Inspection on 03/05/07 for Rosemary Lodge

This inspection was carried out on 3rd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 05/06/08

Rosemary Lodge 07/09/07

Rosemary Lodge 30/09/06

Rosemary Lodge 05/05/06

Rosemary Lodge 08/09/05

Rosemary Lodge 08/04/05

Rosemary Lodge 21/12/04

Rosemary Lodge 27/07/04

Rosemary Lodge 14/11/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Rosemary Lodge 154 Alcester Road South Kings Heath Birmingham West Midlands B14 6AA Lead Inspector Sarah Bennett Key Unannounced Inspection 3rd May 2007 10:15 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 DS0000017019.V336646.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 DS0000017019.V336646.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosemary Lodge Address 154 Alcester Road South Kings Heath Birmingham West Midlands B14 6AA 0121 43 1166 0121 442 6454 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) Mr S.V. Chundoo Elizabeth Campbell Mrs Rajwantee Chundoo Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home adheres to a laundry policy, which ensures that soiled laundry is not transported through the dining area when meals are served or consumed. 30th November 2006 Date of last inspection Brief Description of the Service: Rosemary Lodge is situated on the Alcester Road, Kings Heath; it is a short distance away from the main Kings Heath shopping centre where there is a good range of local facilities. Another smaller local shopping centre is in the opposite direction towards The Maypole. The home was originally two large Victorian houses, has retained many of its original features and is set back behind a parking area for up to 5 cars. Trees and shrubs that have been well maintained surround this area. The main entrance to the home is via some steps up to the front door; this access is unsuitable for wheelchair users and is currently being used as access for the building work that is being carried out. There is another front door, located to the front of the property where people with mobility difficulties can access the home at ground level where access is gained into the dinning area. The home has a passenger lift to where the first floor bedrooms can be accessed; the second floor is office space. There is a garden to the rear of the property. The home caters for up to thirty older people. The bedrooms vary in size and all are decorated in individual colours. There is a large dining/sitting room, a smaller lounge, a ‘Victorian’ themed sitting room, a large quiet sitting room and a conservatory. At the time of the fieldwork inspection, extensive building work was being undertaken to build a new conservatory and additional bathing and toileting facilities for the people living in the home. There is no access from the home into the rear garden and when the builders are at the home part of the ground floor is inaccessible to the people living there. There are signs throughout the home to warn people about the building work. There is a risk assessment for the parts of the home that residents and visitors cannot access due to the building work. There is a notice board for people living in the home and visitors to read information such as progress of the building work and how this would benefit them. A copy of inspection reports for people living in the home and visitors are available in the office. Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 5 The owner said that the fees are at the contracted price and range from £350 – £370 per week. Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced fieldwork inspection was undertaken by two inspectors and was carried out over a period of seven and a half hours. There were twentyfour people living at the home. Information was gathered from speaking with three people living in the home, staff, the Acting Manager, the owner and a professional visiting the home. Following the inspection the home returned the completed CSCI Annual Quality Assurance Assessment (AQAA). Care, health and safety and staff records were looked at. It was not always possible to hold meaningful conversations with some of the people living at the home because they had a form of dementia but care practices were observed in the communal rooms. Since the last inspection the Registered Manager has been moved to the other home operated by the owner and they are not in a management position. An acting manager has been in post for about three to four months. What the service does well: The Adults and Communities Department of the Local Authority undertake a care assessment of people prior to them being provided with a residential placement. The Manager ensures this is completed before a person is admitted to the home. A professional visiting the home said that the service is flexible enough to provide that extra placement that some people need because of their mental health needs. They said they are pleased with the service provided to the people they have placed there and that people are given time and reassurance to settle into the home. People who share bedrooms have been provided with screens to ensure their privacy and dignity. The kitchen was clean and tidy and is accessed by a coded door lock to protect the people living there from harm. Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The assessment process before people move into the home needs to be more detailed so it is clear that the persons needs can be met at the home. Care plans and risk assessments need to be individual so that staff know how to support each person and their needs can be met. All medication received in the home should be audited to make sure that people get the right medication at the right time. There should be evidence that people have been consulted about their life in the home including whether or not they choose to share a bedroom. Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 8 People should be able to do activities that they enjoy so that they have a good quality of life. The people living in the home should be given the information they need so that they know how to make a complaint if needed. Regular audits of the cleaning schedules should be done so that standards of cleanliness and hygiene can be maintained. Staffing levels are not always maintained in sufficient numbers to ensure that the needs of the people living in the home are met. Staff recruitment records must ensure that they evidence that robust checks have been made to ensure that suitable people are employed. Staff need the required training so they can meet individual needs and keep people safe from harm. An effective quality assurance and monitoring system has not been implemented to monitor the quality of service provided and to ensure that the people living in the home benefit from good quality care. Clear and accountable records should be kept of any money that is looked after for the people living there to ensure that it is managed properly. All staff should have regular formal supervision so that they know how to support the people living in the home. All areas of the home should be safe so that people living there are not at risk of tripping or having accidents that could be avoided. Electrical equipment must be tested to make sure it is safe to use. 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 DS0000017019.V336646.R01.S.doc Version 5.2 Page 9 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 DS0000017019.V336646.R01.S.doc Version 5.2 Page 10 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): 1,3,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make an informed choice about whether or not they want to live at the home. The current assessment process is not sufficient to ensure that a person moving into the home will know that all their needs can be met. EVIDENCE: Records sampled of the people who live in the home included a service users guide that was dated March 2006. The owner said that the service users guide and statement of purpose had been updated to include all the relevant and required information. There were twenty- four people living in the home, four people had been admitted to the home since the last inspection and one person was in hospital. One person had recently stayed at the home on respite but had now gone home. Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 11 The Adults and Communities Department of the Local Authority undertake a care assessment of people prior to them being provided with a residential placement; without this assessment people would not receive a care service. Records sampled of the people who live in the home included an assessment completed by the owner whilst the person was in hospital. Although this covered the holistic needs of the person it’s content was brief and the care plan developed from it did not cover all the areas of need identified. The home does not cater for people assessed and referred solely for intermediate care. Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans do not set out the individual’s needs so it is not clear to staff how they support people to meet their needs. Arrangements are generally sufficient to ensure that the management of the medication protects people living in the home and receive their prescribed medication. Arrangements are not sufficient to ensure that the privacy and dignity of people living in the home is always respected. EVIDENCE: Care plans and risk assessments sampled of the people who live in the home showed that these had been developed further since the last inspection. However, care plans were not individual and person centred. For each person it was stated to reduce the risk of them falling they need to be checked every Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 13 two hours unless required by the manager to do an hourly check due to ill health. One persons care plan stated that they used continence aids during the day but it did not state what these were. Goals were identified in care plans. The goal for one person was to promote a good pattern of sleep. This stated that staff are to maintain a four hourly check during the night to change the person’s continence aid. This may not help to promote a good pattern of sleep if the person does not wake up until checked by staff. The owner and Manager said that staff do not disturb the person if they are asleep but this was not stated in the care plan. Care plans had been reviewed monthly. For one person their risk assessment to minimise the risk of fractures due to falls was blank. However, this person needed support from staff to mobilise and walked with a Zimmer frame so could be more at risk of falling if they walked without support. A risk assessment was in place for using the stairs in the records sampled but these were the same for each person and did not show that some people may need more support than others depending on their individual needs. One person’s care plan said that the person does their own nails and their oral hygiene but staff need to explain to the person how these should be done. There was no record of how the person likes these to be done and how they manage with some limited mobility to do their own hand and toenails or what oral hygiene means for the individual. There was no indication as to whether the person has their own teeth or false