Inspection on 15/12/08 for Roseneath

This inspection was carried out on 15th December 2008.

CSCI found this care home to be providing an Poor 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Roseneath 05/02/08

Roseneath 31/07/07

Roseneath 21/04/06

Roseneath 24/08/05

Roseneath 26/04/05

Roseneath 09/12/04

Roseneath 10/08/04

Roseneath 08/03/04

Roseneath 13/08/03

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Roseneath 163-165 Hamstead Road Handsworth Wood Birmingham West Midlands B20 2RL     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kerry Coulter     Date: 1 6 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Roseneath 163-165 Hamstead Road Handsworth Wood Birmingham West Midlands B20 2RL 01215238280 01215515740 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Gillian Goode Type of registration: Number of places registered: Mr M Mughal care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 30 The tregistered person may provide the following category of service only: Care Home Only (Code PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories Old age not falling within any othercategory (OP) 30 Dementia (DE) 20 Date of last inspection Brief description of the care home The home was formerly two large houses that have been converted into one large care home providing accommodation for up to 30 elderly people some of whom may have dementia. The properties are linked on the ground and first floors and at the front of the home. Bedrooms are located on all three floors of the home, although the majority are on the first and second floors. There are two shaft lifts, one in each property giving Care Homes for Older People Page 4 of 37 Over 65 0 30 20 0 Brief description of the care home people easy access to all floors. People all have their own room and some have ensuite facilities. There are two bathrooms on each floor of the home; with the majority equipped with hoists for those people requiring assistance, the bathroom on the first floor has a fully assisted shower. There are also numerous toilets throughout the home. On the ground floor there are four lounges, a conservatory, two dining rooms, a large well-equipped kitchen, a laundry, staff facilities and an office. The home has easy access to public transport and the popular shopping area of Handsworth and community facilities are within five minutes travelling distance from the home. There is ramped access to the front of the home and some parking spaces. To the rear is a pleasant garden with a patio area, shrubs and lawns. For up to date fee information about the home it is advised that the Home Manager is contacted. Non NHS chiropody, hairdressing and newspapers are not included in the fee but are available within the home at an additional charge if required. Our reports are available in the home for people to read on request. Care Homes for Older People Page 5 of 37 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: zero star poor 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: One inspector undertook this fieldwork visit to the home, over one and a half days and the manager of the home assisted us throughout. The home did not know that we were going to be visiting. A second inspector assisted in the inspection for two hours and undertook an observation of the experiences of five people who live at the home. We call this observation Short Observational Framework for Inspection (SOFI). The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects Care Homes for Older People Page 6 of 37 of service provisions that need further development. Information was gathered from speaking to and observing people who lived at the home. Three people were case tracked and this involves discovering their experiences of living at the home by meeting or observing them, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also reviewed. Random questionnaires were sent out in order to gain peoples views about the service. seven people who live at the home (some assisted by staff or their relatives), two staff and three health professionals returned questionnaires. We also spoke with four staff during our visit and with the owner of the home. Prior to the inspection the manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there, improvements and plans for further improvements, which was taken into consideration. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. We did not make any immediate requirements at the end of our visit, however there were some concerns regarding health and safety practice. The Environmental Health Officer was also undertaking a visit to the home on the same day and they left the home with a report about health and safety issues that needed to be actioned. At this visit we found that recruitment practice was poor. As we have made a previous requirement for the home to improve this we are now considering taking enforcement action to ensure recruitment practice protects the people who there. What the care home does well: What has improved since the last inspection? What they could do better: The assessment process should be improved to ensure that individuals needs can be met at the home before they move there. Care plans must be developed to reflect all peoples care needs so that staff have the information they need to meet these. Further improvements are required to the medication administration systems to ensure that people always receive the medication they are prescribed in a safe manner. Staff must support individuals to meet all health care needs so ensuring their well being. A range of activities should be provided so that people can experience a meaningful Care Homes for Older People Page 8 of 37 lifestyle. People should be supported in a way that respects their dignity so ensuring their well being. The home needs to ensure people are offered choice and control over their lives as much as possible so that people lead the life they want to and feel