Inspection on 24/04/07 for Rosegarth

This inspection was carried out on 24th April 2007.

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

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

Other inspections for this house

Rosegarth 07/08/09

Rosegarth 06/08/08

Rosegarth 28/06/06

Rosegarth 07/06/05

Rosegarth 13/01/05

Rosegarth 23/08/04

Rosegarth 19/03/04

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Rosegarth Rosegarth 30 - 32 Belgrave Drive Bridlington East Yorkshire YO15 3JR Lead Inspector Mr M. A. Tomlinson Key Unannounced Inspection 09:30 24 and 30th April 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosegarth Address Rosegarth 30 - 32 Belgrave Drive Bridlington East Yorkshire YO15 3JR 01262 677972 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hexon Limited Mr Stephen Paul Hepworth ****Post Vacant**** Care Home 26 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (26) of places Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th June 2006 Brief Description of the Service: Rosegarth is situated close to the seafront in Bridlington. The home comprises three traditional houses that have been joined internally. The accommodation has single and double rooms the majority of which have en suite facilities. There is a pleasant garden and conservatory where the residents may sit. The home is registered for 26 older people, some of whom may have a dementia. The organisation’s Statement of Purpose is made available to all service users in the entrance hall of the home and in their rooms. Individual copies are available on request. The charges made by the organisation for care and accommodation range from £360.00 to £375.00. This information was correct at 24/04/07. Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit formed an integral part of the annual ‘key inspection’ process for the home undertaken by the Commission for Social Care Inspection (CSCI). Information contained in this report was obtained through discussions with the home’s manager, who had yet to be registered with the CSCI, the staff on duty at the time of the visit, several service users and the relatives of four of the service users. Telephone discussions were also held with two social workers who had clients accommodated in the home. A further visit was made on 30th April primarily to speak with the deputy manager who was not available at the time of the initial visit. This was considered necessary as the deputy manager was not in post at the time of the previous inspection, she had been involved in a recent Adult Protection investigation on behalf of Rosegarth and she was instrumental in a number of changes that had taken place in the home. Reliance was also placed on observation of the staff and the support provided for the service users. The report incorporates information provided by the manager in the pre-inspection questionnaire and survey comment cards returned by visitors to the home. In addition the report includes relevant information obtained by the CSCI prior to, and subsequent to, the inspection visit. A number of statutory records kept by the home were also examined and an inspection of the premises carried out. Feedback was provided for the manager and the area manager on the completion of the inspection visit. What the service does well: The home presents as a friendly and informal environment in which the service users are able to live their lives at their own pace. It is evident that the staff have a good understanding of the service users’ needs and actively promote those elements of care, such as independence, to enable the service users to retain their individuality. It is evident that the staff support the service users in a respectful, patient and empathetic manner. Without exception the service users, their relatives and visitors to the home spoke highly of the staff and management team. These comments included, “ (manager) is a lovely lady – she’ll do anything for you – she’s always kind”, “(manager) and her staff have worked wonders. They are very caring. (manager) is fantastic. She will do anything. I can’t fault her”, “(Deputy manager) is very approachable. She’s got an excellent rapport with clients and staff”, “The staff are brilliant” and “The staff cannot be faulted”. It is evident that the manager is endeavouring to establish a positive and open relationship with the relatives of the service users by encouraging them discuss any problems or issues and by involving them in the programme of social activities. Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The following are those areas that need to be addressed in order to improve the service: • It is apparent that although the care staff are willing and enthusiastic, there are times when they are ‘stretched’ and during these periods the physical care of the service users has to take priority over their social and emotional care needs. It would perhaps be better if the home had a dedicated activity organiser who could tailor the activities to the assessed needs of the service users. This would not prevent the involvement of the care staff but would provide them with a greater degree of flexibility and more time to spend with service users on a oneto-one basis. The service users’ day appears to have become ‘skewed’ insofar as the majority get up early in the morning and go to bed early in the evening. The reason for this needs to be identified and action taken to verify that the service users’ routines are solely for their benefit and based on their wishes. The manager needs to apply to the Commission for Social Care Inspection for registration as a matter of urgency. • • Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 7 • More openness needs to be applied to the ‘Residents Fund’ so that the service users, contributors to the fund and visitors to the home know how the money is being spent. The home would possibly benefit from holding the occasional meeting for relatives of the service users so that they are able to discuss any issues as a group with the management team. This approach may lessen the use of the formal complaints procedure to resolve such issues. • Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5 The pre-admission assessments undertaken on prospective service users provide the manager with sufficient information on which to make a considered decision as to the whether the home can meet the needs of the individual. