CARE HOMES FOR OLDER PEOPLE
Roseland Garratts Lane Banstead Surrey SM7 2EB Lead Inspector
Graham Cheney Announced 14 July 2005 09:30 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 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. Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Roseland Address Garratts Lane, Banstead, Surrey, SM7 2EB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01737 355022 Banstead, Carshalton & District Housing Limited Mrs Sandra Parr CRH Care Home 39 Category(ies) of DE(E) Dementia - Over 65, 3 registration, with number OP Old Age, 39 of places PD(E) Physical Disability - Over 65, 5 Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Of the older people accommodated up to five may have a physical disability. 2. Of the older people accommodated up to three may be people who suffer from dementia. 3. The age range of the persons to be accommodated will be: over 65 years. 4. These Management arrangements must be reviewed should there be any change to the registered persons - Mrs Parr as Registered Manager or Mr Stevens as the Responsible Individual. Date of last inspection 10 January 2005 Brief Description of the Service: Roselands was purpose built to accommodate older people in the 1950s. Since that time the home has been subject to modernisation and development. It now provides a very good standard of accommodation.The home is sited in its own grounds with good sized and well-maintained gardens accessible to the residents and has car parking to the front.The home is well presented, providing a good standard of accommodation for up to 39 older people over 70 years of age. All rooms are for single occupancy and 9 have en-suite facilities. The home has two sitting rooms, an activity room and separate dining room. Plans are in place to extent the dining room and to add on a conservatory. Tea and coffee making facilities are available on each floor.The upstairs accommodation was accessed by stairs or a passenger lift. Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection of Roselands in the CSCI year 2005/2006. It was an announced inspection, which meant that residents and staff knew that it was to take place. The inspection started at 9.30 a.m. and finished at 1.00 p.m. The inspector spent time with the registered persons to start with, to get an update on developments with the home and its operation and then spent time talking with residents before meeting with staff groups. The rest of the time was taken looking at care plans, staffing arrangements, other documents and records. Residents and staff made the inspector very welcome and were happy to talk about life at Roselands. What the service does well:
There have been changes to the management arrangements since the last inspection, with the manager from Roseacre (The other Rose Home owned by the Society) now assuming a general manager role for both homes. The former manager of Roselands retains overall responsibility as the responsible individual acting on behalf of the Society. Heads of care have been appointed to take responsibility for the day to day operation of each of the homes. The management of the home has revised the statement of purpose to reflect these changes. The home provides a very high standard of accommodation, with further improvements (detailed below) pending. Residents all said they were very happy with their rooms, which were a good size, comfortable and well furnished. Residents were encouraged to bring in some of their own furniture and other items to personalise their rooms. One of the residents invited the inspector to see her room, which was personalised with pictures, ornaments and other personal items, reflecting her interests and gave a very homely impression. Comments from relatives and visiting professionals in discussion with the inspector were all very positive about the way the home was run, the staff and the accommodation. All of the residents who spoke to the inspector were happy with the service provided. They said that they found the staff kind and helpful. Residents also said that staff were all hard working and at times seemed very busy. Some of
Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 Page 6 the staff explained that the morning shifts could be especially busy, with dependency levels higher than they had been and the need to adjust to some changes in their working practices recently introduced. An example being the need to complete detailed diary notes on residents to provide evidence that care needs were being met. All of the staff who spoke to the inspector demonstrated a high level of commitment to the residents and the home in general. Residents said that they enjoyed the food and some explained that they were offered an alternative if they did not like the main meal. Further comments are included in the section on what has improved. In the main residents felt in control of their lives, but some found it difficult having reduced mobility and therefore being more reliant on others for support and going out. Residents said they were happy with the activities and the opportunities to go out and felt they were kept up to date with what was happening in the home. What has improved since the last inspection?