teeth. One person’s records stated that they might have ‘slight Parkinson’s Disease’. There was no information about how this is managed. One person has a cat and at the last inspection it was required that there be a risk assessment in place but this had not been completed. One persons care plan for mobility stated that the person needs to be encouraged to use the footrests on their wheelchair. They were observed not using the footrests however, staff did not encourage them to use them to ensure their safety and correct posture. One person’s records stated that they have a history of alcohol abuse. The manager said that staff do not buy drink for this person, as staff know that the individual cannot have alcohol. It is not clear how staff know this as this is not stated in the person’s care plan or risk assessments. Some receipts of the money the person had spent showed that the person’s money had recently been spent on alcohol. The AQAA stated that there is a key working system in place and they hope to improve on key working skills and incorporate this into individual care of the people who live in the home. Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 14 Risk assessments sampled for the people living in the home said that the person might be at greater risk of bruising if they took Warfarin medication. There were no people living in the home that day that were prescribed this medication. Therefore, risk assessments were not person centred and could confuse staff, as they do not know how to support each person who has different needs. The people living in the home were observed to be well dressed. Their clothes were appropriate to their age and gender. Everyone was wearing slippers or shoes that were in good repair so ensuring that they could walk around the home safely and to minimise the risk of them tripping over. There was a basket of tights in the laundry room. The Manager was not sure whom they belonged to and they were not labelled. This could mean that people wear clothes that do not belong to them. Records sampled of the people who live in the home showed that people are registered with a local GP. Contact with other professionals such as the chiropodist, dentist, district nurse, optician and social worker were documented to assist in meeting individual’s health needs. One persons records sampled included a record of when they had a bowel movement. There was no record of the person having a bowel movement for six days and there was no record of any action taken to ensure their wellbeing. Weight records sampled showed that people are weighed regularly to ensure they do not gain or lose a significant amount of weight that could indicate they have a health need. Staff had signed the Medication Administration Records (MARS) appropriately. A local pharmacist supplies the medication and most of the tablets are supplied in weekly blister packs, which make it easier for staff to give them to individuals. In one blister pack it stated that the person had one particular tablet at night. However, in the pack for Thursday the pharmacist had not put any tablets in but two had been put in the Friday dose. Staff said that they had not noticed this before, which could mean that the person had no tablet one night but a double dose the following night. Staff said that they do not audit the medication that is not in the blister pack. It is recommended that they do this so they can be clear that medication is being given as it is prescribed. Senior staff that give medication to the people living in the home have had medication training. One person’s records sampled stated that they were transferred to a shared room in February 2007 due to a leak in the bedroom above theirs and this had been discussed with their social worker. Their records stated that it had been agreed that they would move back into their bedroom once the leak is addressed. The person is still in the shared room and the week before shared Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 15 their room with a person staying at the home on respite. The owner said that the person is now settled in that room and she had spoken to the social worker about it who had agreed. There was no record of this agreement or any indication that the person or their relatives had been consulted about this. Residents who share bedrooms have been provided with screens to ensure their privacy and dignity. Staff were observed talking to the people living in the home with respect to their age and their individual background. Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 16 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, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are not sufficient to ensure that people living in the home experience a meaningful lifestyle or are able to always make choices and have control over their lives. People living in the home have a balanced and varied diet that meets their nutritional needs but they do not always have the variety of food that they would prefer. EVIDENCE: Each person had an activity planner although these were all the same and did not show that individual preferences about activities had been considered. There was no evidence in records sampled that individual’s religious and cultural needs had been considered and how staff are to support individuals to meet them. Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 17 One person said that they like West Indian food but their preferences are not always accommodated. They said that the Manager does buy West Indian food and cooks it for them and another person. It was clear that these two people enjoyed West Indian food despite it not reflecting their racial background. So it is important that the preferences of each person are asked and provided for. The cook said and records showed that there are no special diets to cater for. The cook said she knows what people like and although there is a menu people choose what they want. The menu for the day stated sausages or vegetable lasagne but the cook said that nobody wanted this but had asked for jacket potatoes. So, these had been cooked and were served with cheese and salad. A beef casserole was also prepared as an alternative option. Staff gave one person a jacket potato but they said that they did not want it, staff offered them beef casserole instead, which they preferred. The tables were laid for lunch with serviettes and cutlery. Sauces and salt were put on the tables and a choice of cold drinks were offered. Staff said that food is bought from a local supermarket and some food is delivered as well as a delivery of fruit and vegetables each week. One person prefers to eat their meals upstairs and they are supported to do this and a table and chair provided. One person chooses to sit on their own in the dining room and had their own table. The AQAA stated that a new activity room had been provided as has a weekly tuck shop so that people living in the home can buy items such as chocolate, drinks, newspapers, toiletries or anything they request. The activity room was being redecorated at the time of the visit so was not being used. The AQAA also stated that they hope to improve activities in the next 12 months by introducing more outdoor activities and outings. In the afternoon a visitor came to lead a session of exercise to music with those people who wanted to take part. This took place in the lounge, one person said they did not like it as they thought it was boring so went to spend some time in their bedroom. After this hot drinks were served in the lounge. Some people in one part of the lounge were sitting listening to music, some people said they liked the music and were clearly enjoying it by tapping their feet to the music. One person collected the cups and put them on the trolley. Staff thanked them for this so encouraging them to maintain their independence. Some people were sitting in the other part of lounge, watching the snooker on TV. Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 18 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, 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Current arrangements do not show that people living in the home can be confident that their complaints will be acted upon. Arrangements are not sufficient to ensure that people living in the home are protected from abuse. EVIDENCE: In the office there was a folder marked residents/relatives complaints. There had been no complaints recorded in this since March 2006. In the staff complaints folder there were no complaints recorded since the last inspection. The AQAA stated that all complaints received are recorded in the complaints book and are dealt with within three days. It stated that there had been a small number of complaints in the last twelve months however, it is not clear where these were recorded. There had been no complaints about the home received by the CSCI since the last inspection. The AQAA stated that a complaint meeting is to be introduced within the next twelve months whereby people living in the home, their representatives and staff can resolve issues, concerns or complaints. There will also be a complaints box introduced for those who do not wish to participate in the meeting. Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 19 Staff training records showed that some staff have received training in adult protection and the prevention of abuse since the last inspection. All staff should receive this so they know what to do if there is an allegation of abuse and they are aware of how to protect people living in the home from harm. One person goes out on their own most days. It is good that this person is able to maintain their independence, however, they had money stolen last year when they were out on their own. No risk assessments are in place to ensure they can maintain their independence but they are also protected from harm as much as possible. Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 20 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, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made and are continuing so that people live in a homely and comfortable environment. EVIDENCE: Since the last inspection there had been a lot of building work completed to improve the environment for the people who live there. This included redecoration of parts of the home as well as providing a conservatory, new toilet, shower room and a hairdressing/beauty room. Some of the work is still ongoing which means that the garden is not accessible to people living in the home as it is not safe with building materials currently stored there. The Manager said that the timescale for the completion of these works is the end of Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 21 May 2007. The AQAA stated that over the next twelve months the kitchen will be updated with new units and flooring and the rear garden will be landscaped. The Manager said that the carpets are to be changed in the dining room, hall and some of the bedrooms. On the ground floor there is a room that is going to be redecorated and used as an activities room. Some of the bedrooms had been redecorated and new bedding had been provided. Bedrooms included people’s personal items and photographs of the people important to them. In the bathroom a