valued. All staff should be trained in safeguarding people from abuse to ensure that people are protected from harm and that staff are aware of the required actions that they should undertake. Staff should have the training they need so they have the skills to support the people living there to meet their needs. The recruitment and selection of staff needs to be more robust. A new criminal records check must be gained before new staff commence employment at the home to ensure that people who are unsuitable to work with vulnerable adults do not. There remains a need for a quality assurance system. A quality assurance system would give the home direction and ensures that peoples views are listened to, and identify ways that the home can improve and develop. Management arrangements should be reviewed to help ensure the home is well run and in the best interests of the people living there. Systems to ensure the health and safety of people living at the home need considerable improvement to ensure they are not put at risk of harm. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 37 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 37 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. Information about the home needs to be updated to ensure that accurate and complete information is available for people to make an informed choice that the home is suitable for their needs. The assessment process needs to be improved to ensure that individuals can be confident that their needs can be met at the home prior to admission. Evidence: The home has a statement of purpose and service user guide available. The statement of purpose has been updated since the last inspection and generally has all the required information about the home. The service user guide still needs to be updated, as recommended at the last inspection. It did not reflect that the home is now registered to take people who have dementia and had old address information on how people should contact us if they have a complaint. The range of fees to live at the home needs to be included so that people know how much it costs to live at the home. Care Homes for Older People Page 11 of 37 Evidence: Discussions with the manager show that the guide is only available in a small typed format. Consideration should be given to producing the guide in alternative formats such as large type or audio so that it is more accessible for people who have poor eyesight. A small leaflet has been produced since the last inspection and this does contain some photographs of the home so that people can see what the home looks like before they make a decision to visit or move there. Five of the six people who returned one of our surveys said they had received enough information about the home before they moved there. At the last key inspection it was found that people had been admitted into the home without an assessment of their needs. At this visit we looked at the admission procedures followed for one new person. Records and discussions with the manager show that the manager had been to meet the person before they moved in, their relative had also been to have a look at Roseneath. A pre admission assessment had been completed prior to the person moving in. In addition to completing the assessment the manager had obtained a copy of the social work care plan and a copy of the care plan from their previous care home. Some improvement was seen to be needed to the pre admission assessment to make sure it covers all areas of need. For example the assessment did not cover the persons night time needs nor did it appear to establish if the person had any behaviours that may mean the home cannot meet their needs. Discussion with the persons relative during our visit indicates they feel they have settled well into the home. Care Homes for Older People Page 12 of 37 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current systems in place for care delivery do not always ensure that peoples personal and health care needs are maintained. Minor improvement is needed to the management of medication to ensure that people receive their medication safely and as prescribed. Evidence: At the last inspection it was identified that care planning needed to improve. At this inspection we looked at the care plans for three people. Each person had two separate care plans, the manager said this was because she had obtained new care plan formats and was in the process of updating the care plans. This made it difficult to fully assess peoples care plans as both sets of documents needed to be viewed. Care plans sampled did not always have enough detail about the type of support people needed. For example plans regarding personal care needs sometimes referred to assistance being needed but did not record what type of assistance the person needed or what they could or could not do for themselves. Plans regarding peoples Care Homes for Older People Page 13 of 37 Evidence: continence needs did not inform staff if people were able to communicate when they needed assistance and everyone appeared to be toileted two hourly with no actual assessment of need available. Plans regarding peoples communication and leisure needs were often vague. Some of the older style care plans had some basic information about peoples preferences for example the number of pillows they liked, but the new plans lacked information about many peoples personal preferences. As with the care plans there were two risk assessment formats in place. Risk assessments had been completed for areas such as falls, manual handling, pressure care and smoking but often they did not detail all the risks or control measures in place. For example control measures for pressure care did not include the fact that the home uses pressure relieving equipment for the person. Some assessments that we sampled were found to be inaccurate. For example for one person their falls risk assessment did not take into account they