CARE HOME ADULTS 18-65
Rosemerryn 2a Cadogan Road Camborne Cornwall TR14 7RS Lead Inspector
Lynda Kirtland Unannounced Inspection 22nd August 2007 9:15 Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 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 Rosemerryn DS0000009117.V344095.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 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. Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Rosemerryn Address 2a Cadogan Road Camborne Cornwall TR14 7RS 01209 610210 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) mail@dcact.org Spectrum Vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: Rosemerryn is a home providing accommodation and personal care for up to three adults with a learning disability. It is run by Spectrum, an organisation that provides specialist care in small units for adults with autistic spectrum disorders. Spectrum aims to provide its service users with appropriate support in a domestic style environment in a community setting. Spectrum employs management and care staff to work directly with service users in the home. Senior managers from within the Spectrum organisation visit the home as necessary and provide additional support. The home is a two-storey, detached house, located in the town of Camborne. It is within easy reach of all the towns amenities and is set in spacious grounds, slightly off the street. Service users are provided with single rooms. They have access to a lounge and dining/ kitchen area. The home has a laundry room, three bathrooms and office accommodation for staff. There are no specific adaptations for people with physical or sensory disabilities and not all parts of the home are wheelchair accessible, but the home has two bedrooms on the ground floor and some adaptations could be made if required. Fees range from £1045.00 - £3374.00 per week according the home’s manager at the time of the inspection. Service users are charged extra for certain activities, such as massage and trampolines, private chiropody, hair dressing, alcoholic drinks and are expected to pay some contributions towards leisure activities outside of the home. Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which took place on 22 August 2007. It lasted for approximately six hours. Information about the home received by the Commission since the previous inspection was taken into account when planning the inspection. The purpose of the inspection was to ensure that service users’ needs are appropriately met in the home, with particular regard for ensuring good outcomes for them. This involved talking with service users and observation of the daily life and care provided. There was an inspection of the home’s premises and of written documents concerning the care and protection of the service users and the ongoing management of the home. Staff were interviewed and observed in relation to their care practices and there was a discussion with the home’s acting manager. The principle method used was case tracking. This involves examining the care notes and documents for a select number of residents and following this through with interviews with them and/or their relatives and staff working with them. This provides a useful, in-depth insight as to how residents’ needs are being met in the home. At this inspection, two of the service users were case tracked. It is noted that on the day of inspection the acting manager returned from long term sick leave and therefore due to the management changes in the home since April 2007, this has affected the running of the home. The care of service users has remained to a good standard but management tasks have not been given such a high priority and could account for the reason why this service is now rated from a level 2 to level 1 service. What the service does well:
Admission to the home is based on a detailed assessment so that service users can be confident it will be suitable for them. They are provided with written information about the home, what it provides and what is expected of them, which is available in translated formats so that they can access it directly, if they wish. Service users have detailed written care plans, which set out how the home will meet their personal, health and social care needs, including needs relating to their individual backgrounds and culture, age, sex, religion, individual abilities and sexual orientation. These are regularly reviewed and shared with their representatives so that they can be kept informed of their progress in the home. Staff help them to make important decisions about their lives and enjoy a good quality of life. They are supported and encouraged to take risks to develop their skills, independence and confidence, but in ways which are safe for them and other people.
Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 6 Service users enjoy a very good quality of life in the home. Staff support them to take part in a wide range of activities in the community. They are encouraged to go out to a local social club one evening a week and to maintain valued relationships with their friends and families outside of the home. Staff support service users with their personal care so that they look smart and fashionably dressed, which they appreciate. They are helped to access a range of NHS healthcare providers, such as doctors, opticians and community nurses so that they maintain good general health and d receive any specialist services they need. Service users said that they are safe and well cared for in the home and there is a genuine commitment among the staff team to ensure their welfare and protection from abuse. The staff team is selected fairly and on the basis that people employed to work in the home are fit and suitable to work with vulnerable adults in a care setting so that service users and their representatives can have confidence in the people caring for them. What has improved since the last inspection? What they could do better:
Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 7 The homes Statement updated to accurately provide. In addition its users are able to access Of Purpose and Service Users guide needs to be reflect the services and facilities that Rosemerryn presentation needs to be considered so that Service this document more easily. It was noted that there was some mediation errors. The medication system needs to be reviewed to ensure that medication is administered safely and that records reflect this. All medication in the home must be accounted for and records must reflect this. Staff must go on accredited training in the safe handling of medicines so that Service users are better protected from medication errors. The medication cupboard should be secured to the wall for extra safety. The home’s manager should attend multi-agency training on the protection of vulnerable adults to enhance systems already in place to ensure service users’ welfare and best interests. In respect of the environment the carpets downstairs need to be cleaned or replaced as they have a number of stains on them. The home would benefit from redecoration. Ventilation in a service users’ bedroom must be improved so that they have a healthier atmosphere in their private accommodation, which is currently being affected, by condensation and damp. The upstairs rooms temperature needs to be monitored as they do get hot and in one of them medication is stored. The manager has applied for some ‘coolers’ and it is hoped these will be purchased to address some of the problem. An immediate requirement was issue d in respect of the stairway being repaired, as it was unsafe to use. This was complied with within 24 hours. The proportion of staff who have formal qualifications should be increased so that service users can have confidence that sufficient numbers of people working with them have been assessed as competent to do so. Staff should be provided with formal supervision, with records kept so that service users can be assured that properly trained and supervised staff care for them at all times. Staffing levels must be reviewed to ensure that at all times sufficient and qualified staff numbers are present to meet the needs of Service users as outlined in their individual risk assessments. The major concern is in respect of the fire procedure in the home. The manager informed CSCI that the rear of the property is no longer safe to use as the conservatory wooden floor has rotted. In addition they have built a ‘calm room’ into the conservatory area and so have blocked off access to the back door. This means that there is only one means of access/ exit to the home and heightens concern regarding evacuation in case of a fire. CSCI have discussed this with the fire authority that has agreed to undertake an
Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 8 inspection of the premises to assess this further. (Please refer to management section for details) The manager must submit her application to the commission to be formally registered with the commission so that service users can be confident that she is fit and competent to be in day-to-day charge of the home and to ensure that the home is operating legally. 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. Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 9 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 Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Statement of purpose needs to be reviewed and updated so that it accurately reflects the service that Rosemerryn provides for service users and their representatives information Service users’ needs are assessed prior to their admission so that they can be confident it will meet their health, personal and social care needs, including needs relating to their age, religion, cultural and ethnic backgrounds, abilities, gender and sexual orientation. EVIDENCE: There have been no changes to the service user group since the previous inspection. From observations and talking with service users it was evident that they are settled in the home, and that they get on well with each other and with the staff. The homes Statement Of Purpose and Service Users guide needs to be updated to reflect accurately the services, facilities and staffing arrangements of the home. Service users and their representatives can then have accurate information on what Rosemerryn provides. From documentation inspected it was evident that admissions are made following a full assessment and in consultation with the service user, their
Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 11 family or advocate, and relevant professionals. Transitional work for the service user moving into the home is undertaken in a planned manner and at the service users pace. Service users are provided with written statements of the terms and conditions of their placement, in translated formats, so that they can access the information directly. This is shared with their representatives and relatives. This information now includes the total cost of their placement and a detailed breakdown of how their personal contributions towards the total cost is calculated. Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are aware of their care plans, which fully address their health, personal and social care needs, including needs relating to their individual and diverse backgrounds (age, religion, culture and ethnicity, abilities, gender and sexual orientation). They are able to take safely managed risks and make important decisions about their lives so that they develop their skills and independence. EVIDENCE: Service users, their family, advocate and relevant professionals are involved in the development of individual care plans and their subsequent reviews. The reviews record service users views so that they are aware of the purpose of their placements in the home and are able to contribute to the ongoing care planning process. The care plan has specific headings to address their health, personal and social care needs, including their individual and diverse needs. These are in written form plus in Widget (pictorial) form. Personal Care plans provide service users with specific goals to work towards, and inform and direct staff in how to support the service user to achieve this goal to encourage
Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 13 them to fully maximise their skills for independent living. New staff to the home confirmed they were able to understand the care plans and that the detail of how to assist in a particular task allowed consistency of care. Service users participate in making decisions about important aspects of their daily lives, according to their individual abilities and this was observed during the inspection. Staff were observed supporting service users who required it, to make decisions about what to do during the day. Service users’ written care plans formally consider their abilities to make decisions for themselves and daily care records provide further evidence of the choices they make in their daily lives. Service users can choose the level of privacy they wish to enjoy in their private accommodation. Service users are able to take managed risks, backed up with written risk assessments and risk management plans, particularly with regard to their engagement in higher risk activities. Service users monies are audited at Spectrum Headquarters and therefore was not inspected on this occasion. Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are able to take part in a wide range of activities in and out of the home, which are appropriate to their ages, individual needs, interests and cultural backgrounds so that they develop their skills and confidence. They are supported to maintain valued social and family relationships so that they are not isolated or institutionalised. They are informed of their rights and responsibilities so that they are aware of what is expected of them. They are provided with a wholesome and varied diet so that they enjoy their meals and stay healthy. EVIDENCE: At the time of the inspection, service users were engaged in a range of different individual activities. Their individual needs and preferences are considered as part of the assessment and/or care planning process so that they can be provided with activities that are appropriate for them. They have information, in pictorial formats about the different activities available to them so that they can plan and choose what they will do each week with staff.
Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 15 Service users were continuously in and out of the home during the inspection, going on drives, shopping and walk in the local community, with staff. Their daily care records confirm that they make use of a wide range of community resources, including local fairs, cafes, pubs and shops. All three service users attend a social club in the community once a week, so that they have opportunities to meet people from outside of Spectrum. There are records of their contact with their families, including regular visits home, or visits from relatives to them at Rosemerryn. Needs in relation to their developing personal relationships are considered as part of the ongoing assessment and care planning process, including specific risks. Service users can have access to independent advocacy services, particularly where they do not have close relatives to support them on a regular basis. Service users said that they like the food provided to them at the home Service users take it in turns to choose the meals to be cooked and can help with the shopping and preparation of the meals with staff support. Staff support them according to their individual needs and abilities and they are able to independently access the kitchen, depending on their individual risk assessments. There are clear records of food provided to service users so that staff can monitor their nutritional intake and encourage them to eat healthily. Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ personal and healthcare needs are well met so that they are able to live full and active lives in and out of the home. Medication systems need to improve to ensure that medication errors are prevented. EVIDENCE: Service users individual care plans address their personal care needs. They appeared to be attractively and fashionably dressed and were well groomed so that they can comfortably take part in community life. The home has suitable bathroom facilities so that they can attend to their personal care in private. Service users healthcare needs are considered as part of the care planning process and regularly reviewed. Documentation showed that access to external healthcare providers, including specialists, occurs when needed. There are suitable medication storage facilities but the cabinet needs to be fixed to the wall for extra security. Service users do not currently selfadminister medication. Spectrum has a medication policy that was present in the home.
Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 17 From inspecting MAR sheets it was evident that there have been medication errors. These were in relation to medication not been administered, or administered form the wrong day or tablet sheet. The MAR sheets must be completed as medication is administered. It was difficult to undertake an audit of medicines (PRN) as the MAR sheets did not record the number of tablets it had received and therefore a tablet count of tablets, which were not in blister packs, was difficult to do. This therefore showed more medication was in the cabinet then was recorded on the MAR sheets. It is required that improvements in this area are made. The manager stated that all staff should have attended medication training. First aid training is completed on staff’s induction period and there is always a first aider on duty. Four staff members are currently booked to complete the first aid course. Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are listened to and respected so that their views, concerns and complaints are taken seriously and acted upon. There are formal and informal systems in place to ensure that they are able to feel safe in the home. EVIDENCE: Service users were encouraged to speak to the inspector if they wished in private or with staff present so that they could make their views known or raise any concerns. No concerns were raised. Service users are provided with written copies of the home’s formal complaints procedure and have formal and informal opportunities to raise any concerns with staff before they become serious complaints. The home has written procedures to guide staff on what to do if they suspect a resident is at risk of abuse. There are records to show that staff is recruited on the basis that they are suitable to work with vulnerable adults in a care setting and appropriate checks are made. Residents are not isolated in the home, but take part in a range of activities in the local community and have relationships with people from outside of the home that they can communicate serious concerns to. Spectrum has a whistle blowing policy. It is recommended that the manager attend the Multi Disciplinary Adult Protection course. The home does have a copy of the Cornwall Multi agency adult protection procedure. Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,30 Quality in this outcome area is poor. Whilst the home provides mainly suitable accommodation for service users, further improvements are needed to make it safer and more comfortable for them. Ventilation needs to be improved to two of the service users bedrooms to promote a healthier atmosphere. The home would benefit from being redecorated and new or cleaned carpeting particularly downstairs. An immediate requirement was identified to repair the stairs to ensure that they were safe for Service users and staff use. The home is in the main kept clean and tidy and good hygiene is maintained so that service users and staff are protected from infection risks. EVIDENCE: Service users appeared to be comfortable and happy in the home. It is well located so that it offers privacy as well as good access to the local town. It is an ordinary, domestic building so that service users live in a noninstitutionalised environment in which they can develop their skills and become more independent. It is in the main decorated and furnished to a good standard. Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 20 The conservatory is no longer in use because it requires major refurbishment, but service users have sufficient communal space without it. However as this area is no longer in use and has no access to the back door (unless you climb through a window) this raises concern in respect of accessing and exiting the home in case of a fire – see management section, as there is only one entrance. In addition due to part of the conservatory now being divided to make a RSA or ‘calm room’ as a Service users named it, this has meant that there is no natural ventilation to one Service users bedroom. On inspecting this room it was observed that the room smelt damp, had damp patches on the wall, ceiling needed repair and the room was ‘stuffy. This needs to be addressed immediately. Service users used to sit in the conservatory area and use this as a dining area. However now that part of the conservatory area is used as a ‘calm room’ a large enough table for all Service users to sit at in this area is now not feasible. Therefore dining facilities at this time are divided between the hall and kitchen. The other bedrooms were personalised, comfortably furnished bedrooms. They have lockable bedroom doors with keys, depending on their individual risk assessments. The manager said she would review and revise their risk assessments in this respect The attic rooms were hot and concern was raised that these rooms become too hot the summer. The manager has ordered some ‘coolers’ in the hope that this will reduce the temperature in these rooms. Medication is stored in one of these rooms and it needs to be monitored to ensure that medication is stored at the correct temperature. Other areas for improvement were noted as: stained and marked carpets downstairs need a clean: the home would benefit from being repainted/ re decorated: the window in the downstairs bathroom needs to be cleaned: staff sink which is badly stained should be replaced. Since the last inspection the path at the side of the house has been repaired. The home appeared clean and tidy throughout at the time of the inspection, which was unannounced. There are systems in place to ensure good hygiene and staff were observed using hygiene equipment provided. There are satisfactory systems in place to manage heavily soiled materials, which may represent an infection risk. It is recommended that paper towels are available in the kitchen to promote infection control further. Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staff need to be employed in sufficient numbers at all times to ensure that on outings Service users and staff are safe and reflect the individuals risk assessments. Less than half of the staff team are qualified to the level recommended in the National Minimum Standards so that service users can have confidence that people working with them are competent to do so. Staff are recruited fairly, safely and effectively on the basis that they are suitable to work with vulnerable adults in a care setting. They have access to ongoing training. Staff are well supported but should be provided with more regular, formal supervision so that service users can be assured that they are properly supervised. EVIDENCE: Three staff were on duty at the beginning of the inspection, with a fourth member arriving late morning. Staff felt that within the home there were generally sufficient staffing levels. Rotas showed that there are usually four or five staff members on duty during the day, three staff members in the evening and one waking night and one sleeping in member of staff. Staff sleeps on a put you up bed in the lounge.
Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 22 However when looking at Service users risks assessments it was evident that there were insufficient staffing levels to take service users out safely. For example on the day of inspection one staff member took two Service users out (risk assessments said when out the Service users should have a staffing ratio of 1:1). Two staff members were left in the house with one individual as per his risk assessment. Staff stated that this does occur and agreed that it is not as per the recommendations from the risk assessment and was aware that this could potentially be unsafe. This was discussed with the manager who agreed to review staffing levels to ensure tat at all times there are sufficient staffing levels which correspond to their risk assessments. According to the manager and records held in the home, slightly less than the recommended 50 of care staff are qualified to NVQ level 2, although this situation should improve as more staff are due to complete it in the near future. Staff recruitment records could not be inspected at the time of the inspection, as the manager had not been given clearance to view these documents. She was given this clearance during the inspection but the computer system would not allow her to access this section still. However she forwarded the relevant staff records to CSCI, which evidenced that staff have undergone the necessary clearances before they commenced employment at the home. New staff commented that they felt they had a good induction to their work and the home that they were allocated to work at. Care staff have individual training records and those interviewed during the inspection confirmed that whilst they are booked to attend training that recently quite a few courses have been cancelled which has been frustrating. The manager confirmed this. All agreed that when training is run it is beneficial. Records of individual one-to-one supervision of care staff were out-of-date. The manager was aware of this and was heard to be arranging supervision sessions with staff during the inspection. Staff interviewed said that they were pleased that the manager had returned to work following a period of sickness and they felt well supported by her. Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The homes manager must apply to the Commission to be registered so that an assessment of her fitness to provide this role is assessed. The home is mainly well managed for the benefit of service users. There are formal and informal systems in place to ensure that service users’ views are accounted for in the day-to-day running and ongoing development of the home. There are some systems in place to protect service users from avoidable harm and injury. In particular the fire procedure and process needs to be reviewed urgently to ensure that Service users and staff are able to vacate the building if a fire occurred safely. EVIDENCE: The registered manager Mr Williams, resigned in March 2007. Since which there has been two mangers appointed to the home. Hayley Griffins the current manager returned from sick leave on the day of this inspection. She
Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 24 has been deputy manager of this home for two years and is hoping to be appointed to the registered manager post and will then apply to the commission to be the registered manager. She is completing her NVQ 4 in care and registered manager award. She aims to do the NVQ 4 in management. She agreed to forward her registered manager application to the commission. Staff spoke highly of Ms Griffins skills and felt that she was approachable and listened to their ideas or concerns. From observations Service users were pleased to see her return to the home and communicated with her in a relaxed manner. Ms Griffin has twenty hours dedicated administration time. Due to her recent return from sick leave the quality assurance process has not commenced however views from residents, family and staff plus regulation 26 visits are in the process of being sought. Records are stored confidentially, staff need to be conscious of their recordings to ensure that it adheres to the data protection act i.e. communications book. The home’s environment in the main appeared safe and there are written individual and environmental risk assessments in place to minimise risks to Service users and staff working in the home. Maintenance of the home and its equipment are satisfactory. A major concern identified at this inspection is in respect of fire evacuation arrangements. Prior to the conservatory being blocked off there was access to a second door to enter/ leave the property. However as the conservatory is in need of major refurbishment: the manager stated that the flooring in the conservatory is ‘unsafe’ as the wooden floor has ‘rotted’; there is no access to a back door to the property. The manager said and it was written in their fire risk assessment that if they needed to vacate the property at the rear that they would need to climb through the window on to the conservatory and open the door. The manager agreed that this process has not been tried. CSCI expressed concern in how staff and service users would be able to negotiate a window that is not recognised by fire standards to be used in this manner, plus stepping onto a conservatory floor, which is unsafe. Therefore the fire risk assessment needs to be reviewed urgently as there is only one entrance/ exit to the home. CSCI have contacted the fire authority regarding this who has agreed to undertake an inspection regarding this matter urgently. The home’s fire safety records were completed and up-to-date. There are records of regular tests and checks of safety. Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 25 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 2 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 2 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 X 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 1 X 3 X X 1 X Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 26 Yes 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 YA1 Regulation 4,5 Requirement The homes Statement Of Purpose and Service Users guide must be updated to accurately reflect the services that Rosemerryn provides. This should be presented in an appropriate format for Service users use. All medication in the home must be accounted for and accurately recorded. Staff must undergo accredited training in the safe handling of medicines so that service users are better protected from medication errors. Ventilation must be improved in one of the ground floor bedrooms as damp and mould is present with no access to natural ventilation. The stair way must be repaired immediately for the safety of Service users and staff use. This is an immediate requirement. Staffing levels must be reviewed to ensure that at all times sufficient and qualified staff
DS0000009117.V344095.R01.S.doc Timescale for action 30/12/07 2. 3. YA20 YA20 13(2) 13(2) 30/09/07 30/12/07 4 YA26 23(2)(p) 30/11/07 5 YA24 23 (2)(b) 23/08/07 6 YA32 18(1)(a) 30/09/07 Rosemerryn Version 5.2 Page 27 7 YA37 8(1)(2) 8 YA42 23(4)(b) (c)(iii)(d) (e) numbers are present to meet the needs of Service users as outlined in their risk assessments. The homes manager application for the registered manager post must be sent to the Commission without delay. The fire risk assessment must be reviewed urgently to ensure that there is appropriate and safe means of escape in the event of a fire. 30/09/07 30/09/07 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 YA20 YA23 Good Practice Recommendations The medication cupboard should be attached to the wall for extra security. The home’s manager should undertake multi-agency training on the protection of vulnerable adults from abuse and cascade this to staff working at the home. The décor of the home should be reviewed and carpeting downstairs should be replaced or cleaned to allow a more attractive appearance to the home. The upstairs rooms temperature should be monitored and appropriate action taken to ensure that it is of a comfortable temperature. The proportion of staff qualified to NVQ level 2 should be increased towards achieving the 50 level indicated in the National Minimum Standards. Care staff should be provided with more regular individual/ formal supervision, with records maintained. 3 YA24 4 YA24 5. YA32 6. YA36 Rosemerryn DS0000009117.V344095.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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
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