Inspection on 19/06/07 for Rosemount Care Home Limited

This inspection was carried out on 19th June 2007.

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

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

Other inspections for this house

Rosemount Care Home Limited 24/09/08

Rosemount Care Home Limited 10/10/07

Rosemount Care Home Limited 07/11/06

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 Rosemount Care Home Limited 133 Cheadle Old Road Edgeley Stockport Cheshire SK3 9RH Lead Inspector Tracey Rasmussen Unannounced Inspection 19th June 2007 12.55 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 Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosemount Care Home Limited Address 133 Cheadle Old Road Edgeley Stockport Cheshire SK3 9RH 0161 477 1572 0161 480 3320 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) Rosemount Care Home Ltd Mr Komal Nagjee Coorjee Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 17 service users to include: *up to 17 service users in the category of OP (Old age not falling within any other category). The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 7th November 2006 2. Date of last inspection Brief Description of the Service: Rosemount Care Home is a detached residence in its own grounds, situated in Edgeley, Stockport. Rosemount is registered to provide accommodation and care for up to 17 service users. Rosemount has a large lounge, which adjoins a smaller lounge. Access to the gardens can be gained this way, down steps. The smaller section of the lounge was described as the quiet lounge. Four steps leading from the lounge access the dining room. Handrails are provided to both sides of the steps. Due to the design of the care home it is not practicable for people who have difficulty walking up and down steps or who need to use a wheelchair. The home offers single and shared bedrooms. Some of the shared bedrooms were small and offered limited space. En-suite facilities are not provided but there are two toilets for service users use on the ground floor and three on the first floor. There are two bathrooms, one of which had a shower attachment in the bath. One of the baths has a fixed hoist. There is a stair lift for service users to access the first floor of the home. The home is privately owned and has changed ownership in May 2006. The home has a statement of purpose and service user guide which were reported to be given to prospective service users or their families when they visit the home to look round. A copy of the service user guide was contained in service users’ bedrooms. The current weekly fees range from £321 to £340, dependent on the individual care needs of people living in the home. Further details regarding fees are available from the manager. Additional charges may also be made for hairdressing and other personal requirements. Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced key inspection site visit on the 19th June 2007. This means the owner of the home did not know an inspector was going to visit. The inspection included a review of all available information received by the Commission for Social Care Inspection (CSCI) about the service provided at the home since the last inspection. Six people have contacted the CSCI since the last key inspection to express concerns about a range of issues including care practices and staffing levels. A questionnaire (Annual Quality Assurance Assessment -AQAA) was sent out to the manager at the home about two months before this inspection visit and this provided additional information to assist the inspection process. At this inspection an Expert by Experience was used. This means that an independent volunteer who has experience of receiving care and health services was used to provide a picture of the home and services from the viewpoint of the people living in the home. Comments from the Expert by Experience’s report are used in this report. All key inspection standards were assessed at this visit and information was taken from various sources which included observing care practices, talking with people living in the home; talking with a visitor; interviewing two visiting health and social care professionals, talking with the manager and another member of the staff team. A tour of the home was also undertaken and a sample of care, employment and health and safety records seen. All but one returned comment cards had been filled in by the same member of staff and these contained positive responses. Three residents were case tracked as part of this inspection visit. This means the care service provided to these residents was looked at and this included talking with the people living in the home (where possible) to seek their opinions and looking at their records. A brief explanation of the inspection process was provided to the manager of the home at the beginning of the visit and time was spent at the end of the visit to provide verbal feedback about the number of areas of concern that were identified, particularly in relation to unsafe recruitment practices. What the service does well: Visitors said they were welcomed in the home. Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 6 Visiting professionals in the home were positive about the quality of service provided in the home. The Expert by Experience reported she had, “..managed to speak to a lady who was currently receiving respite care at the home, she appeared to be happy and said her friends were always made welcome when they came to visit.” People spoken with said, “the food was very good” and that there was plenty of it. What has improved since the last inspection? What they could do better: Despite some areas of improvement many areas of development and improvement were still required in the home. Management practices needed improving. Employment recruitment practices were not safe because the proper police checks had not been done on staff to make sure that they were suitable to work at the home. A letter was sent to the home straight after the inspection, for the manager to address this as a matter of urgency. Staffing levels were at times not good enough to make sure people got the care they needed in a timely manner. One returned comment cards said, “more staff is required during the day”. The home was without a cook so care staff were also preparing and cooking meals between caring duties. This potentially puts people at risk of food poisoning and from cross contamination. Records of money held in the home for the people living there were not well maintained, potentially increasing the risk of financial abuse. Some people admitted into the home had care needs that that the home’s registration did not cover and staff did not have the training and expertise to safely care for these. Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 7 Not all care staff who gave out medication had had the necessary training to do this. This has been identified at previous inspections. Two occupied bedrooms smelt unpleasant and discussion indicated that cleaning systems needed reviewing so that odours were removed. The decoration in a number of bedrooms and bathroom was of a poor standard and furnishings showed wear and tear. The shared rooms were very small. The Expert by Experience reported, “Some of the rooms were shared rooms but were really only big enough to accommodate a single person. These rooms provided very little privacy for residents.” The lack of level access in some rooms was restrictive to the independence of people with mobility problems. The social aspects in the home need improving, as there was a lack of activities. People in the home were reluctant to discuss the routines in the homes and the Expert by Experience reported, “ I asked several residents what time they went to bed one lady said, “well they do not like us to stay up too late” but she seemed reluctant to say what time she actually went to bed.” There was limited choices provided at mealtimes and people in the home had not been asked or involved in planning the menus. Quality assurance, home resident meetings and staff team building needed developing and improving. Not all staff had participated in a fire drill and new staff needed to have moving and handling training. 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. Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 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 Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3,4 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People in the home are supplied with information about the services the home offers and can make an informed decision about the suitability of the home. Despite pre-admission assessments being undertaken some people are admitted into the home, who’s care needs cannot fully be met by the services provided in the home. EVIDENCE: Information booklets (Service user guide) were available in resident’s bedrooms and these contained basic information about the service offered in the home. A more detailed information booklet (Statement of Purpose) was available in the office on the ground floor of the home. The Statement of Purpose and a Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 10 copy of the last inspection report needs to be readily accessible to all people living and visiting the home. The manager of the home explained that the home provided two beds to use for short term re-enablement support. Admissions to these beds were usually by the intermediate care team or the rapid response team. The manager stated that for the emergency admissions he usually received a telephone referral and an initial assessment, which he followed up with the home’s assessment of care needs. The manager said if needs could not be met then the referral was refused. For a normal planned admission to the home the manager said he requested a community care assessment and undertook his own assessment. Care files seen did have pre-admission assessments available in them. It was noted that some people had been admitted to the home who did not have good mobility. The home environment is very restrictive in that it does not provide level access to all communal areas and some bedrooms, so that people with even slight mobility problems may struggle to move around in the home independently. It was also noted that one care file identified for a newer admission to the home had a history of care needs associated with old age but also had challenging behaviours due to Alzheimer’s disease. The home is not registered to care for people with care needs associated dementia. The manager must be sure that all people admitted into the home comply with the home’s conditions of registration. One visiting professional who worked closely with people admitted into the home for short term support said, “Here they work very well with us, they promote independence because we only do short stay support. We have physiotherapist and an occupational therapist and a district nurse on the team.” Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People living in the home receive care and support in a respectful manner. The care planning documentation was not always sufficient to meet the personal and health care needs of the people in the home. Medication practices do not always protect people in the home. EVIDENCE: The home provided care and support to 15 people at this visit. The Expert by Experience and the inspector spoke with people living in the home during the inspection visit. It was noted that people living in the home seemed to be reluctant to comment on the quality of care and services. This may have been due in part to the lack of privacy provided by the home and presence of staff in the communal areas. Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 12 One person living in the home said “ it is okay living here’. The Expert by Experience’s report stated, “I also managed to speak to a lady who is currently receiving respite care at the home she appeared to be happy and said her friends were always made welcome when they came to visit.” Returned comment cards all had positive responses. Two separate relatives contacted the CSCI just before and just after the inspection and their comments, were ‘the home was not as good as it was’ and ‘the home has gone down’. One visiting health professional was complimentary about the home and said, ‘this is one of the better homes’; ‘I visit all the time-I can hear staff behind the door encouraging people’ and ‘the care is second to none’ People living in the home were presentable, clothing was co-ordinated and fingernails were manicured. On arrival in the home in the early afternoon residents were sat in the lounges with televisions switched on, a short time later old time music was put on. Interactions observed between staff and residents were task driven, however staff were respectful and attentive when undertaking a task with them. Care plans seen made reference to promoting dignity, choice and privacy. Three case files were looked at in detail for three people living in the homes. Information recorded included pre-admission assessment; assessment of daily living needs and care plans for identified needs. Care plans records, although improved were not as comprehensive and detailed as they could be. Care plans for the social aspects of service needed developing. Some areas of development were noted to improve the quality of the care planning records and these included making care plan actions or interventions more person centred so that the person’s wishes and preferences were recorded. Routines that had proven to be effective, for example managing aggression, also needed to be recorded. Assessments for moving and handling and nutrition were not consistently recorded to a satisfactory standard, records of regular weights were not always maintained and falls monitoring forms did not contain information on how to reduce the risks of falls. Regular reviews were not always undertaken. The home did not have a hoist and it was reported that three people living in the home had deteriorating mobility which meant they needed to be reassessed for a service that was better able to care for their specific care needs. The use of other moving and handling aids was not observed although a moving and handling belt was available in the home. Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 13 It was also noted that care plans referred to aggressive outbursts and incidents by people living in the home. The home is not registered to care for people with dementia and staff had not had training in meeting dementia care needs and in managing challenging behaviour. Professional health care reassessment of these people care needs must undertaken so that more suitable care environments are found. Records of contact with community health services to meet individual care needs were available and these included GP and district nurse. Medication practices were not always safe. The requirement to ensure all staff who gave out medication had training in the safe medication practices had not been addressed. One prescribed medical item was left sitting on a shelf on a communal corridor. Policies and procedures were available for the management of medication in the home, these were not seen at this visit. Systems were in place to track medication from the point of ordering from the doctor to the point of return to the pharmacist. Controlled drug medications were maintained satisfactorily. Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Limited choices were provided at meal times and activities and social interaction did not meet the needs of the people living in the home. Visitors were welcome. EVIDENCE: The manager provided the CSCI with a detailed self-assessment about the quality of daily life and social care that indicated that a good quality of service was provided. This inspection visit did not support the manager’s selfassessment. The afternoon and evening routines were observed and practices during this visit appeared to confirm anonymous concerns forwarded to the CSCI that staff were not allowed to socialise with people in the home. No activities were observed and interactions with the staff team were in relation to undertaking a task. Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 15 Visitors were welcome and seemed to be coming and going throughout the afternoon. Care files did contain information about social history and preferences but evidence that the home used this information to enrich the quality of the daily lives of people living there was not available. The Expert by Experience reported, “I asked several residents what activities were available one lady said “sometimes a beach ball is thrown around but other than that nothing really”. Record were available of activities but these mainly dated from the July and August 2006. Daily written records provided no information about the social aspects of the people’s day. The manager did state that the mobile library now visited the home once a fortnight. One care plan indicated that the home held a Christian Mass service once a week. When asked, the manager said this had been stopped because it interfered with the tea time routines in the home. People in the home were dependent on family taking them out to their religious venue to meet their individual spiritual needs. People in the home were reluctant to comment on the routines in the home. The Expert by Experience report stated, “I asked several residents what time they went to bed, one lady said, “well they do not like us to stay up too late” but she seemed reluctant to say what time she actually went to bed.” Menus identified that a four week rolling menu was provided which offered the main meal of the day at lunch time, the alternative every day to the main meal was corned beef or ham or soup. The evening meal menus choices appeared to be often limited to sandwiches, soup or salads. Records were available of the choices made at meal times by people in the home and these indicated that everyone had the same meal at lunchtime and were asked their preference for the evening meal. The Expert by Experience report stated, “Residents do not appear to be given a choice of food, one resident told me “we eat what we are given”. One person said ‘Lunch was lovely chicken and broccoli pie’ and another person said, “the food was very good”; and that she got plenty and she would ask for more if she was still hungry. Written information from the manager indicated that people in the home had been involved in choosing the meals and menus, however discussion with the manager identified that this involvement by the people living there was restricted to asking them what they wanted for their evening meal. Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 16 The home was without a cook. This meant that care staff were working both in the kitchen and on care. The Expert by Experience reported, “We inspected the kitchen which is adequate, this home does not have a cook, this duty at present falls to care workers who are providing personal care and then going into the kitchen to prepare food”. There was no evidence that safe working practices such as changing uniforms when switching roles between care and food preparation was undertaken and protective clothing such as aprons were not worn. This is unsafe practice and puts the people living in the home at increased risk from cross contamination and cross infection. This issue was discussed with the Food Safety Team, Environmental Health Services, Stockport Metropolitan Borough. Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The systems in place do not fully protect people living in the home from potential abuse and they cannot be wholly confident that complaints are treated seriously. EVIDENCE: The home has a complaints procedure, which was available to people in the home in the information guide available in each bedroom. The manager undertook monthly complaints monitoring and in the last six months two complaints had been received regarding the quality of the furnishings in bedrooms these had been addressed by replacing the furniture. The manager had also received one letter complimenting the service provided in the home. The CSCI received one complaint about the inadequate staffing levels and lack of support from the manager and the deputy. The manager responded to this and stated that staffing levels were being maintained in the home and that he and the deputy manager were supportive to the staff team. Since then a further four separate people have contacted the CSCI anonymously to express similar concern about a range of issues including inadequate staffing, lack of Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 18 support from the management team with care tasks, poor care practice and staff being ‘frightened’ to speak out in the home. These issues were discussed with the manager who was dismissive of these and said he knew that it was a staff member complaining. The manager’s attitude did not promote confidence that the home’s Whistleblowing policy would be implemented nor that an objective review of these concerns would be undertaken. Since last inspection some staff have had training in safe guarding adults from abuse and two staff were reported to be going on Stockport’s Adults and Communities Alerter training course in July. The manager said he did not need to attend the Provider training course to safeguard vulnerable adults because he had had training recently in the home. A copy of the Department of Health’s No Secrets was available in the home but a copy of Stockport’s All Agency Safeguarding Adults Policy and Procedure was not available. The manager should obtain a copy of this so that he can respond quickly and efficiently as required by the local safeguarding adults policy to any suspicions or allegations of abuse. Employment practices and the records regarding the personal finances for people living in the home did not safeguard them. Please see the ‘Staffing’ and ‘Management and Administration’ sections of this report. Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People live in a home that needs redecoration, refurbishment and improved cleaning systems to make it pleasant, comfortable and odour free. EVIDENCE: Rosemount is not a purpose built care home. This means that space is limited in the home especially when equipment such as walking frames and wheelchairs are used. The home does not provide level access to some bedrooms, communal areas and gardens and this does restrict the independence of people in the home with mobility problems. Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 20 The home has three shared bedrooms. The shared bedrooms were small, this meant that space to move around the bedroom was limited and in one room only one of the wardrobe doors could be opened. The lack of adequate privacy curtaining further compromised the privacy and dignity of the people living in these rooms. The owner should consider reducing the number of shared rooms in the home. It was also noted many bedrooms and bathrooms needed refurbishing and redecorating and there was little evidence that people in the home had personalised their rooms. The Expert by Experience report stated, “The home was not inviting. On a tour of the home I was shocked at the state of some of the bedrooms, in one resident’s room full strips of wallpaper were hanging off the wall. Many of the carpets looked liked they needed a good clean and the smell in one room was overpowering, we asked the owner what had been done to try to eradicate the smell he said, “we have tried everything but cannot not get rid of it” another resident now occupies this room. Many of the rooms had curtains that in places were not attached to the rails this made the rooms look neglected. All the rooms had sinks but none had toilets, residents were provided with the old fashioned commodes. The bathrooms are very small and dingy and no showers are provided. Some of the rooms were shared rooms but were really only big enough to accommodate a single person these rooms provided very little privacy for residents.” Two bedrooms smelt unpleasant and were odorous. The manager said about one of the rooms regarding getting rid of the odour, ‘we have tried everything, we cannot do anymore’. Discussion around cleaning systems used in the home suggested that these needed to improve. It is the manager’s responsibility to ensure that all rooms in the home remain odour free. Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Recruitment vetting practices, staffing levels, training and skill mix were not good enough to meet the people’s needs and did not protect them or promote their health, safety and wellbeing. EVIDENCE: A number of anonymous concerns have been identified to the CSCI about staffing levels and practices in the home. At this visit the manager, the deputy manager and a care assistant were on duty. The manager acknowledged that he had struggled to recruit care staff and that the services of a cook had not been retained. Three weeks of staffing rotas were seen and these indicated that staff undertook both caring and cooking duties and that staffing levels did fluctuate through out the week. Evening and weekend staffing levels were reduced sometimes to levels that were potentially unsafe with one staff member providing care and another staff member cooking. The staffing rotas also identified that one staff member had worked every day over the three week period examined and that two staff were not always on Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 22 duty until 10pm (the CSCI wrote to the manager about this issue in February 2007). Both these practices are unsafe and the manager must address them so that the care needs of people in the home can be met in a timely and safe manner. The manager returned information (AQAA) to the CSCI stating that a thorough recruitment procedure was undertaken with reference to obtaining the necessary police and other checks before new staff commenced in the home. Examination of the home’s recruitment records to support the manager’s statement indicated that this was not the case. Employment practices were unsafe and put people in the home at potential risk of abuse by staff who had not been correctly vetted. Three employment files examined for staff working in the home did not contain PovaFirst disclosures or CRB disclosures. Two of these employees had been employed since December 2006 and one of these employees was working alone and unsupervised at night in the home. Other shortfalls in the home’s recruitment practices included, the lack of employment histories, inadequate references, no employee work start dates and only one file had a induction record of training. A letter requiring the manager to urgently address these issues was sent the day after the inspection visit. Almost all the care staff were reported to have a NVQ qualification, however copies of NVQ certificates were not available to support this claim. A training matrix recorded in 2006 had not been updated since then, although a number of staff had had training for Abuse Awareness in 2007. Records were not available to indicate that newer staff in the home had had mandatory training in moving and handling. Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home does not fully promote the health, safety and wellbeing of people living there. The personal finances of the people in the home are not fully safeguarded and there is limited consultation about the service provided. EVIDENCE: The manager of the home reported he would complete the registered manager award in September 2007. The manager has made some progress in the home in developing care planning records and medication practices had improved. However, management practices in relation to recruitment, food Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 24 health and hygiene and the safe storage of people’s personal finances (see below) are areas of concern and must be improved. Two different health professionals spoken with said the manager, ‘sought appropriate support’ and ‘he took on our advice’. Discussion with the manager about the number of the anonymous concerns raised with the CSCI identified that little work had gone into team building within the home. Comments from two separate relative, ‘the manager doesn’t seem to manage the staff very well’ and ‘staff seem frightened to say anything’ support the anonymous concerns raised with the CSCI. Staff meetings had occurred but these were infrequent and minutes were not readily available. The manager should seek ways to develop and improve working relationships in the home. Meeting with residents and relative had not been undertaken and there was little evidence of consultation with people in the home about the service in the home. However, satisfaction surveys had been sent out relatives, (but not to people living in the home), earlier this year and responses were positive. The manager said he had done some quality assurance monitoring but this consisted of a tick list assessment and needed checking for accuracy and needed more development. Discussion with manager about the quality of the décor in bedrooms identified that the owner of the home controlled the financial budget for the home and this restricted the pace of improvement in the home. The manager did hold money in the home for people in the home. Records of this were poorly maintained in a notebook. Staff took money (on behalf of residents) from the accounts without signing for this. Balances were not accurate as money had been deducted to pay the hairdresser and this had not been recorded. One account indicated that money had been deposited and staff reported that this had been spent on personal items for the person but records or receipts to support this expenditure were not available. This poor record keeping potentially puts people in the home at risk of financial abuse, as the manager cannot properly account for monies spent. Accident records were available but no monitoring of these had been undertaken. Some maintenance records including routine checks were seen briefly. Fire safety records were available and maintained up to date, although a fire drill for all staff should be undertaken so that all staff have some experience and awareness of what procedure to follow in the event of a fire. The manager was aware of the new legislation around smoking in public and communal areas and was looking at ways to comply with the legislation. Rosemount Care Home Limited DS0000067305.V339620.