Inspection on 07/09/07 for Rosemary Lodge

This inspection was carried out on 7th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 05/06/08

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 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 7th September 2007 09: 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.V345387.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.V345387.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.V345387.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. 3rd May 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 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 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. At the time of the fieldwork inspection, extensive building work was nearly completed to build a new conservatory, a hairdressing room 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 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 the home’s newssheet and the complaints procedure. A copy of inspection reports for people living in the home and visitors are available in the office. The statement of purpose of the home did not state the fees charged. Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 5 Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The visit was carried out over one day; the home did not know the inspector was going to visit. This was the homes second key inspection for the inspection year 2007 to 2008. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) 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 provisions 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 a questionnaire about the home – Annual Quality Assurance Assessment (AQAA). 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. There were twenty-two people living there and one person was in hospital. An ‘expert by experience’ took part in part of the visit. An ‘expert by experience’ is a person who, because of their shared experience of using services, visits a service with an inspector to help them get a picture of what is like to live there. Where they are quoted directly in this report they are referred to as the ‘ex by ex’. Following the last two key inspections the Commission had concerns about this home and the safety of the people living there. However, this key inspection has found that several improvements had been made improving the lives of the people who live there. 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. The home was clean and smelt nice so it is a pleasant environment for people to live in. Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 7 A relative said, “ I have no complaints, it’s all good.” The ex by ex said, “The home had a pleasant and friendly atmosphere”. The people living there are offered a varied diet and could choose what they wanted to eat. The ex by ex said, “The staff are friendly and polite and it was obvious many of the people living there and staff are fond of each other. It seems a happy home.” What has improved since the last inspection? What they could do better: Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 8 The kitchen floor must be made safe to ensure there is not a risk of people tripping. Risk assessments must be in place where staff work excessive hours without a break. If the risks to the member of staff and the people living there are not minimised this practice must cease. A copy of the updated statement of purpose should be forwarded to the Commission on completion to ensure that it includes the relevant information so that people deciding whether or not they want to live at the home have the information they need. Written risk assessments should be in place for all risks to individuals to ensure their safety and well being. Moving and handling, nutrition and falls assessments should be completed for all the people living there. Where there are no risks to the individual these should be stated so that all staff are aware of how to support the person. Where people can behave in a way that ‘challenges’ a plan should be in place that states what triggers, if any, there are to the behaviour, how staff can distract the person to minimise these behaviours and what psychological support the person needs. This will ensure the individual’s needs are met and minimise the risks to them, the other people living there and staff. Staff should ensure that they record any medication they need to record on individual medication records accurately to ensure that people receive the medication they are prescribed. Eye drops should be stored in the medication fridge. This will ensure that food is not contaminated and the eye drops are stored at the appropriate temperature to ensure their use is effective in meeting the person’s health needs. All the people living there should be given an opportunity to take part in activities and outings. Where they choose not to this should be recorded so it is clear that they have made this choice. The activity room should be used so that the people living there have an alternative space to sit and take part in activities they may enjoy thus enhancing their quality of life. Where people have chosen not to bring their own furniture with them this should be recorded to evidence that people have been offered this choice. The owner should continue to monitor the management arrangements to ensure the home is run in a way that benefits the people living there. The quality assurance system should include asking the views of the people who live there as to how the home is run. 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. Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 9 Records of the emergency lighting testing should be kept to ensure it is being tested to make sure it is working. 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.V345387.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.V345387.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, 4 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 the information they need to make an informed choice about whether or not they want to live at the home. Arrangements have improved so that before a person moves into the home their needs are assessed to ensure they can be met and staff have the skills and knowledge to meet individual’s needs. EVIDENCE: The owner said that the statement of purpose of the home is currently being updated and when it is completed they would forward a copy to the Commission. This was forwarded following the inspection and included the information needed so that people who may be looking to move into the home can make a decision as to whether or not they want to live there. Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 12 The Adults and Communities Department of the Local Authority undertake an assessment of people prior to them being provided with a residential placement: without this assessment the people living here would not receive a service. Records sampled of the people who live in the home included an assessment completed before the person was admitted. Their individual care plan was based on this assessment to ensure that staff know how to support the person to meet their needs. The current statement of purpose included details of assessments being completed prior to a person’s admission to the home to assess whether their needs could be met there. Since the last inspection staff had received training in dementia and care planning so to increase their skills and knowledge in meeting the needs of the people living there. Standard 6 was not assessed, as the home does not cater for people assessed and referred solely for intermediate care. Rosemary Lodge DS0000017019.V345387.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 had improved so that staff have the information in individual’s care plans so they know how to support people to meet their needs and achieve their goals whilst maintaining their privacy. Further improvement is needed to ensure that people’s health needs are always met. The management of the medication is generally sufficient to ensure that people receive their prescribed medication at the right time to ensure their health and well being. EVIDENCE: The records of four of the people living there were looked at. These showed for three people that since the last inspection individual care plans had been developed. The owner said that the other person’s care plan had not yet been completed and this was the only one that needed to be finished. Care plans are Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 14 based on the assessment that is completed before the person moves into the home. They detailed the person’s physical needs including personal care, health and mobility, how they communicate, what choices they can make in their day-to-day lives and what support is needed to help them to make these and their social and emotional needs. Each person also had individual risk assessments. These did not all include all the risks to individuals. One person was observed in the morning standing outside the front door in their dressing gown, they walked to the end of the drive and came back in after about ten minutes. Their records stated that they often spend time standing outside usually to have a cigarette. It was good that people have the freedom to go in and out of their home. However, a risk assessment must be in place to ensure that all risks to the person have been identified so that any action is taken to ensure their safety and well being. One person is able to go out on their own. Since the last inspection they have a risk assessment for this to ensure that the risks to their safety are minimised as much as possible whilst encouraging them to maintain their independence. Care plans had been reviewed monthly and updated where there had been changes to the individual’s needs. Records sampled showed that staff had ensured that where people had health needs they were seen by their GP and where appropriate referrals were made to other health professionals. Visits to health professionals were recorded that included any advice given so that staff know what to do to ensure individual’s health needs are met. The owner said that wheelchair assessments and continence assessments are being completed with the people living there so to ensure that these needs are being met. Risk assessments were generally in place for how staff were to support individuals with moving and handling. In one person’s records sampled this had not been completed. Staff said the person mobilises independently so this needs to be stated on their assessment to ensure all staff working with the person know this. Nutritional and falls assessments had been completed for people who needed support with this or had a history of falls. These need to be completed for all the people living at the home and where support is not needed this should be stated. One person’s nutritional risk assessment stated that they were at a very high risk of being under nourished and to seek dietetic advice. There was no indication in the person’s records to suggest that this advice had been sought. The owner said that she will speak to the person’s GP and request advice but would also monitor the person’s food intake for about a month as their appetite had been good since they were admitted. Each person had been assessed to identify whether or not they were at risk of developing a pressure sore. If they were at risk a plan was in place that stated how staff are to support the individual to minimise these risks. Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 15 One person’s care plan stated that they sometimes behave in a way that ‘challenges’ being verbally and physically aggressive. It stated what staff are to do if this happens. However, it did not state if there were any triggers to this behaviour or if there was anything that staff could do to distract the person from behaving in this way or minimise these behaviours. This should be stated to ensure that the psychological needs of the person have been addressed and if necessary further advice should be sought from the relevant health professionals. Each person now has a hospital admission form so that if they were admitted to hospital there is some information about them for the staff there to know how they can meet their needs. Medication is stored in a locked cabinet. A local pharmacist supplies the medication in blister packs of each dose so that it is easier for staff to know what medication each person has and at what time. Medication