Inspection on 08/02/06 for Rosemead

This inspection was carried out on 8th February 2006.

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

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

Other inspections for this house

Rosemead 17/01/07

Rosemead 02/05/06

Rosemead 28/11/05

Rosemead 24/01/05

Rosemead 13/10/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Rosemead 49 School Lane Bidston Wirral CH43 7RE Lead Inspector Natalie Charnley Unannounced Inspection 8th February 2006 07:40 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 Rosemead DS0000018933.V283050.R02.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 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. Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Rosemead Address 49 School Lane Bidston Wirral CH43 7RE 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) 0151 652 3824 Mrs Mavis Jones Mrs Johanne Huntington-Jones Mrs Mavis Jones Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th November 2005 Brief Description of the Service: Rosemead is a home located in the Bidston area of the Wirral, within a quiet road, close to local shops and transport links. Car parking is available at the front of the building. The home can accommodate up to 14 residents and provides personal care. It is a three story building which has a variety of communal and private areas. A lift is available to take residents between floors. There are eight bedrooms, one of which is ensuite. Three of the bedrooms are shared rooms. The homeowners, one of whom is the registered manager, have a flat on the upper floor to which residents don’t have access. Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over a period of one day. The inspector arrived at the home at 07:40 and left at 14:30 .The inspector spoke with 3 staff, the home manager, and 5 residents. No visitors were available at the time of the inspection. The inspector completed the inspection by looking at the homes records, a tour of the building, formal and informal interviews and information from previous inspection reports. The inspector followed an inspection plan written before the start of the inspection to ensure that all areas that needed covering were done so. Feedback was given to the manager during and at the end of the inspection. Some requirements from the last inspection have not been met and are highlighted at the end of the report along with additional requirements and recommendations. Since the last inspection, the home has been visited by the inspector on 14.12.05 and 03.1.06 to look at how the home have progressed and to offer advice and support. A pharmacy inspection also took place on 14.02.06 which has produced a separate report for the home in which they need to address issues concerning medication. Feedback cards were left for residents and relatives to complete. What the service does well: What has improved since the last inspection? Care plans have been re-organised to make them easier to follow for staff. They are now arranged in folders with dividers between each section. Risks taken by residents are now recorded and reviewed on a regular basis for changes. The home manager has arranged medication training for staff, which was completed on 18.01.06. Further training has been arranged on dementia care, manual handling, food hygiene and first aid. This is to ensure staff are able to provide the care residents living at the home need. The home has put a new heating system in place following failure of the previous system. The system failed due to its age and the home have certificates of safety in place for the new boiler. Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 6 What they could do better: The home needs to address the following standards as a matter of urgency as they have been assessed as having shortfalls. 1. Meeting Needs (standard 3) Residents at the home that have been identified by staff as having dementia/confusion must have a re-assessment by a qualified person, that will look at their needs and decide if Rosemead is a suitable home for them to live in. 2. Contracts (standard 2) Contracts must be made clear as to what a resident is to receive from the home and fees they are to pay. Residents and their representatives must then sign this contract to say that they agree to the terms. 3. Service user plan (standard 7) Residents must have a clear plan of care in place that is updated monthly which is based on their pre admission assessment. This plan must outline what staff need to do for a resident and what they can do for themselves. 4. Social contact and activities (standard 12) The home must plan and offer residents a variety of activities that suit individuals. 5. Protection (standard 18) All staff working at the home must have appropriate checks in place to ensure they are suitable to work with vulnerable people. The manager and staff must make sure they are aware of the local policies and procedures with regard to adult protection and undertake some form of training in this area to comply with Regulation 13(6) Care Homes Regulations 2001 6.Premesis (standard 19) The home must keep all fire doors and exits free from obstacles and are not wedged open and ensure that they are not locked. Residents and staff must be able to use them in an emergency. 7.Infection control (standard 26) A policy must be available for staff with clear guidance to follow. Staff must also receive training to keep their skills in this area up to date. 8.Recruitment (standard 29) The home must always have two written references in place for staff before they start work at the home. Staff files must be kept up to date and in an organised way to ensure all documentation is collected. 9.Staff training (standard 30) In order for staff to care for residents appropriately, a wide range of training must be given to staff. Those administering medication need specialist Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 7 training and an assessment of competence, as well as staff needing support with the core areas and abuse awareness. 10.Quality assurance (standard 33) Residents must be consulted at the home and able to freely express their views. A system to make sure that a good service is provided by the home must be devised and put in place. 