CARE HOMES FOR OLDER PEOPLE
Roselands Cackle Street Main Street Brede Rye East Sussex TN31 6EB Lead Inspector
Jason Denny Unannounced Inspection 8th November 2005 10:45 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 Roselands DS0000021197.V260727.R01.S.doc Version 5.0 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. Roselands DS0000021197.V260727.R01.S.doc Version 5.0 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 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) Pleasantly Limited Miss Sylvia Wells Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Roselands DS0000021197.V260727.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The number of service users to be accommodated must not exceed 20 (twenty) The care home can provide personal care to older people aged 65 (sixty five) years or over on admission 18th July 2005 Date of last inspection 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 and safe 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 DS0000021197.V260727.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an Unannounced routine inspection [second of two planned before April 1st 2006], which took place on November 8, 2005 between 10.45am and 1.50pm. The Inspection found that of the 14 National Minimum Standards inspected, that 7 of these standards had been fully met with all others nearly met with progress being made since the last inspection. One standard was exceeded in relation to medication arrangements. The overall focus of the inspection was on following up on the more detailed inspection of July 18, 2005 of which this report should be read in conjunction with. Along with communal areas and quality assurance new area such as food, medication, the home’s resident’s guide, and how health needs are met, were also looked at. The inspector started the inspection by speaking with 5 residents in communal areas. A discussion with the manager took place around progress since the last inspection. Care records were inspected. At the time of the inspection the home was providing services to 15 people. What the service does well: What has improved since the last inspection?
The first floor communal hallway is in the process of being decorated. The home’s applications form now has a section to include gaps in an applicant’s employment history to assist the home to have more information before deciding to employ someone. The home has given thought to how to more
Roselands DS0000021197.V260727.R01.S.doc Version 5.0 Page 6 quickly provide more that one supported bathroom for up to 20 residents. This includes a plan to purchase a portable hoist, which will open up the use of 5 other bathrooms, along with a plan to make a shower room accessible. The home had originally planned to improve facilities with an extension, which would take longer to achieve. 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 DS0000021197.V260727.R01.S.doc Version 5.0 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 Roselands DS0000021197.V260727.R01.S.doc Version 5.0 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 the following standard(s): 1 The home provides prospective new residents with a basic level of information, which could improve further and be up to date. The information, which is provided, could be better displayed in the home to promote access. Standard 3 assessed and met at the last inspection. Standard 6 not applicable. EVIDENCE: The home’s service user [residents] guidebook, which also contains the statement of purpose, was found in a blue folder in the hallway, which leads off from the reception area. The folder had a small label on one corner identifying it as the guide. The statement of purpose corresponded to all the areas identified in the National Minimum Standards. The guide did not contain the last inspection report of July 18, 2005, but the one before in January 05. A sample contact was seen although this did not include the range of fees charged. The Managers qualifications were not listed. No views of service users [Residents] were found in the guide. The home’s leaflet on the service had a range of photographs and information although the name of the registering body was of pre-April 2002. [East Sussex County Council].
Roselands DS0000021197.V260727.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9 and 10 Care plans 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 as confirmed by visitors, specialists, and residents. Medication arrangements were found to be exceptional due to the provision of medication security safes in each bedroom, which reduces the risk of mistakes. EVIDENCE: Two Individual plans of care were inspected which were found to be filled in on a monthly basis with any changes indicated. The plans were found to be userfriendly and covered the full range of health needs, which the inspector observed during the inspection. Each established resident had clear risk assessments such as around Moving and Handling, resident’s ability to mobilise, and the risk of falls. One resident’s dental issues and other health areas were promptly met when moving in to the home as confirmed in records and discussions. The inspector spoke with the district nurse who was visiting the resident for a skin condition. She confirmed how the home meets the health needs of residents. Staff were observed dispensing medication. Medication records and storage facilities were examined.