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care records of three service users were examined as part of the case tracking process. These included two of the most recently admitted service users. The records contained documentary evidence that these service users had been assessed before they were admitted into the home. The assessments had been carried out by the Manager and were in addition to the Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 10 assessments provided by the service users’ respective placing agencies. The assessments had been based on a format agreed by the home’s parent company, Hexon Limited, and were designed to cover the service users’ main areas of need. The assessments provided the Manager with adequate information on which to make a considered decision as to the appropriateness of the proposed placement. There was evidence in the records that the assessments had been undertaken, where possible, in the service users’ own home and had involved their next of kin. Whilst those service users case tracked could not recall the assessment process, a number of service users’ relatives could. The manager provided evidence that the assessment process, including the assessment records, were in the process of being reviewed and amended to make them more compatible with the National Minimum Standards. She demonstrated a good understanding of the necessity for having a comprehensive pre-admission assessment process. The manager said that prospective service users were encouraged to visit the home before making a decision to be admitted. In the majority of cases this had not been possible due to the service users’ circumstances at the point of admission (e.g. In hospital or too infirm to visit) and consequently their relatives had generally undertaken the task of looking around the home. A relative of a service user said, “ I liked the place as soon as I went in”. Some service users had previously been admitted for respite care and consequently this had been used as a stepping-stone for permanent residency. Those service users admitted on a respite care basis had also been assessed. On occasions a service user had been admitted on an ‘emergency’ basis. In these circumstances a verbal assessment and a basic care plan had been provided by the placing agency until a more detailed assessment could be made. A Social Services’ Assessment Officer said that the manager and the staff were ‘very cooperative and very accommodating’ in such circumstances. Following the requirement made during the previous inspection, the home’s Statement of Purpose (S.O.P.) and the Service Users’ Guide (S.U.G.) had been amended to reflect the management changes in the home. A copy of the S.U.G was to be made available in all of the service users’ bedrooms. A further copy of both documents was available in the entrance hall. The home does not provide Intermediate Care. Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 The service users’ needs are identified in their care plans in sufficient detail to enable the staff to meet the service users’ assessed needs. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The three care records examined contained a care plan developed by the home as well as one provided by the placing authority. The care plans were divided into the main elements of care need using a numerical system of crossreferencing. The manager stated, “ I leave developing a service user’s main care plan for a couple of weeks after their admission as a person can change when they come into care and it takes time to genuinely identify their needs”. The identified care needs were directly linked to medium term goals that were achievable. Whilst the manager or her deputy had set these goals, the service users’ Key Workers had direct involvement through the use of ‘key worker Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 12 records’. The care plans clearly showed the actions to be taken by the staff in order to meet the service users’ needs. Additionally, the care plans included a range of personal assessments for the service users such as a falls assessment, waterflow assessment, pressure sore assessment and a moving and handling assessment. Where the use of bedrails had been deemed necessary for one service user a risk assessment had been undertaken and the use of the bedrails agreed by the service user’s next of kin and their general practitioner. The manager had also sought, and recorded, the service users’ wishes following their death. It was noted that the care plans did not include a personal profile/history of the service user concerned. The care plans examined had been signed in agreement either by the service user concerned or their nominated representative. The more able service users spoken to were aware of their care plans and confirmed that they had been consulted on them. Without exception, all of the service users’ relatives spoken to confirmed that they were invariably invited to the review of the care plans and that they were kept informed of any proposed changes to the care