Inspection on 05/06/08 for Rosemary Lodge

This inspection was carried out on 5th June 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rosemary Lodge 07/09/07

Rosemary Lodge 03/05/07

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 28/09/2008.

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 5th June 2008 09:25 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.V366150.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.V366150.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 432 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.V366150.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. 7th September 2007 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 five 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. There is another front door, located to the front of the property where people with mobility difficulties can access the home at ground level. 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 twenty nine older people. The bedrooms vary in size and all are decorated in individual colours. There is a large dining/sitting room, a ‘Victorian’ themed sitting room, a large quiet sitting room and a conservatory. Extensive building work has been completed to build the conservatory, a hairdressing room and additional bathing and toileting facilities for the people living in the home. There is a notice board for people living in the home and visitors to read information such as the home’s news sheet and the complaints procedure. A copy of inspection reports for people living in the home and visitors are available in the office. The service users guide did not state the fees charged to live at the home. Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 5 Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out over one day; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2008 to 2009. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and an Annual Quality Assurance Assessment (AQAA) completed by the owner and deputy manager. Four people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. The people who live at the home and the staff on duty were spoken to. The Registered Manager was not on duty but the owner was present and assisted throughout. A tour of the premises took place. Care, staff and health and safety records were looked at. Time was spent observing care practices, interaction and support from staff. Some of the people living there, their relatives, staff and professionals who visit the home completed our ‘Have your say’ survey about the home. Their views are included throughout this report. What the service does well: The people living there were well dressed and had been supported with their personal care helping to raise their self-esteem and well being. A relative said, “My mother could not be better cared for anywhere else. Rosemary Lodge is the best I know of in every way. The staff care.” Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 7 The assessment process is detailed so that before people move into the home it is clear that their needs can be met there. The home was clean and smelt nice so it is a pleasant environment for people to live in. The people living there are offered a varied diet and could choose what they wanted to eat. Relatives said, “Staff are very understanding, nothing is too much trouble for them. They deserve more money for what they do.” “We will be happy to recommend Rosemary Lodge where you can safely leave loved ones knowing that they are in a clean and loving environment.” Professionals said, “ There is good communication from staff with families and professionals.” Activities are provided and people have an opportunity to go out of the home and do the things they enjoy. One person said, “ It makes or breaks you this place, I think it has made me.” The people living there have the information they need so if they are unhappy with the service provided they know how to make a complaint. Before staff start working there the right checks are completed to make sure that ‘suitable’ people are employed to work with the people living there. What has improved since the last inspection? The requirements from the last inspection had been met to improve the service for the people living there. The kitchen floor had been made safe so there is not a risk of people tripping. The kitchen had been refurbished so it is clean and hygienic to prepare food in. Improvements to the building have provided more space and ensure that people live in a safe, homely and comfortable environment. Staff are no longer working excessive hours without a break, which could impact on their well being and that of the people living there. The statement of purpose had been updated so that it includes the relevant information for people deciding whether or not they want to live at the home. Staff have received more training so they know how to meet the needs of the people living there and keep them safe from harm. Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 8 Moving and handling, nutrition and falls assessments were completed for all the people living there so that staff know how to support people safely. Where people can behave in a way that ‘challenges’ they have a plan that states what triggers, if any, there are to the behaviour and how staff can distract the person to minimise these behaviours. This ensures the individual’s needs are met and minimises the risks to them, the other people living there and staff. A medication fridge had been provided so that food is not contaminated and all medication is stored at the appropriate temperature so it is effective in meeting the person’s health needs. Staff have regular supervision to ensure that they are supported to meet the needs of the people living in the home. What they could do better: Written risk assessments must be in place for all risks to individuals to ensure their safety and well being. The service users guide should include the fees charged to live there so that prospective service users have all the information they need. Individual’s weight records should be regularly monitored. Where a person has lost or gained a significant amount of weight this must be investigated to ensure their health and well being. The management of the medication should be improved to ensure it is being given to individuals as prescribed to meet their health needs. Systems should be in place so that staff know that all the people living there are having the required nutrition to ensure their health and well being. All staff should receive training about adult protection and the prevention of abuse so they know how to safeguard the people living there. The cook, laundry and domestic staff should receive training that is relevant so to feel valued in their role and how this impacts on the lives of the people living there. Consideration should be given to replacing the manual hoist with an electric one so that people can have more choice as to whether they have a bath or shower without putting staff at risk of injury. Consideration should be given as to how people who smoke and choose to can continue to do so in their home without this impacting on the health of others. Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 9 There needs to be a set timescale as to when the Registered Manager is competent in managing the home or alternative management arrangements should be made. 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.V366150.R01.S.doc Version 5.2 Page 10 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.V366150.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have most of the information they need to make a choice as to whether or not they want to live there. Individual’s needs are assessed before they move in to ensure they can be met there. EVIDENCE: The service users guide had been updated to include most of the relevant information so that prospective service users would have the information they need about the home. It did not include the fees that are charged to live there and this should be added. Records sampled of people who had moved in since the last inspection included an assessment of their physical, psychological and social needs. This had been completed before they were admitted to ensure their needs could be met Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 12 there. This helps to avoid any risk of the person having to move again because their needs cannot be met at the home. Records showed that after four weeks living at the home a review had taken place with the person, their relatives where appropriate and their social worker to ensure they were happy and their needs were met there. A person living there said, “I had a very well organised introduction and trial period at the home.” The home does not provide intermediate care; therefore, standard 6 relating to this was not assessed. Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 13 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 adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are not always sufficient to ensure that staff know how to meet individual’s needs so their health needs are met safely, which could impact on their well being. EVIDENCE: The records of four of the people living there were looked at. These included an individual care plan that stated how staff are to support the person to meet their needs. Care plans are regularly reviewed and updated if there are any changes. The owner said and records showed that where appropriate individuals relatives are involved in their reviews. Professionals said, “When people move into the home personal, detailed care plans are formulated and these continue to be monitored/changed to meet their changing needs.” One person’s daily report sampled stated that they were very argumentative towards staff at teatime and refused to come to the table so their tea was Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 14 given in the lounge area. The wording of this report does not show that the staff who wrote this had looked into why the person was behaving in this way although this member of staff had since left the home. The owner said that this person was often confused around teatime so a care plan is needed so that staff know how to support the person and minimise the risks to their well being. One person who had recently been admitted to the home did not have any risk assessments. The owner said they plan to update all risk assessments the following week and will do this person’s then. This is needed so that staff know how to help the person to be as independent as possible whilst knowing what to do to minimise risks to their safety. Other records sampled included risk assessments so that staff know how to support individuals. One person’s risk assessment about the risk of their behaviour stated how this affected the person being moved. It did not state how it affected the person, the other people living there or staff but their daily records showed that their behaviour can have a detrimental affect. The owner said that the moving and handling assessor was visiting the following week to assess the people living there as to what assistance they needed to move around. She had informed relatives of this and asked for their input if they can. Records sampled included a moving and handling assessment that stated how staff are to support them to move and what equipment is needed, if any to assist with this. A health professional said, “ We have not observed any moving and handling issues here and have never had to question any injuries.” This indicates that people are being supported to move appropriately to minimise any risks of injuries to them. The people living there were had individual styles of hair and dress that was appropriate to their age, gender and cultural background. It was evident that attention had been paid to individual’s personal care. Records showed that people had haircuts and styling regularly if they wanted this. Health professionals said, “ People are clean and well looked after.” Records for one person showed that when they moved into the home a referral was made to the wheelchair service so they could have a wheelchair to use when going out. An assessment was completed and they now have a wheelchair so it is easier for staff to take them out more often. They went out for a walk with staff during the afternoon using their wheelchair. Professionals stated, “Communication is excellent as is their understanding of old age and mental illness.” “Every effort has been made to offer personalised care to a wide variety of people. “ “Management of anxiety and low mood is done in a very positive, person