Inspection on 21/07/09 for Rosemount Residential Care Home

This inspection was carried out on 21st July 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosemount Residential Care Home 09/02/09

Rosemount Residential Care Home 09/01/08

Rosemount Residential Care Home 11/06/07

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Rosemount Residential Care Home 48 Old Exeter Street Chudleigh Newton Abbot Devon TQ13 0JX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Judy Hill     Date: 2 1 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 38 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Rosemount Residential Care Home 48 Old Exeter Street Chudleigh Newton Abbot Devon TQ13 0JX 01626853416 01626852398 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mariarod Care Homes UK Ltd care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Rosemount Residential Home is registered to provide accommodation and care for a maximum of twenty people who are elderly and who may have dementia or physical disabilities. Rosemount is situated close to the centre of the Chudleigh and is a short walk from the shops and other local amenities. Information about the service is available from the home in a brochure and copies of inspection reports can be obtained from the home or are available on the CQC website. The current fees are 350 pounds a week and extra charges are made for toiletries at 8 to 9 pounds a month and entertainment, which is 2 pounds a week. Other extras include the services of a professional Chiropodist and Hairdresser, newspapers, taxis and items of a personal nature. Care Homes for Older People Page 4 of 38 Over 65 0 20 20 20 0 0 0 9 0 2 2 0 0 9 Brief description of the care home Care Homes for Older People Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection ended with an unannounced visit to the home that was carried out by two inspectors on 21st July 2009. The information contained in this report was gained during the site visit, from the service providers action plan following receipt of the previous inspection report and from other information received by the Care Quality Commission between inspections. This includes information received in surveys that were completed and returned to us by nine members of staff, four of the people who live at Rosemount and three health and social care professionals. We have also received an Annual Audit report from the service providers. During the site visit we looked closely at the needs assessments and care plans of three of the residents who were selected randomly. This methodology is known as Case Tracking and it enables use a representative sample to assess the quality of the service provided. We spoke with the people we case tracked, but also with other people we met during the site visit. Care Homes for Older People Page 6 of 38 We also sat in the residents lounge and carried out a two hour observation to measure and record how the staff and residents interact with each other. This methodology is called a Short Observational Framework Inspection or SOFI and was carried out in addition to our more general direct and indirect observations of live at the home. During our visit we also spoke with the manager and the staff on duty and looked at a sample of staff recruitment records and the staff training records. We also carried out a physical inspection of the premises, inspected the arrangements that are made for the storage and administration of the residents medication, the menu plans and choices, the record of complaints, the homes brochure and the Fire Safety Log Book. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? What they could do better: The home still does not have a Statement of Purpose or Service Users Guides, therefore prospective and current residents and their representatives still do not have access to all of the written information they need to tell them what they should expect from the home and the service provided. Individual care planning is being carried out and reviewed, but the people who use the service and their representatives are not sufficiently involved in planning their care and the records of care planning are not well organised so that they can provide a clear guidance to the staff about what peoples individual needs are and how they can be met. Sufficient care is not always taken to ensure that the privacy and dignity of the residents is protected. More care should be taken to ensure that the bathrooms and bathroom equipment is kept clean and to ensure that the staff wear protective clothing when necessary. This will reduce the risk of the spread of infection. Care Homes for Older People Page 8 of 38 The staffing levels need to be reviewed to ensure that there are always enough staff on duty to meet the residents needs, including their need for stimulation. Regular risk assessments should be carried out on the premises to ensure that they are safely maintained. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 38 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering using the service and current residents do not have access to sufficient information about the home or the service that they should expect to receive. Evidence: Requirements were made following the last key inspection, which was carried out on 9th February 2009, for the registered person to produce a written Statement of Purpose and written Service Users Guides. This is because the information that was provided in a Home Handbook did not include some of the required and recommended information and it did not provided people who may be considering using the service or current residents with an accurate description of the home or the service they can expect from it. Since the last inspection a brochure has been produced to replace the Home Handbook. This is clearly written and good use is of photographs to break up the text. Care Homes for Older People Page 11 of 38 Evidence: It does not however, contain all of the information that is required and recommended to be provided in a Statement of Purpose and a Service Users Guide. The brochure does not provide the reader with the