manual hoist was provided over the bath. Staff said this was working but could sometimes be difficult to use and an electric hoist would make it easier. There was a walk-in cupboard off the dining room where the freezer was stored. A hole had been made above the door for a vent to be fitted to make the cupboard cooler for safe storage of frozen food. There was limited space in the cupboard and the Manager said that they also plan to put a fridge in there. Safe access to the fridge and freezer need to be considered as well as ensuring that the temperature is cool enough to store food safely. The kitchen was clean and all food that had been prepared for lunch was covered. Food in the freezer and fridge was labelled and dated. The chopping boards were very scratched, which could be a risk to food hygiene. All cereals and rice were stored in sealed boxes on shelves so ensuring that they could be kept fresh. A conservatory had been built onto the lounge to make this bigger. It was not yet finished. There was a step up to the conservatory from the lounge, which could make it difficult for those with mobility or visual impairments to access. The safety of people needs to be considered before this is used. New chairs had been provided in the lounge so that people are more comfortable. There were vases of fresh flowers and pot plants in the dining room and around the home making it more pleasant. The cupboard outside one of the bedrooms that leads to the loft was locked with a nail and could be opened easily. This needs securing so people can be safe. Some bedrooms had an unpleasant odour of urine but generally the home was clean. On each toilet door there was a cleaning chart and the regular cleaning and checking of the toilets had been assigned to carers four times a day. One of these charts showed that on one day the toilet had only been checked and cleaned three times and on three days only two times. Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 22 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, 30, Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is not enough staff on each shift and staff have not received sufficient training to ensure that the needs of people living in the home are met. The home’s recruitment practices do not ensure that the people living in the home are protected. EVIDENCE: The Manager said that they had recently recruited to the staff vacancies. The cook had been employed since the last inspection. Rotas showed and the Manager said there are four members of staff on shift during the day although sometimes people are off sick. There were only three members of staff on the late shift because one person was on holiday and another person was on maternity leave. The Manager said that they were interviewing the following week for someone to cover the maternity leave. Rotas showed on 2nd April there were three staff on the early shift including the Manager plus the cook, and two laundry/domestic staff. There were three staff on the late shift as there were two staff off sick that day. On 3rd April there were five care staff including the Manager on the early shift and two staff on the late shift as there were two staff off sick that day. Given the number of the people living in the home and that some people need one member of staff to support them with Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 23 their personal hygiene needs or with moving around the home two members of staff are not sufficient to ensure that people are receiving the support they need or they can be safe from harm. Rotas showed that at the weekends there are no catering or domestic/laundry staff on duty, which means that care staff have to perform these tasks in addition to supporting the people who live in the home. There were three staff on the late shift on the day of this visit. The Manager said that none of the people who live in the home could use the garden at the moment, as it is not safe with the building work going on. There were lots of old windows and wood with old nails in stored there. In the afternoon one person was observed wandering around the lounge and went out to the garden through the open laundry door. They walked through the garden where the building work was going on. As soon as staff were alerted to this they went to the garden, supported them to come back in and shut the laundry door. The staffing levels meant that it was not possible for staff to always be alert to where each person was to ensure their safety. The AQAA stated that 97 of staff have NVQ level 2 or above in Care. This exceeds the standard that at least 50 of staff have received this training. Five staff recruitment records were sampled. All of the records included a completed application form. Only one of the records included two written references for the applicant. Three of the five records included a Criminal Records Bureau (CRB) check that had been sought for employment at this home. Some records had a CRB from their previous employment. CRB’s are not transferable from one employment to another and a new one must be applied for, for each applicant to ensure that suitable people are employed. One person’s application form showed a gap in their employment history. There was no evidence that the reasons for this gap had been explored to ensure that there were no circumstances that could put the people living at the home at risk. One member of staff records sampled showed that they were born in another country but there were no details of whether they could work or live in the UK and if there were any restrictions on their employment. One person’s records showed that they had not