were confused and had a history of falls. Whilst the outcome of the assessment would still have been that they were at high risk their actual score would have been considerably higher if it had been accurately completed. One person had a nutritional assessment completed that recorded they were of normal weight when other information suggested they were in fact underweight. The actual outcome of the assessment directed that a referral was needed to the dietitian but the manager said this had not yet been done. She said this would be followed up and the person reweighed. Health records sampled show that people have regular check ups from the dentist and optician, and the chiropodist was visiting the home during our inspection. Records sampled did show that usually when people are unwell medical advice is sought when needed. Three health professionals returned surveys to us and said that peoples health needs are usually met. However health records do need to be improved. One persons records showed they had a blood test several months ago, however the record did not show what the test was for or what the outcome was. Discussions with the manager show she was aware what the test was for but not the outcome, she said she would contact the GP to find out. The new care plans completed had a health assessment included, however this was very basic in content and would benefit from further development. Several people at the home have diabetes. We looked at the care plan for one person and found it needed improvement, to include guidance for staff on signs that the person is unwell and how to respond. Records did not show that the person had an annual check up regarding their diabetes. We spoke with three staff about how they would know if someone was unwell from diabetes and their knowledge was adequate. One person at the home is assessed as being at risk of pressure sores. Not all staff spoken with were aware of this, two out of three were aware and had some basic Care Homes for Older People Page 14 of 37 Evidence: knowledge of the measures in place to reduce the risk of pressure areas developing. At the last inspection it was identified that for one person sampled they had only a strip wash with no bath or shower for over a month. At this visit we looked at the personal hygiene records for two people. This again showed that generally people have a strip wash with only infrequent baths or showers. We spoke with one person during our visit, they told us they were usually supported by staff to have a strip wash but that they would prefer a shower. More attention needs to be paid to peoples personal appearance. We saw that several gentleman who live at the home had not been supported by staff to shave and this does not promote peoples dignity. We looked at the homes systems for the administration of medication. Only senior staff at the home administer medication and certificates were available in the home to evidence that they had received suitable training to do this. At the last inspection we made some recommendations for improvement and these have generally been met. Previously there had been gaps in the signing of medication administration records, records sampled during our visit had generally been satisfactorily signed when medication had been administered. Usually the home obtains copies of the prescriptions so that staff can check that that people are receiving the right medication. However copies of prescriptions were not available for the current month, the manager said this was because the pharmacist had not returned them to the home. Storage of medication was secure and generally satisfactory. Sampled creams had been dated on opening so that the home knows when creams need to be discarded. One person was prescribed medication that they only have as required. There were no specific guidelines in place for this person so that staff know when this needs to be given. Guidelines need to be completed to make sure people receive as required medication when they need it. For one person it was not clear on their medication administration record (MAR) that their medication was as required, as it stated to give as directed, with no explanation of what this meant. Their MAR also directed that one of their medications was required twice a day but was being signed for once a day. The manager provided evidence that the GP had reduced the dose some time ago, however the manager needs to be proactive in ensuring that the MAR is in line with the GP prescription. On the first day of our visit we saw staff giving the morning medication. They did this in a safe manner, referring to the medication administration record before giving any medication and not signing the record until after administration. Staff did take some Care Homes for Older People Page 15 of 37 Evidence: considerable time in completing this task so that some people did not get their medication until 11am. However discussion with staff shows that they were fully aware that timing for peoples next may need adjustment to ensure a safe time span between doses. At this visit the pharmacist from the Primary Care Trust was spoken with as he was visiting the home to complete a medication audit. He said there were still areas the home needed to improve on, but that overall medication systems at the home were improving. Care Homes for Older People Page 16 of 37 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. Arrangements need some improvement to ensure that the people living there experience a meaningful lifestyle that meets their individual needs. Evidence: There is brief information in peoples care records about their past leisure interests and hobbies. Care plans sampled were quite vague about activities to be provided to people and do not ensure that peoples leisure preferences are taken into account. One person who lives at the home told us he likes to play chess but that he does not get to play at Roseneath as he has no one