correct name and address of the registered provider, which is Mariarod Care Homes UK Limited, although it does provide accurate details of the registered manager, who is Ms Rosemarie Anne Noon, and information about her qualifications. Accurate information is not provided on the number of staff employed, their relevant qualifications, the training that they have received or their experience. Also information about the organisational structure of the home is not provided. Accurate information is provided about the number of people who can be accommodated, which is up to twenty, and the categories of registration, which are old age, dementia and physical disability. The brochure does not state that home is not registered to provide nursing care. Information is provided on the homes admissions policy but no reference is made about how emergency admissions will be arranged. Information on the arrangements made for people to engage in social activities is included, although this does not tell the reader that they are required to pay extra for the two outside entertainers that visit the home on alternate weeks and no information is provided about how peoples hobbies and leisure interests will be catered for. No information is provided about the arrangements for consultation with people about the operation of the care home, although reference is made about consultation on care planning and assessment with the people who use the service and their representatives. Nothing is mentioned in the brochure about the fire precautions and associated emergency procedures in the home. Reference is made to facilitating peoples religious needs and to acknowledging the rights of the residents to receive visitors and to make and receive telephone calls. A summary of the complaints procedure is not included in the brochure, although we were told by the manager that laminated copies of the complaints procedure had been given to each of the residents and we saw these in some peoples bedrooms. Care Homes for Older People Page 12 of 38 Evidence: Information about the number of single and double bedrooms is included in the brochure. The arrangements for respecting peoples privacy is included in the brochure. However, although the brochure correctly informs the reader that all doors are lockable, it does not state that the residents are not given keys to their bedrooms and therefore cannot lock their bedroom doors from the outside. The brochure does include a statement of aims and objectives and statements of facilities and services. Although the brochure could be revised and built upon to provide a Statement of Purpose, it cannot be adapted to substitute Service Users Guides as these must include some information that relates exclusively to each of the residents. For example, the terms and conditions in respect of the accommodation to be provided, details of the amount and method of payment of their fees and a contract for the provision of services and facilities by the registered provider to the individual resident. We did not look at all of the residents needs assessments but used a process called Case Tracking which enables us to focus on the needs assessments, plan of care and care delivery for a small number of residents, in this case three. The needs of each of the three residents had been assessed prior to their admission into Rosemount either as people moving into a care home for the first time or for people transferring from other care homes. Care Homes for Older People Page 13 of 38 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care provided for the residents is not based on their individually assessed wishes and needs. Evidence: Following the last inspection a requirement was made highlighting the need to ensure that each of the residents and, if appropriate, their representatives, are involved in reviewing their needs assessments and planning how their care should be provided. When we looked at the records of care planning and reviews for the three people we case tracked we saw no evidence that they had been directly involved in the processes. The residents files are kept in the office and when we looked at the files for the three people we case tracked we found evidence that peoples assessed needs are regularly being reviewed and that individual risk assessments are being carried out and reviewed. We did not see clearly written care plans that the staff could follow to enable them to provide a service that is tailored to meet the individual wishes and needs of each of the people they care for. Care Homes for Older People Page 14 of 38 Evidence: Separate files are kept for the staff to use to record their daily reports and these, but not the care plans, are used daily by the staff. When we looked at the information contained in the residents case files we found a number of discrepancies and contradictory information. For example, one person was described as having chronic schizophrenia in his initial assessment and, the fact that he had transferred to the home from a home that was registered to provide care for people with a mental illness supported this. However, no further reference was made to this condition, instead references were found indicating that he had learning disabilities and dementia with no information to indicate the origins of these diagnosis. Another person was described as being fully mobile, but needing to use a walking frame, stair lift and wheelchair. Another resident was described as having good vision with glasses and also as having poor vision. Many of the documents in the residents case files had not been dated so it was sometimes difficult to distinguish between current and past needs and without working care plans for the staff to follow, needs that have been identified were not necessarily being met. For example, in one of the care plans we looked at we saw that the resident needed to be transferred with a hoist. No guidance was provided on the type of hoist needed or on the number of staff needed to operate the hoist. The records then told us that a hoist was no longer needed, but no evidence was seen to show that this decision