centred way.” Records showed that people were weighed regularly to ensure they were well, as a significant weight loss or gain can be an indicator of an underlying health Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 15 need. One person’s records indicated that they had lost 10 pounds in weight in a month. However, their nutritional risk assessment that was reviewed on the same day they were weighed stated that there was no cause for concern so no changes were made. Some of their records stated they had refused meals but generally they stated that they had eaten well. One person’s records showed that since October 2007 they had lost over one and a half stone in weight. Their nutritional risk assessment that was last reviewed in March this year stated that there were no concerns. The owner said that she had asked the GP to refer this person to the dietician but this was not recorded to show that action had been taken. This person was observed to eat only half their dinner. Weight charts should be monitored and where people are losing or gaining weight the reasons for this should be investigated. In the morning one person was coughing, staff asked if they wanted to see the GP, which they did. Staff were observed making an appointment for the person and telling them when it was to ensure they could get any treatment they need. Records sampled showed that people are referred to health professionals as needed. They have regular check ups with the dentist and optician to ensure they are well and treatment is given where needed to improve their health. Medication is stored in a locked cabinet so that people it is not prescribed for cannot take it. The pharmacist supplies the medication in weekly packs for each person. Two staff give medication to individuals and were observed ensuring that the person had taken it before they signed to say it had been given. All the Medication Administration Record (MAR) sampled had been signed appropriately indicating that people had been given their medication as prescribed. Since the last inspection a separate fridge had been provided so that medication that needs to be kept cool can be to ensure its effectiveness. One person was prescribed medication in sachets. It stated that they could have up to three sachets daily when required. Their MAR stated that they had been given these but it did not state whether they had been given one, two or three. The owner said that she had discussed this with the GP and asked them to be more specific, not just put as directed as they have written this on several people’s medication. This can make it difficult for staff to know how much to give. One person’s MAR stated on June 2nd fourteen tablets had been received of which seven had been given. There were six tablets left in the box but there should have been seven. It was difficult to audit other medication that was in boxes and not in the individual packets supplied from the pharmacist because staff had not written on the box the date they had started giving the medication. A member of staff audits the medication weekly to ensure it is being given as prescribed but said they had not done the audit for this week yet. Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 16 Some people are prescribed Controlled Drugs (CD’s). These need to be stored and recorded separately in accordance with pharmaceutical guidelines so they are not misused. A separate CD cabinet is provided. CD’s stored were recorded appropriately in the CD register and this cross-referenced with the person’s MAR indicating that the medication had been given as prescribed. There was not a photograph of the person at the front of their MAR. It is good practice to do this so that if there were unfamiliar staff giving the medication they would know who to give it to. Most people had their breakfast before the start of this inspection. However, some people got up later and were served what breakfast they wanted where they wanted it indicating that staff are flexible about mealtimes and what time people get up. Staff were observed during the day allowing people time to move around and not rushing them with doing things or supporting them to move. Professionals said, “ Staff treat the people living here as individuals and holistically.” Staff were observed talking to individuals with respect. Staff were observed knocking on people’s doors before entering and bathroom and toilet doors were always shut to give people privacy. Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 17 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, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living there are able to do the things they enjoy and maintain relationships that are important to them. People are offered a varied and healthy diet and enjoy their meals. EVIDENCE: The activity co-ordinator was off sick at the time of the visit. Staff rotas had been amended so that people could still do activities. During the afternoon a visitor came to take an exercise class. They said they visited weekly. People seemed to enjoy this and staff were observed gently encouraging people who at first did not want to take part to do so. Staff said that they use the ‘Ring & Ride’ transport service for some people to go out. A garden fete is planned during the summer. The owner said there was a Christmas party that lots of relatives attended. Relatives said, “The home has made strenuous efforts to provide exercise and entertainment on a regular basis.” Professionals said, “They encourage excursions and have a programme of activity.” “Every effort is made to support people to live the life they choose as long as there are no Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 18 real risk issues that would adversely impact on individuals.” “Often the people living there go out.” Records sampled showed that people spend time watching TV, listening to music, play darts, watch films, sitting in the garden, have sing- a- longs and go to day centres. Records showed where people are offered an activity but had chosen not to do this. Records of all the activities that people do are kept by the activity co-ordinator. Records stated when people had visits from their relatives and friends. Throughout the day there were visitors to see individuals and it was observed that staff made them welcome. There