests 3/12/03. The proprietor said that the London Fire and Emergency Planning Authority were seen to have visited in the last 12 months, and made recommendations but not requirements.RosedenePage 46 Standard 43 (43.1 ­ 43. 7) Y.A. & Standard 34 (34.1 ­ 34.5) O.P. The overall management of the service ( within or external to the home) ensures the effectiveness, financial viability and accountability of the home. 0 Key findings/Evidence Standard met? This Standard was not assessed during this inspection.Standard 35 (35.1 ­ 35.6) O.P. Specific The registered manager ensures that service users control their own money except where they state that they do not wish to or they lack capacity and that safeguards are in place to protect the interests of the service user. Number of service users subject to Power of Attorney processes Number of service users subject to Enduring Power of Attorney processes Number of service users subject to Guardianship Orders 5 0 02 Key findings/Evidence Standard met? The proprietor states in the pre-inspection questionnaire that he acts as appointee for approximately thirty service users. The proprietor supplied a copy of a letter from an accountant, stating that `transactions involving client money are adequately controlled and recorded in the accounting records in a way which distinguishes them from any other transactions and that service users money is individually accountable, and interest earned is retained within the `client account and `not distributed to service users or to the proprietor.RosedenePage 47 PART C(where applicable)COMPLIANCE WITH CONDITIONSCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceLead Inspector Second Inspector Locality Manager DateMark Stroud Norma VieiraSignature Signature SignatureRosedenePage 48 PART D(where applicable)LAY ASSESSORS SUMMARYLay Assessor Date Public reportsSignatureIt should be noted that all NCSC inspection reports are public documents.RosedenePage 49 PART EE.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.We would welcome comments on the content of this report relating to the Inspection conducted on 18 December 2003 and any factual inaccuracies: Please limit your comments to one side of A4 if possible Comments and action plan were received from the provider. These are available upon request from the SW London office.RosedenePage 50 Action taken by the NCSC in response to provider comments: Amendments to the report were necessary NOComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurateYESYESNote: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. E.2 Please provide the Commission with a written Action Plan by which indicates how requirements are to be addressed and stating a clear timescale for completion. This will be kept on file and made available on request. ,You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required YESAction plan was received at the point of publicationYESAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planYESNONOOther: enter details here RosedenePage 51 E.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.E.3.1 I of confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or E.3.2 I of am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) for the following reasons: 02/04/2004 T LEWISPrint Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.RosedenePage 52 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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