The home continues to operate to a high standard with plans in place to extend the dining room, add a conservatory to increase the communal areas and improve office accommodation. The registered persons confirmed that the funding was in place and that building regulations approval had been sought. Although the new management team had only been in post for a few weeks the majority of staff seemed to think that the home was operating well, although some needed to get used to some of the new ways of working. An example of this was for staff to discuss the next day’s menus with each resident to help them make their selection for lunch and evening meal. The responsible individual considered in his report of his recent Regulation 26 visit (The Care Homes Regulations 2001 as amended, requires the responsible individual to carry out their own inspection of the home and report their findings to CSCI) that this “has undoubtedly resulted in residents being more involved in making their choice.” It also gave time for staff and residents to have a chat and this was particularly important for less able residents. Staff recognised the value of this for residents but found it time consuming, needing to get used to the change. Some of the residents preferred to use the old system whereby the menu was posted and they wrote down their selection. As stated above care staff were being asked to make more detailed notes on the needs, wishes of the residents and the care and support provided. This has lead to an improvement in the overall care planning with more evidence that the residents’ needs and aspirations were being met. Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 Page 7 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.
Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 On the evidence provided the assessed standard was being met. This should ensure that prospective residents have the information and opportunities to be able to make an informed choice about whether to move into the home and remain in control of their life thereafter EVIDENCE: The home has revised its statement of purpose to reflect recent changes in the management arrangements for the home. This provides all the required information about the home, how it is run, the staff and services provided. Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 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 standard(s) 7, 9 On the evidence provided and giving the improvements in recording information about residents, detailed below, standard 7 was considered to have been met on this occasion. With continued development this should ensure that residents’ care needs are recognised and appropriate care and support provided. Standard 9 was considered almost met with revisions recommended to the home’s medication policy. This ensure that all residents safely receive the medication as prescribed by their doctor. EVIDENCE: Care staff were being asked to make more detailed notes on the needs, wishes of the residents and the care and support provided. This has lead to an improvement in the overall care planning with more evidence that the residents’ needs and aspirations were being met. The home’s management have revised their medication policy and provided a copy to the inspector. This generally follows the Royal Pharmaceutical Society’s good practice guidance, however the advice of CSCI’s pharmacy inspector was
Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 Page 11 sought with regard to best practice for recording details of medication obtained for residents who self medicate, the dispensing of medication for residents going out or on holiday and the disposal of medication when a person dies. It was recommended that the home’s policy be revised to incorporate the pharmacy inspector’s advice (sent under a separate cover) to ensure compliance with the good practice guidance. Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 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 standard(s) 12, 14, 15 The evidence gathered indicated that these standards were fully met and therefore the home was supporting residents to maintain control and autonomy over their lives as far as they were able. Catering arrangements were commended based on the very positive comments from residents. EVIDENCE: In the main residents felt in control of their lives, but some found it difficult having reduced mobility and therefore being more reliant on others for support and going out. Residents said they were happy with the activities and the opportunities to go out and felt they were kept up to date with what was happening in the home. Residents said that they enjoyed the food and some explained that they were offered an alternative if they did not like the main meal. Staff have recently been asked to discuss the next day’s menus with each resident to help them make their selection for lunch and evening meal. The responsible individual considered in his report of his recent Regulation 26 visit (The Care Homes Regulations 2001 as amended, requires the responsible individual to carry out their own inspection of the home and report their findings to CSCI) that this “has undoubtedly resulted in residents being more
Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 Page 13 involved in making their choice.” It also gave time for staff and residents to have a chat and this was particularly important for less able residents. Staff recognised the value of this for residents but found it time consuming, needing to get used to the change. Some of the residents preferred to use the old system whereby the menu was posted and they wrote down their selection. Either way this provided clear evidence of residents retaining control of their lives and supported to make choices. Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 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 standard(s) These standards were not assessed on this occasion, the home having previously demonstrated a commitment to protecting residents and dealing appropriately with any complaints. EVIDENCE: Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 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 standard(s) 19, 20, 23, 24 All of the assessed standards were met. The home provides a high standard of accommodation for its residents, which was considered safe and comfortable. EVIDENCE: The home provides a very high standard of accommodation, with further improvements (detailed below) pending. Residents all said they were very happy with their rooms, which were a good size, comfortable and well furnished. Residents were encouraged to bring in some of their own furniture and other items to personalise their rooms. One of the residents invited the inspector to see her room, which was personalised with pictures, ornaments and other personal items, reflecting her interests and gave a very homely impression. The home continues to operate to a high standard with plans in place to extend the dining room, add a conservatory to increase the communal areas and improve office accommodation. The registered persons confirmed that the funding was in place and that building regulations approval had been sought.
Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 30 Evidence gathered during this inspection confirmed that the home meets each of the assessed standards. Staff on duty appeared to be enthusiastic and committed to supporting residents, with training and development being given a priority. The only shortcoming being the need to ensure housekeeping staff are appropriately trained in fire safety arrangements. EVIDENCE: All of the residents who spoke to the inspector were happy with the service provided. They said that they found the staff kind and helpful. Residents also said that staff were all hard working and at times seemed very busy. Some of the staff explained that the morning shifts could be especially busy, with dependency levels higher than they had been and the need to adjust to some changes in their working practices recently introduced. An example being the need to complete detailed diary notes on residents to provide evidence that care needs were being met. All of the staff who spoke to the inspector demonstrated a high level of commitment to the residents and the home in general. In discussion with the inspector some of the housekeeping staff seemed unclear about what action to take should there be a fire in the home. The home had evidence that regular training has been provided, but it would appear that some staff had not been in attendance. It was a requirement that the management identify all staff who have not received fire safety training in the last year and arrange for them to attend such training within the next
Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 Page 17 three months. In the interim staff must be made aware of the home’s internal policy and procedure in the event of fire. Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 38 Evidence gathered during this inspection confirmed that, with the exception of standard 38, the home meets each of the assessed standards and was seen to be well run with sound and accountable management support. Compliance with standard 38 was compromised by concerns over the failure to comply with COSHH (Control of substances hazardous to health) requirements. which was considered a safety risk. EVIDENCE: There have been changes to the management arrangements since the last inspection, with the manager from Roseacre (The other Rose Home owned by the Society) now assuming a general manager role for both homes. The former manager of Roselands retains overall responsibility as the responsible individual acting on behalf of the Society. Heads of care have been appointed to take responsibility for the day to day operation of each of the homes.
Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 Page 19 Comments from relatives and visiting professionals in discussion with the inspector were all very positive about the way the home was run, the staff and the accommodation. Although the new management team had only been in post for a few weeks the majority of staff seemed to think that the home was operating well, although some needed to get used to some of the new ways of working. An example of this was for staff to discuss the next day’s menus with each resident to help them make their selection for lunch and evening meal. The responsible individual considered in his report of his recent Regulation 26 visit (The Care Homes Regulations 2001 as amended, requires the responsible individual to carry out their own inspection of the home and report their findings to CSCI) that this “has undoubtedly resulted in residents being more involved in making their choice.” It also gave time for staff and residents to have a chat and this was particularly important for less able residents. Staff recognised the value of this for residents but found it time consuming, needing to get used to the change. Some of the residents preferred to use the old system whereby the menu was posted and they wrote down their selection. Inspectors found evidence that the staff were dispensing chemicals, for example cleaning products, from the original container into smaller spray containers for use in bathrooms. Whilst the catering manager was able to present a notice explaining a colour coding process, other staff did not know exactly what chemical they were using. This was contrary to COSHH (The control of substance hazardous to health) regulations and must be stopped promptly to reduce the potential risk to staff and clients. Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 4
COMPLAINTS AND PROTECTION 3 3 x x 3 3 x x STAFFING Standard No Score 27 x 28 3 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 3 3 x x x x 2 Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 Page 21 no Are there any outstanding requirements from the last inspection? 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 OP30 Regulation 18(1) 23(4) Requirement Timescale for action 28/09/05 2. OP38 23(5) 13(4) It was a requirement that the management identify all staff who have not received fire safety training in the last year and arrange for them to attend such training within the next three months. In the interim staff must be made aware of the home’s internal policy and procedure in the event of fire. The practice of staff dispensing ongoing chemicals cleaning products from 14/07/05 the original container into smaller spray containers for use in bathrooms, which was contrary to COSHH (The control of substance hazardous to health) regulations and must be stopped promptly to reduce the risk to staff and clients. 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.
Roseland Refer to Standard OP9 Good Practice Recommendations It was recommended that the home’s policy be revised to
h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 Page 22 incorporate the pharmacy inspector’s advice to ensure compliance with the good practice guidance. Roseland h09 H58 s13772 Roseland v226239 140705 stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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