Inspection on 16/07/07 for Roseland Care Home

This inspection was carried out on 16th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Roseland Care Home 25/02/08

Roseland Care Home 04/12/06

Roseland Care Home 11/04/06

Roseland Care Home 09/11/05

Roseland Care Home 06/07/05

Roseland Care Home 23/02/05

Roseland Care Home 12/08/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Roseland Care Home 57 Draycott Avenue Kenton Middlesex HA3 0BL Lead Inspector Diane Roberts Key Unannounced Inspection 16th July 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Roseland Care Home DS0000017443.V342688.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. Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roseland Care Home Address 57 Draycott Avenue Kenton Middlesex HA3 0BL 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) 020 8907 4080 020 8959 1249 Mr Jerome Manuel Coral Lavinia Lake Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th December 2006 Brief Description of the Service: Roseland Care Home is situated in a busy residential road off Kenton Road. It is close to a large supermarket, local shops, and tube and bus routes. It is a detached house on two floors. There is one double and eight single bedrooms. There is a large lounge and separate dining area as well as a kitchen, laundry, shower and toilet on the ground floor. There are two single and one double room on the ground floor. Upstairs rooms are all single and there is a bathroom on the first floor. There are no en-suite facilities in the home. There is a chair lift to the first floor. There is a pleasant garden laid mainly to lawn with trees and shrubs at the rear of the property. Garden furniture is provided for service users who like to sit out in the Summer. There is off street parking at the front of the house for three cars. Parking is also available on the main road. At the front of the home there are borders containing shrubs and bushes. A Service Users Guide is available and fees are currently £370.00 - £390.00 per week. Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out as part of the annual inspection programme for this home. The registered manager was available on the fieldwork day of the inspection. The inspection focused upon all of the key standards. A full tour of the premises was undertaken. 3 residents, 1 relative and 2 staff were spoken to during the inspection and Relatives completed feedback sheets and these comments were taken into account when writing the report. Due to the dependency levels of the residents completion of feedback surveys was not possible and whilst it was possible to speak to some residents, feedback was limited. The proprietor and the manager at this home need to ensure that all the required documentation for inspection is available in the home at all times. What the service does well: What has improved since the last inspection? What they could do better: Since starting work at the home the manager has made significant progress, but she now needs to ensue that standards are maintained and improved upon so that the home develops positively with residents best interests in mind. Shortfalls in relation to care provision, activities, specialist diets, adult protection, premises safety, staffing levels, staff training, staff recruitment, quality assurance and health and safety all need work and the manager and the proprietor need to work together to address these matters. Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 6 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. Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. People using this service experience an adequate outcome in this area. This judgement has been made using available evidence including a visit to this service. Assessments are in place that helps to ensure that the team at the home can meet residents’ needs prior to admission. Further development of information available to residents at this time would help to ensure they have an informed choice, as far as possible. EVIDENCE: The manager has a pre-admission assessment system in place and completed all the assessments herself. The manager’s assessment is supplemented by social services assessment documentation. Recent assessments were inspected and were found to have been completed well, with a good level of recording and detail, which outlined current needs, personal preferences, social care and family history. The assessment covered all the required areas. Assessments were seen to have been completed within an appropriate Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 9 timescale in relation to admission and where possible information had been obtained from residents’ families or carers. Residents’ files showed that they had contracts in place and where possible had been signed by the resident or their family member. The home has a service user guide in place that contains all the required information. No guides were seen around the home or in residents’ bedrooms. The manager needs to evidence that this guide is in use and has been given to residents or their relatives. The format of the service users guide was also discussed, in the relation to the dependency levels of residents in the home, and it is felt that the guide could be more user friendly or the manager could develop different ways of communicating this information to residents. Records completed by managers and other staff would indicate that some residents, recently admitted, might have a diagnosis of dementia. This was discussed with the manager in relation to the registration of the home. Documentation was seen to be confusing and the manager must be assured that she has the correct medical information, prior to admission, so that she is not admitting out of category to the home. Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using this service experience an adequate outcome in this area. This judgement has been made using available evidence including a visit to this service. Standards of care at the home are generally acceptable and relatives and residents are happy, however care systems at the home need to improve so that the team can evidence a proactive, resident led approach to care provision and ensure positive outcomes for residents. EVIDENCE: Since the manager has been in post she has worked hard to put in place a clear and simple to use care-planning system in place. This system has been used for some time now and 2 care plans were case tracked and other care records were also inspected. The care planning system primarily relates to the activities of daily living with certain subjects matters enhanced allowing for more detailed information to be included. The care plans that were in place contained a good level of detailed information, some of which identified abilities, some resident preferences and any behavioural issues that may affect care provision. Whilst the care plans were suitably detailed they could be more Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 11 person centred, containing more information on resident preferences and personal objectives for improvement and change, which some residents had in place and others did not. One resident was noted to have conflicting information on their abilities and this was not helping to optimise the residents abilities and promote self worth. The main shortfall with the care plans is that the reviews are not being kept up to date. Some care plans were seen to have been written in March 2007, reviewed in April 2007 and not reviewed since, others were written in October 2006, reviewed in Feb 2007 and not since. Because of the lack of review, it is unclear whether identified needs and issues, that the team have been good at noting, have been suitably followed up and met. This is disappointing but the manager states that specific identified needs, as noted by the inspector, have been met although no evidence is available. The social side of the care planning system was limited although some good family histories were in place. Daily notes were of a variable quality. Some were quite informative and evidenced resident choice whilst others primarily stated ‘seems fine’. This does not reflect the resident well-being and the care provided, linking into their care plan. There is no evidence that either residents or their relative have been involved in the care planning process. The manager has completed some good work on the care planning but she needs to maintain the standard she has put in place and develop it further. Records show that residents’ healthcare needs are generally being met. There is a proactive approach to contacting the visiting GP’S and residents also have access to chiropodists, opticians etc. Doctors advice, as noted in the daily notes was not always reflected in the care plans and this relates to the current lack of review. A range of risk assessments are in place for residents that cover, falls, manual handling, risk of wandering and nutrition etc. Risk assessments, that were noted to have been completed in February 2007, stated a three monthly review. The review had not been completed 5 months later. The monitoring of residents weights has previously been an issue at this home with weights not being adequately monitored. Records were checked and were found to be inconsistent. The home has a new set of scales. This was discussed with the manager. Records show that not all residents have an up to date assessment in place for the promotion of continence. The manager reports that she is trying to address this. This is resulting in a limited approach to the promotion of continence and residents having to buy their own pads, as the proprietor will no provide these. On touring the home it was noted that there were many prescription and nonprescription skin creams around, some of which did not identify who they belonged to, in bathrooms etc. The use of such creams should be reviewed in the home, with residents using such items having an appropriate rational and care plan in place. Communal use of creams must not take place due to the infection control risks. Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 12 Some resident have bedrails in place, which were noted not to have the correct bumper/protection posing a risk of entrapment. This was discussed with the manager who stated that she needed to order some. This needs to be addressed. The team manage the residents’ medication via a nomad system, delivered monthly. The manager reports good relationships with chemist and visiting doctors. Residents records reviewed showed evidence of review, although one resident had been on antibiotics for one year and the manager did not know the reason behind this. MAR sheets were neatly maintained and items are checked in. Residents were seen to be on standard medications and no controlled drugs were in use although the home does have suitable storage if they do need it. A returns system is in place and records maintained. It was noted that one set of Metformin had been dispensed out of its original container and a handwritten label stuck on. This is not acceptable practice and the manager could not account for the change. It was also noted that the team do not have access to any medication books as a resource for information and this may be of value. Interaction between staff and residents was seen and heard to be appropriate and friendly. Whilst there is some good information, staff could evidence residents’ choices/dignity in the care plans more, showing an appreciation of the diversity of individuals. Relatives who commented felt that the staff team were caring towards the residents and that care standards were good. Residents who commented said that the staff team were nice. It was noted that attention to detail with regard to residents care needs work, to ensure their dignity is maintained, for example, management of facial hair, clean nails etc. Roseland Care Home DS0000017443.V342688.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 and 15. People using this service experience an adequate outcome in this area. This judgement has been made using available evidence including a visit to this service. The activities programme at the home needs work to ensure that it relates to residents individual needs and optimises their abilities. The meal service at the home requires some review to ensure that residents’ needs are being met in full. EVIDENCE: Some care plans in the home contain good detail that relate to resident choice and how they would spend time in the home and their daily routine, odd daily notes reflect resident choice around this, for example, ‘x had a lovely lie in this morning’. This approach to care planning should be developed further. Social care plans were seen to be inconsistent and limited in many cases. From discussion with relatives, interests that residents had previously had not be identified by staff and reflected in their social care plan. A basic activities programme, dated May 2007, is displayed in the hallway and includes, watching TV, bingo, church, cake making, drawing, beauty