had been made following an assessment. The registered manager confirmed that the staff did not refer to the case files on a regular basis, although she told us they did read the daily records. We saw records providing evidence that people in the home are visited by chiropodists, opticians, district nurses, GPs and audiologists. Visits from Social Workers were also recorded. We also saw evidence that people who need to attend healthcare appointments outside their home are being escorted by the staff. During our site visit we noted that each of the residents has a wall mounted call bell in their bedrooms. Although these have leads to enable people to use them, some of the leads had been tied up and were out of reach of the residents. We noted that some people also have call bells which they can wear around their necks of keep close to them. We heard one resident calling out for a drink and were told that he was unable to use his call bell, which had been tied up. Although there was a jug of water in the room, this was not within reach of the resident. Care Homes for Older People Page 15 of 38 Evidence: All of the people we met during the site visit looked well cared for with the finer details, such as such as eye care, nail care and appropriate foot wear present, although we did note that one resident had her shoes on the wrong feet. The management of medicines is generally performed well at the home. Medicines are supplied in individual blister packs and stored in locked medicine cupboards. Controlled drugs can be stored within a locked box, although none were being used at the time of the site visit. The home has a controlled drugs register. Medicines needing to be stored within a fridge are kept in a designated fridge. However, there were no thermometers within the fridge to enable medicines to be stored at the correct temperature. The home had acted upon a recommendation made in the report of the last inspection and provided information leaflets with each of the medication administration record sheets which highlights what the medication is used for and what possible side effects to look out for. We saw that the medication administration record sheets were well maintained and that a robust receipt and returns process was being followed by the staff at the home. Although the medication record sheets were in good order, we discussed the benefits of obtaining two signatures to show that two members of staff have checked any hand written entries. This will reduce the risk of errors being made when copying a prescription. We were told that there was no separate homely remedy policy for the staff to follow. Specimen signatures had been recorded of the staff who had been trained to handle and administer the residents medication, but we were told that this list needs updating. Rosemount has four double bedrooms and although the manager told us that the people who share a bedroom did not object to doing so, no evidence was provided to show us that they had chosen to share a room in preference to having a bedroom of their own. Each of the double bedrooms have screens provided for privacy. During the site visit we observed a member of staff entering an occupied bedroom without knocking and waiting to be invited in. We also heard a member of staff assisting a resident in the toilet, because he had not closed the door. This does indicate that training is needed to ensure that the staff understand that the privacy and dignity of all of the people who use the service should be respected and maintained. Care Homes for Older People Page 16 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Rosemount does not provide the people who use the service with enough opportunities to engage in stimulating activities. Evidence: A Short Observational Framework Inspection (SOFI) tool was used during the site visit to enable us to measure how the staff interact with the residents. Five residents were discretely observed in the lounge for just over two hours. We saw examples of good and poor staff interactions and some of the staff gave both types of interaction depending on which person they were caring for. The SOFI showed us that the people who were less able to respond to the staff experienced more episodes of being passive or withdrawn than people who were able to communicate or interact with the staff. We saw one member of staff working with two people at a pace that was too quick for them. The same member of staff was then observed working with another person at a more relaxed pace and providing them with explanations, validating them and recognising their abilities. One person who displayed signs of being withdrawn was ignored and not engaged in any conversation or interaction with the staff or any other residents for the whole of Care Homes for Older People Page 17 of 38 Evidence: the two hours that the observation was carried out. The most positive staff interaction we observed was not by a care worker but by the Chef who was observed engaging in the particular interests of one resident and chatting with other residents which resulted in laughter and positive interactions. Other staff did not provide such positive interactions and often stood watching people in a neutral manner. We saw examples where staff performed tasks such as moving people in wheelchairs, with no clear explanation and reassurance and examples where the staff did give calm and clear reassurance. We noted that the time people were most alert and positive were at coffee time and lunchtime. We also noted that the staff spent time holding their own conversations in the kitchen while people were sitting at the dining table waiting for their lunch. One person told us that the food was brilliant and that there was always plenty of it. Other people described the food as smashing. One person said that they really appreciated the choice of meals and that there was nothing provided that was not to their taste. The kitchen was seen to be well organised, clean and well stocked. The chef told us that he performed opening and closing checks using the Safer Food Better Business programme and that he follows a