to play with. Most people who returned surveys to us indicated that there were not always activities available for them to join in. Records and discussions with staff do show that activities are offered to people on a daily basis. This is usually activities such as knitting, painting, dominoes, reading and ball games. Activities are quite repetitive and more thought needs to be given to providing a range of activities that engage people and meet their personal preferences. The home accommodates some people who have dementia and discussion with the manager indicates that there are no staff who have had any training on providing Care Homes for Older People Page 17 of 37 Evidence: appropriate activities for people who have dementia and who may be more difficult to engage. Records sampled and discussion with staff show that a regular church service is held at the home which people seem to enjoy. Staff said that preparations for Christmas events were under way and that a Christmas party had been held for people at the home and their relatives. A professional singer had provided the entertainment. Photographs of the event showed people having a good time. Visitors are welcome in the home. Staff said and it was observed that some people have regular contact and visits from their family and friends. As stated earlier peoples relatives were invited to attend the homes Christmas party. We spoke with one relative who told us that they were always made welcome at the home and there were no restrictions on when they could visit. People generally have a choice of how and where they spend their days. A number of people spent time in their own rooms watching television, others sat in the lounge and joined in with any activities that are on offer. People are offered some choices and control over their lives but this could be improved. For example people are offered choices of meals but at lunch everyone with the exception of one person was given orange squash with their meal with no choice of drinks offered. As stated earlier in this report people often are often supported to have a strip wash but discussion indicates some people would prefer to have a bath or shower. At the last inspection it was recommended that staff have training in the Mental Capacity Act so that they have a better understanding of issues of peoples capacity to make their own choices. Discussion with the manager indicates that the home has obtained the Department of Health training packs for this and that staff are working through this. The home has a four week rotating menu, this generally showed that a variety of nutritious meals are on offer. The home accommodates people from different cultural backgrounds and discussions with staff and the cook indicate that food is available to meet peoples preferences. For each meal there is a choice of two options. People who live at the home told us there is always a choice of meal. Peoples comments included mixed variety of meals, have started to provide Caribbean dishes, staff ask you in the morning what you want, they do cultural foods, food is generally good and food is nice. We saw that the home had supplies of fresh fruit, staff and people who live at the home said fresh fruit was always available. Care Homes for Older People Page 18 of 37 Evidence: We saw that staff practice at meal times needed to improve to make meal times a more pleasurable and social occasion. For example condiment sets were seen to be available but these were not provided at lunchtime so that people did not have access to salt and pepper if they wanted it. When food was brought to people they were not always spoken to by staff or told what the food was. Some people needed assistance with there meals and we saw that sometimes staff stood over people to help them eat rather than sitting down next to them. Care Homes for Older People Page 19 of 37 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. People living in the home are generally confident that their complaints will be listened to and acted upon. The systems in place to safeguard people from harm need improvement to ensure that people are protected from abuse. Evidence: The home has a complaints procedure, this was on display in the home. The procedure was in small print and may be difficult for people with poor eyesight to read. We brought this to the manager attention and she made arrangements for the procedure to be produced in larger print during our visit. We have not received any complaints about the home since its last inspection and the annual quality assurance assessment completed by the manager recorded that the home had not received any complaints directly. The home has a folder for complaints and compliments but there is no actual log within the folder where staff would record if a complaint is received. The two staff who returned surveys to us said they knew what to do if people wanted to make a complaint. Two health professionals who returned surveys said that the home usually responds to any concerns. All but one person who lives at the home who returned a survey said that they knew who to speak to if they were unhappy and how to make a complaint. One person told us staff listen and put things right. Care Homes for Older People Page 20 of 37 Evidence: Since the last inspection there were concerns raised by the vulnerable person officer from the police about the number of incidents in the home where people were being assaulted by other people who live there. Safeguarding procedures have been instigated by Birmingham social services to ensure people are being protected and as a result some people have been moved from the home, social services have also temporarily suspended admitting any new people to the home. Discussions with staff and sampling of records during our visit indicate that there have been no recent physical assaults between people who live at the home. At the last inspection it was identified that the home did