Administration Records (MARS) sampled had been signed appropriately and these crossreferenced with the blister pack indicating that medication had been given as signed. One person who had moved in within the last month had their medication supplied by another pharmacist and it was not yet in blister packs. Staff had signed their MARS appropriately. However, for one of their medications on the box is stated that the dose was 8mg/500mg but on their MARS it stated 30mg/500mg. This was clearly an error in writing it down and they would not have been overdosed as only 8mg/500mg had been supplied. However, if they had been admitted to hospital during this time and the only information that went with them was the MARS then it is likely that they would have been overdosed on this medication. The risk of this happening again is to be reduced, as they are now to have their MARS printed by the pharmacist. However, if other people are admitted without their MARS being printed staff need to ensure that they record carefully the medication that is prescribed for the individual. Copies of prescriptions are kept so that staff know what is prescribed for the individual. Some people are prescribed inhalers, these had the individual’s name on them to ensure the risk of cross-infection is reduced and the person has the dose that they are prescribed. A phone call was received from one person’s GP surgery asking for staff to collect the person’s prescription. Straightaway the deputy manager asked a member of staff to go and collect it so that the person could begin their course of medication. Eye drops for some people were stored in the food fridge in the kitchen, which could risk contamination of the food. The owner said that they have recently bought a medication fridge and intend to use it to store eye drops and any other medication that should be stored in a fridge. Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 16 The people living there were well dressed and had individual styles of hair and dress. Staff were observed talking to people in a way that respected them as individuals and their age and gender. Care plans stated what support the person needed with their personal care and what ability the person had to care for themselves so maintaining their independence and dignity. It also stated whether or not the person can choose their own clothes and how staff are to support them to enable the individual to make choices as much as they are able to. Rosemary Lodge DS0000017019.V345387.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 adequate. This judgement has been made using available evidence including a visit to this service. Arrangements had improved but further improvement is needed to ensure that people have more opportunity to experience a meaningful lifestyle and have some choice and control over their lives. The people living there have a balanced and varied diet that meets their nutritional needs ensuring their health and well being. EVIDENCE: Since the last inspection a part-time activity co-ordinator has been employed. Daily records sampled showed that this had improved the activities that were offered to the people living there. Staff said and records showed that some people have been to the park, for walks, out for picnics, for pub lunches, out for coffee and to the garden show at Kings Heath Park. The following Monday a group were planning to go to the Nature Centre. It was not clear how people are asked whether or not they want to take part in these activities outside the home to ensure that everyone has the opportunity to take part if they want to. One person’s daily records sampled did not record any activities other than Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 18 sitting in their armchair. The ex by ex said, “Most people just seem to sit there with nothing to occupy them. One person said she loved to knit and embroider but had not been given any encouragement to do this. I asked several people about activities and they seemed unaware that there was any. One person told me that they had had someone come and give them some exercise to do, but she hadn’t joined in. One person mentioned bingo. She said that she would like to play cards and another lady jumped in and said she didn’t.” The owner said that some day trips had been organised but that the people living there had either not shown an interest in wanting to go or had said on the day the trip was organised that they no longer wanted to go. Some people may not have been out of the home for a long time so may need extra encouragement and support to do so. One person goes to a day centre twice a week. The activity co-ordinator said that they are arranging ‘Ring & Ride’ transport for some people so that they can go out more often. One person goes out on their own and a risk assessment has been completed to ensure they are as safe as possible whilst maintaining their independence. There is a weekly tuck shop where the people living there can buy items such as chocolate, drinks, newspapers or anything they request. Records showed that other activities include bingo, quizzes, sing–a-longs, film afternoons, board games, listening to classical music, arts and crafts and a ‘Ladies beauty night’. People said and records showed that if people want to they could go to church. Once a month a communion service is held at the home for people to go to if they want to. Some records stated that people had helped to lay the tables for meals so encouraging their independence skills and helping them to feel valued by having a role within the home. A hairdresser comes into the home every week, the owner said that the hairdressing room would be ready to use in the next week. This would provide better facilities for people to have their hair washed and more privacy. Some people were reading the ‘Metro’ newspaper. The TV was on in one part of the lounge and music was playing in the other end. The ex by ex said’ “ It was difficult to hear either satisfactorily”. A separate large activity room is provided that was being redecorated at the time of the last inspection. The owner said it is not used very often and they plan to make it a relaxing room with equipment that will help people to relax more. They said this would be