Inspection on 29/11/06 for Rosemary Lodge

This inspection was carried out on 29th November 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rosemary Lodge 18/06/07

Rosemary Lodge 24/02/06

Rosemary Lodge 26/08/05

Rosemary Lodge 23/11/04

Rosemary Lodge 14/04/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Rosemary Lodge 9 The Drive Wimbledon London SW20 8TG Lead Inspector Janet Pitt Unannounced Inspection 29th November, 4th & 11th December 2006 09:55 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 Rosemary Lodge DS0000019118.V321759.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. Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosemary Lodge Address 9 The Drive Wimbledon London SW20 8TG 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 8946 6963 020 8296 0025 The Wimbledon Guild Mrs Margaret Redway Care Home 44 Category(ies) of Dementia - over 65 years of age (4), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (4), Old age, not falling within any other category (22), Physical disability (25) Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can admit up to four named service users aged 50 years and over. 24th February 2006 Date of last inspection Brief Description of the Service: Rosemary Lodge is situated in a residential area of Wimbledon, close to local bus routes. The home is within a twenty-minute walk to Wimbledon Village. The home provides nursing and personal care for up to forty-seven older people. Rosemary Lodge is registered to provide care for up to four people with dementia and up to twenty-seven people who may have physical disabilities. The home is owned and managed by the Wimbledon Guild a registered charity. Accommodation is provided over three floors and includes a lounge, sun lounge, dining room, thirty-two single bedrooms and four shared bedrooms. Two passenger lifts serve each floor. Rosemary Lodge has access to a large level garden, which is mainly laid to lawn, with a paved area, pond, shrubs and trees. There is limited parking to the front of the home, however parking is also available on the street. Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced inspection. Three site visits were made lasting a total of nine and a quarter hours. Thirty surveys were sent to residents, relatives and staff members. Nine resident, twelve relative and eight staff surveys were completed. Findings from these surveys are reflected in the report. Three telephone conversations with relatives were held and one email was received in respect of the service. Records relating to staffing and care planning were examined. A tour of the premises was undertaken. The inspector had the opportunity to talk with three residents during the site visits. Five members of staff, including the manager were spoken with. The inspector was able to observe a staff meeting during one site visit. Fees range from £506 to £731, depending on assessed needs. What the service does well: What has improved since the last inspection? What they could do better: The home needs to improve in many areas. These are detailed in the main body of the report and the requirements. A quote from a survey sums up the main issues: ‘Generally the home is good and the staff are well-meaning. In an emergency they really pull together very well and are thoughtful and kind. It is in the every day sphere that there are failings- a general lack of organisation and efficiency and leadership.’ The person also raises concerns about use of temporary staff and the perceived impact on continuity of care. The quote finishes: ‘It would be good if organisation and efficiency could be improved without sacrificing the pleasant un-institutional atmosphere.’ Rosemary Lodge DS0000019118.V321759.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. Rosemary Lodge DS0000019118.V321759.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 Rosemary Lodge DS0000019118.V321759.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, 2, 3 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The admission of new residents is not particularly personalised and there is little consideration of individual needs. Assessments of residents do not fully identify their needs. Not all residents are provided with a copy of their contract. Prospective residents and their representatives are able to visit the home prior to admission. EVIDENCE: The majority of residents receive a contract detailing what is included in the fee. One of the respondents to the surveys said they had not received a contract. The majority (eight out of nine) resident respondents said they had received enough information prior to moving into the home. Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 9 A member of staff was showing prospective relatives around the home on one of the site visits. One comment from a survey stated: ‘My sister and I looked at four other homes before choosing this one. There were a lot of practical things I needed to know that I am only finding out by trial and error when visiting.’ Residents and their relatives need to be confident that information is given once someone has been admitted to the home. Residents are assessed prior to and on admission to the home. Examination of assessments showed that limited information was taken prior to entering the home. Religious needs and preferred language were noted. However, other social information such as occupation or social interests were not consistently detailed. Moving and handling assessments did not specify the type of hoist or sling size to be use. Interventions for challenging behaviour and ‘wandering’ were not detailed in assessments. Vague phrases such as ‘regular aperients’ and ‘no issues with speech’ did not provide clear information on needs. This places residents at risk of not having care needs identified or met. Assessments examined were completed by one nurse and therefore information was not individualised and resident focused. This was discussed with the manager. Comments from surveys and telephone conversations mentioned lack of permanent staff in the home affecting care. All staff whether permanent or agency must make sure that they act according to their Codes of Conduct and provide a professional service. Rosemary Lodge DS0000019118.V321759.