therapy, beetle drive. One resident confirmed that ‘the ladies tell us what to do and we draw to pass the time away’. Records evidence that residents have access to Holy Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 14 Communion and that they have birthday cakes on their birthdays. On weekends and Mondays, no activities are provided, giving a three-day period with limited social stimulation. From review of the records, the activities programme does link to residents’ preferences or past interests. The team need to ensure that residents individual and group needs are met and a more person centred approach to residents’ choices and maintaining and developing their strengths and abilities is developed. The home is currently without a chef and the manager is trying to recruit to this post. In the meantime the care staff are carrying out this role, taking them away from care and social duties. These staff covering the post do have food hygiene certificates in place. Residents tend to take their meals in the dining room apart from one person who chooses to sit elsewhere. The mealtime was seen to be very quiet and relaxed and the tables are laid nicely with condiments available. Menus are displayed but the writing is small and consideration should be given to the format for the resident group. Whilst menus are in place there is no nutritional record to show what residents have actually had, against the menu, or alternatives/specialist diets that have been provided. This was discussed with the manager. From discussion with staff there is a relaxed approach to the provision of a diabetic diet and residents were noted to be eating inappropriate food items. Staff report that this is an ‘occasional treat’, but there are no records to evidence this or that they are providing a diet in the residents best interests. This should be addressed. Residents spoken to said ‘the food is nice’ and the food is pretty good’. Roseland Care Home DS0000017443.V342688.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 and 18. People using this service experience a poor outcome in this area. This judgement has been made using available evidence including a visit to this service. Whilst complaint management in the home is good, shortfalls were noted with regard to recruitment and adult protection training amongst staff that could potentially put residents at risk. EVIDENCE: The home has satisfactory complaints procedure in place, which is displayed in the home and can be found in the service users guide. Consideration should be given to reviewing the format to help make it as accessible as possible to residents. Relatives confirm that they are aware of the procedure and said that the manager has responded appropriately and ‘we have only had minor concerns to date but these have always been dealt with’. The manager has received two complaints since the last inspection, one relating to laundry and one relating to a resident wandering at night, the latter having no evidence. Both matters were seen, from the records, to have been dealt with appropriately by the manager and within good timescales. The home had received a compliment since the last inspection and this said ‘my relative was really happy at Roseland and look forward to seeing the staff, who were so good with her’. The manager has up to date adult protection procedures in place, which include local guidance from placing social service departments. From Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 16 discussion, the manager demonstrates a good understanding of the management of such issues. Staff training records show that there is a significant shortfall in staff training on adult protection with 9 staff out of 12 staff untrained. The training plan only allows for 4 training places on this subject, which does not address the shortfall. This needs to be addressed. As outlined in the Staffing/Management and Adminstration section of this report, shortfalls in the recruitment procedures can put residents at risk and must be addressed. Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 17 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 and 26. People using this service experience an adequate outcome in this area. This judgement has been made using available evidence including a visit to this service. The environment in the home is generally acceptable to residents and relatives and they feel that it provides a homely atmosphere. Improvements to some of the facilities and areas could enhance their quality of life further and maintain their safety. EVIDENCE: A full tour of the home was undertaken. The forecourt of the home has recently been block paved and gives a neat front to the property. The home has a large, secure back garden and a new patio and pathway has been laid, creating a large flowerbed, which has been planted. Residents were seen to be making use of this area with their relatives. Many of the bedrooms have been painted since the last inspection; all are the same colour including the hallways and lounges, which does not indicate that residents have been consulted about Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 18 the décor in their rooms. Bedrooms, which have yet to be painted, are different colours. This unfortunately gives a stark and sometimes bare appearance to the home. The manager confirmed that new carpets had also been laid and that further ones were on order. The home was seen to be generally clean but attention to detail is needed as cobwebs were noted and toilets could be cleaner. The care staff are also responsible for the cleaning in the home. No odours were noted in the home. A resident who commented said that her room was ‘comfortable and like home’. Relatives who commented said that ‘ they were happy with their relatives bedroom which has a new carpet’ and another said ‘ perhaps updating/modernising some of the rooms and facilities, i.e. bathrooms, bedrooms and toilets would be an improvement’. Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using this service experience a poor outcome in this area. This judgement has been made using available evidence including a visit to this service. It is positive for residents that the staff team at the home is stable. However, the current staffing levels, gaps in recruitment and poor training provision at the home require work to ensure that residents needs can be met in full and that they are safe. EVIDENCE: The home has a reasonably stable staff team with a low turnover. Current staffing levels are 2 care staff morning and evening and at night. In addition to this are the managers hours during the week. No past rotas were available for inspection. The manager reported that these are taken off the premises by the proprietor. These should be available for inspection. The current staff levels limit the time that can be given to residents, especially with regard to social care and interaction, as the care staff are also doing the cleaning and the cooking whilst there is no chef. The manager should review the current levels with this issue in mind and address the shortfalls noted. One resident, who could go out with staff, is not able to do this at the current time. The manager has had a training need analysis carried out and has planed training related to the results. This documentation was not available for inspection. Training records do not evidence that any care staff have this Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 20 qualification but two staff will be undertaking NVQ level 2 at some point this year. Two staff files were checked to review the current recruitment procedures in the home. The manager reports that the proprietor often recruits and starts staff without her input. Staff files show a basic application form in place that requires review in order to show past employers etc. Other records show that staff have been working at other homes in the area but these are not evident on the application and have not been put forward as referees. References and immigrations status was in place but CRB checks were not on file, with old CRB checks from other homes being in evident. The manager reports that the proprietor actions these but there is no evidence of this on one file and no POVA first checks in place. This must be addressed in order to ensure resident safety. This was discussed with the manager. The proprietor of the home does not supply the manager with a training budget. The manager can only supply staff training through in house systems or free training supplied locally. She has been able to purchase training DVD’S. Staff have to self fund any training that ensures a cost. Training records show that compliance is quite good with food hygiene and medication training but there are significant shortfalls with regard to manual handling, fire safety, health and safety, infection control and first aid. In addition to this no training is provided for specialist subjects that would enhance the quality of care for residents, for example, diabetes, nutrition and continence etc. The manager has an identified list of training needs but no evidence that any training sessions are actually planned. The manager has an induction programme in place that at the current time is not linked to Skills for Care. A basic home induction is in place and these were seen to have been completed. Staff files show evidence of regular supervision. Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 21 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 and 38. People using this service experience a poor outcome in this area. This judgement has been made using available evidence including a visit to this service. Management systems in the home require work in order to ensure a safe, good quality service and that more residents’ views are regularly taken into account, affecting the development of services and facilities. EVIDENCE: The manager has been working at the home for just over a year. She is currently undertaking the registered managers award. At the last inspection the manager stated that she had taken on board the need for regular staff meetings, but has not actually carried this out, with staff meetings being held only once or twice a year. The last staff meeting was in March 2007. Good Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 22 minutes are taken and show that a wide variety of subjects are discussed and that staff actively take part. It is recommended that these continue on a regular basis. The manager needs to improve management systems in the home so that a quality service is provided, records are up to date and residents are safe. The recruitment and training of staff is of particular concern. On discussion the manager states that she is really only just starting to develop the quality assurance programme in the home. She has developed and completed resident, relative and visiting professionals questionnaires and has sent these out with limited success. It may be of value to consider different ways of obtaining feedback from residents as the manager says that obtaining feedback from them is difficult. A new system has been purchased for the home, which contains a series of audit, which cover, the environment, medication, accidents etc. but the manager has yet to start using these. Comments from the District Nursing team included ‘staff always helpful and clients always seem well cared for and relaxed. Till now I have had no problems at all with any aspect of help that I have needed’. Relatives comments included ‘ I am not sure if there are enough staff on duty in the evening to deal with food preparation and bedtimes’, ‘staff on duty are always charming and helpful even when under pressure’, ‘can my relative have her teeth in at mealtimes and she prefers tom soup’, ‘very happy apart from lack of communication and follow up regarding medical and personal care for my relative, however, when I did bring these matters to your attention they were acted upon promptly’, ‘very helpful and friendly staff’, ‘staff always do their best to answer questions’, ‘my relative seems contented and well settled’, ‘plus points are friendly nature of staff and informal welcome for visitors’, ‘Coral is a great manager very friendly compared to some other managers’ and ‘great improvement in last 3 months this needs to be kept up’. This feedback was dated December 2006. The manager does hold some personal monies on behalf of residents in the home. Some residents were seen to be spending money on continence pads as assessments are not up to date. This is not acceptable. The manager states that she is trying to get all of them assessed by continence advisor. Monies and records were checked at random. A two-signature system is in place and receipts are available. These were found to be in order. The home has a health and safety policy in place. An environmental risk assessment was completed in 2005/06. This now needs review. Accident records were inspected. These were seen to be correctly completed in sufficient detail and where required notifications had been