received an induction when they started earlier this year or have they received any training since. The training matrix showed that nine members of staff had training in risk assessment in January 2007. This year four members of staff had training in food hygiene and seven members of staff training in moving and handling. Training in infection control is booked for May 2007 and training in the safe handling of medicines is booked for June 2007. Training records showed that staff had fire safety training in May 2006 and first aid in 2005. All staff must have refresher training in fire safety to ensure they know how to minimise the risks of a fire starting. Staff training records showed that some staff have received training in adult protection and the prevention of abuse since the last inspection. All staff Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 24 should receive this so they know what to do if there is an allegation of abuse and they are aware of how to protect people living in the home from harm. Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Acting Manager has made improvements to ensure that the home is run in a way that benefits the people living there and in their best interests. The financial interests of people living in the home are not sufficiently safeguarded. Staff have not been appropriately supervised to ensure they can meet the needs of the people living there. Arrangements are not sufficient to ensure that the health, safety and welfare of people living in the home is promoted and protected. EVIDENCE: Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 26 Following the last inspection the Registered Manager for this home was moved to the other home owned by the same owner but not in a management position. The Acting Manager had worked at this home for about three to four months. It was evident that she has made changes to improve the home and meet the requirements from the last inspection. However, she has not yet been at the home long enough to improve all areas to ensure that the home meets the Care Homes Regulations and is a good service for the people who live there. The “disarray in the office” stated in the last report had been cleared so that records could be accessed easier to ensure that records are maintained to protect the people who live there. In the office there was a quality assurance folder in which there was a letter from a quality assurance company dated November 2005 but there was no evidence that a quality assurance system had been used. There had been an internal audit completed in March 2006 but none since. The Deputy Manager completed the AQAA and this was returned within the stated timescale. This could now form the basis of the home’s quality assurance system. The AQAA stated how improvements are being made to improve life for the people who live there and these need to be monitored to ensure the improvements are made. Resident’s financial transactions records were kept in a folder in the office. There was no person named on these records apart from two of the twenty-six sampled. The Manager confirmed that she only has responsibility for one persons finances and this is only to collect it when they are not able to and to buy things at their request. It should be clear whom these records are referring to. Two members of staff had signed the receipt but not the person who has spent the money although they are able to do this. Receipts of purchases were not itemised as to what was purchased. There was not a financial risk assessment for the person or the process and transaction arrangements or policy and procedures for managing people’s finances. Records showed that the person spends a lot of their money on cigarettes. The manager said that the person likes to share their cigarettes with others and wants to do this. There was nothing about this in the persons care plan or risk assessments to ensure they are protected and not being exploited by others. The Manager and the Deputy Manager had training in the supervision of staff in January 2007. Staff supervision records showed that staff had not had regular formal, supervision sessions to ensure that they are performing their job role, their training and development needs are identified and they are able to meet the needs of the people living in the home. However, since the Acting Manager has been in post a supervision schedule has been implemented and staff are beginning to receive formal supervisions and observations of their practice are being undertaken to ensure that care practice improves to improve the quality of life for the people who live there. The Acting Manager said she now supervises night staff on a fortnightly basis. Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 27 The owner said they have completed a risk assessment of the building but it needs to be typed up. Given that building work is still taking place so increasing the hazards to the people living in the home this must be available so that staff know what action they need to take to ensure that the risks can be minimised. An electrician completed the annual test of the portable electrical appliances to make sure they are safe to use in July 2005 so this is now out of date. A new boiler was installed in September 2006 so improving the heating system and ensuring that the gas equipment was safe. Records showed that staff test the fridge and freezer temperatures daily to make sure that food is stored safely and at the right temperature. Risk assessments were in place for all hazardous products that are used. Data sheets matched with the products used, their usage and the risk and actions recorded to ensure that staff use the products safely so not putting at risk their health or that of the people who live in the home. Fire records showed that staff test the fire alarm, emergency lighting and fire equipment regularly to make sure they are working properly. Where they had not been working properly action had been taken to make sure they were repaired. Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 28 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 3 X 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 3 3 2 X 3 2 2 STAFFING Standard No Score 27 1 28 4 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 1 1 X 2 Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 29 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 OP4 Regulation 17(1) Requirement The Registered Person is required to ensure there are trained and competent staff working in the care home that are trained in dementia and care planning so that the needs of people living in the home are met. THIS REQUIREMENT REMAINS UNMET SINCE 30/08/04. All people using the service must have an up to date, individual, detailed care plan. This will ensure that they receive person centred support that meets their needs. All people using the service must have individual risk assessments in place for the risks identified for them. This is to ensure that the risks to people’s safety are reduced whilst ensuring that they can maintain their independence. All care staff must have training in adult protection and the prevention of abuse so that they DS0000017019.V336646.R01.S.doc Timescale for action 31/10/07 2. OP7 15 (1) 31/07/07 3. OP7 13 (4) (ac) 30/06/07 4. OP18 13 (6) 31/08/07 Rosemary Lodge Version 5.2 Page 30 5. OP19 13 (4) (ac) 6. OP19 13 (4) (ac) 7. OP27 18 (1) (a, c) 8. OP28 18(1) possess the knowledge and skills to respond appropriately in allegations of suspected abuse and can help to keep people safe from harm. Partially met since last inspection. How people move from the lounge to the new conservatory must be considered so that people living in the home are not at risk of tripping or falling. The cupboard that provides access to the loft must be secured so that people living in the home are not at risk of harm. Staffing levels must be reviewed and increased where necessary to ensure the safety of the people living in the home and ensure their needs are met. All staff must receive an induction and the required mandatory training that complies with Skills for Care (previously TOPSS) foundation standards to ensure that the needs of people living in the home are met. THIS REQUIREMENT REMAINS UNMET SINCE 01/12/04. 30/06/07 03/06/07 30/06/07 31/10/07 9. OP29 19Sch 2 10. OP33 35 The Registered Person must 30/06/07 ensure that staff recruitment records comply with Schedule 2 and a more robust recruitment process is implemented to protect the people living in the home. Comprehensive records must be maintained so that people living in the home, staff and visitor are protected. THIS REQUIREMENT REMAINS UNMET SINCE 01/12/04. An effective quality assurance 30/09/07 and quality monitoring system must be implemented that meets DS0000017019.V336646.R01.S.doc Version 5.2 Page 31 Rosemary Lodge the minimum standards. Systems and processes must be in place to monitor the quality of services being provided so that the people living in the home benefit. THIS REQUIREMENT REMAINS UNMET SINCE 01/12/04 11. OP38 23(2) An electrician must test the electrical equipment provided at the home for use by people living there or staff to ensure it is safe to use. 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The assessment process should be further developed so to ensure that all the person’s needs have been considered when assessing whether or not their needs can be met at the home. Appropriate interventions should be carried out for people who are at risk of falling so the risk of this can be minimised as much as possible. Appropriate interventions should be carried out for people who are at risk of constipation to ensure their health and well-being is maintained. All medication received into the home should be audited regularly so that a clear audit trail is established. This will ensure that people are receiving the right medication at the right time. Where people share a bedroom an agreement should be in place to show that the people sharing the room or their representative have been consulted about this and it is their choice to do so. The programme of activities and outings should meet individual’s expectations so that people living in the home experience a meaningful quality of life. 2. 3. 4. OP8 OP8 OP9 5. OP10 6. OP12 Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 32 7. OP14 Records should demonstrate how people living in the home are empowered to exercise their choices and preferences within the home. E.g. shared rooms and meal choices. Information about complaints and concerns should be available so it is clear that the views of the people living in the home are being listened to. Regular audits of cleaning schedules should be completed to ensure that the home is being kept clean and hygiene standards are being maintained. The way in which the service manages the money of people who live in the home should be reviewed to be more transparent and to promote independence. All staff should have formal, supervision sessions at least six times a year to ensure that they are supported to meet the needs of the people living in the home. 8. OP16 9. 10. 11. OP26 OP35 OP36 Rosemary Lodge DS0000017019.V336646.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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