plans. The manager, the service user concerned and their next of kin, the Key Worker and the nominated representative of the service user’s placing authority attended the six monthly or annual review of the care plan. The care plans were in the process of being revised and updated by the deputy manager. At the front of each care plan was a ‘health diagnosis’ for the respective service user so that staff could readily refer to it when, for example, speaking with health care professionals on the telephone. The care records contained information relating to visits by the heath care professionals. From these records it was evident that the service users had good access to healthcare support. A visiting Community Nurse commented, “I am now quite happy with the place and the way that things are being done. They (staff) listen to me and follow my instructions. A member of staff is always present when I’m attending to a patient. They feel confident to refer patients directly to me. The storage of my notes has been sorted out. I think that that it’s (Rosegarth) improved and that care is quite good”. The Community Nurse also confirmed that the staff were pro-active in minimising the possibility of service users developing pressure sores. A service user confirmed that they had recently had a hearing test and was waiting to be fitted with a hearing aid. The relatives of service users were complimentary with regard to the support provided by the staff in monitoring the service users’ healthcare needs. The home does not have a dedicated space or room for use by health care and supporting services. Consequently a service user’s bedroom is used, with their agreement, for chiropody and hairdressing. This obviously impacts upon the service user’s privacy and raises a question of hygiene. Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 13 The process of storing, recording and administering the service users’ medication remained unchanged. The home continued to use a Monitored Dosage System (MDS) for the bulk of the medication. One-off and non-MDS medication was administered directly from the original containers. The medication administration records (MAR) were complete and up to date. According to the staff the MAR sheets were completed at the point of administration. Only nominated and trained staff had responsibility for the administration of medication. Following the comments made during the previous inspection visit regarding a medication recording error, the deputy manager had been delegated the task of overseeing and auditing the medication process. This helped ensure that the possibility of error was minimised and that any made were quickly identified and acted upon. The records confirmed that the medicines were audited weekly. A refrigerator was available in the medication storage room for the storage of special medicines such as eye drops. Separate secure facilities were available for the storage of Controlled Drugs with a dedicated register being signed by two staff involved in the administration process. The in-use medication was administered from a lockable drugs trolley. The deputy manager confirmed that anchorage points for the trolley are to be fitted in specific areas around the home. From a description of the medication administration process provided by the deputy manager, it was evident that it was efficient and safe. The service users had lockable facilities in their rooms in which they could store medication but at the time of the inspection visit none of the service users were assessed as capable of safely self-administering their medication. It was evident from discussions with the service users and their relatives that emphasis had been placed on the promotion of the service users’ dignity and privacy. Their privacy and dignity of the service users was promoted by the majority occupying single bedrooms and having en suite facilities The shared rooms had privacy screening available and had adjacent toilets. It was observed that the staff spoke to the service users in a mature and appropriate manner and provided assistance in a sensitive and patient way. A service user had unfortunately died the day before the inspection visit. It was evident from the way that the family of this service user were met and spoken to by the manager and the staff that emphasis was placed on the providing good levels of support in these circumstances. The manager confirmed that a representative of the home would always attend a service user’s funeral as a token of respect. Whilst all of the service users spoken to expressed satisfaction with the standard of care provided, one commented, “ The staff are fine but they don’t have much time to spend with you. They’ll say, I’ll be with you in five minutes but it’s normally half an hour” and another said, “Sometimes I get bored but the staff do their best”. (See staffing). Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 14 Two service users had made such progress since being admitted into Rosegarth that they were able to return home. The relative of one of these service users commented, “They’re (staff) excellent. I’m pleasantly surprised. I’m sorry in some ways that she (service user) is going to leave” (going home). Comments from other relatives and visitors to the home included, “We’ve seen considerable improvement. We’re delighted. We were really concerned when she (service user) came in, as we didn’t think she would make it. The staff can’t be faulted”, “Mum’s Key Worker is fabulous. She really cares. If there was such a thing as a commendation for staff then I would give it to her” and “My team thinks that Rosegarth is a good placement. It always provides a good impression”. Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 A good cross-section of social activities is provided for the service users but to an extent their implementation is dependent upon the availability of staff and the involvement of the service users’ relatives. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In general the service users expressed their satisfaction with their quality of life at Rosegarth although, as previously mentioned in this report, some service users said that they were bored at times. It was evident that a range of social activities were in place that took into account the service users’ needs and wishes. The planned activities were clearly displayed on a notice board. The majority of these activities were undertaken on a group basis such as trips out. The service users spoken to valued these activities and said that they particularly enjoyed input from external musical entertainers. Several of the service users’ relatives said that Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 16 they were directly involved with the programme of social activities. One stated, “ There’s lots of activities and trips organised”. The manager provided evidence that she was in the process of expanding and developing the programme of social activities. The existing staff were expected to run and/or participate in these activities. Whilst the staff expressed no objections to this one stated, “ There’s no problem in doing the activities providing we’ve got time”. From discussions with, and observation of, the care staff it was evident that they were kept busy in providing basic physical care for the service users. A service user said that staff could not always respond immediately to requests for assistance, as they were always busy. A social worker said, “ They could do with another staff member or entertainments officer to provide social activities”. The service users’ key workers were expected to spend a minimum of two hours each week with the service users allocated to them. This could, however, be integral with the provision of physical care such as bathing. It was evident that in addition to organised trips out, some of the service users were also taken out by their relatives. In some cases this was not possible as the service users concerned did not have any relatives living close by. The manager had acknowledged this and consequently endeavoured to bring the community to the service users through the use of external entertainers and representatives of local churches. Whilst the service users looked relaxed and expressed satisfaction with their environment, there was some controversy around their times for getting up in the morning and retiring in the evening. It was evident from discussions with the staff and service users that all of the service users, except two, were ‘assisted’ to get up by the night staff in the morning. The process for helping people to get up generally started from 6 a.m. and was completed by 7.30 a.m. According to the manager this was because the service users were awake and wanted to get up. One service user indicated, however, that they were ‘encouraged’ to get up by the night staff even if they didn’t want to. A member of staff also intimated that the night staff got the service users up in order to lessen the workload for the day staff. At the other end of the day the service users were getting ready for bed from 6 p.m. and retiring to their rooms shortly after that. The outcome appeared to be that the service users’ day had been ‘skewed’ to an early morning and early evening routine. On the positive side, the service users confirmed that the night staff were attentive and helpful and would promptly respond to calls for assistance. During the inspection visit a steady stream of visitors, mainly relatives of service users, visited the home. It was observed that they were received in a friendly and welcoming manner by the staff. This was confirmed by those visitors spoken to who, without exception, said that they could visit the home at any time and were always made to feel welcome. It was noted that visitors were offered refreshment and could have it with the service user concerned. Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 17 Two relatives of service users said that they could have a meal in the home if they wished and one said that they had come for their Christmas lunch. The manager and the deputy manager had, with the agreement of the service user concerned or their representative, some responsibility for safeguarding the service users’ personal money. Full records were maintained of this including the retention of receipts of transactions. The Manager and the Area Manager had regularly audited these records. The records indicated that the service users had signed following the receipt of money or any transaction made on their behalf. The home employed a dedicated cook. She had considerable catering experience and demonstrated a sound understanding of the dietary needs of older people. The menus indicated that the meals were reasonably varied and endeavoured to take into account the preferences of the service users. They also provided a genuine choice. The minutes of the service users’ meetings indicated that the meals were a regular agenda item. Without exception the service users commended the quality of the meals and expressed their satisfaction with them. They said that they particularly enjoyed the home baking. Special diets were provided for those service users who were diabetic. Emphasis was placed on the use of fresh meat and vegetables. The cook had ready access to information on each service user relating to their dietary needs. It was apparent that the cook liaised closely with the care staff in order to monitor the service users’ food intake and nutritional needs. Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The network of internal and external support provided for the service users should ensure that any concern would be quickly identified and acted upon. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An appropriate complaints procedure was in place and was included in the Service Users’ Guide, which was available in each of the bedrooms. The more able service users said that they could talk to their Key Worker about any problems. The relatives of the service users felt confident that they could raise any concerns or problems with the Manager or her deputy. The home had received several complaints from the relatives of a service user. According to these relatives these had been investigated and they felt that they had now established a positive and open relationship with the manager and were able to discuss issues without necessarily resorting to the use of the formal complaints procedure. These relatives felt that they should be more involved in the home for example by being invited to attend service users’ meetings. They also felt that the home should be more open regarding the service users’ fund. Both of these issues were discussed with the Manager. All of the service users had been referred to the home by the local authority and consequently had been allocated a representative of the local social Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 19 services to monitor their welfare. The representatives spoken to expressed satisfaction with the service provided by the home and felt confident that they could openly discuss any issues with the management team. Complaints received by the home were fully recorded. The records also contained evidence of the action taken following a complaint and the subsequent outcome. All complaints had been referred to Hexon the parent company of Rosegarth. During the past year the home had been the subject of an Adult Protection investigation by social services. Whilst the allegation was not substantiated, the process was well handled by the Deputy Manager in an open and positive manner. The majority of the staff had received training on Adult Protection and the Safeguarding process. The Local Authority protocol was available for reference. The staff demonstrated a sound understanding of the types and indications of abuse and of the actions they should take should they receive allegations of abuse. Posters were displayed in the home to inform visitors on how to identify and report abuse. Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25 and 26 Whilst in general the environment provides the service users with homely, comfortable and suitable accommodation, the lack of a dedicated room for use by the hairdresser and chiropodist undermines the privacy, dignity and hygiene of a service user. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No major changes had been made to the property since the previous inspection visit. In general it continued to be well maintained, decorated and furnished to a good standard. By having several lounges the service users had a choice of where, and with whom, they wished to spend their time. Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 21 The majority of the service users’ bedrooms were inspected. They were furnished to a good standard and had been personalised by the occupant. In several instances the bedrooms were more like a bed-sit and did not present as being in a care home. Having en suite toilets were seen as being very important by the service users although several also had a commode available. These were of a modern design and were not particularly obvious to the visitor. The agreement of the service users or their representatives had been obtained when it had been deemed necessary for them to share a room thereby making a positive choice. Privacy screening was available in these rooms. All of the service users had lockable facilities in their rooms. Whilst the bedroom doors had locks none of the service users used them. It was noted that some of the bed-bases were stained and required changing. All of the bedrooms had been individually risk assessed. As previously stated in this report, the home did not have a dedicated room for use by the chiropodist or hairdresser and a service user’s room on the ground floor was used for these activities. This raised a question of privacy and hygiene for the occupant of this room. It was noted that some of the stair carpets were starting to show signs of wear and could consequently become tripping hazards in the future if not addressed. A passenger lift provided access to the first floor. The two bedrooms on the top floor were accessed via a short flight of stairs and consequently the service users occupying these rooms had to be fully ambulant. A service user occupying one of these rooms said that he liked living there as he saw it as his ‘flat’. The natural and artificial lighting was appropriate throughout the property. The home was warm and very clean. The service users and their families confirmed that this standard of cleanliness was the norm. The domestics confirmed that the rooms were cleaned and dusted daily. Even though a considerable number of the service users were incontinent, there was no physical evidence of this in the way of smells. Emphasis had been placed on good standards of infection control including staff training on the subject. The home had a pleasant and secluded rear garden that had suitable seating for use by the service users. One service user had been encouraged and assisted to help maintain the garden. The main entrance to the property had a ramp available for use by service users who had mobility problems. Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 22 From the inspection of the premises and an examination of the records it was apparent that the premises met the specific requirements of the Fire and Environmental Health Departments. Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 29 and 30 The level of day staffing and the availability of staff dictates the standard of care provided for the service users and the current staffing level could limit the amount of social and emotional care that can be provided. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No changes had been made to the level of staffing since the previous inspection. In general there were three care staff on duty during the day plus a manager and catering and domestic staff. It was evident that the level of staffing was adequate to meet the physical needs of the service users. As previously identified in this report, however, doubts existed as to the capacity of the staff to fully meet the service users social and emotional needs. To an extent the problem had been overcome by encouraging the relatives of the service users to become involved in the programme of social activities. Whilst the Manager was keen to expand the programme of activities and provide an increased level of one-to-one care, it was evident that this would totally depend on the availability of the staff. One service user indicated that staff were so busy during the day that they could not always promptly respond to requests for assistance. Without exception the service users and visitors to the home commended the attitude and support provided by the staff but also Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 24 acknowledged that the staff were ‘stretched’ at times. In the circumstances where there was staff sickness the manager had to rely on coverage by existing staff or the deputy manager. It was not, according to the manager, company policy to use agency staff. The company had employed, however, a ‘floating’ member of night staff who could be used by any of the organisation’s four homes to provide additional night coverage. A Social Services’ Care Manager commented, “They could do with another member of staff or an Entertainments Officer to provide social activities”. The staff had all been provided with an opportunity to participate in range of training courses. These included statutory and professional subjects. These were reflected in the staff records. Some of the staff, primarily due their age and previous experience, were, according to the manager, reluctant to participate in formal training courses. To overcome this problem the deputy manager was intending to introduce in-house training tailored to the needs of these staff. The manager or deputy manager would provide this training. Over 50 of the staff had either achieved, or were in the process of achieving, a National Vocational Qualification at level 2 or above. Overall the staff team represented a good balance in terms of age and experience. The staff had established a good relationship with the service users and visitors to the home. There were a number of complimentary comments made relating to staff including, “The staff and manager are very accommodating”, “The staff are brilliant”, “They’re good staff here”, “The staff can’t be faulted” and “The staff are very good”. A recent allegation of an inappropriate attitude being shown by a member of staff had been resolved. An appropriate staff recruitment and selection procedure was in place. This involved prospective staff submitting a formal application, undergoing an interview, providing a minimum of two references and being appropriately vetted. From the staff records it was evident that all staff, except two, had been provided with checks by the Criminal Record Bureau (CRB) which included a POVA check. The CRB for one member of staff who had been employed in the home for a considerable length of time had been lost and consequently a further check had been applied for. One of the night staff had undergone a POVA First check and was still waiting for the result of their CRB check. According to the deputy manager this member of staff was employed as a ‘third person’ on nights and was subject to supervision. The staff confirmed that they received regular supervision from the management team. Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 39 The staff are well supported by the management team that consequently enables the staff to provide a good standard of care for the service users. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is well qualified and has considerable experience of providing care for older people. She came into post last November when the registered manager at that time decided to stand down and continue their employment in the home as a Senior Carer. The current manager underwent a trial period of three months, which is the policy of the parent company. She has yet, Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 26 however, to become registered with the Commission for Social Care Inspection (CSCI). The manager stated that there had been some delay involved in obtaining a medical clearance from her General Practitioner, which consequently delayed the submission of the registration application forms. This has now been resolved and subsequent to the inspection visit the manager has provided verbal confirmation that the application forms have been sent to the CSCI. It was evident from discussions with health and social care professionals and visitors to the home that following a rather difficult period at the start of her employment, the manager had made considerable improvement to the service. She had particularly concentrated on developing the programme of activities to meet the service users