CARE HOMES FOR OLDER PEOPLE
Roselands Cackle Street, Main Street Brede, Rye East Sussex TN31 6EB Lead Inspector
Jason Denny Unannounced 18 July 2005 10:00 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. Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Roselands Address Cackle Street Main Street Brede, Rye East Sussex TN31 6EB 01424 882338 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) Pleasantly Limited Miss Sylvia Wells Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (OP) 20 of places Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The number of service users to be accommodated must not exceed 20 (twenty) 2. The care home can only provide personal care to older people aged 65 (sixty five) years or over on admission Date of last inspection 24 January 2005 Brief Description of the Service: Roselands is a converted Guest House that has been adapted to its present use as a care home. It has extensive grounds and off road parking. Roselands is located in an isolated and quiet situation outside of the village of Brede near to the town of Rye in East Sussex. Residents are able to safely walk around its extensive grounds with the long driveway a popular walking route. Roselands is registered for 20 people who are over the age of 65. The home is suitable for people over 65 years who are vulnerable and in need of care and support. The home has level access throughout with the provision of a shaft lift and ramping. The home also has its own passenger lift. There are 19 rooms one of which can be used as a shared facility. Five bedrooms have en-suite shower or bath facilities. Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an Unannounced routine inspection [first of two planned before April 1st 2006], which took place on Monday July 18, between 10.00am and 2.15pm. The Inspection found that of the 16 National Minimum Standards inspected, that 10 of these standards had been fully met with all others nearly met with progress being made since the last inspection. The overall focus of the inspection was on residents’ involvement in the home, the environment, staff training, and newest Residents. This included discussions and examination of a range of records. The inspector started the inspection by speaking with 3 staff followed by residents [7 in total] in communal areas. The rest of home was also toured including bedrooms and bathrooms. Two residents were spoken with in their room. A discussion with the management team took place around progress since the last inspection. Activities were assessed along with how the home protects vulnerable people. Care and staff documentation were inspected. At the time of the inspection the home was providing services to 12 people. What the service does well: What has improved since the last inspection?
The care-plans now show the full range of Residents needs, along with how these will be met in practice, with evidence of ongoing and regular review with changes indicated. Four care staff have started the National Vocational
Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 Page 6 Qualification [NVQ] in Care level 2. The induction of new staff is full with other established staff recently going on a refresher course. The home’s recruitment practice in relation to new staff is tighter with all main checks carried out. The home now maintains written evidence of staff being supervised and supported in their roles. Other aspects of administration were seen to be improving. The manager has started a NVQ level 4 in Management and Care. All radiators have been covered with a nice wood finish. Safety valves are now fitted to all hot Water outlets available to Residents. Some maintenance of electrical works has taken place. Restrictors are now fitted to all windows. Some painting had also taken place in the home. Evidence was seen of how the home was moving towards meeting most of the other standards. The organisation which own and manage Roselands have since the last inspection sent the Commission monthly reports of their visits to show how the home is being supported. 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.
Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The way in which the home assesses prospective or existing residents ensures that it continues to meet needs. The Inspector found that the home’s assessment information was full, and tallied up with his observations and discussions with individual residents and staff. The home was seen to comfortably meet the needs of all residents. EVIDENCE: The inspector looked at 5 assessment records including the newest resident along with the resulting care-plans. Those residents concerned, along with their key working staff, as well as the manager, were spoken with. Residents were also observed in relation to how staff supported them, such as with walking about. The home manager and her deputy had personally assessed residents before moving in, based on the assessments examined. The manager also confirmed in writing to relevant people whether or not the home could meet particular needs. Some pre-assessment information also had care plans from previous homes along with a social care assessment from social services where they were paying the fee. The home has purchased and introduced a new format for recording assessment information. This format was found to be comprehensive and clearly presented. The information for example, showed peoples preferred waking up, and retiring times.
Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 Page 9 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 Care plans have improved to clearly show the needs and abilities of each resident and how these needs are met in practice. Any diverse or cultural needs are recorded where required. The home was found to be meeting resident’s health needs and was fully aware of what additional support it required. The inspector judged that resident’s rights were upheld with plans indicating what they can do for themselves. Staff demonstrated a good understanding of the key areas in the care-plans leading to positive outcomes. EVIDENCE: Five Individual plans of care were inspected and were found to be sufficiently detailed, up to date, and contained clear information. Since the last inspection the home has introduced a new form along with the care-plan to show an ongoing assessment of needs. These were found to be filled in on a monthly basis with any changes indicated. The plans were found to be user-friendly and covered the full range of health needs, which the inspector observed during the inspection. Staff were found to contribute to the plans of care and were found to be actively involved in them. Each established resident had clear risk assessments such as around Moving and Handling, resident’s ability to mobilise, and the risk of falls. Staff interviewed, were clear about the main content in the Care-plan and explained how care-plans showed the choices which resident can make and what support if any, they need with personal
Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 Page 10 care. One resident with a recent history of dental problems indicated how this need was promptly met when moving in to the home. This was also confirmed in records. The home was found to have introduced photographs of each resident to go on the front of their care-plans to assist staff to put a face to the information contained. Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 Page 11 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 The home was found to provide a good range of activities based on resident preferences. Routines were found to be flexible for Residents who are treated as individuals. EVIDENCE: Staff, management, and residents indicated that activities are organised depending on the preferences and needs of Residents. Staff who have worked in the home over 5 years explained that the level of activities in the home depend on what Residents live there. It was explained that the current group of 12 residents are not demanding a lot of activity although some activity is taking place regularly. A music man visits quarterly, and 3 of the residents go out on mini-bus outing on weekly basis with another organisation. Several churches visit on a monthly basis and organise communal services. The home was found to have a range of activity aids such as bingo cards and board games, such as chess. Records and discussions showed that Residents preferences for activities and interests and hobbies are recorded when people move into the home. Some residents were observed to be listening to Wartime music in a lounge. One resident indicated that he liked the fact that the home was located some distance from the road and had large grounds. This fact encouraged him to go for daily walks with no risk to his safety. Residents were observed to come and go as they pleased with some choosing to take meals in their rooms or read their own ordered newspaper in the conservatory.
Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 Page 12 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) 16 & 18 The home operates in an open manner and has not had a formal complaint or concern in recent years. The home has a clear recording form should any complaints be made. Staff continue to demonstrate a sound understanding on how to prevent and report abuse in accordance with the homes policy. All Residents and visitors are made fully aware of how to complain or raise concerns. Staff were observed to treat residents with the highest levels of respect and sensitivity. Residents have their valuables securely stored. EVIDENCE: The home has a comprehensive complaint policy. This procedure and forms are in the reception area to the home and in resident’s contracts. There was no record of any complaint made to the home since the Commission came into existence in 2002. The inspector saw a form for recording complaints or concerns. The manager was advised to put these into a clearly labelled complaints file. The home was found to have a policy on the prevention of Abuse and guidelines on how to report suspected abuse. Staff who spoke with the inspector demonstrated a full and sound understanding of all the issues involved, including whistle blowing and who to report concerns too. A number of staff have covered formal adult protection training on either their NVQ’s, in their induction, or in basic care practice training. All Residents spoken too confirmed the sensitive care they receive and were knowledgeable about whom to report concerns too. Residents were observed to have immediate access to them. Residents are not encouraged to bring in valuables into the home. However, the home has a safe deposit box for residents, which only the manager and her deputy have, access to. A record is maintained of any valuables deposited. In addition to this residents have the option of their own
Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 Page 13 room key, or for their room to be locked on their behalf. In each room there is a lockable wall mounted safe box. Where this box is not used for storing medication, residents can store valuables within. Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 Page 14 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) 19,21,22 & 24 Roseland’s has a homely and well-appointed feel throughout especially in regard to a well-maintained conservatory, lounge and dining room, which are popular with residents. Bedrooms are spacious and well equipped with many enjoying sweeping countryside views. Resident’s benefit from extensive grounds and the off road quiet location. The front entrance area to the home lets its down and does not reflect the quality of most of the interior. One working suitable bathroom area is insufficient for a home registered for up to 20 people. Some hallway areas need redecoration. EVIDENCE: The inspector toured both the interior and exterior of the home. The front entrance to the home, which includes a ramped access, was inspected, including paintwork windows and front door entrance all of which needed attention. The main areas identified for attention were the window frames and front door. The front garden was found to be decorative and well maintained. All communal areas were toured including a dining room, a lounge, and a popular conservatory area. The inspector looked in all rooms except that of a resident who was ill and who had visitors. The inspector saw the one working bathroom complete with
Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 Page 15 adaptations for the needs of older people. A shower room was inspected although the shower was in need of repair and adaptation, to create safe walkin access. This shower was also located in the same room as a sluice. The manager pointed out the difficulty of finding an alternative room although the home are exploring options such as a extension. Five of the bedrooms have either showers or baths although these are not used in practice. Residents prefer or require support with bathing, which usually means that 2 care staff is needed, meaning one bath at a time. The home stated that at the present time the one bathing facility was meeting the needs of 12 people. Bedrooms were found to be well equipped, clean, tidy and popular with all residents spoken with. The premises were found to be safe with level access throughout, along with ramps and a working passenger lift. The home was found to be looking to organise an assessment of the home by a occupational therapist just in case any further adaptations are needed. The inspector noted some cracks on window-sill areas in some rooms and communal areas. Some parts of hallways needed repainting. The inspector saw that an initial attempt had began on some walls in the form of a alternative colour being painted on in a few lines leaving a clash of colours. A plan for redecoration works was requested. Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 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) 27,28,29 & 30 There were sufficient numbers of staff on duty on the day of the inspection to meet needs of resident’s along with other tasks. The rota showed that all times there is sufficient staff to meet assessed need. The home was found to have tightened recruitment checks in order to protect residents and ensure the suitability of workers is established before employment commences. Staff training has improved in relation to inductions for new staff and National recognised qualifications. Residents praised the quality of the staff and gave examples of how well supported they are. Staff stated how impressed they were with recent improvements to training provision, which was assisting them in their jobs. Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 Page 17 EVIDENCE: According to records and discussions with the management, two care staff cover the morning and two care staff cover the afternoon and evening shift. This is complemented by both the manager and deputy who worked 9-5pm and assist on the care-side where required. In addition the home has cleaner, a cook and kitchen assistant 7 days of the week. The cook prepares all meals including suppers. On the day of the inspection due to a vacancy, the deputy was doing the cooking. Staff confirmed that staffing levels were suitable to meet needs. Staffing levels were found to be unchanged since the last inspection despite a fall in resident numbers. Four staff have since the last inspection started a NVQ 2 course. One staff member was awaiting a visit from her assessor. The home currently has one person with this qualification but is on course to meet that Government target of 50 of care-staff with this qualification by December 2005. Two of the staff interviewed indicated that they had the fuller range of basic training such as food hygiene, fire, first aid, Moving and Handling along with other training. These staff had also done a basic care course along with a foundation course. The manager stated and showed, that new staff now go straight onto the NVQ as an condition of employment. A Staffing file of the newest member of staff was inspected. Three appropriate references were found along with a police CRB before employment in the home officially started as confirmed by the manager. The manager was aware of Protection of Vulnerable Adults checks prior to employment commencing but stated that she prefers to wait for the full Police Criminal Records Check before starting someone in the home who has at least 1 weeks Shadowing by a senior member of staff. The person’s application form was complete except for the absence of a section accounting for gaps in employment history. The home was found to have developed a training and development programme to meet NTO workforce training targets. The inspector saw a completed induction. Five staff [including new staff] were found to have had a one day induction course at a local college since the last inspection. A checklist induction into the homes systems was also seen and completed. Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 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) 31,33 & 36 The home continues to benefit from a well-established, skilled, and motivated management team. The home was found to be conducted in an open and friendly manner with staff supported to carry out their roles. The manager was found to have introduced formal written supervision to assist and support staff to meet the aims of the home. The home was again advised to demonstrate and encourage the full involvement of residents in the running of the home by regular surveying of their views with an action plan developed based on the results. EVIDENCE: The registered manager has started a NVQ Level 4 in care and management as confirmed in discussions. The deputy/assistant manager has a National vocational qualification at both Level 2 and 3. The staff team were observed to have easy access to management. The inspector spoke to a number of Residents and staff about how the home was managed which indicated positive outcomes.
Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 Page 19 The home has now fully developed its own quality assurance system for measuring the views of Residents and their representatives. The home has implemented a questionnaire-based system. The inspector examined copies of the 5 questionnaires filled in which date back to December 04. The manager stated that these questionnaires would shortly be offered to all residents and their representatives. Once this survey takes place a short report of the main outcomes along with an action plan will be published in the home and placed in the service user [resident] guide. This action plan will in turn inform the overall yearly plan for the home. Since the last inspection the Commission has received monthly visit reports by the managing organisation’s representative. The home has over the last two months introduced written supervisions for staff with the aim of these occurring at least 6 times a year. A sample of these were seen which showed staff receiving feedback on their performance as well as discussing any issues. A visitor’s book was found to have been introduced on the day of the inspection, based on protecting the safety and rights of residents. Entries were found in the book of people who had arrived before the inspector. Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 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 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 2 x 2 2 x 3 x x STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x 2 x x 3 x x Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 19 Regulation 23[2][b]& [d] Requirement That the home must be kept in a good state of repair and decoration, both externally and internally. That the Registered provider sends the Commission its plan by the timescale shown for the redecoration and renewal of the front entrance area to the home, and the internal redecoration of some communual hallways and window sills. That the bathing facilities within the home must be improved to provide service users [Residents] with sufficient and suitable facilities. Requirement made at the last Inspection January 2005. That further development of the home’s quality assurance monitoring systems must take place. That service users [residents] are regularly consulted as to their views by the use of a survey. That the results of this survey are published in the home in the form of a report including an action plan and how this affects the overall annual plan for the Timescale for action 18/10/05 2. 21 23[J] Timescale Extension 18/11/05 3. 33 24 Timescale Extension 18/11/05 Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 Page 22 home. requirement of the last 5 Inspections. Requirement first made 30/03/03. 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 22 Good Practice Recommendations That an assessment of the premises and facilities should be undertaken by a suitably qualified person, or qualified Occupational Therapist, to advise on the suitability of disability equipment and environmental adaptations. That gaps in the candidates employment history for at least the last 5 years, are accounted for on the homes application form. 2. 29 Roselands H59-H10 S21197 Roselands V231316 180705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Ivy House 3 Ivy Terrace Eastbourne East Susssex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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