Inspection on 07/08/09 for Rosegarth

This inspection was carried out on 7th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosegarth 06/08/08

Rosegarth 24/04/07

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 15/11/2009.

Key inspection report Care homes for older people Name: Address: Rosegarth Rosegarth 30 - 32 Belgrave Drive Bridlington East Yorkshire YO15 3JR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Beverly Hill     Date: 0 7 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Rosegarth Rosegarth 30 - 32 Belgrave Drive Bridlington East Yorkshire YO15 3JR 01262677972 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hexon Limited Name of registered manager (if applicable) Miss Kirsty Louise Sutton Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Rosegarth is situated close to the seafront in Bridlington and is registered to provide care and support to twenty-six older people, some of whom may have dementia care needs. The home comprises of four traditional houses that have been joined internally. It is close to shops and local facilities. The accommodation has a mixture of single and shared bedrooms, many of which have en-suite facilities. Communal areas consists of two lounges, a dining room and a small sitting room leading onto a small garden area. People wishing to smoke use the area just outside this sitting room. Care Homes for Older People Page 4 of 34 Over 65 26 26 0 0 Brief description of the care home There is a further garden leading from one of the other lounges. Street parking is available at the front and rear of the home. The homes Statement of Purpose and Service User Guide is available in the entrance hall of the home and in bedrooms. The weekly fees for care and accommodation range from 420.00 to 520.00 pounds. There are optional extras for items such as toiletries, chiropody and hairdressing. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that the people that use this service experience adequate quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key unannounced inspection on 6th August 2008 including information gathered during a site visit to the home, which took approximately nine hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Rosegarth. We also had discussions with the registered manager, staff members and several relatives. Information was also obtained from surveys received from residents (some completed with the assistance of relatives) and staff members. Comments from the surveys and discussions have been used in the report. Care Homes for Older People Page 6 of 34 We looked at assessments of need made before people were admitted to the home, and the homes care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. The providers had not returned their annual quality assurance assessment (AQAA). The manager told us they had difficulties in down-loading the assessment form electronically so had requested a hard copy to complete. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. We will look at the document when it does arrive and speak with management as required. We would like to thank the people that live in Rosegarth, the staff team and management for their hospitality during the visit, and also thank the people who completed surveys and had discussions with us. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The recording of medication needs care to ensure the medication administration record is correct and staff have clear guidance. Staff could try to establish if there are any specific activities or occupations people would like to participate in to broaden the activity plan already in place, especially for Care Homes for Older People Page 8 of 34 people with dementia. The provision of more designated activity coordinator hours would enhance the time available to residents. Menus could be expanded to offer more choice on a rolling programme of meals. Currently there is a one week rotating menu, which limits choices for people. Everyday niggles are addressed straight away but there has been an issue when a complaint was not addressed appropriately and investigated as a safgeuarding of adults issue. This means that it wasnt referred to the local authority as policies and procedures dictate. All levels of management need to use safeguarding policies and procedures to help protect people. The environment is generally homely and pleasant but one of the bathrooms is quite jaded and in need of redecoration. This could be added to the refurbishment plan. There should also be a system of checking that any bed rails in use continue to be safe and secure. There were very good comments about the care received by the staff team, however the number of care staffing hours was less that it should be for the numbers of residents and their dependency needs. This could mean that care could be missed or people may have to wait longer than necessary or it may mean that there is insufficent staff available to cover unforeseen shortfalls. As mentioned in the improvements section above, staff training in specific areas could be improved to ensure staff have knowledge and skills in the mental health problems affecting residents and in the conditions affecting older people. More staff could complete dementia care training but it is recognised that five staff have completed an awareness course and others that had completed the course have since left. During audits or evaluating surveys, if shortfalls have been highlighted, an action plan would focus attention in addressing them and evidence that they have been resolved. Staff said they were well supported and received formal supervision. This needs to be expanded now to ensure that care staff receive a minimum of six supervision sessions a year. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had their needs assessed prior to admission to the home. This helped in the decision-making process as to whether the home was able to meet peoples needs. Evidence: We looked at three care files during the visit, one of which was for a person recently admitted to the home as an emergency for respite care. It was clear that the manager had gathered information during an initial discussion with the local authority and had quickly obtained the assessment and care plan produced by care management staff. This enabled the manager to determine whether the persons needs could be met in the home. The manager completed pre-admission assessments in a more planned way for people not admitted in emergencies. These entailed visits to the persons home or hospital and discussions with them and their relatives. The in-house assessment documentation used, needs to include more detailed information about mobility and Care Homes for Older People Page 11 of 34 Evidence: psychological needs. There is a separate health section and the manager confirmed that this could be used to discuss any issues affecting peoples physical or psychological health. The manager should write to potential residents or their representatives following the assessment letting them know the home is able to meet their needs. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had their health and personal care needs planned for and met in ways that promoted privacy, dignity and independence. Although people received their medication as prescribed some recording shortfalls could lead to mistakes being made. Evidence: The three care files examined contained a wealth of information on which to formulate plans of care. This included assessments and care plans from the local authority, the homes own pre-admission assessments, risk analysis, personal profiles and a, getting to know you document, which listed likes and dislikes, family involvement etc. Staff had completed full care plans that referred to the assessment information, contained likes and dislikes and informed staff what the person could do for themselves. This helped to remind staff to maintain peoples independence. The care files were well organised and information was easy to find. There was evidence that care plans were evaluated monthly and reviews took place with the local Care Homes for Older People Page 13 of 34 Evidence: authority on an annual basis for people funded by care management. To improve staff could ensure that residents signed their care plans to evidence that they had seen them and agreed to the contents. Staff documented the care provided during the day and night and key workers completed notes of additional one to one conversations and tasks they completed for and with people. To improve the key worker notes could specify the amount of time spent in one to one support. The manager confirmed key workers aimed to spend two hours a week of this additional interaction. Risk assessments were completed for a range of issues such as moving and handling, use of the bath hoist, falls, pressure areas, continence, nutrition, and if vulnerable people had a tendency to leave the building unescorted. The risk assessments were kept under review and updated as needs changed. People had access to a range of health care professionals and there was evidence that health and personal care needs were met. People spoken with and surveys received from them confirmed this. All six surveys from residents stated they received the care and support, and medical attention they required either, always or usually. Comments were, the standards are very good, the care is good, care and consideration is always there, the staff are very good at caring and I saw the optician recently but I would like to see a dentist. This was mentioned to the manager who was aware and had contacted a health professional involved in supporting the person. There were some recording issues to address but generally the home managed medication in an appropriate way. It was stored and stock controlled well and there was evidence that the manager routinely audited the medication administration record (MAR) charts to ensure staff were completing them thoroughly. Medication was delivered to the home in a monitored dosage system from a local pharmacy and they completed annual checks, provided basic training and gave advice when required. Some recording areas to improve were: On occasions there was some medication prescribed and delivered mid-cycle and staff were not consistently recording its entry into the home. They also need to carry forward to the next MAR any remaining medication. This will enable a clearer audit of medication in the home. There were times were staff were hand writing information onto the MAR but full Care Homes for Older People Page 14 of 34 Evidence: instructions were not always recorded. Two staff signatures are required for transcribing to avoid mistakes. There were times when the dosage of medication on the MAR had been crossed out and changed and the manager confirmed this was either after discussion with the prescriber or through the residents choice. Changes in doses needs to be double-signed. One resident was prescribed peptac medication, as directed with no dose or times indicated. There needs to be clear instructions for staff on the MAR. There was also one resident receiving specific eye drop medication that had been prescribed orally. We checked this out with the Commissions pharmacist inspector who advised that this mode of administration was unlicensed. The manager contacted the prescriber and they changed the prescription. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally the home provides a good quality of live for residents. However, this could be improved further for some residents by enhancing the everyday choices they are able to make. This includes providing more opportunities for social stimulation, especially for people with dementia, and a greater range of meals. Evidence: The company employed an activity coordinator for the residential homes in the group and three hours a week were allotted for Rosegarth. The manager advised that during the week on the days the activity coordinator did not visit the home, she spent two hours in the afternoons working on the floor to free up staff to complete activities with people. A weekly plan was devised and on display. There were no activities on Mondays as the hairdresser visited the home and Fridays was dedicated to hand and nail care. Activities included bingo, quizzes, dominoes and cards, one to one chats, story telling and walks to the sea front. Tuesdays were the, activity afternoons with the coordinator but this could be changed if necessary. There was evidence of other events such as watching tennis, a clothes party, sitting out in the garden and a theatre production at Christmas. In surveys, two people told us the home provided activities they could participate in, Care Homes for Older People Page 16 of 34 Evidence: always, three said this was, usually and one person said, sometimes. When asked what the home could do better, one resident stated, entertainment. This was also echoed in surveys from staff. In discussions people said, we used to have someone play the organ but he doesnt come now, I like knitting and handicrafts, there is nothing to do - I would like to do handicrafts and I would like to have trips out to the moors. The discussions with people and examination of records indicated that the home has not got it quite right for everyone and people with dementia required more stimulation to ensure their needs were fully met. Three hours a week is a small portion of time allotted for twenty-six residents and although existing staff try to provide more stimulation this can be disjointed when they are called away to assist people. Some residents have continued to access community facilities. One or two residents regularly go to the local shops on their own, another pays privately to attend a local day centre and three residents have remained a part of local church and community groups. Local clergy visit the home for spiritual support. The manager advised that health and social care professionals continued to have involvement with some residents and were looking into gardening groups and supported holidays. One resident was on a waiting list for a placement at a swimming group. Some residents told us they could make some choices about aspects of their lives such as rising and retiring, where to sit in the home, when to go out and what meals to have. However, for some people choices were limited, as there were few activities especially, for people with dementia, and there was a limited menu. Visitors to the home were welcomed at any time and people spoken with told us they were always made to feel welcome and were offered refreshments. Relatives were very happy with the care provided to their family members and there were some very positive comments, friendly staff and we are greeted well, we can visit anytime and we are always offered coffee, if ever I need to go into a home I would come here and the staff are extremely caring and I am always made very welcome. The home had a weekly menu, and although people spoken with generally liked the meals, the choice was limited. It was suggested the manager seek advice from the local dietician to broaden the menu. Comments from residents about the meals were, quality food but something different would be appreciated, the food is very nice, there are two choices at lunchtime, I would like something different at times - Kirsty brought in ice cream and that was very nice, the food is excellent and I like toasted cheese but they cant do it - theres no electric grill. This was mentioned to the manager to try and resolve, as it was a small request. Out of the six surveys we Care Homes for Older People Page 17 of 34 Evidence: received from residents, four people stated they liked the meals, always and two people said this was, usually. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite managers being fully aware of safeguarding of adults policies and procedures, these were not used appropriately. Not using the multi-agency policies and procedures means that the right people did not complete an investigation at the time and this could place residents welfare at risk. Evidence: The home had a complaints policy and procedure that was on display and staff members spoken with were aware of what to do if people expressed any concerns to them. We received six surveys from residents and five stated they knew how to make a complaint and who to speak to if they were unhappy about anything. One relative told us, Kirsty (manager) sorts out little niggles. The manager maintained a log of any complaints and there were two recorded in the file since the last inspection. One had been dealt with appropriately but the other complaint was an issue that should have been dealt with under the homes safeguarding of adults policy and procedure. Senior managers had investigated the complaint instead of referring it to the local authority, which is the lead agency in investigating any allegations of abuse. Not using the correct procedures meant that the incident was not investigated appropriately. The proprietor had dismissed the staff member involved following a disciplinary investigation. The manager was advised to submit a retrospective referral to the local authority, on the day of the site visit, and will forward the staff members name to the manager of the protection of vulnerable Care Homes for Older People Page 19 of 34 Evidence: adults (pova) register for possible inclusion. Prompt referral of any allegation of abuse means that the correct authority can give advice and investigate the issues quickly. The area manager has completed, train the trainer safeguarding of adults from abuse training with the local authority and has facilitated this training to staff in the home. The registered manager has completed more in depth safeguarding training, specifically for managers and regarding their role in referral and investigation, with the local authority. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were provided with a warm, clean and homely environment. Evidence: The home consisted of four houses on the corner of a junction, which were joined back to back, which meant that two were in Belgrave Road and two in Horsforth Road. The main entrance was in Belgrave Road. The home was clean and tidy and free from any malodours. Communal rooms consisted of a large dining room and two lounges, one of which had doors leading onto an enclosed garden. There was also a small tiled sitting room with a door leading to another garden space at the side of the one of the houses. This was used for people wishing to smoke. The rooms were decorated in a homely way. Some of the carpets were a little worn and the manager confirmed they were due to be replaced by the end of the year. The home had a selection of single and shared bedrooms, some had en-suite facilities including a shower. Shared bedrooms had divider screens to aid privacy. Bedrooms were personalised to varying degrees dependent on the choice and taste of the residents. The home had sufficient bathing and toilet facilities. One of the assisted bathrooms, which had a hand operated hoist, looked jaded and was in need of redecoration. It was also used as an overflow for the laundry. Care Homes for Older People Page 21 of 34 Evidence: People spoken with were happy with the cleanliness of their bedrooms and home in general, its a very clean home, Im very happy with my bedroom, its a comfortable home - my bedroom is clean and tidy, its a very nice home here, it always smells nice, the cleanliness is good, her room is kept to a good standard and its always clean and tidy. All six surveys received from residents stated the home was clean and fresh either, always or usually. Staff also said that they tried to keep the environment clean and homely for people. One resident did tell us that their clothes were not always put away neatly in their wardrobe leading to them looking creased when worn. We checked a selection of wardrobes during the day and clothes were generally put away in a neat fashion but staff need to be vigilant and ensure standards are maintained. The manager confirmed that the home had an ongoing redecoration plan and the environment was checked frequently to enable any minor issues to be resolved quickly. The laundry was small and overflowed into the downstairs bathroom with laundered clothes stored in baskets on shelves prior to being taken back to bedrooms. Staff, however said it was sufficient for their needs. Care Homes for Older People Page 22 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were insufficient numbers of staff to care for the range of needs of people living in the home. This may mean that residents may have to wait for attention or some aspects of care like social stimulation could be limited. Some gaps in specific training means that not all staff have the skills required to meet the range of needs of the people living there. Evidence: Discussion with the staff team and examination of staff rotas indicated that there were three care staff on duty during the day and two at night. The manager was supernumerary but did work, on the floor on some afternoons and was available to help care staff out during unforeseen shortages. The home had sufficient catering, domestic and maintenance staff. The amount of care hours provided was 420 per week. We calculated home needed to provide 460.82 hours per week based on the dependency levels of twenty-four residents. The manager told us six people had high needs, twelve had medium needs and six had low needs . An increase in the numbers of residents or an alteration of dependency levels would affect the care staffing hours. Despite the shortfall in care staffing hours or because of the managers organisational skills and willingness to work, on the floor, and the very low level needs of some residents, people did not mention they felt rushed during care tasks. Care Homes for Older People Page 23 of 34 Evidence: Residents described the staff team as, very good, caring, most are all right, wonderful staff - its an excellent home and the care is good. In surveys, when asked if staff were available when needed, one person said this was, always and five stated, usually. Relatives said, care and consideration is always there, staff are extremely caring, they are very approachable, carers are wonderful to mum and staff in general are terrific. The home generally had a sound recruitment process which included obtaining references and thorough checks prior to commencing employment. We noted that one person started working on nights after a preliminary check against the protection of vulnerable adults register but prior to the return of the full criminal record bureau check (CRB). This must only occur in exceptional circumstances, which should be recorded, and the staff member must be subject to stringent supervision arrangements. We accepted the managers assurances that the staff member worked initially on days and then as an extra staff member on nights until