11.Financial procedures (standard 34) The home must produce a business plan to demonstrate how the home will address areas such as training, environmental repairs and recruitment. The plan must demonstrate that the home is financial viability. 12. Safe working practice (standard 38) Portable appliance and water testing must be carried out by 11th February 2006. The home must be able to demonstrate that residents are kept in a safe environment at all times. It is very concerning that eight of the above issues have not been addressed since they were made subjects of requirements at the last inspection, and in addition further requirements have now been added. 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. Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 8 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 Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3 Residents can access the information they need to make an informed choice about the home and the services it provides and contracts need to be updated to accurately show the conditions of residency to make sure residents are clear about what the home offers. A new needs assessment is now in place, however it does not show if it was completed before a resident moves to the home, allowing staff to ensure that they can meet the residents needs. Residents currently living at the home may not be in the correct type of care environment and may not be having they’re needs met. EVIDENCE: The service user guide and statement of purpose is available for residents and their families to read on request as it is kept in the deputy mangers office. It was recommended to the manager that this information be freely available to residents and could perhaps be displayed in the hallway. These documents provide information to residents about how the home is run and the staff that Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 10 will care for them. It also addresses how residents will have their rights and independence maintained. Two resident contracts were sampled, both referred to making complaints to the ‘National Care Standards Commission’, which is no longer in existence. This must be changed to read ‘Care Standards Commission’ so residents are clear whom to contact if they need to do so. There is space within the contracts for a ‘monthly charge’ to be entered, so residents are aware of how much they are paying. In both cases this was blank. Neither contract were dated and only one was signed by a resident. The home need to ensure that each resident has a clear contract that shows the terms and conditions of their stay and that it is signed and dated by all parties. The home has put a new form in place since the last inspection; to fill in for all pre-admission assessments. The most recent resident to move into the home on 27.1.06 had details recorded regarding her physical and mental health. An example of good practice was identified as the home had looked up and recorded details about a specific medical condition that they were not familiar with about this resident. The assessment was not dated or signed by the manager who completed the paperwork making it hard to see if the assessment had been infact, completed before the resident moved to the home. During the last inspection in November 2005, staff at the home identified ten of the fourteen residents as being potentially out of the category of the home. This means that they may have needs that staff cannot attend to effectively. Since the inspection, the home have had seven residents assessed by a social worker, however have no written confirmation regarding any decisions that were made. The home must chase this up as matter or urgency along with the three remaining outstanding assessments. Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9 and 10 Residents feel they are treated with respect and have their privacy maintained at all times. Whilst parts of the system for planning care for residents have improved, the plans do not reflect what care staff need to provide to individual residents or what staff need to do to support a resident to do. Medication practices are unacceptable leaving residents at risk from harm and abuse. EVIDENCE: Care plans are now recorded in a more organised way and updated monthly, with different sections in place. Risk assessments are now completed for all residents for manual handling, falls, pressure sores and nutrition. These have been completed to a satisfactory standard following support and guidance from the inspector. A form for recording likes and dislikes gives staff an idea of daily choices that a resident may have, this is an example of good practice. Three care plans were looked at. Despite many attempts to show staff how to write a care plan, all three plans were very poor. Plans showed no goals for residents to achieve and there was little information for staff about how to give care to individual residents. Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 12 None of the residents spoken to were aware that they had a care plan written about them and staff confirmed that they are not involved in this process. The home must now begin to seek the views of residents when developing a care plan to make sure they are individual and reflect what a resident needs and wants. Medication records and storage areas were looked at in the home. The medication trolley was found to be very dirty and sticky from spilt medication, staff were asked to clean this up at the time of the visit. Medications that are given at variable does (i.e. one or two at a time) were not recorded correctly, and it was not possible to see how many tablets a resident had been given. Various boxes of dressings were in the medicine trolley prescribed to residents who had passed away some time ago and seven boxes of hospital tablets were also stored for a resident who was no longer living at the home. Staff were handwriting some medications into records, however these were not being double signed or dated by two staff to ensure that mistakes are not made. Two residents, who take their inhalers themselves, had no paperwork in place to show if they were capable or safe to do so. One medicine was being kept in the trolley as ‘stock’ for residents who have loose stools. No protocol was in place for staff to know when to give this medicine or where to record that it had been given, on closer inspection, no medication policy was available at the home as it had appeared to have been ‘lost’. No patient