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, 9,10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident has a care plan but the practice of involving residents in the development and review of the plan is variable. The plan in most cases includes the basic information necessary to plan the individuals’ care and includes a risk assessment. Residents have access to health care services both within the home and in the local community. There is evidence in the care plan of health care treatment and intervention, but this lacks specific detail. Staff need to be aware of the need to treat residents with respect and dignity. The wishes of residents about terminal care and arrangements after death are not always recorded. Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 11 EVIDENCE: Residents’ need to be confident that care plans are individualised and contain specific details of how needs are to be met. There was limited evidence of how to deliver care in plans. One care plan examined was noted to lead from assessed needs, and there was evidence of intervention by other health professionals as identified in assessments. This needs to be consistent. Interventions to make sure that needs are met were not detailed. For example, one resident presented with challenging behaviour, but there were no details of how this presented. A care plan on managing a resident who also presented challenging behaviour had: ‘[the resident] disrupts the atmosphere of the other residents at times and tends to knock on the table with a spoon, fork or knife.’ There was no information on how this behaviour could be minimised and what the cause of it was. Surveys respondents indicated that they usually or always received the care and support they required. However, some improvements could be made. Comments included: ‘ One to one care could be improved especially feeding assistance and physiotherapy’ and ‘the large number of temporary staff and the lack of clear leadership “at the coal face” means that care and support is uneven, although always well meaning.’ Staff surveys also echoed these concerns about use of agency staff and leadership of the home. Action needs to be taken to make sure that there is consistency in care given. If agency staff are relied on, then the home must make sure that these people carry out their duties in a professional manner. Daily records do not consistently document how care needs are met. Bland phrases, such as, ‘washed and dressed’ and ‘fluid encouraged at all times’ do not evidence specific interventions to make sure that care is given according to the resident’s plan. Concerns were raised about communication between staff and residents: ‘few of the staff seem to have the necessary skills to communicate effectively with people with dementia. This results in frustration on both sides and leads to behaviour towards residents which is often insensitive and sometimes downright rude.…There is a tendency to adopt over-familiar forms of address towards people used to the standards of courtesy and professional distance of the older generation.’ The home must make sure that staff maintain residents’ privacy and dignity at all times. Medication systems within the home do not always make sure that residents are protected from harm. Examination of the Medication Administration Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 12 Records (MAR) showed there were no gaps in recording of medicines administered, but topical cream administration was not consistently noted. Residents’ allergies were not always noted on the MAR sheets. One resident was noted to be on Warfarin, but the dosage was not clear. Entries had been by hand and were seen to have been crossed out and re-written. ‘As directed’ and ‘as required’ were noted to be on some prescriptions. Clear instructions for administration are needed to make sure that residents receive the correct treatment. Some residents had dressings prescribed and supplied, even though wounds had healed. A senior nurse was asked about this. They reported that it was so the home could have a stock. The home must make sure that there is no stock of any prescribed products, prescribed products are the property of the resident and not the home. There was difficulty in tracking wound care, entries were noted to have been made inconsistently and there was a lack of wound charts. One example noted was when an entry in September 2006 noted wounds on a resident’s legs, the next entry relating to these wounds was in November 2006. This could lead to residents not receiving adequate wound care. There has been some improvement in detailing end of life care. Staff must make sure that residents wishes are documented and acted upon. One resident was noted to follow a particular faith, but had no wish to practice. The care plan stated: ‘encourage to participate in services and encourage to see priest.’ This does not indicate that relevant information about residents is being acted upon. Rosemary Lodge DS0000019118.V321759.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are given the opportunity to take part in activities within the home, but wish to have more activities in the community. Food served is generally good, but variety is needed in the evening meals. Visitors are able to meet with residents in private. Noise levels within the lounge need to be addressed to enable a sociable environment. Staff need to be aware of how to approach residents in an appropriate manner. EVIDENCE: Surveys indicated that activities could be improved. Only two of the nine resident surveys received indicated that there were usually or always suitable activities. Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 14 Comments included: ‘It is not always possible to be included in outdoor trips because places for wheelchairs in the transport used by the home is limited.’ And ‘there is little activity that [the resident] can participate in. [They] enjoy music and one to one contact like manicures and aromatherapy, but this is infrequent.’ ‘the activities organisers seem to be fairly comfortable devising activities for residents without mental [health] problems, but at a total loss when it comes to providing for those with dementia. There is a complete absence of any creative or tactile activities, and more effort could be made to find out what kinds of activities individual residents might find engaging.’ Other comments raised concerns about the level of noise within the lounge area. As follows: ‘The atmosphere in the lounge with TV blaring is neither peaceful nor stimulating and with a little more thought and imagination this could be much improved.’ Relatives when spoken with also mentioned this. It was noted during site visits that the television was relied on for stimulation when there were no planned activities. Residents were not consistently asked about whether they wished to watch the programme on the television. One resident was engaged in reading a newspaper and then attempted to do the crossword. When the resident asked for help the member of staff who assisted was unable to communicate effectively. It was apparent that the care worker did not know how to approach residents and assist them with activities. The home must make sure that activities are planned with all residents needs taken into consideration. Residents will then be able to lead fulfilling lives and maintain their interests. The home has a spacious dining room, which is light and airy. It provides a socialable space for residents to dine in. The majority of surveys indicated that food served was good. Improvements could be made with supper: ‘The food is very good and not overly “institutional” in its presentation and service. However suppers are very unappetising and not nutritious.’ And ‘the lunch seems varied and nutritious, but the tea time/supper menu is bland and unimaginative with too much tinned pasta.’ One carer was noted to offer one resident a drink, but none of the other four in the room. Visitors are made welcome in the home. All surveys received from relatives indicated that they were able to visit in private if they wished. However, one comment stated that the lounge was not conducive to visiting, due to noise levels. Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 15 There were issues with visiting immobile residents in private: ‘Until recently it was not easy to see immobile residents in private, but it has now been agreed that relatives can ask for them to be moved from the lounge for visits.’ This does not demonstrate that residents are given choice and control over their lives. Residents need to be able to maintain significant relationships. Limited evidence was available in care documentation about this subject. Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that generally meets the minimum standards and Regulations. Residents and their representatives need to be confident that the process is followed. Staff need to be proactive when dealing with complaints. There is a Protection of Vulnerable Adults procedure in place; staff must make sure this is implemented when needed. EVIDENCE: No formal complaints have been received by the CSCI or the home. However, residents and relatives are not always confident that concerns will be acted upon. Surveys indicated that a small number of relatives were unaware of how to make a complaint. Residents who responded were aware of how to make a complaint. The main issues regarding the complaints process within the home related to small concerns, which could be dealt with effectively at a local level: Comments received included: ‘small issues are not always acted upon, for instance enquiries about missing laundry were not investigated.’ And ‘I have Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 17 never made a formal complaint about a serious matter, but have complained about missing clothes and spectacles.’ Also care of clothing was highlighted: ‘[my relative’s] clothes are often mislaid (despite being clearly labelled), while sometimes clothes that are not the [resident’s] appear in [the] cupboard. Clothes are often badly laundered and so deteriorate quickly.’ On one of the site visits two staff members were observed dealing with a relative who was enquiring about missing laundry. The staff did not go and look for the items, but said that if the clothes were not found in a few days they would look. Lack of proactive responses to small issues increases the likelyhood of formal complaints being made. It also does not demonstrate respect for residents’ belongings. One staff survey alleged that obvious injuries and bruising to residents are not always reported. No specific examples were given. However, staff must make sure that residents are protected from harm. Any potential situations where abuse is suspected must be reported and investigated. Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 18 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, 22 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a maintained environment, which provides aids and equipment to meet the care needs of residents. Staff must make sure that this equipment is used. Where rooms are shared it is only by agreement and screens are provided fro privacy. Residents are able to bring in small personal items and furniture into the home. Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 19 EVIDENCE: Residents live in an environment, which is safe and maintained. This was evidenced in a tour of the premises. Suitable equipment is available to make sure that residents needs can be met. Residents need to be moved safely; therefore, staff must make sure that moving and handled equipment is used. (See under Staffing). The lounge featured in many surveys, one stated: ‘The common areas: the lounge is extremely unsatisfactory. It is firstly, too small; with chairs arranged around the perimeter with arms almost touching, often mostly occupied, it is impossible for visitors to sit alongside residents or to move furniture into more sociable arrangements. The television is a perpetual intrusive presence…’ The chief executive of the Wimbledon Guild who own the home said that there are plans for an extension to improve communal space. This would also make access to the dining room better and allow more activities to take place. No issues with regard to cleanliness were noted on the tour of the building. One survey said that on occasion toilets could be fresher. Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are generally satisfied that the care they receive meets their needs, but there are some times when no one is available to consistently assist them. Staff need to be clear in their role and what is expected of them The recruitment procedure has not always been followed which has resulted in residents being placed at risk of harm. EVIDENCE: Residents are supported by staff that have access to relevant training. However, training provided is not always put into practice. On one site visit a carer was noted to be moving a resident inappropriately. Staff must make sure that training given is put into practice to protect residents from harm. The home has clear policies and procedures for staff recruitment. These need to followed to make sure that all necessary checks are undertaken. Residents need to be confident that staff that care for them are recruited properly. Information contained in the staff files examined showed that Criminal Records Bureau checks were obtained. Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 21 References from two people had been requested, but not always received prior to the employee commencing. In one file the member of staff had not given the previous employer as a referee, and this had not been followed up by the home. One nurse who had been recruited did not have a PIN number verification check. From the files examined it was clear that during the period that the manager had been on sabbatical, employees were recruited via telephone interviews. Minimal notes were available of the questions asked and the responses given. Since the manager has returned face-to-face interviews have recommenced. However, all staff must make sure that they follow correct recruitment procedures to make sure that residents are not placed at risk. The home has sufficient numbers of staff, as indicated in the duty rota. Attention to effective deployment of staff is needed. Concerns raised by relatives included the fact that on occasions there are delays in assisting residents with personal care. One relative commented that their resident often waited for assistance and it had taken four to five hours for the resident to have a wash and get dressed in the morning. All staff must take responsibility for the role they have to perform. Meeting of needs must be resident focused and not task orientated. Staff surveys indicated that there is an over reliance on agency staff: Staff need to make sure they are able to effectively communicate with residents and their relatives. Comments from surveys included: ‘the lack of designated key worker to act as a conduit…..is a constant frustration.’ At the staff meeting the issue of agency staff was raised and discussed. Also the implementation of a key worker system. The home must prioritise action on these two concerns, to make sure that residents received consistent care and know who is responsible for their care. Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 22 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, 32, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is qualified and has the necessary experience to run the home, however an inclusive and proactive approach is needed, to make sure that staff feel valued. Residents and visitors need to be able to identify members of staff, to improve communication within the home. EVIDENCE: Improvements are being made in communication between the home and stakeholders. A relative group has been formed to enable resident views to be expressed. Due to their condition many of the residents rely on their relatives or representatives to act as advocates. Representatives of the relatives group Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 23 are able to meet with the Registered Persons for the home to discuss any issues. A staff meeting was observed on one of the site visits. Staff were able to express their views and it was noted that actions were taken when needed. There was discussion around identification of staff. New name badges were to be purchased. The use of a white board with staff photographs was mentioned. The inspector stated that the home should be wary of ‘institutionalising’ Rosemary Lodge, as it is the residents’ home and the environment must reflect this. Surveys indicated that they found it difficult to identify staff members. Comments from surveys included: ‘visitors to the home find it difficult to know who to talk to, or even who is in charge at any one moment.’ During a conversation with one relative, a comment was made about name badges. The relative was concerned that this issue was taking a while to resolve. It was also mentioned that some staff were reluctant to wear badges. Staff must make sure that they can be identified and their role in the home is apparent. This will make sure that residents, relatives and other visitors to the home are able to address the correct people if they have any concerns. The home manager has managed Rosemary Lodge for a number of years. She has recently completed the NVQ level 4 and was awaiting confirmation of the qualification at the time of inspection. The CSCI has concerns over the management style of the home. Evidence from surveys indicated that staff do not always feel supported and issues they may have are not listened to or acted upon. Staff have stated that when extra support is needed such as extra members of staff, it is promised but does not materialise. Due to the sensitive nature of this issue comments contained in surveys have not been used to evidence this. Some relatives also raised similar concerns. The manager needs to make sure that a proactive approach is promoted. This will make sure that staff, residents and relatives know that their views are acknowledged and acted upon if necessary. Rosemary Lodge DS0000019118.V321759.