Roselands DS0000021197.V260727.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 15 The inspector sampled a meal, which was found to be hot, tasty, plentiful, wholesome, and healthy. Residents [Service users] confirmed that they liked the food, that there is choice, good portions, and flexibility about mealtimes including where they take meals. Residents are consulted with on a daily basis in relation to meal choices. EVIDENCE: The kitchen was inspected in relation to food stocks and shopping arrangements, which includes the delivery of fresh fruit. Residents were spoken with in relation to the food and when and where it is served. Breakfast was identified as usually starting around 8am either in rooms or in the dining room with others having this earlier if they prefer. A meal was observed being prepared by the manager and was sampled by the inspector. Menu sheets are completed on a daily basis where residents are consulted with in relation to their choices. These menu sheets were seen during the inspection. Roselands DS0000021197.V260727.R01.S.doc Version 5.0 Page 11 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 the following standard(s): None of these standards were inspected at this inspection. Standard 16 and 18 both fully met at the last inspection 18 July 2005. No complaints made since the last inspection. EVIDENCE: Roselands DS0000021197.V260727.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 19,21 & 22 Roselands 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 although work has started. The home was found to have formulated a plan to address all shortfalls with completion of work expected by the next inspection. The home is advised as best practice, rather than any particular concern, to have the premises assessed by an occupational therapist. 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,
Roselands DS0000021197.V260727.R01.S.doc Version 5.0 Page 13 including paintwork windows and front door. Hallway painting on the first floor was found to have started with all other work identified in the last report due to be completed by 31/03/05. The interior of the home is taking priority as evidenced in a plan sent to the Commission since the last inspection. All communal areas were toured including a dining room, a lounge, and conservatory area. A possible shower room referred to in the last report was still in the process of being made fit and safe for possible use by residents with the manager stating that this should be soon. 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 supported bathing facility was meeting the needs of 15 people. The manager stated that she had a quote for a portable hoist, which she is hopeful of purchasing before the end of the year. If the hoist is purchased this will mean that the other bedroom baths referred to and another communal bathroom, which currently is unsupported, would be accessible for use. The home showed evidence of looking into an occupational therapy assessment of the premises with the owner stating cost as being prohibitive based on quotes so far collected the lowest being £250. There was no evidence that any particular residents required this service. Roselands DS0000021197.V260727.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 The home has improved its application form to ensure that the tightest possible recruitment practices are followed in the best interests of residents. All staffing standards inspected at the last inspection 18 July 2005. EVIDENCE: The inspector examined the home’s revised application form, which now includes a section to encourage the applicant to account for any recorded gaps in their employment history. All other aspects of recruitment was found to be fully met at the last inspection as evident in staffing files examined. No new staff have started work in the home since the last inspection. The home is looking for a full time cook to relieve the responsibility on the manager and the deputy. Roselands DS0000021197.V260727.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 The home continues to benefit from a well-established, skilled, and motivated management team. The manger is advised to complete the relevant management course as soon as possible in line with the expectations of being registered. 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. Financial arrangements for residents are sensibly managed by the home. Health and Safety areas were found to be in order with the exception of electricity certification. EVIDENCE: The registered manager was described at the last inspection of having started a NVQ Level 4 in care and management. However it was confirmed at this inspection that no progress had been made since the last inspection although the course had now been commenced following a visit from a tutor the
Roselands DS0000021197.V260727.R01.S.doc Version 5.0 Page 16 previous day. 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 manager stated that she is looking at developing an effective office area. The home has developed its own quality assurance system for measuring the views of Residents and their representatives. The manager again 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 showing written evidence of resident involvement and improving information to prospective new residents. The Commission receives monthly visit reports by the managing organisation’s representative although there is no reference to the views of residents in these reports. The last report 181005 did contain a reference to one resident requesting a particular type of fiction publication. The homes health and safety certification was inspected with the only exception being Portable Appliance Testing information and Mains electricity. The manager stated that the registered provider had organised for this to be carried out. The inspector therefore requested that evidence in the form of safety certificates is sent to the Commission. Roselands DS0000021197.V260727.R01.S.doc Version 5.0 Page 17 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 4 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X 2 2 X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Roselands DS0000021197.V260727.R01.S.doc Version 5.0 Page 18 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 OP1 Regulation 5 & 6[a] Timescale for action That the Service user guide must 01/02/06 be kept up to date and must contain all necessary information namely: Service user views on the home, the Manager’s qualifications, the range of fees charged, and the most recent Inspection report. That the guide is clearly displayed and available in the home. That the home must be kept in a 01/04/06 good state of repair and decoration, both externally and internally. That the Registered provider must complete the necessary work by the extended timescale shown for the redecoration and renewal of the front entrance area to the home, and the internal redecoration of some communal hallways and window sills. [Requirement made at the last 2 Inspections.] Requirement first made July 2005. Timescale Extension 01/04/06 That the bathing facilities within 01/03/06 the home must be improved to provide service users [Residents] with sufficient and suitable
DS0000021197.V260727.R01.S.doc Version 5.0 Page 19 Requirement 2 OP19 23[2][b]& [d] 3 OP21 23[J] Roselands 4 OP33 24 5 OP38 13[4] facilities. [Requirement made at the last 3 Inspections]. Requirement first made January 2005. Timescale Extension 01/03/06 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 showing how this affects the overall annual plan for the home. Requirement of the last 6 Inspections. Requirement first made 30/03/03. Timescale Extension 01/03/06 That the Registered Person must by the date shown send the Commission a safety certificate in relation to both Portable Appliance Testing and Mains Electricity. Electricity at Work Regulations 1989 01/03/06 08/01/06 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 OP22 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 monthly section 26 reports contain clearer evidence that sufficient number of service users have been spoken with in order to form an opinion on the quality of the care.
DS0000021197.V260727.R01.S.doc Version 5.0 Page 20 2 OP33 Roselands Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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