made to the CSCI. The manager says that the number of accidents has reduced due to risk assessments and more close monitoring. There are also reduced admissions to hospital as staff are not ringing ambulances for inappropriate reasons. Arrangements in relation to fire safety were inspected in relation to the maintenance and testing of equipment. These were found to be in order apart Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 23 from inconsistent fire alarm testing, which had not been done since March 2007. This was discussed with the manager. A fire safety risk assessment was completed in 2004/5. This must be reviewed on a regular basis. Random sampling of maintenance and safety certification for equipment and fixtures in the home was undertaken. The certificate for the electrical wiring of the home was only partly available and therefore not evidencing an expiry date, with the initial work being carried out in 2004. The manager reported that the gas safety checks had just been completed and they were awaiting the certificate. The home has a chair lift, which does not have an up to date safety certificate in place. The manager reports that the proprietor often takes such documents off the premises. The manager was reminded that these must be available for inspection. The home has one lifting hoist with a sling system. At the current time the manager reports that this has no safety certificate as no residents are using this. It is stored in the shed. This was discussed, as this equipment may be of use should a resident fall or suddenly need hoisting. This type of equipment should be available so that residents’ needs can be met at all times and staff are ‘lifting’ safely. Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 1 Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 and 23 Requirement The manager must ensure that she has all the required information with regard to medical history so that admissions to the home are within the registration category and that the team can meet the needs of the individual. Residents must have an up to date care plan in place that outlines their current needs. This must be kept under review and where possible involves them or their relative in the process. Where risk assessments are completed for residents these must outline the current risk and subsequent management and be kept under regular review. Residents’ weights must be regularly monitored and the appropriate plan of care put in place. Prescribed medication must not be dispensed into alternative containers. Residents care plans must reflect their individual preferences and choices regarding their care and DS0000017443.V342688.R01.S.doc Timescale for action 14/09/07 2 OP7 12 and 15 30/09/07 3 OP8 12 and 13 30/09/07 4 OP8 12 14/09/07 5 6 OP9 OP10 OP14 13 12 14/09/07 30/09/07 Roseland Care Home Version 5.2 Page 26 7 OP12 16 8 OP15 16 9 OP18 13 10 OP19 13 and 23 11 OP26 OP27 18 12 OP29 18 13 OP30 18 14 OP30 18 be more person centred to evidence that staff appreciate the diversity of individual residents. Through assessment and consultation, the team at the home must ensure that residents’ individual social care needs are met and that their independence and self worth is promoted. The team need to evidence that residents are receiving an appropriate diet, that alternatives are offered and that specialist diets are properly catered for. The manager must ensure that all staff receive training in the protection of service users from abuse and recruit staff appropriately to ensure residents safety. The home must be maintained in a safe manner with regard to regular testing of fire alarms, review of fire risk assessment, provision of a safety certificate for the wiring of the home, the chair lift and resident lift hoist. Sufficient care and ancillary staff must be employed and on duty to ensure that the home is clean, suitable meals are provided and that residents needs can be met in full. All staff working at the home must have the appropriate police/personal checks in place to help ensure resident safety. Training in fire safety, first aid, manual handling, infection control must be provided to all staff to ensure the safety of residents and that the staff team can meet all their needs. Training in additional subjects that relate to the individual care DS0000017443.V342688.R01.S.doc 30/09/07 30/09/07 30/09/07 30/09/07 31/08/07 14/09/07 30/09/07 30/09/07 Page 27 Roseland Care Home Version 5.2 15 OP33 24 16 OP35 12 and 13 17 OP38 13 18 OP38 OP27 OP29 17 needs of residents must be provided in order to ensure that the care needs of residents can be met in full. This relates to, for example, diabetes, mental health, dementia, continence etc. A robust quality assurance system must be in place that obtains feedback from residents, relatives and visiting professionals and is backed up by an internal audit system. All residents must have up to date continence assessments where required so that their personal monies are being spent appropriately. Residents using bedrails must have the correct equipment in place. Manager advised on the day of the inspection. Records required under the Care Home Regulations 2001, must be available for inspection in the home at any time. 30/10/07 30/09/07 31/08/07 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP1 OP7 OP8 OP16 Good Practice Recommendations The service user guide should be reviewed so it is more user friendly for residents in relation to format, print size etc. and be freely available in the home. Consideration should be given to developing a more person centred approach to care planning. The use of skin creams in the home should be reviewed in order to ensure that they are appropriate to the care needs of residents. The format of the complaints procedure should be reviewed with the resident group in mind to make it more DS0000017443.V342688.R01.S.doc Version 5.2 Page 28 Roseland Care Home 5 6 7 8 OP19 OP28 OP31 OP38 accessible to them. Residents should be involved in choosing the décor of their rooms and the home in general. NVQ training should be provided to all care staff to help improve the quality of care provided to residents. Regular staff meetings should be held. The environmental health and safety audit should be reviewed. Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Harrow Area Office 4th Floor, Aspect Gate 166 College Road Harrow London HA1 1BH 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 Roseland Care Home DS0000017443.V342688.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!