information leaflets were available for residents of staff to read about the medications that they were taking. Staff were observed giving the lunchtime medicines out. One resident was given painkillers, which staff reported that they sometimes ‘crush’ or ‘give in a spoonful of jam’. This practice is very dangerous as medications that are crushed may not work correctly and hiding medications in food may be viewed as a form of forcing a resident to take tablets against their will. Eighteen painkillers ha been given out of the cassette boxes in which they are stored, however, a record had not been made to show if they had been given. Advise was given to staff and due to the very serious medication errors that were occurring, an immediate requirement notice was left. This gives the home a very short time scale to put problems right and keep residents safe. Residents spoken to stated that they liked living at the home and made comments such as “staff are very respectful”. Staff were observed addressing residents in a pleasant way and respecting their privacy by knocking on doors to bathrooms and bedrooms before walking in. The downstairs toilet was noted to have a ‘bath list’ displayed on it showing when each resident was to be given a bath. Residents spoken to stated that they had a ‘specific day’ when they went in the bath, but could have one on other days if they wanted to. The bath list must be removed to protect the confidentiality of residents. Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14 and 15 Activities are not full filling the wishes of residents, and residents feel that they would like these to be expanded to add more variety Residents are encouraged to make daily choices and keep control over their lives, however this could be expanded further. They have a tasty, balanced diet, however are not always sure of any alternatives on offer to them at mealtimes. EVIDENCE: The home record activities that residents join in with in an ‘activity book’. This showed that staff are doing activities such as carpet bowls, reading papers and books to residents and singing. There is no plan of activities; they are planned on the day. Residents spoken to stated they felt ‘bored’ and that ‘all there is to do is watch television’. One lady commented that the home ‘only ever has ITV on the television’ but that she would like to watch BBC1. A group of residents spoken to during lunchtime stated that “we would like to go out more” and “we occasionally get some entertainment but it would be nice if this could be more often”. When these comments were discussed with the manager and the staff, it was commented that residents did not want to do any activities and that the types of activities that are provided are sufficient to keep them stimulated. Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 14 Residents were asked to if they could make choices over their lives and what they did at the home. Comments were made such as “ we can get up and go to bed when we want” and “ we can chose most things”. It was noted that the home have very early meal times, serving breakfast between 5 and 7am, lunch at 11am, tea at 3pm and supper at 6.30pm. Residents were asked for their comments on this, none had a problem with the times but two residents commented that they “ had got used to it” and “that’s just the way it is here, we don’t really mind”. None of the residents spoken to during the visit were aware of what was on the lunch menu and if there was an alternative. The menus that are planned are very rarely followed by staff and decisions are often made shortly before starting cooking. The meal served for lunch was hot and well presented, and residents appeared to enjoy their meal of chicken dinner and fruit flan. One resident is currently on a low fat diet and under the care of the hospital dietician to help support the home in reducing his weight. Other residents commented, “food is nice and tasty here” and “we get lovely food, but only have an occasional choice”. Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Staff do not have sufficient knowledge of adult protection procedures which leaves residents at risk from abuse. EVIDENCE: Despite being a requirement of the last inspection, the home still do not have a copy of the local council “ Safeguarding Adults” policy. Staff would need to use this and be aware of its details if an allegation of abuse was made at the home. Two members of staff interviewed, had received no training in this area and were not aware of the policy and its importance. Three staff files sampled showed, including that of a member of staff due to start work at the home, that the home had undertaken CRB (Criminal record Bureau) and POVA (Protection of vulnerable adults) checks. Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Areas of the home are not safe for residents as they present a fire risk, the home have been given an immediate requirement notice to cease this poor practice. The infection control procedures at the home are not known by staff and leave residents at risk. EVIDENCE: A tour of the ground floor of the home was undertaken. The front pathway to the home was severely bumpy and had cracked tarmac. Following a recommendation that was made, the home are looking into having this repaired as it hinders access, especially for wheelchairs of people with poor mobility. The home is well maintained and pleasantly decorated, which creates a homely atmosphere for residents. Residents commented that they liked the decor at the home and that they were happy with their environment. One chair was found to have stuffing coming out as it had split on the headrest. The home have purchased a reflexology chair for the residents to use, many of the residents stated that they enjoyed this as it helped them “relax”. Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 17 The main lounge at the home had a fire door that was wedged open and access to the fire exit in the conservatory was blocked by a chair. This exit was also bolted shut. An immediate requirement notice was issued for the home to stop these practices in order to keep the residents safe. The home have experienced a recent failure of the heating system and have installed a new one. This has caused disruption to some areas of the home due to new pipes having to be fitted; however the residents have not been disturbed. The tumble dryer in the laundry was not working and despite the buying a small domestic sized dryer, the laundry and radiators at the home had a lot of washing that was out drying. The laundry was very cluttered and was in need of cleaning to ensure the health and safety of residents and staff. The home has two infection control policies in place; both have conflicting information, which may cause confusion to staff when dealing with issues at the home. A single policy must be put in place and training provided to staff in order to protect the residents. Staff spoken to were not sure what was in the home policy and when asked where it was kept replied “I don’t know”. Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,29 and 30 50 of care staff hold a specialist qualification, however training and training records need to be developed further to ensure staff are kept up to date. The home has poor recruitment practices that do not check the staff effectively before they start work. This leaves residents at risk from harm and abuse. EVIDENCE: The home employ a total of eleven staff, 10 of which are care staff who look after residents. 4 staff have NVQ level 2 or above which is a specialist qualification in care, one member of staff is currently studying towards one. This makes a total of 50 of the staff will hold a specialist qualification. Arrangements have been made for staff to attend training updates on dementia, manual handling, food hygiene and first aid between now and March 2006. The training will take place in the home as this suits the needs of staff so they don’t have far to travel. The home do not have formal training records that show when staff need updates on mandatory training, this would be a useful tool to implement to enable the manager to keep up to date with what training needs to be arranged. Staff confirmed that they are encouraged to attend training sessions and that they are paid to do so. Three staff files were looked at, including one for a member of staff due to start work at the home. Files were very disorganised and the new member of staff had some of the paperwork at home, according to the deputy manager. The new member of staff had two references in place, one was computer typed Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 19 and the other was on a scrap piece of paper. Neither had been formally addressed to the home and had been supplied directly from the member of staff. Neither record had been dated and could it could not be determined if they were recent. No application form, interview checklist or medical checks were available. The deputy manager stated that medical information was not asked for and an interview form was never filled in when people apply for a job. Another staff member who started work in November 2005 had only one computer typed reference in place, which was not dated; again, this was supplied by the member of staff. No photograph was on her file as a form of identification. The home managers granddaughter who works as a care assistant had no references on file and a blank application form, however a job description and induction form were recorded. The manager could not see why checks must be carried out on a member of her family as she “knew them well” The manager must put in place appropriate checks on all staff before they start work including a photograph, two written references that are officially signed and sated, a full and completed application form to look check if there are any gaps in employment history, a medical form and terms and conditions of employment as a matter of urgency. The manager was advised not to let the new member of staff start work until all appropriate checks were in place, in order to protect the residents. Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,34, 35 and 38 The manager has poor knowledge and understanding of her roles and responsibilities regarding running a safe care home, leaving staff and residents at risk. The home cannot demonstrate how they intend to develop the skills of the staff and environment of the home to ensure residents continue to be well cared for. Financial records at the home safeguard residents and allow them to use money independently. Health and safety checks at the home are not all up to date and leave residents at risk from harm. EVIDENCE: The manager of the home is also the co-owner, and has owned the home for the past nine years. The manager has recently been awarded NVQ level 4 in management and the deputy manager is also nearing the end of this course. This is a specialist qualification about how to manage a care home. The manager has an additional qualification in care management awarded by City Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 21 and Guilds. Despite these qualifications, the manager does not show that she understands her role as a registered manager. Examples of this are with regard to poor recruitment practices, seeking the views of residents and providing residents with a stimulating environment in which to live. Requirements made from the last inspection remain outstanding, and despite a lot of input from the inspector the manager shows a very poor understanding of care planning. The home is responsible for four resident’s money. Money is given to residents on a weekly basis, despite only being paid to the home monthly. Residents sign to say that they have received monies and it then becomes their own responsibility. The home do not have a current business plan to demonstrate how they are going to invest and develop the home in the future and are not able to demonstrate that they are financially viable. A plan must be drawn up on an annual basis and be open to inspection. Accidents are recorded in detail by the home, however the manager has no system in place to monitor accidents to see if any patterns are occurring. Safety certificates were checked for gas, electric and fire and were found to be up to date. No records were available to show that portable appliances such as lamps and televisions had been checked. As this is a health and safety risk to residents an immediate requirement notice was left. Water temperatures are also not monitored. This must be carried out to ensure that no bacteria grow in the water and that residents cannot scald themselves. The home stated that they have received a visit from the environmental health officer at the end of 2005, however the report was not available at the home. Following discussion on the telephone with this officer, advise was sought regarding the home that are not recording the temperature of foods or monitoring storage temperatures. A recommendation has been made to the home on this subject and they have been sent a copy of the booklet “safer food, better business”. The last recorded fire drill at the home was done on 4.5.05 and is out of date; this must be done as a matter of urgency. The home first aid box was checked and found to be incomplete, only containing one opened plaster and an open dressing. The manager may wish to re stock this box. Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 22 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 2 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 1 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 1 X X X X X X 2 STAFFING Standard No Score 27 X 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X 2 3 X X 1 Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5(1)(c) Requirement The registered person must ensure that all residents are provided with a detailed contract that clearly outlines terms and conditions. Contracts must be signed and dated by the home and the resident or their representative and contain accurate details regarding contacting the Commission for Social Care Inspection. The registered person must ensure that all residents receive a pre admission assessment and that this is clearly recorded as to when it has been completed (remains outstanding from previous reports due 1.12.04, 1.4 05 and 1.1.06) The registered person must ensure that all residents identified during the inspection receive an assessment to make sure they are in the correct DS0000018933.V283050.R02.S.doc Timescale for action 31/03/06 2 OP3 14 01/01/06 3. OP4 14 31/03/06 Rosemead Version 5.1 Page 24 home that can meet their needs (remains outstanding from previous report due 1.2.06) 4. OP7 15(1) The registered person must ensure all residents have a clear and comprehensive plan of care that they are involved with developing (remains outstanding from previous reports due 1.12.04 ,1.4.05, and 1.1.06) 5 OP9 13(2) 1.The registered person must ensure that all staff that gives out medication are trained appropriately and receive a competence assessment. 2.The registered person must ensure that all drugs entering and leaving the home are correctly signed and dated. 3.Medications and dressings belonging to residents no longer living at the home must be disposed of. 4. A medication policy must be put in place. 5.The registered person must investigate the discrepancy of the 18 missing tablets for the identified residents and forward an explanation to the Commission for Social Care Inspection. 6. All medications must be given as prescribed and recorded appropriately 8.The practice of secondary dispensing, crushing and hiding medications must cease. 9. Residents who self administer medication must have a risk assessment in place Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 25 01/03/06 08/02/06 10 The trolley storing medications must be cleaned 11 The stock of loperaminde must not be used unless a strict protocol is developed to advise staff on when to give the drug. Consent must be sought from residents GP’s to carry out this practice. (remain outstanding from previous report due: 1.2.06 6. OP12 16(1)(n) The registered person must provide structured and varied activities for residents living at the home. (remains outstanding from previous report: due 1.1.06) 7. OP18 18(1) The registered person must ensure all staff are trained on dealing with abuse and that a copy of the local adult protection guidelines are obtained The registered person must ensure fire doors are not wedged open and that the fire exit to the conservatory is kept open and free from obstacles. The registered person must ensure that staff are trained in infection control procedures and that a single policy is in place and available to staff (remains outstanding from previous report:due 1.3.06) 11 OP29 19 The registered person must ensure that all staff must have 2 written references on file and that all requirements as listed in schedule 2 of the care home regulations (2001) are obtained and held on file (Part outstanding from Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 26 01/01/06 30/03/06 8 OP19 13(4)(a) 08/02/06 9 OP26 18(1) 30/03/06 01/01/06 previous report: due 1.1.06) 12 OP30 18(1)(a) The registered person must ensure all staff receives mandatory training and that training records are kept up to date. (part outstanding from previous report: due 1.4.06) 13 OP31 9(1)(2) The registered manager must be able to demonstrate that she is competent to manage the needs of the residents safely 01/05/06 01/04/06 14 OP33 16(2)(m) The registered person must 01/04/06 ensure that quality assurance monitoring takes place within the home. (remains outstanding from previous report:due 1.3.06) 15 OP35 25 The registered person must 01/04/06 provide Commission for Social Care Inspection with an up to date business plan that shows the financial viability of the home The registered person must ensure that safety checks are carried out on portable appliances and that water temperatures are checked and recorded 08/02/06 16 OP38 13 Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 27 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 OP10 OP15 Good Practice Recommendations The registered person may wish to remove the bath list from the toilet door to protect the privacy of the residents The registered person may wish to look at how residents are informed about the meals they eat and the choices that are on offer. The registered person may wish to look into re covering the driveway area and repairing the torn seat in the lounge. The registered person may wish to consider modernising the laundry area The manager may wish to keep a record of food temperatures and fridge/freezer temperatures as an example of good practice. 3. OP19 4. 5. OP26 OP38 Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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. Extracts may not be used or reproduced without the express permission of CSCI Rosemead DS0000018933.V283050.R02.S.doc Version 5.1 Page 29 - 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. 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