CARE HOMES FOR OLDER PEOPLE
Rosemont Yealm Road Newton Ferrers Plymouth Devon PL8 1BX Lead Inspector
Jane Gurnell Unannounced Inspection 7th March 2006 10:30 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 Rosemont DS0000003798.V279802.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 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. Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Rosemont Address Yealm Road Newton Ferrers Plymouth Devon PL8 1BX 01752 872445 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr D M Beckhurst Mr D M Beckhurst Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3rd August 2005 Brief Description of the Service: Rosemont is a care home registered to provide care for 19 people in the category of old age only. It is owned and managed by Mr Beckhurst, who is assisted by Mrs Coleman the matron. It currently accommodates 13 older people in single rooms. Two rooms are en suite. The premises comprise a large, older property which stands in its own grounds, overlooking the picturesque creek of Newton Ferrers. There is a dining room, two lounges and a conservatory. The home has a stair lift and ramps. Those service users with limited mobility are provided with accommodation on the ground and mezzanine floors as there are a few steps remaining to access the first floor. Adjoining the property are two privately owned flats which are not connected to the care home. The proprietor and his family live in one flat and the second is used as staff accommodation. Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on 7th March 2006. A tour of the premises took place, and records relating to the care planning process and staff training and recruitment were inspected. Seven service users were spoken with, all of who expressed their satisfaction with the care they receive. Staff on duty were observed in the course of their daily duties and were seen to treat service users respectfully. Mrs Elizabeth Coleman, the matron, was present and she and her staff team assisted the inspector throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better:
The join in the carpet in the first floor hallway requires repairing as it currently poses a trip hazard. An immediate requirement notice was given for this to be attended to as a matter of urgency. The training programme must be maintained to ensure the care staff have the required knowledge and skills to
Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 6 deal with emergencies: dates of planned training must be provided to the Commission. A minimum of 50 of care staff should have a National Vocational Qualification or equivalent. The Registered Provider should consult with a training provider to ensure the induction training provided for newly appointed staff meets the National Training Organisation’s specifications. Risk assessments relating to the temperature of hot water to wash hand basins are required to ensure service users are not at risk of scalding. Service users must be consulted over the arrangements for leisure activities. One bedroom must be redecorated as the wallpaper is coming away in several places. The home should have a quality assurance system and an annual development plan that formally consults service users over improvements to the service. A record should be made when a CRB disclosure has been seen and confirmed as satisfactory. The premises and facilities should be assessed by an occupational therapist to ensure it meet the needs of the service users. The toilet on the first floor does not have a wash hand basin and it is recommended that a waterless hand cleaner be made available to reduce the risk of cross infection. 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. Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 7 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 Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 8 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): 3, 5 The admission procedure ensures that service users needs are assessed prior to admission. EVIDENCE: The matron confirmed that prospective service users have their needs assessed prior to admission to ensure that the care staff at Rosemont are able to meet their needs. Prospective service users are able to visit Rosemont before making a decision to move in. The assessment for a newly admitted service user was available: this consisted of a hospital assessment and information from the service user’s family as the service user had moved from Yorkshire. This service user described that her family had visited Rosemont on her behalf and that she was very pleased with the home and the care and support she received. Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 9 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, 8, 9, 10 Service users’ health and personal care needs are being met and residents are treated respectfully. The home’s practices relating to medication administration are safe. EVIDENCE: Service users described living in the home as “very good” and “lovely” and confirmed that their needs were met: many said that nothing was too much trouble for the staff. The recently admitted service user said that she was “delighted” with Rosemont and felt very much at home. Care plans detailed service users’ care needs and included risk assessments relating to activities of daily living, mobility and falls. There was evidence that these had been reviewed in consultation with the service users. The District Nurse was visiting at the time of the inspection and confirmed that she visits twice each week to support residents with additional health care needs and that she is kept fully informed of the service users’ nursing care needs. Medication administration records were well maintained and medication was stored safely. Those care staff responsible for medication administration have recently completed updated training in safe practice.
Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 10 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, 13, 14, 15 Support to undertake leisure activities in the home could be improved upon. Meals are varied and nutritious. EVIDENCE: Those service users who are independent described that they are free to come and go and continue with their leisure interests outside of the home. Those service users with limited mobility and not able to leave the home independently said that there is very little to do during the day and they would value some organised activities and the occasion trip out to local places of interest. Service users said that the meals are plentiful and of good quality. Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 11 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): 16, 18 Complaints and suggestions from service users, relatives or other visitors to the home, are treated seriously. Service users are listened to and issues resolved promptly. EVIDENCE: Service users said that the owner, matron and staff were very approachable and they were confident that any issues of concern would be listened to and dealt with. No complaints had been received since the last inspection Staff have not yet received training in issues relating to abuse and the protection of vulnerable adults, however a training video has been purchased. Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 12 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, 21, 22, 23, 24, 25, 26 Service users are provided with accommodation that is homely, comfortable, and clean, however failure to ensure maintenance tasks are undertaken places service users at risk. EVIDENCE: Rosemont has a good range of communal space including a lounge/dining room, a separate lounge, and a conservatory with views of the estuary. Many of the bedrooms are very large, with one offering a lounge area as well as a bedroom. Two bedrooms provide en suite shower facilities. One bedroom was in need of redecoration as the wallpaper was coming away in several places. The ground floor bathroom has been refurbished with the exception of the area identified to be a shower cubicle. However this shower is not suitable for service users as the entrance is very narrow and has 2 steps. Plans have now been made for this to become a storage area. Two of the 3 bathrooms are fitted with bath chairs to assist service users with poor mobility.
Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 13 The toilet on the first floor does not have a wash hand basin and it is recommended that a waterless hand cleaner be made available to reduce the risk of cross infection. The home was found to be clean on the day of the inspection and service users confirmed that it is always clean. The premises have not yet been assessed by an occupational therapist. Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 14 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): 27, 28, 29, 30 Sufficient staff are employed to meet the needs of those service users currently living at Rosemont, these staff however aren’t adequately trained to deal with emergencies. Pre-employment checks for new staff ensure service users are protected. EVIDENCE: Service users described the staff as very kind and caring and confirmed they responded promptly to requests for assistance indicating that there are sufficient care staff to meet the needs of those currently living in the home. Care staff are supported by domestic staff. Staffing levels should be kept under review to respond to the changing needs of the service users. Individual training records are maintained and these have recently been reviewed to identify training needs. Staff require updates in their first aid, food hygiene, manual handling and infection control training. Only 3 care staff have an NVQ qualification, including the matron, with a further member of staff in training. The matron is undertaking the Registered Manager Award. Induction training for newly appointed staff does not meet the National Training Organisation’s specifications. A number of staff have enrolled in a distance learning course relating to the care needs of older people with dementia. Those staff files examined contained the necessary documentation. Criminal Record Bureau checks are obtained through Devon County Council for all newly
Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 15 appointed staff prior to their commencement, however due to the nature of the information sent to the home by the Council, it was recommended that a record was made when the disclosure had been seen and assessed as satisfactory. Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 16 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): 35, 36, 37, 38 Management practices could be improved upon to ensure the health and safety of the service users is protected. EVIDENCE: Mrs Coleman is undertaking the Registered Manager Award and as such is reviewing the management of the home. Issues relating to the health and safety of service users and care staff must be attended to as a matter of urgency: ongoing staff training relating to first aid, food hygiene, manual handling and infection control will ensure that staff have the knowledge and skills to deal with emergencies. Formal quality assurance and service user consultation over service improvement have not yet been introduced. Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 17 Service users and their relatives retain responsibility for their finances and no service users’ money is held by the home. Staff performance is reviewed 6 times a year; although this is recorded it is not always done in formal consultation with the member of staff. Staff meetings have been introduced to discuss issues relating to the care needs of the service users and the management of the home: minutes of these were not available at the time of the inspection. Radiators have been covered to protect service users from burns. Risks assessments relating to protecting service users from scalds from uncontrolled hot water in wash hand basins have not been undertaken for every service user. Those windows tested by the inspector had been fitted with opening restrictors and Mrs Coleman confirmed that all windows above ground level had been restricted. The join in the first floor hallway carpet had come apart causing a trip hazard: an immediate requirement notice was issued at the time of the inspection for this to be repaired. With the exception of the previous week, the testing of the fire alarm system had been undertaken as required. Staff had received fire safety training through the use of a training video and questionnaire: it is recommended that all staff receive training from an external training provider at least once a year. Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 18 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 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X 2 2 3 2 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 2 3 2 Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 19 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 OP12 Regulation 16 Requirement The Registered Provider must consult with service users regarding a programme of activities and provide facilities for activities in relation to recreation, fitness and training. Care staff must receive training in the protection of vulnerable adults. The join in the carpet on the first floor hallway must be repaired and made safe. Bedroom 5 must be redecorated. Risk assessments must be undertaken for every service user to the risk of scalding from uncontrolled hot water in wash hand basins. Where a risk is identified the temperature of the hot water must be controlled. All staff must receive regular training in first aid, manual handling, infection control and food hygiene. A programme detailing the dates this training has been arranged for must be sent to the Commission.
DS0000003798.V279802.R01.S.doc Timescale for action 30/06/06 2. 3. 4. 5. OP18 OP19 OP24 OP25 30 13 23 13 31/05/06 07/03/06 30/06/06 24/03/06 6. OP38 13 30/04/06 Rosemont Version 5.1 Page 20 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. 3. 4. Refer to Standard OP22 OP28 OP29 OP30 Good Practice Recommendations The premises and facilities should be assessed by an occupational therapist. A minimum of 50 of care staff should have a National Vocational Qualification or equivalent. A record should be made when a CRB disclosure has been seen and conformed as satisfactory. The Registered Provider should consult with a training provider to ensure the induction training provided for newly appointed staff meets the National Training Organisation’s specifications. The home should have a quality assurance system and an annual development plan. The review of staff performance should be done in consultation with the member of staff concerned. Records of staff meetings should be made available. A waterless hand cleaner should be made available in the first floor toilet to reduce the risk of cross infection. It is recommended that all staff receive fire safety training from an external training provider at least once a year. 5. 6. 7. 8. OP33 OP36 OP21 OP38 Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Rosemont DS0000003798.V279802.R01.S.doc Version 5.1 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