redecorated before it can be used. This room provides space for people to sit and enjoy activities of their choice with less distraction than the busy ness of the lounge and dining room so should be used more often. Daily records sampled showed that people are supported to keep in contact with their family and friends. Records showed and people said that their Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 19 relatives visited. One person’s relatives visited briefly during the afternoon to see how they were. Staff were observed to make them feel welcome and they said they would be visiting again at the weekend. Records showed that earlier in the week there had been a meeting with the people living there asking their likes and dislikes about activities and foods. For people who chose not to attend the meeting staff had discussed this with them individually. Care plans sampled stated what time people usually choose to go to bed and to get up and what foods they enjoy eating. There is a choice of two cooked meals at lunchtime and the staff said that changes to this could be accommodated to suit individuals. The ex by ex said, “As it was Friday, the menu for the day was fish and chips or prawn omelette and salad. When one person was asked which they would like for lunch they said could they have egg and chips instead and that was fine. I ate lunch with people and had a prawn omelette and salad and bread and butter, it was very good. People were taken to the dining tables more than thirty minutes before the meal is served and this seemed an unnecessarily long time. There were condiments including tomato sauce and salad cream. A pudding is served every day. Soft drinks were available with the meal.” Food records showed and people said that breakfast includes a choice of cereals and in the evenings people have a choice of sandwiches. Some people choose not to eat in the dining room and this wish is respected. The owner and some of the people living there said that the people who smoke can do so upstairs on the landing where a table and chairs are provided and they will also be able to smoke in the conservatory when it is finished. One person’s care plan assessed the risks of them smoking but also stated that staff need to try to introduce new activities to them to take their mind off smoking. Rosemary Lodge DS0000017019.V345387.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 generally ensure that the people living there and their relatives and friends can be confident that their complaints will be listened to, taken seriously and acted upon. Arrangements ensure that the people living there are protected from abuse. EVIDENCE: The complaints procedure was displayed on a board in the lounge so that the people living there could see it. It stated that all complaints would be investigated within 28 days and included the details of how to contact the Commission. The Commission had received a copy of a complaint letter sent to the home in August 2007 from a reviewing officer of the Adults and Communities Department of the Local Authority. This was regarding the records of the person they were reviewing either not being available or not containing enough information and staff not being aware of the person’s needs. The owner stated that they had not received this letter but would investigate and forward the outcome to the Commission. Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 21 The complaints log showed that seven complaints had been made to the home in the last year. Records showed that these had been investigated appropriately and where necessary action had been taken by the owner to ensure that improvements were made. Action included audits being carried out unannounced to ensure that people were receiving appropriate personal care and reviewing night staff tasks. One of the complaints was an allegation from a person living there about a member of staff. This was investigated by the person’s social worker and no evidence was found to show that the member of staff had abused the person and there were no concerns about the way the person was being cared for at the home. Risk assessments had been put in place regarding the allegations that this person has made to ensure their safety and that of the staff caring for them. One person living there goes out on their own. At the last inspection it was found that this was good to maintain the person’s independence but they had been at risk when out in the community and there was not a risk assessment in place. This had been developed to ensure that all risks to their safety were minimised as much as possible. Since the last inspection all staff had received training in adult protection and the prevention of abuse so they know how to safeguard the people living there. Rosemary Lodge DS0000017019.V345387.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, 23, 24, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements had been made but need to continue to ensure that people live in a safe, comfortable, clean and well maintained environment. EVIDENCE: Over the last year there has been major building work going on in the home. This is to extend the facilities available on the ground floor to include a conservatory, hairdressing room and accessible walk-in shower and WC. Most of the work had been completed, some painting outside was being done and the flooring needed to be fitted in the hairdressing room and the shower room. Decking had been installed outside the conservatory door to allow easier access to the garden. The owner said they are getting a new lawn laid and some new garden furniture to make this a more pleasant place for the people Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 23 living there to spend time in. They have not been able to use the garden since the building work started. The owner has a plan of improvements to the environment to continue after this. The next improvement will be to the kitchen where there will be new flooring and tiling and following that the bathrooms are to be refurbished. Part of the flooring in the kitchen was starting to rise on the join, which could be a tripping hazard. The owner said that they have received quotes to get it replaced but in the interim would ensure that