is a separate activity room and staff said this is used often particularly for darts and beer and cinema nights, which take place each Thursday evening. On Sundays the activity is watching movies. Staff took one person for a local walk in their wheelchair in the afternoon, which they seemed to enjoy. Some people are able to go out on their own. They were observed doing this during the day so helping to maintain their independence. Some meetings had been held with the people living there. Minutes of these showed that they talked about the menu, activities, outings, the garden, Christmas menus and parties. There are also relatives meetings where they discuss the menus, activities, the routines of the home, staff, complaints, compliments and the environment. This gives relatives an opportunity to speak about these things on behalf of the people living there who may not be able to verbalise their views. The people living there are able to bring their personal possessions and furniture to the home if they want to so they can have familiar possessions and things they like around them. Since the last inspection the owner said they have developed a form to show that people are asked this when they first come to live at the home and they are asked to sign if they do not wish to do this. Lunch was served about 1pm. Some people had helped to lay the table so helping them to maintain some independence. People were given time to eat and the meal was not rushed. A choice of corned beef hash, mash and vegetables; chicken, mash and vegetables or chicken salad was available. Fruit and ice cream was offered for dessert. The atmosphere in the dining room was relaxed and some people were chatting and laughing with staff or some of the other people living there. Not everyone wanted to eat in the dining room so their meal was taken to their bedroom or another room where they chose to sit. People sat around small tables and one person chose to sit on their own. Condiments and sauces were provided as were a choice of cold drinks. Staff said that the entrance to the home through the dining room is not used at Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 19 mealtimes, as this is disrespectful to the people living there to have people coming in and out while they are eating. It was not clear how staff know how much food a person has to ensure they are receiving adequate nourishment. Some people ate very little but this was not recorded anywhere. The owner said they would ask staff to record how much people who they had concerns about had eaten to ensure that people were receiving the nutrition they required. Relatives said, “ The home provides a varied menu of well presented food.” Staff said that people have been offered a cooked breakfast on some mornings. They found that people did not want a full cooked breakfast too often but would like to have eggs or tomatoes on toast and this is given. Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that complaints of the people living there and their representatives are listened to and acted on to improve their lives. Arrangements generally ensure that the people living there are protected from abuse. EVIDENCE: The complaints procedure was displayed by the front door so that all visitors were made aware of this. There was a suggestion box on the hall table for the people living there and visitors to make any suggestions as to how the home could be run. Letters and cards complimenting the staff on the care they have provided for the people living there were displayed in the home. One said, “ Many thanks for all the care that you gave and kindness shown.” All concerns raised are documented. Records showed that they were investigated appropriately and action was taken to make improvements. A relative said, “It has never been necessary to make a formal complaint. Minor issues have always been completely dealt with.” A professional said, “If Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 21 concerns are raised prompt meetings/discussions are arranged to establish the facts and if possible resolved.” The owner said there have been a couple of incidents where food and items like toilet rolls and foil had gone missing. This had been reported to the police and staff had been made aware that it is not acceptable that items bought for the people living there should be taken. Staff training records showed that half of the staff team had recently received updated training on adult protection and the prevention of abuse. All staff should receive this training so they know how to safeguard the people living there. Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 22 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, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that people live in a homely, comfortable, clean and safe environment that meets their individual needs. EVIDENCE: The owner said that refurbishment of the home is ongoing. In the next week they planned to move the lounge to the front of the home and the dining room to the back. This will mean that the dining room is next to the kitchen and that when people sit in the lounge they can look outside at the front of the home. They are replacing the carpet in the dining room with wooden flooring to make this easier to keep clean. The kitchen had been refurbished and all walls tiled. A new cooker had been bought. New curtains had been ordered for the lounge and blinds for the conservatory. Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 23 There is a separate activity room, which was well decorated and homely. The conservatory is well decorated and furnished and there were houseplants in there making it feel homely. There were vases of fresh flowers around the home. At the last inspection there was a step from the lounge into the conservatory. This is now level so that the people living there can access the conservatory safely. The garden has been made accessible. There is a ramp from the conservatory to the decking area where people can sit and enjoy being in the garden. The rest of the garden can also be accessed from this area. The owner said that new garden furniture had been ordered and new fencing had been provided. The garden was well maintained and colourful with hanging baskets, pots, grassed areas and shrubs making it a pleasant place to spend time in. In the bathroom on the first floor there is a manual hoist so that people can get in and out of the bath. Staff said that it is hard work to use so they do not use it that often but use the shower or the bathroom downstairs where there is an electric hoist. Consideration should be given to replacing the manual hoist with an electric one so that people can have more choice as to whether they have a bath or shower without putting staff at risk of injury. Bedrooms seen were well decorated and contained the individual’s personal possessions. Carpets had been replaced in some bedrooms with flooring to reduce offensive odours. Some people share a bedroom. Screens were provided in shared rooms to give individual’s privacy and their part of the room had been personalised. Some rooms have an en suite toilet and wash hand basin. It was disappointing to see memos on all the bedroom doors from the manager reminding staff to knock on doors and to visiting professionals, relatives and friends to ask permission before entering. This detracted from the homely feel making it more institutionalised. Some people in the home smoke and have done for several years. The conservatory was going to be the smoking area but relatives disagreed with this and said that it was not fair on the majority of people who do not smoke. It is good that the owner listens to relatives when they are speaking on behalf of the people living there. Therefore, the smoking area remains on the landing on the first floor and some people spend a lot of their day in this area, which is their choice and lifestyle. This area is not compliant with Smoke Free Regulations 2007 as non-smokers may use this landing to get to their bedrooms from the lift or use the bathroom and toilet. Consideration should be given as to how people who smoke and choose to can continue to do so in their home without this impacting on the health of others. In the laundry there were individual boxes on the shelves to put people’s clothes in. Staff said that this reduces the problem of getting people’s clothes mixed up so that people do not wear clothes that are not theirs. Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 24 The home was clean and apart from one bedroom was free from offensive odours. Flooring had been put in this bedroom to replace the carpet and staff said it was cleaned at least daily but was difficult to remove the odour. Relatives said, “ The home is always fresh and clean.” Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 25 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 good. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing, their support and development generally ensure that they know how to meet the needs of the people living there. People who live there are protected by the home’s recruitment practices. EVIDENCE: The owner said that since the last inspection two staff had left. Staff are currently working extra hours to cover these vacancies so that staff know the people living there. In the morning the deputy manager was on duty with two care staff, a cook, laundry assistant and two domestic staff. Staff said there are usually three care staff but some staff were on holiday this week. Staff who completed the survey said there are usually enough staff to meet the needs of the people living there. The AQAA stated that twenty out of twenty three staff have National Vocational qualification (NVQ) level 2 or above in Care and others are working towards achieving it. This exceeds the standard that at least 50 of staff have achieved this qualification so they have the skills and knowledge to meet the needs of the people living there. Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 26 The records of three of the staff who work there were looked at. These included the required recruitment records including evidence that a satisfactory Criminal Records Bureau (CRB) check had been undertaken. This ensures that ‘suitable’ staff are employed to work with the people living there. The owner said that training is ongoing, last month staff had health and safety, food hygiene and moving and handling training. The fire lecture was due this month. A psychologist did some training for staff in mental health and challenging behaviour so they know how to meet the needs of all the people living there. The staff training matrix showed that staff had training in care planning, moving and handling, dementia, mental health, risk assessment, food hygiene, health and safety, abuse, the accredited ‘Safe Handling of Medicines’ course, first aid and fire safety. Records showed that care staff mainly had received the training but the cook, laundry and domestic staff had very little training. Although they are not providing direct care to the people living there the job they do impacts on the quality of life of the people living there. They should receive training that is relevant so to feel valued in their role and how this impacts on the lives of the people living there. Staff said in the surveys they completed, “We are given relevant training.” “Staff have completed all mandatory training.” “ There are regular staff meetings to discuss any concerns or problems.” “Completing ongoing training helps me to provide a high standard of care considering the different needs of people.” Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 27 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 adequate. This judgement has been made using available evidence including a visit to this service. Management arrangements do not ensure that people live in a well run home. The health, safety and welfare of the people living there is generally promoted and protected. EVIDENCE: The Registered Manager has NVQ level 4 and the Registered Managers Award so they should have the skills and knowledge to manage the home. At the last inspection the Registered Manager was at the home being supervised by the owner, as previously they had not managed the home effectively. The Registered Manager has returned to the home. The owner is overseeing the manager. They have given them specific tasks to do, which they are Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 28 monitoring to ensure they can do these effectively before other tasks are given. The owner said that some improvements had been made in the manager’s performance. Key