Inspection on 21/02/08 for Rosehurst

This inspection was carried out on 21st February 2008.

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

Rosehurst 16/12/08

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

CARE HOMES FOR OLDER PEOPLE Rosehurst 162 Church Path Deal Kent CT14 9TJ Lead Inspector Lois Tozer Unannounced Inspection 09:25 21 February 2008 st 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 Rosehurst DS0000070256.V358018.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. Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosehurst Address 162 Church Path Deal Kent CT14 9TJ 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) 01304 372312 Rosehurst Care Ltd Clair Parfitt Care Home 22 Category(ies) of Dementia (0) registration, with number of places Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). Care home only - (PC) to service users of the following gender : Either whose primary care needs on admission to the home are within the following category : Dementia (DE) maximum number of service users 22. The maximum number of service users to be accommodated is 22. 3. Date of last inspection N/A Brief Description of the Service: Rosehurst is a registered residential care home for up to 22 older people. The registration of this home permits that people may live here if they have been diagnosed with dementia. The building is a detached property with a patio garden to the side and a large (soon to be lawn) garden at the rear. Both gardens are secluded and surrounded by a high brick wall. Car parking is available at the rear of the property accessed via Middle Deal Road, there is also limited street parking. The home is located within a busy residential area of Deal, and is within a few minutes walk of the local hospital. The home is within walking distance of several local shops and public transport, but is some distance from Deal town centre. Accommodation comprises of 16 single rooms and three double rooms situated over two floors. Double rooms are mainly used for people who have additional care needs, such as needing hoist equipment. The first floor is accessed via a stair lift. Each bedroom has a private wash-hand basin and call bell. There are no en-suite facilities provided in the bedrooms, although there are adequate communal bathroom and toilets. On the ground floor there is a large lounge and two smaller lounges one of which opens up onto the patio area. The dining area opens directly onto the Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 5 kitchen, so the cook is directly involved with residents during meal times. The current fees for the service at the time of the visit are £377.38 per week. There are additional charges for chiropody, toiletries and hairdressing. This is the first CSCI key inspection for the home under its new ownership. Information on the homes services and the CSCI reports for prospective service users/relatives will be referred to in the Service User Guide. The email address for the home is rosehurstcare@yahoo.co.uk Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key site visit took place on 21st February 2008 between 09:25 am and 4:05 pm. The manager, area manager, people who live at the home and staff assisted with the process. The inspector who carried out the site visit was made welcome. We received an AQAA (Annual Quality Assurance Assessment) before the inspection. This had been completed by the manager and was the first time this had been submitted. It told us a lot of factual information, and showed us where improvements had been targeted. It helped us decide on the areas we would focus on at the site visit. The inspection process consisted of information collected before, during and in the few days after the visit to the home. Some of the information seen at the home was assessment and care plans, medication records, health support plans, training information and staff records, including recruitment and menu information. Twelve people live at the home. We sent out a variety of surveys in advance of our visit and one staff, two friends / relatives, an independent support worker and two residents returned their comments. We spoke at length with two residents and briefly with a further four. Although some people have varying degrees of dementia, we were able to assess their relationships with staff and their outward signs of wellbeing. The overall star rating for this home is ‘Two Stars’, which means the home is providing a good service. What the service does well: The assessment of residents is thorough and involves the person (to as much degree as they are able to be involved), their family and significant others and their care manager. It is very well researched and detailed. The care and support plan is very detailed and tells staff what they need to know to give people a personalised service. We saw that there is a ‘person centred plan’ template in place, and this will be filled with life history and social support information. Staff are receiving training in this type of planning. People have support from staff to take their medication. It is held centrally, unless capacity assessments show that a person is able to look after and administer their medicine themselves. Staff follow the policy and procedures carefully and understand what to do if there is a problem. Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 7 Activities and events are organised several times a week, but some people are not keen to be involved. We saw that residents had regular contact with staff in a way that gave them individual attention. We saw that staff made sure people had choice for meals and were supported with dignity. We observed that people who were partially sighted were given lots of support and warning before they were moved or anything around them changed. We saw that healthcare support was good, and that there was no delay in seeking medical help and following advice. The staff team are well trained and have kind attitudes. They make sure people have a positive experience each day and spend time with people speaking, singing or just holding hands. The quality assurance process employed by the new owners has made sure that the things that matter most to residents are improved first. 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. The summary of this inspection report can be made available in other formats on request. Rosehurst DS0000070256.V358018.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 Rosehurst DS0000070256.V358018.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): 3, 6 People who use the service experience good quality outcomes in this area. Prospective residents can be certain that they will have a full physical and social needs assessment before moving to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked the assessments that had taken place for two people. These showed us that the care manager, families and significant others as well as the resident had been involved. The move to the home had been carefully planned, and special support needs, likes and dislikes had been considered. There was information that told us about the person’s life and social history. A careful review of physical and mental health had also taken place, which included a skin viability assessment, continence support needs and oral health. Almost all of this information had been transferred into a detailed support Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 10 plan, but we noticed that support around denture care and oral hygiene had been missed. Although the home offers short stays, such as respite care, it does not currently offer intermediate care. Rosehurst DS0000070256.V358018.