it was made safe. Bedrooms seen included personal items and photographs and new bedding had been provided making the rooms more homely and comfortable. One bedroom seen on the second floor included the person’s own furniture apart from the wardrobe. The owner said they encourage people to bring their own furniture if they want to. The ex by ex said, “One person became upset when I asked if they had been able to bring any of their own furniture. She said no, all her home had gone! Only knickknacks and photos were allowed. Others seemed quite happy with this arrangement, pointing out their furniture would be too big.” Some people have to share a bedroom and screens are provided to give some privacy. The ex by ex said, “I asked one of the ladies who is sharing a room if she was really happy with the arrangement. She said she was and explained they had a screen in between for privacy.” The activity room is not used that often and there was nobody using it during the day. New curtains were delivered during the day and the owner said the room is to be redecorated and new furniture bought so it can be used more often. The home was clean and there were no offensive odours making it a pleasant environment to live in. Since the last inspection cleaning schedules have been regularly monitored by the deputy manager to ensure that staff are ensuring that the home is kept clean to minimise risks of cross infection. Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 24 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 are generally sufficient to ensure that the needs of the people living there are met. The people living there are protected by the home’s recruitment policy and practices. EVIDENCE: There were three care staff on duty, two domestic staff, a laundry assistant, a cook and a maintenance staff on duty in the morning. The deputy manager was also on duty. The activity co-ordinator was on a day shift. Rotas showed that one member of staff had worked a night shift followed by an early shift on two separate occasions. The owner said that this was at the member of staff’s request and they felt that this was not detrimental to their health. A risk assessment needs to be completed to ensure that there are no risks to the member of staff working these excessive hours without a rest and that there are no risks to the people living there. If these risks are not minimised then this practice must cease and the member of staff must be given a break before resuming their next shift. Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 25 The owner said that one domestic staff is leaving in October so they were interviewing at the time of the visit to fill this vacancy. The owner said they are also recruiting care assistants, a kitchen assistant and another cook. Permanent staff or staff who work at the other home the owner owns, cover vacancies and sickness to maintain consistency for the people living there. The AQAA completed in May 2007 stated that 97 of staff have completed NVQ level 2 or above in Health and Social Care. This exceeds this standard that at least 50 of staff have achieved this qualification. One member of staff’s records sampled showed that they had already achieved NVQ level 2 and are now working towards level 3. This helps to ensure that staff have the skills and knowledge to meet the needs of the people living there. Four records of the staff employed there were looked at. These included the required recruitment records including evidence that a Criminal Records Bureau (CRB) check had been completed to ensure that ‘suitable’ people are employed to work there. Records showed that staff had received training in medication, risk assessment, care planning, dementia, food hygiene, adult protection and the prevention of abuse, infection control and health and safety. Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 26 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. Arrangements have improved to ensure that the home is run in a way that benefits the people living there. Arrangements for supervising staff have improved and need to continue so that they are supported appropriately to meet the needs of the people living there. Generally the health, safety and welfare of people living in the home is promoted and protected. EVIDENCE: At the last inspection the Registered Manager had been moved to the other home operated by the owner and they were not in a management position. They remain in employment there. An Acting Manager was in post however Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 27 due to personal reasons they are not able to currently be in this position and they are now the Deputy Manager. The owner is overseeing this home but is also the Registered Manager of the other home they operate. The owner said that she has allocated some tasks to senior staff. One is responsible for doing the care plans and auditing the medication systems. One is responsible for supervising the domestic staff and cooks and the other responsible for doing the cleaning audits. The owner said she would continue to review the management situation over the next few months. At the last inspection one person’s financial transaction records were not clear to show how their money was being spent. The owner said that one person asks for their money to be cashed and asks one of the owners to buy their cigarettes. All the other people living in the home have responsibility for their own money or they have a relative or friend who does this for them. The owner said that this person refuses to go to the post office to collect their money and it is difficult for them to get in and out of a taxi. The person relies on one of the owners to get their money and buy their cigarettes, which is what they spend most of their money on. They have requested input from the social worker with this but this had not been provided. Financial transaction forms are completed and the person witnesses these and signs to agree their money has been spent in the way they want. A financial risk assessment needs to be completed for the individual, which they should be asked to sign to show that they agree to the risks involved with the owner handling their money. The owner said that audits are completed during