not have its own safeguarding policy or a copy of Birmingham City Council Safeguarding policy. These were seen to be available at this inspection. Discussion with staff and sampling of training records shows that not all staff have received training in safeguarding people from abuse. This was also identified at the last inspection. The manager was able to provide evidence to show that this training is now being arranged so that all staff know how to keep people safe from abuse. We spoke with three staff during our visit about what they would do if they witnessed abuse taking place. Whilst their answers were basic the action they described indicates people would be protected. Some people had inventories of their personal possessions but not everyone had this. Some peoples inventories were also not up to date. Everyone should have an up to date inventory of their possessions so that staff are aware if any of their personal possessions goes missing. We looked at the homes recruitment procedures and these were not robust and do not protect people from having unsuitable people working with them, this is further detailed within the staffing section of this report. Care Homes for Older People Page 21 of 37 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. People are generally provided with a warm, comfortable and clean environment to live in. A number of improvements are planned to further enhance the environment for the people who live there. Evidence: The home was found to be warm, and generally clean and homely. Improvements continue to be made to the environment with redecoration of some bedrooms and communal areas and refurbishment of communal bathrooms and shower rooms having been completed. Bathrooms have assisted baths and showers have level access so that they are accessible to people with mobility difficulties. Discussion with the owner indicates that further refurbishment is planned to remaining bedrooms and some en suite shower rooms. Staff spoken with said that the owner had been making lots of improvements to the premises. It has previously been identified that the flooring outside the kitchen was uneven and presented a tripping hazard. New laminate flooring has now been fitted to this area. However at this visit we saw that there was damage to the dining room and conservatory floors and that these areas could pose a tripping hazard to people. We brought this to the attention of the owner who said he would ensure repairs are carried out. Care Homes for Older People Page 22 of 37 Evidence: We found that some windows in the home did not close properly making rooms draughty. An audit of windows should be undertaken to identify where repairs are needed. Some rooms in the home were not well lit despite having the lights turned on, this was usually in rooms where energy saving bulbs were being used. The home needs to make sure rooms have satisfactory lighting as poor lighting could pose a hazard to people who have poor eyesight. The home has a staff call system. Problems have been highlighted since 2005 that the call points from either baths and toilets could not be accessed in the part of the home that was previously 165 Hamstead Road. Work has now been completed to install a new call system throughout the home. We looked at some bedrooms during our visit. Some bedrooms were homely in style whilst others were quite bare. The home needs to consult with people to make sure their bedroom meet their personal preferences. Toilets, bathrooms and the laundry were seen to have satisfactory hand washing facilities and there were no unpleasant odours noted in the home during our visit. The home had a food hygiene inspection by Birmingham City Council in October, the outcome of this was that food hygiene standard are fair. The report identified that a new lidded bin was needed in the kitchen and this has now been obtained. It was also identified that the kitchen floor was splitting and lifting and so needed repair. This has yet to be done but the timescale given has not yet been exceeded. The food hygiene report said that the kitchen units would benefit from being replaced and that this is planned to be done in the future. Care Homes for Older People Page 23 of 37 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing, their recruitment, support and development are variable, which could impact on the health and welfare of the people living there. Evidence: The home staffing levels currently are three care staff throughout the daytime shifts from 8am to 10pm with management hours in addition and two care staff on duty at night. The home has a cook who works from 7am to 1.30 pm and also domestic support. Discussion with staff indicates that this level of staff is generally sufficient given that the home is not at full occupancy. Staff said that when occupancy levels are higher then there is additional staffing. Turnover of staff at the home is minimal with the majority of staff spoken to having worked at the home for several years. This means that people know the staff who support them. Four people who returned surveys to us said that staff were always available when needed. During our visit one person who lives at the home told us always enough staff, they have more staff on duty if they have more residents. It is not clear how many staff have actually completed a National Vocational Qualification (NVQ) in care. The annual quality assurance assessment completed by Care Homes for Older People Page 24 of 37 Evidence: the manager recorded that all staff had achieved an NVQ but the homes training matrix did not show this. The manager also told us that a bank staff had just commenced an NVQ so clearly not all staff have this. People who live at the home told us staff listen, one said care staff are friendly and caring. We carried out a two hour observation of the experiences of five people who live at the home. We saw staff interacting with people, some interactions were positive