home cleaning schedule. On the day of the inspection people were enjoying a choice of breaded fish and chips or home made chicken pie and vegetables. Desert was a choice of rice pudding or treacle sponge. A bowl of fresh fruit was seen on the dining table which people could help themselves to if they wished. The staff were seen assisted some people to eat. The way this was performed varied. One member of staff sat alongside the person and assisted in an unhurried manner, another member of staff stood over a person and rushed the meal, offering only minimal interaction. During the afternoon we observed five people enjoying a game of bingo. Other people were either in their bedrooms or sitting passively in the lounge. We discussed the findings of our SOFI with the registered manager and stressed the importance of ensuring that everyone has access to some form of stimulation and that for some people the only time this was provided was at mealtimes. During the site visit we saw a posters in the hallway telling people about the entertainment that had been organised for them. The posters stated that outside Care Homes for Older People Page 18 of 38 Evidence: entertainers are brought into the home once a week and that the residents pay an extra charge of two pounds a week for this. Following the last inspection an activities organiser was appointed and records were seen to show that he regularly took small groups of people out into the community, which the registered manager said that they enjoyed. This person is no longer employed and the outings have stopped. Peoples right to receive visitor in their home are respected and no restrictions are placed on visiting times. People have access to the telephone in the office to make and receive calls and may, if they choose to do so, have a telephone line connected at their own expense, in their bedroom. Care Homes for Older People Page 19 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service and their representatives have access to the complaints procedure and policies and procedures are in place to protect people from the threat of abuse. Evidence: The home does not currently have a Statement of Purpose or Service Users Guides but each of the residents has been given a copy of the complaints procedure and reference is made to the complaints procedure in the homes brochure. The complaints procedure that was seen in some of the bedrooms and it was noted that this document needs to be amended as it does not contain the correct name address and telephone number of the Care Quality Commission. A book is kept in the entrance of the home for visitors to record any complaints or comments they may have about the care. We were told that only one complaint had been received since the last inspection. This was from a nurse who complained that one of the bedrooms was damp and appropriate action was taken to remedy this. The service providers response to complaints has on previous occasions been a cause of concern. These issues appear to have been resolved and there was no evidence to indicate that complaints would not be taken seriously and dealt with in a positive and constructive manner. Care Homes for Older People Page 20 of 38 Evidence: Policies and procedures are in place to protect the residents from the threat of abuse and, with the exception of recently recruited staff, training has been provided on the Protection of Vulnerable Adults. Care Homes for Older People Page 21 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortably furnished and reasonably well maintained. Evidence: Rosemount is an end of terraced house close to the centre of Chudleigh. The main entrance is to the side of the property and this leads out to a driveway that provides off street parking for four cars. Behind the driveway there is a small paved patio garden with chairs and tables for the residents use. On the ground floor there is a very large through lounge/dining room. This room, which is well presented, is the only communal room in the house. There is a small staff office on the ground floor and a separate office, which is used by the manager on the second floor. The people who use the service may use the office to make and receive telephone calls in private if they wish to do so. The bedrooms are on the ground floor and the first floor. There are two flights of stairs between floors and stair lifts have been fitted to both of them. The home has four double and twelve single bedrooms. No evidence was seen to tell us that people who share a bedroom had requested to do so and, although the registered manager told us that the people sharing rooms did not mind sharing, Care Homes for Older People Page 22 of 38 Evidence: people should be given the option of moving to a single room as and when vacancies become available. The bedrooms we saw during the site visit were comfortably furnished and reasonably well decorated. Some had been personalized by the person using the room. Each of the bedrooms has a wall mounted call bell and in addition to this some of the residents use pendent call bells which they can wear around their necks or keep close to them. Most of the bedrooms have been fitted with a lock that enables people to lock their bedroom doors from the inside if they wish to do so. The tops of the keys to the bedroom doors have been removed and the keys have been left in the locks so that the staff can, with the aid of a pair of pliers, gain access to a locked room if they need to do so in an emergency. This does not meet the National Minimum Standards as people are unable to lock their bedroom doors from the outside when they leave their rooms. There are communal bathrooms and toilets on both the ground and the first floor. One of the bathrooms contained a bath that had a dull surface. It was not clear whether this was a worn surface or that it had not been cleaned. White debris was also noted on the hoist and the hoist coil. The toilet nearest to the kitchen has not been fitted with a lock for privacy. The kitchen is next to the dining room. The chef told us that the kitchen had been inspected by the Environmental Health Officer