targets are set at her supervision that are recorded and the outcome monitored regularly by the owner. The owner is also the Registered Manager of the other home she owns. It was discussed with the owner that in the long-term she cannot continue to manage both homes as this could be detrimental to her health and could affect the people living in both homes. There needs to be a set timescale as to when the Registered Manager needs to be competent in managing the home or alternative management arrangements should be made. The owner said that every year surveys are sent to relatives asking for their views about the home. Where concerns had been raised records showed that these were looked into and improvements made. This indicates that the views of the people living there and their relatives are considered and used to improve the service provided. Minutes were seen of the annual quality assurance meeting held in May this year following surveys being completed. This stated that there had been improvements to the environment, training and care plans. The plans to continue to improve the service were documented. No formal complaints had been received. The people living there or their relatives look after their own money apart from one person whose money is looked after by the owner, as is the individual’s wish. A risk assessment is in place and records are kept to ensure this person’s money is spent on the things they want. When people move into the home an inventory of their belongings is recorded. One person’s records sampled who moved to the home in April this year did not include this. Two people’s inventories had not been updated since November 2007. These should be updated regularly so it is clear if something should go missing when the person last had the item and what it was. This ensures individual’s possessions are safe. Since the last inspection staff records showed that supervisions had become more regular. Often these are practice observations to ensure that the member of staff is performing well in supporting the people living there. Where appropriate areas for improvement are identified and followed up at the next supervision. An engineer visited during the day to service the fire alarm and left recommendations that the fire signs in the home were not as standard. Fire records showed that staff do a visual test of the fire extinguishers monthly to ensure they would work if there were a fire. An engineer had serviced the extinguishers in May this year. Staff test the fire equipment regularly to make sure it is working. Staff tested the water temperatures monthly to make sure they were not too hot or cold up until February this year. The records showed that there was a gap between February and May this year when they were not tested. They Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 29 should be tested monthly to ensure that people are not at risk of being scalded by hot water. Assessments were in place to show staff how to use and store hazardous substances so these are used and stored safely. A Corgi registered engineer had completed the annual test of the gas equipment in April this year and stated that it was safe to use. An electrician tests the portable electrical appliances every year, as required to make sure they are safe to use. Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 2 X X 3 X 2 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 2 3 X 2 Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13 (4) Requirement Written risk assessments must be in place for all risks to individuals to ensure their safety and well being. Timescale for action 31/07/08 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 OP1 Good Practice Recommendations The service users guide should include the fees charged to live there. This will ensure that prospective service users have all the information they need to make a choice as to whether or not they want to live there. Individual’s weight records should be regularly monitored. Where a person has lost or gained a significant amount of weight this must be investigated to ensure their health and well being. Systems should be in place to ensure that medication stored in boxes can be audited to check that it is being given to individuals as prescribed. Medication Administration Records should state the dosage given to the individual if it varies so it is clear what they need to meet their health needs. DS0000017019.V366150.R01.S.doc Version 5.2 Page 32 2. OP8 3. 4. OP9 OP9 Rosemary Lodge 5. OP9 6. 7. 8. OP15 OP18 OP21 9. 10. 11. 12. 13. OP24 OP26 OP30 OP31 OP35 14. OP38 There should be a photograph of the person at the front of their Medication Administration Record. If unfamiliar staff were giving the medication they would know who to give it to. Systems should be in place so that staff know that all the people living there are having the required nutrition to ensure their health and well being. All staff should receive training adult protection and the prevention of abuse so they know how to safeguard the people living there. Consideration should be given to replacing the manual hoist with an electric one so that people can have more choice as to whether they have a bath or shower without putting staff at risk of injury. The memos on the bedroom doors should be removed so the home is homely and comfortable for the people living there. Consideration should be given as to how people who smoke and choose to can continue to do so in their home without this impacting on the health of others. The cook, laundry and domestic staff should receive training that is relevant so to feel valued in their role and how this impacts on the lives of the people living there. There needs to be a set timescale as to when the Registered Manager is competent in managing the home or alternative management arrangements should be made. Inventories of belongings should be updated regularly so it is clear if something should go missing when the person last had the item and what it was. This ensures individual’s possessions are safe. Water temperatures should be tested monthly to ensure that people are not at risk of being scalded by hot water. Rosemary Lodge DS0000017019.V366150.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 DS0000017019.V366150.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!