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 2 2 X 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 N/a 18 2 2 X X 2 X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 3 X X 3 Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 25 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 Requirement The registered person must ensure that information is given to residents and their representatives, about the running of the home. The registered person must ensure that all residents receive a contract, detailing terms and conditions. The registered person must ensure that assessments are fully completed and contain specific information. The registered person must ensure that all qualified staff complete admission assessments. This will ensure that assessments are resident focused. The registered person must ensure that care plans are individualised and contain specific details of how needs are to be met. The registered person must ensure that daily records reflect actual care given. (previous timescale of 30/11/05 and 30/05/06 not met) DS0000019118.V321759.R01.S.doc Timescale for action 30/04/07 2 OP2 5(1) (c) & 5A 14 30/04/07 3 OP3 30/04/07 4 OP3 14 30/04/07 5 OP7 17 (1) (a) & Sch 3 30/04/07 6 OP7 15 Sch 3 (3) (k) 30/04/07 Rosemary Lodge Version 5.2 Page 26 7 OP8 13 (4) (c) 8 OP9 13 (2) 9 OP9 13 (2) 10 11 OP9 OP9 13 (2) 13 (2) 12 13 OP9 OP10 13 (2) 12 (5) (b) 14 OP10 12 (4) (b) 15 OP11 12 (2) 16 OP12 16 (2) (n) 17 OP12 12 (4) (a) Daily records must not contain bland statements. The registered person must ensure that the skin condition of residents is recorded accurately. (previous timescale of 30/05/06 not met) The registered person must ensure that excess stocks of medication, including dressings, are returned to the pharmacist. The registered person must ensure that clear directions are available for medication administration. The registered person must ensure that changes in dosages are written separately. The registered person must ensure that allergies are noted on MAR sheets, or an entry made if there are no known allergies. The registered person must ensure that medications are signed for when given. The registered person must ensure that there is effective communication between staff and residents that is appropriate. The registered person must ensure that religious needs are noted on admission and addressed. (previous timescale of 30/11/05 and 30/05/06 not met) The registered person must ensure that residents’ wishes in the event of death are documented. (previous timescale of 30/11/05 and 30/05/06 not met) The registered person must ensure that activities are individualised and resident focused. The registered person must DS0000019118.V321759.R01.S.doc 30/04/07 30/04/07 30/04/07 30/04/07 30/04/07 30/04/07 30/04/07 30/04/07 30/04/07 30/04/07 30/04/07 Page 27 Rosemary Lodge Version 5.2 18 OP13 16 (2) (m) 12 19 OP14 20 21 OP15 OP16 16 (2) (i) 22 (3) 22 OP16 22 23 OP16 22 (3) 24 OP18 13 (6) 25 OP19 23 (2) (f) & (i) ensure that the atmosphere in the main lounge is not dominated by the television. The registered person must ensure that residents are able to maintain or develop significant relationships if they wish. The registered person must ensure that meeting residents’ needs is the primary aim of the home. The home must demonstrate that residents have choice and control over their lives. The registered person must ensure that suppers are varied and nutritious. The registered person must ensure that moving and handling is undertaken appropriately in the home. (previous timescale of 30/05/06 not met) The registered person must ensure that the complaints process is followed and complainants are aware of the outcomes. All concerns whether written or verbal need to be documented. Concerns must be dealt with at a local level when ever possible. The registered person must ensure that staff are able to dealt with concerns at a local level and maintain effective relationships with residents representatives. The registered person must ensure that staff are aware of the need to report any possible incidents of abuse and a full investigation is undertaken, in line with Adult Protection Procedures. The registered person must ensure that the lounge furniture is not arranged in an ‘institutionalised’ manner and DS0000019118.V321759.R01.S.doc 30/04/07 30/04/07 30/04/07 30/04/07 30/04/07 30/04/07 30/04/07 30/04/07 Rosemary Lodge Version 5.2 Page 28 26 OP27 12 (1) 27 OP29 19 &Sch 2 28 OP29 19 29 30 OP32 12 (5) (b) 10 OP32 31 OP32 12 (5) (a) 32 OP30 10 there is space for visitors. The registered person must ensure that consistent care is given to residents, in a timely manner, by all staff. Key working must be implemented to make sure there is effective communication in the home. The registered person must ensure that staff files contain information as required by the Schedules and appropriate checks are carried out on staff. (previous timescale of 30/05/06 not met) The registered person must ensure all staff undergo a thorough recruitment process prior to being employed. (previous timescale of 30/05/06 not met) The registered person must ensure that staff members are easily identifiable. The registered manager must ensure that they are supportive to staff members and act upon issues raised. Staff must be supported to carry out their roles effectively. The registered manager must maintain good relationships with residents, staff and relatives and be proactive in the running of the home. The registered person must ensure that training provided is put into practice. 30/04/07 30/04/07 30/04/07 30/04/07 30/04/07 30/04/07 30/04/07 Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Rosemary Lodge DS0000019118.V321759.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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