shortly after he took up his post and we were shown a copy of a report of this visit which was carried out on 17th March 2009. Some recommendations were made for improvement and the chef said he was working towards meeting these. The laundry was seen to be well equipped with equipment suitable for washing foul laundry. Dissolvable red bags are used to transport dirty linen. Systems are in place for keeping dirty and clean linen separate. Personal protective equipment and hand washing facilities are available but not always used by the staff. This was demonstrated when we observed a member of staff working in the kitchen with no gloves or apron on and later working in the laundry with no gloves or apron on. The member of staff told us that she knew she should be wearing protective clothing but had forgotten to put them on. Care Homes for Older People Page 23 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Higher staffing levels and more staff training would improve quality of the care provided for the residents. Evidence: We asked to see the staff files and were told that some of these were at the managers own home and not on the premises. The files we did see all contained a photograph and an application form containing details of employment histories and the names and addresses of referees. Corresponding references were seen. Health is assessed by staff declaring they are fit to work on the application form. Evidence was seen that Criminal Record Bureau checks and Protection of Vulnerable Adults checks are carried out. The only thing missing from the staff files was proof of identity, for example a photocopy of a driving licence or birth certificate. All staff are issued with a copy of their terms and conditions of their employment. The manager and staff told us that induction training is provided and we saw records that provided evidence of this. However, we did feel that the induction training may have been rushed and that additional training could have been provided for the overseas staff, to help them to adjust to living and working in a new country. We were given a mixed response by the people we spoke to about the quality of the staff. One person told us that they liked the staff that were always smiling. One Care Homes for Older People Page 24 of 38 Evidence: person told us that the staff tended to treat everyone the same, as if they were stupid or had dementia. One person said that the staff were OK, and that some of them were very good, but said that some were just here because it was a job and that the residents could tell the difference. The feedback we received from the surveys that were completed and returnd to us all made very positive comments about the qualities of the staff. We looked at staff training records and discussed the provision of staff training with two members of staff and the registered manager. We also received nine surveys that had been completed by staff members. This told us that training had been provided for some, but not all of the staff in the health and safety related areas of Health and Safety, Fire Safety, Manual Handling, Infection Control, Moving and Handling and First Aid and that some updates were overdue. We were told that additional training had been booked and would be commencing after 1st September 2009 to fill some of the gaps and, or, update the provision of training in Moving and Handling, Dementia Care, Health and Safety and Fire Safety. The registered manager and deputy manager had attended a training course on the Mental Capacity Act. The provision of specialist training was limited to training in dementia care, but the registered manager told us that the home was looking after six people who have learning disabilities and records showed us that some of the people who live at the home have diagnosed mental illnesses. There was no evidence that any training had been provided to help the staff to understand their specific behaviours or conditions. We were given a mixed response by the people we spoke to about the quality of the staff. One person told us that they liked the staff that were always smiling. One person told us that the staff tended to treat everyone the same, as if they were stupid or had dementia. One person said that the staff were OK, and that some of them were very good, but said that some were just here because it was a job and that the residents could tell the difference. The care staffing levels are a little too low to meet the needs of the residents. This was made evident during the site visit when we saw that some people got little or no attention from the staff and that other people were helped at a pace that was to fast for them. Care Homes for Older People Page 25 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the running of this home since the last inspection but further work is needed to ensure that the people who live at Rosemount are cared for in a well managed and safe home environment. Evidence: Mrs Rosemarie Noon is the sole director of Mariarod Care Homes UK Limited and the registered manager of Rosemount. Mrs Noon is a qualified manager, having completed her Registered Managers Award and her National Vocational Qualification in Care at Level 4 and has considerable experience of caring for people in a residential setting. In addition to managing Rosemount, Mrs Noon is also registered to provide supported living for two people who have learning disabilities in her own home. However, both of the people she provides a supported living service for have been living at Rosemount for at least six months while repairs are carried out at their own home. This temporary arrangement does not appear to have a negative impact on the permanent residents, although it does reduce the number of single bedrooms available. Care Homes for Older People Page 26 of 38 Evidence: Mrs Noon has appointed a deputy manager to help her to manage the home on a day to day basis. Since the last inspection Mrs Noon has carried out an Annual Quality Audit which used surveys to gain feedback from the people who use the service and their next of kin about the quality of the service