the CRB was returned. The company had access to an area manager that had completed, train the trainer courses in safeguarding adults from abuse and moving and handling. These were cascaded to staff in the company. According to information provided by the manager, all but very new staff had completed a basic one day first aid course, moving and handling, basic food hygiene, infection control and fire safety. Six senior carers had completed a course in safe handing of medicines and catering staff had completed more advanced food hygiene. Most staff had completed awareness training in mental capacity legislation and some had completed sessions in continence products. Five staff had completed a distance learning course in dementia awareness. There was evidence that a specific topic related to a residents health needs was discussed in supervision, for example multiple sclerosis. However, the staff team did not have access to any training in how to support people with mental health needs and because of staff turnover, only a third of care staff had completed any dementia awareness training. 53 percent of care staff had, however, completed a national vocational qualification (NVQ)in care at level 2 or 3 with a further three staff progressing through level 2. A staff member with level 2 was also progressing to level 3. This percentage of staff in possession of an NVQ was a very good achievement and exceeds the requirement of standard 28 for 50 percent of care staff to be trained to this level. Induction for new staff consisted of an orientation to the homes way of working and Care Homes for Older People Page 24 of 34 Evidence: the allocation of a mentor to guide their practice and support them during the first few months. They also had discussions with the manager about skills for care, common induction standards. However, new staff should work through the skills for care evidence workbooks which allows their competence to be assessed and checked by the manager prior to completion. Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a caring manager, who does focus on residents needs, however, there are shortfalls in staffing hours, staff supervision, specific training and adherance to policies and procedures. This could mean that not all residents needs will be fully met. Evidence: The registered manager has worked a total of sixteen and a half years in care, the last two years as manager of Rosecroft. She has completed the Registered Managers Award and her fitness to be the manager was assessed when she completed registration with the Commission in May 2009. In discussion it was clear that she kept herself up to date with relevant training and had the needs of residents at the focus of her management style. Senior managers visited the home to comply with regulation 26, which states a responsible individual must visit the home and satisfy themselves that the home is managed appropriately. There was evidence they spoke to residents and staff, toured Care Homes for Older People Page 26 of 34 Evidence: the building and examined documentation. Senior managers provided a support network for the manager and staff. Since the last inspection there had been an occasion when senior management advice about safeguarding (as discussed earlier in the report) had conflicted with the managers training, and knowledge of policies and procedures. We are assured that the manager is now aware of her full role and responsibilities regarding safeguarding issues. Residents spoken with knew the managers name, which told us she got out and about the home rather than being office-based. Residents, relatives and staff all had very nice things to say about the manager, Kirsty would sort things out for us, the home is well managed by Kirsty, excellent staff support, the manager is always there for residents and staff, its a very well run home, since Kirsty has taken over there is much improvement, she really cares about people - you cant fault Kirsty, she is firm but fair and she is strict with staff and runs a tight ship. Staff told us that the atmosphere was very friendly, that morale was high and they enjoyed their jobs, its a good place to work - you feel like getting up in the morning and going to work. Staff told us they were well supported by the manager on a day to day basis and there was evidence that some formal supervision took place. However, care staff did not receive the required six supervision sessions per year. The home has a quality assurance system that includes audits of systems and questionnaires to residents, relatives, staff and professional visitors. The manager advised that any issues were brought up in meetings with staff and residents. The manager could produce action plans when information is collated from audits and questionnaires. This will focus attention on any shortfalls and plan how they are going to be addressed. The management of residents finances was not assessed thoroughly at this site visit but the process was discussed the manager. They advised that family members mainly managed finances but a small amount of personal allowance was held by the home for safekeeping. Individual records were maintained and receipts obtained for any purchases made by staff on behalf of residents. Money was securely held with restricted access. The home also had a residents fund made up of donations and activities that have raised money. This was maintained by the manager and overseen by the companys accounts officer. Equipment in the home was serviced and any repairs carried out quickly. Since the last inspection window restrictors have been fitted to upstairs windows. Fire alarm tests were carried out and staff completed fire drills, and participated in a range of Care Homes for Older People Page 27 of 34 Evidence: mandatory training, to ensure they could support people safely. Some residents required bed rails to prevent them from rolling out of bed and injuring themselves. Risk assessments for the use of bed rails had been completed. We checked the bed rails in use during the visit and found that two were unstable due to the use of lightweight mattresses on top of them. The manager addressed this problem within fortyeight hours but staff should be more proactive in checking health and safety issues in the home and bringing them to the managers attention. Generally the manager made sure that the Commission was kept informed of any incidents that affected the wellbeing of residents. There had been one occasion since the last inspection when we did not receive a notification. We discussed this with the manager on the day. Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 16 People with dementia must be provided with more opportunities for social stimulation. This will help to prevent boredom, slow down the deterioration in cognitive abilities and enhance the quality of their lives. 30/09/2009 2 16 13 When complaints are 31/08/2009 received there must be a system of analysing whether the issue constitutes an allegation of abuse. This will enable staff to recognise what is a complaint that can be dealt with internally and what needs to be referred to another agency. 3 18 13 The multi-agency policies and procedures must be initiated when there are any allegations of abuse or poor practice. 31/08/2009 Care Homes for Older People Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that residents welfare and safety are protected and the right people complete investigations into allegations of abuse. 4 27 18 Staffing hours must be 18/09/2009 adjusted to ensure there are sufficient numbers of care staff available to support the people living in the home. This will ensure that the minimum amount of care staff are available to care for people and that all their care needs will be met. 5 30 18 The staff team must receive 31/12/2009 training in how to support people with specific needs associated with dementia and mental health problems. This will ensure staff have the skills and knowledge about a range of health needs and ensure care is not missed. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 People should receive written confirmation that, having regard to the pre-admission assessment, their needs can Care Homes for Older People Page 31 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations be met in the home. 2 3 The in-house pre-admission assessment documentation should be expanded to include full mobility and psychological needs. This will help to prompt the assessor to examine the full range of needs. Residents should be encouraged to sign their care plans to evidence they have read them and agreed the contents. When hand writing medication onto the MAR the full manufacturers instructions should be written and signed by two staff. This will help to avoid mistakes. All medication should be recorded into the home on receipt and amounts carried forward onto the current MAR for medication delivered mid-cycle so not in a moniitored dosage system. Staff should have clear instruction for medications prescribed, as directed. This will ensure the prescribers instructions are carried out and avoid mistakes. A monthly at a glance log of who has participated in activites will enable staff to see who has not joined in. This will enable examination of whether activities need to be tailored further to meet the needs of all people living in the home. Increasing the choice of stimulation and meal provision should be considered to enhance peoples well being and quality of life. Advice should be sought from the dietician about broadening the menu. This will enable people to have a more extended range of meals and hence increase their choice. In view of one comment from a survey that suggested the resident was unaware of whom to speak to if they were unhappy and unaware of how to make a complaint, staff should ensure all residents are reminded of how to make a complaint. The downstairs bathroom should be added to the redecoration and refurbishment plan to ensure, in time, it is updated and provided with upgraded moving and handling equipment. This will provide care staff with an electronic rather than a hand operated means of moving and handling Page 32 of 34 3 4 7 9 5 9 6 9 7 12 8 14 9 15 10 16 11 21 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations people. 12 30 New staff should complete evidence sections of skills for care common induction standards. This will enable the manager or assessor to be sure that new staff are competent prior to signing off the induction as completed. The training plan should include a range of needs associated with conditions affecting older people, for example, strokes, diabetes, arthritis and Parkinsons disease. This will give staff increased awareness and knowledge about a range of needs. Action plans should be produced when information is collated from audits and questionnaires is gathered. This will focus attention on any shortfalls and enable plans as to how they are going to be addressed. Care staff should have a minimum of six formal, one to one supervision sessions each year. An observation of their practice would also enhance the supervision process and enable the supervisor to be sure of the staff members competence. Staff should build in bed rail safety checks into the general health and safety checks of the home. This will ensure they are in working order and safe to use. 13 30 14 33 15 36 16 38 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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