the night to ensure that the people living there are being supported appropriately. They have also introduced a staff signing in book as some staff were coming in late, which affects the service provided. This is being monitored by one of the administrative staff who also regularly checks the storeroom and monitors people’s food records to make sure they are receiving a healthy diet. Staff records sampled showed that since the last inspection a system of assessing each member of staff’s practice in line with the procedure manual had been introduced. Staff were observed carrying out care tasks and were assessed on these. Where improvement was needed this was highlighted and is monitored to ensure that staff are competent in meeting the needs of the people living there. The owner said that after the last inspection they had a relatives meeting, to which about twelve relatives came. All suggestions that they made were acted upon and they plan to have another meeting around Christmas time. A newsletter of the home is now produced, this is displayed around the home and includes information about activities, birthdays, parties, staff news and what is happening with the building works. Staff records sampled showed that they had not had regular formal supervision sessions with their manager at least six times a year. However, since the last inspection this had improved. As stated above the care practice of staff is being regularly assessed. This will help to improve staff performance and so improve the care provided to the people living there. The owner said that in Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 28 addition to this supervision sessions would be held more regularly. The owner said that the previous week there was a team building lunch and staff meeting that all staff attended and staff meetings would now be held monthly. Prior to a meeting in August this year these had not been held regularly. Fire records showed that the staff test the fire alarm regularly to make sure it is working. Staff had tested the emergency lighting regularly but records of this testing stopped in January 2007. The owner said it was still being tested but the records of this could not be found. Records showed that the portable electrical appliances had been tested in July 2007 to make sure they are safe to use. Staff had tested the fridge and freezer temperatures generally daily to make sure they were within the safe limits for food to be stored to minimise the risk of food poisoning. There were some days in August when these were not recorded. Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 29 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 3 3 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 2 3 X 3 2 X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 X 2 Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 30 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. 2. Standard OP19 OP27 Regulation 13 (4) (ac) 13 (4) (ac) Requirement The kitchen floor must be made safe to ensure there is not a risk of people tripping. Risk assessments must be in place where staff work excessive hours without a break. If the risks to the member of staff and the people living there are not minimised this practice must cease. Timescale for action 08/10/07 08/10/07 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. 2. Refer to Standard OP7 OP8 Good Practice Recommendations Written risk assessments should be in place for all risks to individuals to ensure their safety and well being. Moving and handling, nutrition and falls assessments should be completed for all the people living there. Where there are no risks to the individual these should be stated so that all staff are aware of how to support the person. Where people can behave in a way that ‘challenges’ a plan should be in place that states what triggers, if any, there DS0000017019.V345387.R01.S.doc Version 5.2 Page 31 3. OP8 Rosemary Lodge 4. 5. OP9 OP9 6. OP12 are to the behaviour, how staff can distract the person to minimise these behaviours and what psychological support the person needs. This will ensure the individual’s needs are met and minimise the risks to them, the other people living there and staff. Staff should ensure that they record any medication they need to record on the MARS accurately to ensure that people receive the medication they are prescribed. Eye drops should be stored in the medication fridge. This will ensure that food is not contaminated and the eye drops are stored at the appropriate temperature to ensure their use is effective in meeting the person’s health needs. All the people living there should be given an opportunity to take part in activities and outings. Where they choose not to this should be recorded so it is clear that they have made this choice. The activity room should be used so that the people living there have an alternative space to sit and take part in activities they may enjoy thus enhancing their quality of life. Where people have chosen not to bring their own furniture with them this should be recorded to evidence that people have been offered this choice. The owner should continue to monitor the management arrangements to ensure the home is run in a way that benefits the people living there. The quality assurance system should include asking the views of the people who live there as to how the home is run and whether or not it meets its stated aims, objectives and statement of purpose. A risk assessment should be in place to ensure that when the owner manages the money of people who live in the home this is transparent, protects the individual and promotes 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. Records of the emergency lighting testing should be kept to ensure it is being tested to make sure it is working properly so that the exits would be clear if there was a fire. 7. OP12 OP20 8. 9. 10. OP24 OP31 OP33 11. OP35 12. OP36 13. OP38 Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 32 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. Extracts may not be used or reproduced without the express permission of CSCI Rosemary Lodge DS0000017019.V345387.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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