provided. Information gained from the surveys is being used to initiate changes that should improve the quality of the service provided. Mrs Noon said that she did not handle any money for or on behalf of the residents and that people who needed assistance would be encouraged to ask a family member, social services or a legal representative for help. Out of pocket expenses are paid for by the home if necessary and included in the monthly bills. Staff meetings are not held but that one to one meetings are held with the staff. The manager said that these were not formal supervision meetings, which should be carried out at least six times a year, with each member of staff and recorded. With the exception of some of the staff files, most of the records that are required to be kept by the care home are being kept. However, the records that relate directly to the assessment and care of the people who use the service do need to be better organised so that the care staff can easily accesses the information they need to help them to meet the assessed needs of the residents in a planned manner. During the site visit we observed some working practices that are not safe. For example, a member of staff was seen working in the kitchen and the laundry without using protective gloves and aprons. We saw a bedroom door being held open with a wedge. The fire safety register of residents, which containing information about their mobility and the room that they occupy, had not been kept up to date. We received assurances from the deputy manager that this record would be updated as a matter of urgency. The fire safety log book showed us that the fire alarm was not being tested weekly as recommended by the Fire Safety Service. This indicates that the registered manager needs to carry out a full risk assessment of all working practices to ensure that the home is run safely. Care Homes for Older People Page 27 of 38 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 1 5 The registered persons must 10/04/2009 produce written Service Users Guides. This document must include all of the information listed in regulation 5 and should also include the information listed in National Minimum Standard 1. Each of the residents must be given a Service Users Guide. To ensure that the residents have access to the information they need about the home and the service they can expect to be provided. 2 1 4 The registered person must 10/04/2009 produce a written Statement of Purpose. This documents must include all of the information listed in regulations 4, including Schedule 1, of the Care Homes Regulations and should also include the information listed in National Minimum Standard 1. The Statement of Purpose must be kept at the home and available to the prospective and current residents and their representatives on request. Care Homes for Older People Page 28 of 38 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action To ensure that the people have access to the information they need about the home and the service they can expect to be provided. 3 7 15(1) & 15(2) The registered person must 10/04/2008 ensure that each resident and/or a representative, who could be a family member, is directly involved in developing and reviewing their plan of care. This should include a review of their needs assessment, individual risk assessments and risk management plans and care plans. 4 7 15 The registered person must 12/03/2009 consult the residents when preparing and reviewing their individual care plans. If a resident is not considered to have the capacity to contribute, clear evidence should be provided to support this assumption. This is to enable the residents to retain control of their lives. 5 12 16 The registered providers 10/04/2009 must consult the residents about their social interests and make arrangements to enable them to engage in a range of activities both inside and outside their home environment. Care Homes for Older People Page 29 of 38 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action This is to prevent them from getting bored. 6 27 18 The registered person must 10/02/2008 review the care and ancillary staffing levels to ensure that they are high enough to meet the number and needs of the residents. 7 27 18 The registered provider must 16/04/2009 review the care staffing levels. to ensure that there are always sufficient staff on duty to meet the physical, mental and social needs of the residents. 8 30 18 The registered person must 10/07/2008 ensure that all of the staff receive the training they need to meet the needs of the people who live at the home. This should include induction training, health and safety related training and any specialised training needs identified the individual assessments and reviews of the residents needs. Care Homes for Older People Page 30 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The registered person must 23/10/2009 produce a written Statement of Purpose. This document must contain all of the information listed in regulation 4 and Schedule 1 of the Care Homes Regulations and must be kept at the home and available for inspection on request by every resident and their representatives. This is to ensure that people have access to the information they need about the home and the service they can expect. 2 2 5 The registered person must 23/10/2009 produce written Service Users Guides. These documents must include the information listed in Regulation 5 of the Care Homes Regulations and should also include the information listed in National Page 31 of 38 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Minimum Standard 1. Each of the residents must be given a Service Users Guide. Ths is to ensure that the people who live at Rosemount have access to the information they need about the home and the service provided. 