CARE HOMES FOR OLDER PEOPLE
Rosegarth Rosegarth 30 - 32 Belgrave Drive Bridlington East Yorkshire YO15 3JR Lead Inspector
Mrs Rosalind Sanderson Key Unannounced Inspection 28th June 2006 09:30 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.V302049.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.V302049.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.V302049.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th June 2005 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 many of which have en suite facilities. There is a pleasant garden and conservatory where the more able 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. Individual copies are available on request. The charges made by the organisation for care and accommodation range from £323.00 to £368.00. This information was correct at 25/5/06 Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection process on this occasion included sending letters out to relatives and service users so that their comments about the service could be taken into account. 5 comment cards were sent out to relatives and 100 were returned. 60 of comment cards were returned from service users. Comments received will be included in this report. The inspector completed an ‘Inspection Record’ with information that had been supplied by the home. The record helped the inspector with the planning of the inspection. A visit to the home took place. This lasted for six hours and was carried out by one inspector. During the site visit 5 service users, 5 staff, 2 relatives and 2 members of the management team were spoken with. During the visit care practices were observed, where appropriate, and time was also spent watching the general activity within the home. This enabled the Inspector to gain an insight of what life is like at Rosegarth for the people that live there. Discussions took place with the Acting Manager around the details of the Registration Certificate. It was agreed that discussions would take place with the Area Manager around the numbers and categories of service users that the home is registered for. What the service does well:
Rosegarth provides a pleasant environment and atmosphere for residents to live. Some commented ‘ I love my room, it is full of all things important to me’ ‘My daughter is able to come and see me when she wants’ ‘I am able to go out to the hairdresser so can choose who does my hair’ ‘It’s free and easy here, the staff are very good’ ‘The best thing about living here is the friends you make and the company’ Activities provided at the home suit the individual and collective needs of residents. Comment from comment cards include, ‘I am unable to join in a lot of the activities as I am blind but I love the music afternoons that we have’ ‘I enjoy the occasional trips out but would always welcome more activities.’ Residents are encouraged to maintain any social activities that they undertook before coming to live here. Consideration is given to people of different religious beliefs when arrangements are made for visiting clergy. Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 6 Staff are friendly and always make visitors feel welcome. One visitor said, ‘The staff are excellent, five star! We are always made to feel welcome’ The food provided at the home offers a well-balanced nutritious diet that residents appreciate. The comments received include, ‘The meals are good’ and ‘ Meals are extremely adequate with a good variety offered’. The cook is knowledgeable about individual residents dietary requirements. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. 6 is not applicable Quality in this outcome area is adequate. People that need respite care are not always assured their needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Records of service users showed that for those who live at the home permanently their care needs had been looked at in detail and information from other sources such as hospitals and care managers had also been considered. This means that staff are fully aware of these needs before a person comes to live at Rosegarth. Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 9 However, the records of a service user admitted for a short stay to the home did not have these assessments in place. This meant that staff had not been aware of the care needs of this person. The statement of purpose does not reflect the recent management changes at the home. Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. Service users healthcare needs are not always met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans showed that they had been based on the initial assessment of people’s needs that had been carried out before admission. The records were complete and had all the necessary documentation in place to fully inform staff as to how people need looking after. A comment received from a service user was, ‘I like the staff, they are good but do not have much time’ Relatives commented, ‘the care at Rosegarth is very good’ and another said, ‘the staff are very efficient and my ………. is very highly cared for’. Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 11 However the relative of a person who had been admitted for a short stay had complained that his relative had not received the care that he had told the home they needed and had missed an appointment with a health care professional. Records showed that in some cases people who were admitted for short stays did not have records completed in as much detail as the longer term residents. Staff that deal with medications have undertaken training to ensure that this is done safely. At each shift there is a signed handover of the drug keys to ensure that only authorised staff hold the drug keys. The medication administration records were completed and there was a system in place for returning unused medication to the chemist The drugs that are known as ‘controlled drugs’ were looked at. In one case the records showed that there were five drugs left in the container but there should have been four according to the controlled drug register and medication administration record for that resident. This means that the drugs, which were for pain relief, have been signed for as given to the resident but they had not been given. Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14, and 15 Quality in this outcome area is good. Residents are provided with a well balanced diet and are able to enjoy their lifestyles and range of activities on offer at Rosegarth This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents spoken with were satisfied with the lives they lead at Rosegarth. Comments included, ‘ I love my room, it is full of all things important to me’ ‘My daughter is able to come and see me when she wants’ ‘I am able to go out to the hairdresser so can choose who does my hair’ ‘It’s free and easy here, the staff are very good’ ‘The best thing about living here is the friends you make and the company’ Comment cards returned contained comments such as, ‘I am unable to join in a lot of the activities but I love the music afternoons that we have’ ‘I enjoy the occasional trips out but would always welcome more activities.’ Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 13 One resident described how they are able to continue with their love of ‘bingo’ and visit the local bingo hall most nights. A taxi is arranged to collect them and bring them home. People’s religious beliefs are respected and arrangements have been made for Church of England ministers to visit to give Communion and also for Catholic priests to visit the home for those people that have the Catholic faith. People are able to see their visitors in private. A visitor said, ‘The staff are excellent, five star! We are always made to feel welcome’ Food provided at the home is good. People living at Rosegarth appreciate the variety of food provided. They said, ‘The meals are good’ and ‘ Meals are extremely adequate with a good variety offered’. The cook was knowledgeable about residents’ dietary needs and was able to describe special diets and how she would ‘enrich’ a diet for people whose appetites were poor. Recommendations from a recent Environmental Health Officer visit had been actioned. Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. Service users are protected through staff training and feel they are listened to. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users said they felt happy to approach the manager and confident she would address any concerns they had. One said, ‘If I had a complaint I would see the manager she comes to see me each day and I know she would sort things out for me’. The procedure is clearly displayed in the entrance hall and in the service users guide. A recent complaint received by the Commission for Social Care Inspection had been referred to ERYC for investigation. The manager was aware of the details of the complaint. All staff spoken with were clear about Protection of Vulnerable Adults recognition and reporting procedures. Most staff had received the training and the home had a copy of the Local Authority Multi Agency Policy to refer to. Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. Service users live in a safe, well-maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is warm and welcoming and there are no unpleasant odours. Since the last inspection additional bathing facilities have been provided that include a ‘wet room’ type shower. This will benefit those residents who find it difficult to get in the bath or who prefer to take a shower. Some communal areas have recently been decorated, and it is planned that further refurbishment will take place. The gardens are beautifully kept and residents enjoy sitting in the conservatory and enjoying the views. Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 16 Bedrooms seen were individualised, and contained personal belongings. Privacy curtains are supplied in shared rooms. Residents occupying shared rooms have chosen to do so. One said: ‘ is my best friend, we love sharing a room’ The laundry is now completed ‘on site’. The equipment is suitable for its purpose. Staff report that the laundry is now managed much better now it does not have to be done elsewhere. The home meets the fire safety requirements. Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. Recruitment procedures are not always robust and could place service users at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a programme of training in place to ensure that staff receive training to enable them to care for the residents efficiently and safely. Evidence was seen of induction training and some staff were due to attend an external course for induction in care. Staff confirmed that they feel they receive sufficient training to equip them for their role. Currently 12 of staff hold a qualification in care at NVQ level 2 or above. Staff records showed that in all cases two written references had been obtained along with a full employment history. Rotas show that there are sufficient staff on duty and staff spoken with felt that generally this was the case. Recent management changes at the home have resulted in a few staff changes. This appears to have been handled well. In two cases the staff members had started work without a full CRB or POVA 1st check in place. The manager had thought, incorrectly, that this would be acceptable if the staff worked under supervision. In addition to this the
Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 18 manager had not had her checks completed as she was applying to become registered with the Commission for Social Care Inspection. The Area Manager had thought, incorrectly, that these checks would be carried out as part of this process and she did not need to do them. In order that residents are protected and cared for by safe staff, these checks must always be in place before employment starts. An official letter was sent to the providers to ensure that this happens from now onwards and that those staff in post without these checks have them completed. Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is adequate. To ensure that the home is well managed the requirements made in this report must be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a new manager who has been in post since February 2006. She is currently applying to be registered with the Commission for Social Care Inspection. She has qualifications at NVQ level 3 and is currently undertaking her NVQ level 4 in care and shortly starting her Registered Manager’s Award. This will make her more fully aware of her role and responsibilities. Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 20 She has introduced a programme of activities and this continues to be developed and is appreciated by residents. The key worker system has been developed and staff now have responsibilities for individual residents and attends reviews of their care. The care plans have also been developed but it is only the manager that records in these. These would be more useful to staff if they all had input into them. There is a quality assurance system in place, again this is in the process of being developed in order that the management are more fully informed of how well the service is performing for the residents. The manager does not have a deputy in post and she is on call at all times apart from holidays. The previous manager left because of the pressure and responsibilities that the position brings. Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 21 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 OP7 OP37 OP38 Regulation 13,14,15, 17 Requirement The registered person must make arrangements to ensure that all residents admitted to the home for long or short stays have: • A full assessment of their needs carried out. • Care plans in place based on the needs assessment. • Reviews of the care plans and associated assessments to ensure that current needs are met. All staff must have access to these documents and contribute to the development of the care plans. The registered person must ensure that systems are in place to ensure residents receive prescribed medication and that this is recorded correctly. Timescale for action 19/07/06 2. OP9 OP37 OP38 12,13(2), 17 28/06/06 Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 23 3. OP29 12,18,19 The registered person must make sure that before any person is employed at the home the pre employment checks are in place including: • A CRB check for this employment. The registered person must ensure that for those employees identified at the inspection without a CRB check the following applies: • • A CRB is applied for. The members of staff work under supervision until this is received 28/06/06 4. OP29 12,18,19 05/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP1 OP28 OP31 OP33 Good Practice Recommendations The registered person should update the statement of purpose to include the recent management changes. The registered person must continue to encourage staff to undertake training to NVQ level 2 in care. The registered person should ensure that the acting manager undertakes a qualification in management and care to NVQ level 4. The registered person should further develop the quality assurance systems to make sure that all stakeholders views are sought and taken into account in the development of the service. Rosegarth DS0000055667.V302049.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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