but many interactions often only happened when staff were undertaking tasks. We discussed the recruitment procedure with the manager and looked at the recruitment records for two staff. For one staff who had worked at the home for several years there was no application form and no references in their file. A criminal records bureau (CRB) check had only recently been completed. The manager said the records were not available as the staff had been recruited by the previous owner. She said it had only recently come to light that the staff had not had a CRB check done. Given that the manager has been at the home since 2007 she should have had systems in place to have identified this issue much sooner. We also looked at the recruitment records for the newest member of staff. Whilst references and a police check had been obtained from their home country before they started work overall recruitment procedures followed had been poor. An application form was available along with a statement of having no criminal convictions but these were dated as having been completed after the staff started working in the home. The CRB check had also recently been completed, again after the staff had started working in the home. The manager said that as the person had been recruited from another country via an agency and had not realised these checks were needed. Discussion indicates that the CRB had only been obtained when a contracting officer from Birmingham City Council pointed out to the home that it was required. We made a requirement at our last inspection for the home to improve recruitment procedures. Evidence shows this has not been done and people may be put at risk by poor recruitment procedures. We are considering taking enforcement action about this to ensure practice is improved and robust procedures are in place so that people are properly safeguarded from possible abuse. We looked at records and spoke with staff and the manager about the training on offer. Staff spoken with said they were generally happy with the training that was on offer at the home, one said that it had improved since the current manager started working at the home. The home has a training matrix in place but this was not reflective of all the training staff had. We could not cross reference this with individual staff training records as the home does not have these, although some training certificates were available. The matrix showed that not all staff had received fire Care Homes for Older People Page 25 of 37 Evidence: training although discussion with the manager and three staff indicated fire training had taken place this year. One staff had a certificate to show they had done fire training but this had not been recorded on the matrix. The manager needs to ensure training records are up to date and record all training undertaken, as recommended from the previous inspection. It was of concern that for one bank staff who has worked at the home for several years there was no record of any training being undertaken. The manager confirmed this was the case but said they were starting an NVQ. The matrix indicates that most staff have completed training in dementia and manual handling. Only half of the staff appear to have received training in first aid, infection control and safeguarding people from abuse. The manager was able to provide evidence that further training is being arranged for fire, manual handling and abuse. Our last report identified that more staff needed to have first aid training and this is further detailed in the management section of this report. Care Homes for Older People Page 26 of 37 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not always ensure that the home is run in the best interests of the people living there or ensure their safety and well being. Evidence: Evidence at this inspection indicate that management arrangements at the home need improvement. The manager needs to ensure she undertakes the role effectively and carries out her responsibilities to make sure the home is being well managed. At this inspection we found that some previous requirements had not been met and were concerned that the manager had been unaware that criminal record bureau checks were required for all staff. The manager completed and returned the annual quality assurance assessment for the home when we asked for it. As identified at the last inspection this document needs to be completed in more detail. It did also not fully identify the improvements that were needed at the home or how they would be made. Our discussions indicate that the manager is very caring and wants to improve the home but evidence does not show that she has the level of knowledge needed. Care Homes for Older People Page 27 of 37 Evidence: Discussion with the manager and owner shows that the manager generally undertakes all areas of responsibility in the home without the support of a deputy. The home does have seniors but their areas of responsibility is limited. An indication that management arrangements need review is the fact that the owner has requested the manager cancel her booked Christmas holiday abroad so that there is someone who can manage the home over the Christmas period. Previous inspections have identified that the home has no quality assurance programme which if available would assist in identifying areas that require development at the home. The owner does visit the home very regularly and writes and monthly report of the visit which shows he does speak with people at the home and staff. However this is the only formal method that the home has in place to seek peoples views. The home does not have a satisfactory system of seeking peoples views about the service they receive. There is also a need to solicit the views of relatives, staff and other professionals about the home and improvements that could be made. Discussion with the manager indicate that the home has also not held a residents meeting since