Inspection on 03/03/06 for Rosemary Residential Care Home

This inspection was carried out on 3rd March 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosemary Residential Care Home 29/08/08

Rosemary Residential Care Home 11/09/07

Rosemary Residential Care Home 02/08/06

Rosemary Residential Care Home 29/06/05

Rosemary Residential Care Home 11/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Rosemary Residential Care Home Rosemary Residential Care Home 2 Guinea Lane Fishponds Bristol BS16 2HB Lead Inspector Sandra Jones Unannounced Inspection 8th February & 3 March 2006 09:30 rd Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 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 Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 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 Adults 18-65. 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 Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Rosemary Residential Care Home Address Rosemary Residential Care Home 2 Guinea Lane Fishponds Bristol BS16 2HB 0117 9584190 0117 9020515 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) Mrs Regina Odeh Mrs Regina Odeh Care Home 10 Category(ies) of Learning disability (1), Mental disorder, registration, with number excluding learning disability or dementia (8), of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (1) Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate up to 8 persons with mental disorder aged 19 - 64 years May accommodate up to 1 person with a learning disability aged 50 years and over May accommodate up to 1 person with mental disorder aged 65 years and over 29th June 2005 Date of last inspection Brief Description of the Service: Rosemary is situated off Fishponds Road close to shops, places of worship and parks. Originally, the property was two domestic dwellings, converted to provide accommodation to ten people with mental health care needs. The home blends well with its local environment. It is operated by Mrs R. Odeh and registered to accommodate nine adults and one person over 65 years. Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted on 08/02/06 & 3/03/06. It was based on assessing key standards, consulting with residents on the standards of care and seeking feedback from the staff on the conduct of the home. Other sources used to make judgements on the outcomes for residents included examining records and touring the premises. Three residents agreed to give feedback and four members of staff on duty made comments about the home. What the service does well: What has improved since the last inspection? What they could do better: Two requirements that relate to risk assessments and medication profiles are outstanding from the last inspection. These must be addressed promptly to promote the developing standards of care. CRB’s must be in place for existing staff to establish their suitability to work with vulnerable adults. Members of staff without CRBs must not be left unsupervised to work with until CRBs are obtained. Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 6 In terms of care planning a better link between monthly summaries and care plans must be developed to assess the manner in which the individual makes decisions and choices. Residents goals and aspirations regarding education and occupation must be sought as part of a person centred approach to meeting residents needs. 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. Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not examined at this inspection. EVIDENCE: Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 The introduction of Person centred plans has placed the individual at the centre of their care. A better link between monthly summaries and pcp must be developed to define the manner in which make decisions and choices. Risk assessments are completed for any activity that may involve an element of risk. For residents under section, risk assessments must offer guidance on the action to be taken for any breeches of conditions. EVIDENCE: Since the last inspection steps have been taken towards developing a person centred approach to meeting needs. Individual files were reorganised and person centred plans (PCP) were introduced. Care plan list the identified needs and action plans incorporate key principles of rights, choice, independence and inclusion. It is clear that individuals likes, dislikes and preferred routines were considered in developing the action plans with the resident. Six residents are under section 117 of the Mental Health Act and risk assessments must offer guidance on the conditions of the section, breeches and actions to be taken in the event of a breech. Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 10 Monthly summaries provide an overview of events and the individual’s well being. A better link must be created between the monthly summaries and pcp’s to establish the decision making processes and choices that residents can make. Residents meetings occurred in January to discuss menu planning and from the records residents supported the meeting. Residents were given the opportunity to make menu selections, which are included in the updated menus. Risk assessments are generally based on diffusing and diverting aggressive, inappropriate and violent behaviours. Action plans must be reviewed and updated along with the pcp, with clear instructions to the staff on their action in the event that the situation escalates. The kitchen is locked at night to reduce the risk of fire. There is a second kitchen that can be used by residents to make refreshments. Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 16 & 17 Residents engage in activities of their choice but their goals and aspirations in terms of education and occupation must be sought as part of the person centred approach. Residents reported that they are free to leave the home and do not require the support of the staff in the local community. Family and friends are welcome at the home. Residents are satisfied about the rules and routines of home. Resident input into menu planning and are satisfied with the meals provided at the home. EVIDENCE: Nine residents are currently accommodated and two attend structured community based activities and college coursed and one has input from a community psychiatric nurse. Two residents are moving into supported living. The other residents organise their leisure and recreational activities, which include visiting friends, watching television and shopping. It was understood that employment and education is discussed with residents. As part of the Person Centred approach to meeting needs, residents goals and aspiration in terms of developing their independence. Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 12 The residents currently accommodated can leave the home without staff support. Residents giving feedback confirmed that they do not require staff support to visit local shops and amenities. The behaviour of two residents currently limits their freedom to visit local shops. Five residents have regular contact with family members and one has an intimate relationship with a person that lives outside the home. With the exception of one, bedrooms are single and lockable and keys to the home and bedrooms are provided. Residents agreed that bedrooms can be locked. There are rules on smoking and alcohol. Smoking is permitted in designated areas only. There is access to all areas of the home during the day and although the kitchen is locked at night, residents can prepare refreshments in the smaller kitchen. Residents are not expected to participate in household chores. Residents consulted were satisfied with the rules and expectations of both parties. Since the last inspection, residents have has input into the menu planning. Records of food provided evidence a varied diet and the range of foods kept in the home were consistent with the menus. Generally residents have their meals in the dining room and reported that the meals are adequate and sufficient quantities are served. Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 &20 Residents physical needs are met and assessed regularly. Residents medications are well managed by the staff and to protect residents with managing medication, individual profiles must be developed. EVIDENCE: Care coordinators are appointed to review placements funded by the local authority. Psychiatrists, community psychiatric nurse, social workers and occupational health therapists have input into the well being of the residents accommodated. The staff assesses health care needs promptly. Files viewed showed that service users access health care professionals such as the primary health care team, opticians, Psychiatrists and dentists. There was also evidence of monitoring of weight and annual GP checks. Members of staff accompany three residents on GP’s visits, while the other residents are able to visit their GP’s independently. It is usual for members of staff to accompany residents on hospital visits. Residents giving feedback confirmed the support provided by the staff. Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 14 Opticians visit the home and residents use the local dentist for dental checkups. Two residents have diabetes, one is controlled by diet and medication, while the other resident is insulin controlled. Members of staff supervise that the resident is injecting the medication correctly each day. Medication leaflets are made available to the staff, to ensure awareness about the medications being administered profiles must be developed. Individual profiles that describe the prescribed medications, their purpose, side effects and compatibility with homely remedies. Prescribed medications are administered by the staff through a monitored dosage system. The staff sign the records of administration, immediately after administration. A record of medications received is maintained. Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Residents confirmed that their views are sought and acted upon. The commitment to safeguard residents from abuse is promoted through training. EVIDENCE: There were no complaints from residents or their representatives since the last inspection. Residents consulted described the procedure for making complaints and expressed their confidence with the service providers action to resolve their complaints. With the exception of newly recruited staff, members of staff have attended POVA training. Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not examined at this inspection. EVIDENCE: Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 & 35 For recruitment procedures to ensure that members of staff are suitable to work with vulnerable adults, crb must be obtained. Members of staff must not be left unsupervised without obtaining a crb. Mental health awareness training and vocational qualifications will ensure that the staff at the home are competent to meet the changing needs of the residents. EVIDENCE: Personnel files for the staff employed at the home were examined. Completed application forms, two references and current photographs were included in their files. It was understood that crb’s are in progress for two staff, the service provider must ensure that members of staff are not left unsupervised unless crb are obtained. Two members of staff from outside the UK are employed at the home for a limited period. Information held in their personnel records include written references, proof of identity, work permits, copies of professional qualifications and police clearances. It was understood from the service provider that external mental health awareness training is to be rearranged for the staff to attend. Since the last Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 18 inspection, two members of staff were registered onto the NVQ level 2. Statutory training is provided and existing staff undertake refresher training. Members of staff undertaking vocational qualification are aware of the positive benefits to residents and to their personal development. Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 & 41 The training programme in place will facilitate a positive culture where staff have skills to meet the residents changing needs. The records that relate to residents cash held, fees paid and fire safety were accurate and up to date. EVIDENCE: The two most recently employed members of staff from overseas agreed to give feedback on the conduct of the home. Both members of staff are employed as senior staff and during their probationary period are gaining insight into the needs of the residents. Gaining experience from observing staff addressing issues and diffusing incidents of aggression and violence ensure their skills with managing situations are increasing. Existing staff described the training to be provided and vocational qualifications in progress. Positive comments were made about the advantages of undertaking the qualifications, which are confirming their practices. Members of staff reported Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 20 that the service provider is always available and approachable. Residents giving feedback stated that the staff respected their rights and the service provider was aware of their needs. A record of the fees charged at the home is available and for Local Authority placements remittance advice are provided. Fees are paid directly into the home’s account on and records of fees paid by the authority were available for inspection. Facilities for the safekeeping of cash exist at the home and currently one resident has cash in safekeeping. The records include the dates of transactions, balances held, their purpose and signature of the resident. The records of fire safety checks and practices were examined and records indicate that checks and practices are conducted at the stipulated frequencies. Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 x 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 x 33 x 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 x 15 x 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 2 x x 3 x x 3 x x Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 22 no Are there any outstanding requirements from the last inspection? 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 YA6 Regulation 12(3) Requirement A better link must be developed between care plans and monthly summaries to define the manner in which the individual makes decisions and choices. For residents subject to section under the Mental Health Act, care plans must detail the consequences for any breeches. (Previously required 29/06/05) Risk assessments must be dated and reviewed with the care plans Residents goals and aspirations in terms of education and occupation must be sought as part of a person centred approach to meeting residents needs Medication profiles must be developed for each resident that has regular prescribed medication. (Previously required 29/06/05) An enhanced level CRB Disclosure must be obtained for each staff member. Timescale for action 30/06/06 2. YA6 18(1)(a) 30/06/06 3. 3. YA9 YA12 13(4) 12(1) (b) 30/06/06 30/06/06 4. YA20 13(2) 30/04/06 5. YA34 19 30/04/06 Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rosemary Residential Care Home DS0000026565.V281751.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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