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 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 2 x 2 1 x 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 2 x x x 2 x x 1 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 2 x 1 x 2 1 Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation Requirement Timescale for action 31/07/07 2 OP7 OP8 3 OP26 4 OP27 5 OP29 12, 14, 15 The manager must only admit people to the home whose care needs comply with the home’s conditions of registration. 12, 14, 15 The manager must ensure that regular reassessments of care needs are undertaken and as care needs change, referrals for professional re- assessments are undertaken so that more suitable care services can be provided. 13, 16 The registered person must ensure that adequate arrangements are made to keep the home clean, prevent the spread of infection and eliminate offensive odours. 18 The manager must ensure that there are sufficient staff on duty at all times to meet the needs of the people living in the home. 19 The manager must ensure that all staff employed in the home have a returned PovaFirst disclosure and that these staff members do not work unsupervised until a full CRB disclosure is received in the home so people are safe. DS0000067305.V339620.R01.S.doc 31/07/07 31/07/07 31/07/07 29/06/07 Rosemount Care Home Limited Version 5.2 Page 27 6 OP29 19 7 OP35 OP18 17, 13 8 OP38 OP15 13, 16 The manager must also ensure a thorough recruitment procedure is undertaken and information detailed in Schedule 2 of the Care Homes Regulation 2001 is obtained prior to the commencement of employment for all new employees. The manager must ensure money held on behalf of people living in the home is recorded properly so they are protected from recording errors and financial abuse. The manager must ensure that safe working practices are undertaken at all times so that people in the home are not put at risk from poor food, health and hygiene practices. 15/07/07 15/07/07 15/07/07 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. Refer to Standard OP1 Good Practice Recommendations Copies of the home’s information guide (Statement of Purpose) and the home’s last inspection report should be readily available to people living in the home and visitors so that there is full information about what type of service the home offers. Care plan interventions need to be developed to include more person centred information about each person’s preferences and this details how each person’s care needs are met in accordance with preference. Care plans need to be evaluated regularly for their effectiveness and this is recorded. Assessment information must be accurate. Information such as weights and details of how to move and transfer someone needs to be recorded so that the appropriate care can be provided. The registered person should ensure that all staff DS0000067305.V339620.R01.S.doc Version 5.2 Page 28 2 OP7 3 4 OP7 OP8 5 OP9 Rosemount Care Home Limited 6 7 8 9 OP9 OP12 OP12 OP14 10 OP15 11 OP16 OP32 12. OP18 13 OP18 14 15 16 OP19 OP23 OP28 17 OP30 members employed by the home, with responsibility for medication administration have received appropriate training. Prescribed medical items should always be stored safely in a locked cupboard or drawer The manager must ensure that person centred social activity are undertaken with people living in the home and records of this maintained. The manager should ensure that the home offers diverse spiritual support to people from different faiths. Routines in the home should be made more flexible so that people living there have more choice and staff are encouraged to support each person in their personal wishes and choices. The manager should ensure that people in the home are consulted about the range and choices provided by the menus in the home and menus should provide varied meals so people’s health and wellbeing are promoted. The manager should seek ways for people in the home, staff and visitors to openly express concerns about the home and services it provides so that improvements can be made in the quality of service and better working relationships promoted. The manager should ensure that all staff continue benefit from training in safeguarding people from abuse and this includes the free Alerter training provided by Stockport’s Adults and Communities. The manager should ensure a copy of the local All Agency Safeguarding policy and procedure is available in the home and that Provider training to safeguard adults provided by Stockport Adults and Communities is undertaken so that in the event of an allegation or suspicion of abuse the correct procedure is implemented without delay to protect people living in the home. The registered person should ensure that internal redecoration and refurbishment continue to be undertaken. The registered person should reduce the number of shared bedrooms to provide spacious single accommodation and promote the privacy and dignity of the people living there. Copies of all qualifications including NVQ certificates should held on each staff member’s file so that the manager can correctly assess the skills and abilities of the workforce. The manager should continue with a training programme for all staff including new staff and the training matrix should be kept up to date. DS0000067305.V339620.R01.S.doc Version 5.2 Page 29 Rosemount Care Home Limited 18 19 OP33 OP38 The manager should develop effective quality assurance systems that include the views of people who live in the home. The registered person must provide all staff employed at the home, in whatever capacity, with fire drill training and practice at a minimum of six monthly. Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rosemount Care Home Limited DS0000067305.V339620.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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