our last inspection and so there is limited opportunity for people to contribute towards how the home is run. The home does keep small amounts of money on behalf of some people. We looked at the records for three people. These were up to date and receipts were available for expenditure. Records show that the owner audits the money to make sure it is correct. Records show that staff meetings do not take place very regularly. The frequency of these needs to be improved to ensure that all staff are kept updated about the changing needs of the people living there, best practice and changes within the home. We looked at the systems for health and safety. As stated earlier in this report not all staff have had manual handling training and this is being arranged for staff. We saw staff assisting people to transfer from wheelchairs and this was being done in a safe manner. Not all staff have had training in first aid and sampling of staff rotas shows that sometimes there are no staff on duty at night who have had first aid training. This means that if people have an accident or are unwell they might not receive the first aid training they need. Accident procedures on display in the home were out of date and referred to regulations that no longer exist. As stated earlier in this report the home has had new call bells installed and a certificate showed these had been serviced. However discussion with the manager shows that there is no system in place to regularly check these are working. This could result in people being unable to alert Care Homes for Older People Page 28 of 37 Evidence: staff in an emergency if the bell was not working. Regular checking reduces the risk of this happening. Discussions with the manager and sampling of records show that since the last inspection a new fire panel has been fitted in the home. A certificate was available to show that the fire alarms had been serviced by an engineer. We looked at the fire records for the home and found these were difficult to track as they loose leaf and out of order. They showed that generally fire alarms are tested regularly but that there were some gaps in tests and one of twenty days from November. Records show that the emergency lighting is tested monthly as required and regular fire drills are carried out. We looked around the home and found that one fire door had part of its smoke seal missing, the owner said he would arrange for this to be repaired. We saw that the COSHH cupboard was unlocked, this was locked by the owner when brought to his attention. Arrangements for the storage of COSHH products needs to improve so that people are not put at risk of harm by dangerous substances. We also saw that one window restrictor had broken and been repaired but it was not clear that the repair was effective and would prevent people from over riding it. Wardrobes in peoples bedrooms had been secured to the walls with brackets but some screws securing these were loose. One wardrobe was seen to be propped up on blocks of wood that did not look like they had been secured. One toilet had a bolt lock fitted to the door, this means that if staff needed to gain access to this area in an emergency they may not be able to. We brought these matters to the attention of the manager and queried if the home carried out regular health and safety audits of the premises. The manager confirmed that health and safety audits are not carried out. The home has systems in place for monitoring the temperature of the water in the home to make sure people are not put at risk of scalding. However the records showed that temperatures had not recently been tested. Certificates were available to show that the hoist and bath lifts used in the home had been serviced. The gas safety certificate for the home had expired in November, the manager said this had been retested and is safe but that the home was awaiting the new certificate. Following our visit to the home the manager sent us evidence that the new gas dryer was safe to use. The home has two passenger lifts, certificates were available to show they had been serviced. However there was not a thorough examination certificate to show they were safe to use. Following the inspection the home sent copies of certificates to us, these were dated the day after our inspection. These indicate that the lifts are safe to use but that some improvements are needed. Care Homes for Older People Page 29 of 37 Evidence: Records are kept of accidents in the home and these indicate that treatment is sought from health professionals when needed. However discussion with the manager indicates that there is currently no system in place to audit the accident records, identify and reoccurring trends and implement strategies to reduce the risk of further accidents. At the same time we were undertaking our inspection, an Environmental Health Officer was also at the home for part of day one looking at health and safety issues. They identified that the home needed to improve systems in place for health and safety and left the home with a report about the action they need to take. The home needs to ensure it complies with any requirements made so that people are safeguarded from the risk of injury Care Homes for Older People Page 30 of 37 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 7 15 People who live at the home 05/03/2008 must have a comprehensive plan of their care that identifies all their needs, choices and capabilities to ensure that staff are aware of their needs and actions that are` required to address them. Recruitment and selection 05/03/2008 procedures must be robust to ensure that residents are protected from people who are unsuitable to work with vulnerable people. 