social care needs. Feedback from the service users and their relatives confirmed that this had been relatively successful. As previously mentioned in this report, however, the long-term success of this will be dependent upon the availability of staff to undertake and oversee the activities. She had also made improvements to infection control within the home by having anti-bacterial dispensers fitted for use by the staff. A significant improvement made since the previous inspection was the employment of an experienced deputy manager. This action, and the subsequently delegation of tasks to the deputy manager, had enabled the manager to spend more time on her specific management role. It was apparent from discussions with the manager and her deputy that they complemented each other and had developed into a cohesive and supportive management team. The deputy manager had also made considerable changes that included the revision of the care plans, greater involvement of the key workers and a review of the medication procedures. The deputy manager also worked some evenings, nights and weekends on the basis that this was the best way of evaluating the service during these periods. With exception of the petty cash, the manager did not have responsibility for any budgets but had to apply to her head office for purchases and the cost of staff training. She also did not have access to the Internet or e-mail facilities thereby limiting her access to the latest information on the care of the elderly and restricting her lines of communication. It was evident from the comments made by the service users and their relatives that the manager and her deputy had established a good relationship with them. Comments included, “ (manager) is a lovely lady – she’ll do anything for you – she’s always kind”, “(manager) and her staff have worked wonders. They are very caring”, “ (manager) is fantastic. She will do anything. I can’t fault her. I’m confident that I can talk to her” and “ (deputy manager) is very approachable. She’s got an excellent rapport with clients and staff”. Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 27 The home had a sound Quality Assurance monitoring process. This included regular audits of all parts of the service by the manager or the area manager. The relatives of service users confirmed that they had been asked to complete questionnaires as to their satisfaction and opinion of the service. The manager demonstrated a sound understanding of the purpose of quality assurance and the need for continuous monitoring of the service provided by the home. As previously indicated in the report appropriate arrangements were in place to safeguard service users’ personal spending money including the recording of all transactions made on a service user’s behalf. A number of statutory records including care plans, medication records, fire safety records, health and safety and accident records were inspected. They were all properly maintained and were up to date. The servicing certificates for the home’s electrical and gas systems indicated that they were safe for use. The electrical equipment, including that belonging to the service users, had been checked for safety. The passenger lift and other lifting equipment in the home had been regularly serviced. A record had been maintained of the temperature of the hot water that was accessible to the service users. It was apparent from the records and the inspection of the premises that all reasonable steps had been taken, including the training of staff and the implementation of formal risk assessments, to ensure a safe environment for the service users and the staff. Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 4 X 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 3 3 Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP10 Regulation 12(4)(a) Requirement A service user’s room must not be used for the purposes of providing chiropody and hairdressing for all of the service users as this negates the privacy of the occupant of that room. Such service should be provided in the privacy of the service users’ own rooms or ideally in a dedicated room set-aside for this purpose. The practice of service users getting up early in the morning and retiring early at night must be reviewed to ensure that it is based on the wishes of the service users and not on the needs of the staff. An audit of the service users’ beds must be undertaken to confirm that they are not stained and are fit for purpose. Those assessed as not being fit for purpose must be replaced. Plans must be made to replace the stair carpets that are showing signs of wear. The day staffing level must be DS0000055667.V336790.R01.S.doc Version 5.2 Page 30 Timescale for action 01/09/07 2 OP14 12(2)(3) 01/07/07 3 OP19 OP26 23 01/07/07 4 Rosegarth OP27 18(1) 5 OP31 8(1) reviewed to ensure that there are sufficient care staff available not only to meet the service users’ physical needs but also their social and emotional needs. The manager must apply for registration to the Commission for Social Care Inspection as a matter of urgency. 01/07/07 01/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The service users’ care plans should also include a profile/history of the respective service user to enable the staff to see them more as a person rather that a service user. Consideration should be given to providing the manager with devolved budgets so that she has more control over the day-to-day running of the home. It would be beneficial to the home and the manager if she had access to the Internet and E-mail facilities. 2 3 RCN RCN Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rosegarth DS0000055667.V336790.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!