3 7 15 The registered person must 28/09/2009 ensure that the care staff have access to clear and up to date care plans which tell them how peoples individual assessed needs should be met. This is to enable peoples wishes to be taken into account and their needs to be met. The registered person must 28/09/2009 consult the residents when preparing and reviewing care plans. If any resident is not considered to have the capacity to contribute, clear evidence should be provided to support this assumption. This is to enable the residents to retain control over their lives. The registered person must ensure that any mental or physical conditions referred 28/09/2009 4 7 12 5 8 12 Care Homes for Older People Page 32 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action to in the residents case files has been professionally diagnosed and not assumed. Recorded evidence of their diagnosis should be kept in the residents case files. Also, systems must be in place to ensure that people have the finer details of care attended to. For example, footwear correctly fitted and call bells and drinks within reach. This will mean that people have proper provision for their health and welfare. 6 12 12 The registered person must ensure that systems are in place to ensure that the staffs interactions with all of the residents are positive and that none of the residents are rushed or ignored. This will show that the residents are treated with dignity and respect. 7 12 14 The registered providers must consult the residents about their social interests and make arrangements to enable them to engage in a range of activities both 28/09/2009 28/09/2009 Care Homes for Older People Page 33 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action inside and outside their home environment. This is to ensure that people can lead stimulated lives. 8 15 12 The registered provider must ensure that people who need assistance with meals are helped in a sensitive way. This will respect the persons dignity and ensure mealtimes are an enjoyable occasion. 9 27 18 The registered person must review the staffing levels to ensure that there are enough staff on duty at all times to meet the health and welfare, which includes their need for social and emotional support, needs of the people who use the service. This would improve the quality of care provided for the residents. 10 30 18 The registered person must 29/09/2009 ensure that all of the staff receive training that is appropriate for the work that they are to perform. This should include induction and foundation training that 29/10/2009 28/09/2009 Care Homes for Older People Page 34 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action meets Skills for Care Standards, the provision of up to date training in health and safety related topics, such as moving and handling, First Aid, Health and Safety, Fire Safety, Basic Food Hygiene and Infection Control and in specialised areas which relate to the assessed needs of the people who use the service, such as Dementia Care, caring for people with learning disabilities and caring for people with a diagnosed mental illness. This would improve the quality of care provided for the residents. 11 38 13 The registered manager must ensure that safe working practices are followed by the staff at all times. This must include ensuring that fire safety tests are carried out at the frequency recommended by the Fire Safety Service and that regular risk assessments are carried out of the premises to ensure that the premises are maintained as safely as possible. 29/09/2009 Care Homes for Older People Page 35 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will reduce the risk of injury to the residents and staff and reduce the risk of the spread of infection. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Two signatures on hand written entries on the Medication Administration Record sheets would minimise errors being made when transcribing prescriptions. A homely remedy policy would allow people to have over the counter medicines in a timely yet same way. Systems should be in place to ensure that medicines that require refrigeration are stored at correct temperatures. 2 10 To ensure that people only share a bedroom if they have requested to do so, single bedrooms should be offered to each of the residents who are currently sharing a room as and when single rooms become available. To preserve the dignity and privacy of the residents, the staff should be reminded to knock on the residents bedroom doors before they enter a room and to shut the door to their bedroom, bathroom or toilet before providing assistance to a resident. 3 16 The complaints procedure should be amended to give the correct name, address and telephone number of the Care Quality Commission and a summary of this document must be included in the Statement of Purpose and Service Users Guide when they are written. Arrangements should be made for the staff who have not received training on the Protection Of Vulnerable Adults to receive this training. People should not share a bedroom unless they have 4 18 5 19 Care Homes for Older People Page 36 of 38 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations requested to do so. Therefore the people who are currently sharing a room should be offered a single bedroom as and when vacant rooms become available. 6 19 To reduce the risk of the spread of infection, the staff must be reminded to use protective clothing when working in the kitchen and the laundry and bathroom and any equipment in the bathrooms must be kept clean. To respect the peoples privacy suitable locks, which can be used by the residents to lock their doors from the inside and from the outside, should be fitted on all bedroom doors. These should have a mechanism to enable the staff override the lock in the event of an emergency. Locks should also be fitted to all toilet doors. Staff files should be kept at the home at all times and available for inspection and proof of identity, such as a copy of a birth certificate or driving license should be kept in the staff files. Each member of staff should receive one to one supervision with their manager at least six times a year. These should be recorded and cover all aspects of care practice, the philosophy of care in the home and career and training development needs. 7 19 8 29 9 36 Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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