2 29 19 Care Homes for Older People Page 31 of 37 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 7 15 People who live at the home must have a comprehensive plan of their care that identifies all their needs and choices. To ensure that staff are aware of their needs and the actions that are required to meet them. 30/01/2009 2 8 12 The service must make proper provision for the health and welfare of people who live at Roseneath. This will help ensure that they receive the care and monitoring that their conditions require. 30/01/2009 3 9 13 Medication administration charts must accurately record the medication prescribed to people. This will help to ensure people get the medication they are prescribed in a safe manner. 30/01/2009 Care Homes for Older People Page 32 of 37 4 19 13 Ensure repairs are carried out to damaged areas of flooring in the lounge and conservatory. This will ensure flooring is in good condition and does not pose a tripping hazard to people. 30/01/2009 5 29 19 Undertake an audit to 28/01/2009 ensure that all staff currently employed at Roseneath, have the documentation in place as identified in Schedule 2. Undertake a risk assessment and action with regard to the outcomes of this audit, in respect of any staff working without the correct documentation. To ensure that people are protected from staff who are unsuitable to work with vulnerable people. 6 29 19 Put in place a process to ensure that people do not work in the care home until formal and satisfactory application and appointment processes have been completed. To ensure that people are protected from staff who are unsuitable to work with vulnerable people. 28/01/2009 7 38 13 The home must ensure that 02/02/2009 requirements made by the Environmental Health Officer are actioned and that the Care Homes for Older People Page 33 of 37 home is free from hazards to people who live there. To ensure the health and safety of people is promoted and protected. 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 1 The service user guide should be updated to ensure people are provided with information that is up to date in a format that they can understand. The range of fees should be included within the guide so that people know how much it costs to live there. The pre admission assessment should be more in-depth to make sure that the home has all of the information it needs to make a decision about whether the persons needs can be satisfactorily met. Where people are prescribed medication as required individual guidelines should be completed so that staff are clear about when the person needs to have the medication they need to stay healthy. Copies of prescriptions for medication should be available so that staff can check that people have received and are being given the correct medication they need to stay healthy. People should be supported to undertake personal care in a way that meets their personal preferences and upholds their dignity. A range of activities should be provided that meets peoples personal needs and preferences so ensuring their well being. The home needs to ensure people are offered choice and control over their lives as much as possible so that people lead the life they want to and feel valued. Meal time practice needs to be improved to ensure it is a pleasurable and sociable experience for people and they receive the support they need from staff in a respectful manner. Everyone should have an up to date inventory of their possessions so that staff are aware if any item goes Page 34 of 37 2 3 3 9 4 9 5 10 6 12 7 14 8 15 9 18 Care Homes for Older People missing and can take appropriate action. 10 18 Ensure that all staff have received training in safeguarding people from abuse to ensure that people are protected from harm and that staff are aware of the required actions that they should undertake. (Previous recommendation) An audit should be carried out of all windows in the home to identify any that do not close properely and the necessary repairs carried out so that the home is comfortable place to live. Review the lighting in the home to make sure that rooms have satisfactory lighting and are appropriate to people who have poor eyesight. Further consultation is needed with people to ensure their bedrooms are homely in style and reflect peoples personal preferences. Ensure recommendations made following the food hygiene inspection are completed so that food hygiene standards in the home are improved. Appropriate training should be provided for each member of staff so that they have the skills and knowledge appropriate to their role and ensure that the needs of the people living there are met. There should be a comprehensive record of all training that has been undertaken by staff. Management arrangements should be reviewed to ensure the home is being effectively managed for the benefit of the people who live there. There remains a need for a quality assurance system. A quality assurance system would give the home direction and ensures that peoples views are listened to, and identify ways that the home can improve and develop. The frequency of staff meetings should be increased to ensure that all staff are kept updated about the changing needs of the people living there, best practice and changes within the home. The home should implement a system of health and safety audits to make sure that the health and safety of people is promoted and protected. The fire alarms need to be tested more frequently to make sure the alarms are working and would alert people should a fire occur. A system of checking the staff call bells should be implemented to make sure they are in good working order Page 35 of 37 11 19 12 19 13 24 14 26 15 30 16 17 30 31 18 33 19 36 20 38 21 38 22 38 Care Homes for Older People and people can call for assistance in an emergency. 23 38 More staff should be trained in first aid so that people can be assured there will be staff available who are competent in giving first aid, should it be needed. Care Homes for Older People Page 36 of 37 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 37 of 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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