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, 10 People who use the service experience good quality outcomes in this area. People can feel certain that they will receive support as they like it from kind, considerate and knowledgeable staff in all matters of personal and health care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The team aim to give individual care to each person, and we observed this taking place. Staff follow clear care support plans that make say what individuals likes and dislikes are. Extra support needs are made clear. We discussed the importance of writing up oral care, including denture care in the plan, considering the use of denture sterilization products, as this had been overlooked. This is a required improvement that the manager agreed to attend to straight away. The daily records show that staff are recording the support given in detail, so the type of support can be accurately reviewed. Any hospital admissions and Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 12 discharge instructions are clearly recorded and followed. A visiting district nurse told us that the care in the home was good. Pressure sores were rare, and when they did occur, the home took immediate action to seek nursing help. General health records showed that people had GP support to review medication regularly. We saw that two people had medication reductions, and that records easily evidenced when the doctor had been and what she or he had recommended. Medicine is stored centrally, although the home does have a policy to assess people for the ability to administer and keep medicine in their own room. We saw staff support people to take medicine in a safe way. They completed recording charts carefully. Where medicine had come from a resident’s own home, a full, recorded stock inventory had taken place. Staff have training in administration of medication and make sure that all of the right processes to protect people are followed. During our visit we saw staff supporting all of the residents. They did so in a kind and gentle manner and with good humour, using peoples preferred names. They took care to protect people’s privacy by speaking and prompting discreetly. We observed a person having support who had a visual impairment. The staff supported their orientation by explaining exactly what they were going to do before they did it. The person looked secure and relaxed. We noticed that a bath rota had been displayed in a communal bathroom. The manager agreed that this was not a discreet place for such information, and removed it. Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 13 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, 15 People who use the service experience excellent quality outcomes in this area. People living at the home know that they will have a high quality lifestyle maintained and that as their needs change, plans are in place to remind staff what is important to the individual. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw people enjoying the company and contact of staff throughout our visit. We saw that staff took their time to spend short periods of good quality time with each individual, and made sure no one was hurried. One particular good piece of support was staff rousing a person with an old fashioned song, sung very quietly, until the person joined in. They then sang together. When the song was ended, the staff gave the resident their hot drink and a soft fruit snack. They had become sufficiently awake and alert to feed themselves and enjoy it. Residents, at the moment, do not get much opportunity to leave the home unless supported by relatives or friends. The manager is hoping that this will Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 14 change for people who would like to get out now and again. She has introduced a ‘key-worker’ system, and hopes to make it possible, with careful rota planning, for occasional trips to town. Friends and relatives are very welcome, and the visitor’s book showed us that there are many visitors on most days. They visit throughout the waking day without restriction. There are plans to have an Easter Event for residents and families, so the community will come to the home. Good care planning has recorded what people like and dislike. Staff are having training at present in ‘person-centred planning’. This will make sure that residents and their relatives have a big say in what they want from their lives, and gives key-workers and residents a chance to plan how this will be made to happen. Particularly careful recording around what people find annoying is taking place, for example, very bright light, or noise, or crowds. This is important, so where people may become less able to say what the problem is, staff will be aware of personal dislikes and support them to avoid issues. Meals are all home cooked from fresh ingredients. There is a good food budget, and residents and staff told us that it’s always tasty. We saw staff asking people what they would like for dinner from the choice on offer. This was recorded, and the cook prepared meals accordingly. The amount people ate was recorded and if there were any particular issues, more detailed recordings were in place. People who needed support to eat had 1:1 help, which was unrushed. The home recognised that appetites could be small, so provide snacks and drinks though the day and evening. Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 15 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, 18 People who use the service experience good quality outcomes in this area. People living at the home can be sure that their complaints will be taken seriously and that their rights will be protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed by the visitors book in the hall for all to see. It is clear and to the point. We asked two residents what they would do if they had a problem or a moan. One told us they would speak to the manager, the other pointed towards a staff member and smiled saying ‘they would sort it out’. We discussed how staff support people who have dementia with the complaints procedure. A staff member was clear that it’s very important to have good background information about a person, so if memories re-surface, and seem fresh, staff can be aware and give sensitive support. The staff member told us that any concerns raised or indicated through behaviour by residents would be recorded and that the manager would be told. All staff have received Adult Protection training. Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 16 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, 21, 26 People who use the service experience adequate quality outcomes in this area. The home environment is being modernised, but is comfortable and homely. There are some areas of infection control that need improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has been materially neglected for a long time, so the plan is to update and modernise with quality products as the budget allows, and there is a renewal and refurbishment plan in place. The new owners are renovating bedrooms one at a time. Some empty rooms are having new flooring and carpets. Some people already have new bedcovers and soft furnishings. The rooms have personal items, but few people have brought their own furniture in. Some rooms look a little bare and plain, as are hallways but the manager is quite aware of this, and this is included in the improvement plan. Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 17 The fire risk assessment has been reviewed, and a full evacuation of residents to test it out took place recently. External fire exits are being improved in the within the next month, as doors locked with number pads are not integral to the alarm system. Many of the big trees and shrubs that blocked out light have been removed, which staff and residents tell us has improved the whole house. The communal areas are homely and comfortable. People are being involved with redecoration plans. The bathrooms are serviceable, although dated and worn through heavy use. Some renewals have taken place, and new flooring will be fitted to both bathrooms in the next few weeks. A new ‘sluice facility’ washing machine has been purchased, improving the laundry facilities. There are some infection control issues that the manager must address, for example, there is no commode-emptying or cleaning place. This means staff having to empty pots into the toilet, risking splashing. This is a required improvement. Toilet rolls need holders and one bathroom / WC is being used to air-dry clean clothes, all of which pose an infection control risk. Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 18 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, 30 People who use the service experience good quality outcomes in this area. Residents can feel confident that their needs will be met by staff who are motivated and competent in their job role. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff are available in numbers that met individual resident’s needs. On the day of our visit, there were 12 residents, who were supported by two care staff, the manager, a cook and a cleaner. At no time did people have to wait long for support and staff seemed calm, unrushed and were spending quality time with people. The manager has reassessed needs recently and has recruited more staff to meet changing needs and to provide more social opportunities. Having a dedicated cook and cleaner makes sure that the home runs efficiently. The manager is available for direct care and support if needed. We observed that, when the need arose, she worked directly with residents. This made sure their immediate needs were met without delay. Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 19 Over 90 of the staff have obtained an NVQ qualification, and the new owners have invested in updating the staff training. Staff are pleased to have received good dementia awareness training and found the work books useful. They will be doing the Skills for Care leaning sets to improve their skills of dementia support in the coming months. Each staff member has a development plan and supervision is conducted for each person with regular, private meetings with the manager. We looked at the recruitment process, examining the file of the last person to be employed. This was in good order and had all the documentation, such as police check, references and application form. The new owner has provided an improved application form, which will help with future selection. Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 20 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, 33, 35, 38 People who use the service experience good quality outcomes in this area. Residents can feel confident that the home is run and managed efficiently and safely. They can be sure that they at the centre of development and improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is registered with CSCI and has achieved the NVQ4 in health and social care and is currently studying for the Registered Managers Award (RMA). She is also registered with Skills for Care and is undertaking dementia-learning sets. Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 21 The manager told us that the quality assurance system is still new to the home, but that she and the new owners had focused development on the things that will have the biggest impact on life quality for residents. So far this has been providing high quality food, better staff training, the redecoration and personalisation of rooms, gaining proper access to the gardens and finding out how people feel about the way the home is run. Staff meetings take place so ideas can be discussed and debated, and the staff we spoke to during the visit felt their ideas were listened to and knew they could approach the manager with any concerns. Staff are being supported to learn person centred planning, as the home has recently been granted registration to provide a specialist service for people who have dementia. This will make sure that choices and preferences that have lifelong meaning to people can be monitored and maintained through the quality assurance process. Currently, the home does not keep any money on resident’s behalf, but this is being reviewed and a system is available to make sure any monies held will be fully accountable. The AQAA told us that all the safety certificates were up to date, and that the environment had received a full audit. The manager told us a full, up to date, fire risk assessment had taken place. All residents had recently had support to practice evacuating the building, and this was successful. Some external exits have been identified as needing improvement, and this is happening. Other action points where improvements are needed have been documented, and the new owners are driving forward the ongoing development of the house. They have identified a risk of scalding water in hand-wash basins and are currently fitting thermostatic mixer valves to all facilities. Staff have had the right training to make sure people are supported safely. There is a training schedule in place to make sure staff are kept up to date. Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 22 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A 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 OP7 Regulation 15(1) Requirement To make sure that each individual gets the right support for oral hygiene and denture care, plans and risk assessments must detail the support required. So that staff and residents are protected from cross infection risks, a suitable facility for emptying and cleaning commodes must be provided. Timescale for action 28/03/08 2 OP26 13(3) 01/06/08 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 OP26 Good Practice Recommendations All toilets must be provided with suitable toilet roll holders. Items of clothing should not be dried in an area where there is a toilet. Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Rosehurst DS0000070256.V358018.R01.S.doc Version 5.2 Page 25 - 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. 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