Inspection on 10/10/07 for Rosetrees

This inspection was carried out on 10th October 2007.

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

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

Other inspections for this house

Rosetrees 18/04/06

Rosetrees 11/10/05

Rosetrees 03/05/05

Rosetrees 03/11/04

Rosetrees 09/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Rosetrees Asher Loftus Way Colney Hatch Lane Friern Barnet London N11 3ND Lead Inspector Daniel Lim Key Unannounced Inspection 09:30 10th & 11 September 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosetrees Address Asher Loftus Way Colney Hatch Lane Friern Barnet London N11 3ND 020 8920 4150 020 8920 4171 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Jewish Care Manager awaiting registration Care Home 57 Category(ies) of Dementia - over 65 years of age (57), Old age, registration, with number not falling within any other category (57) of places Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th April 2006 Brief Description of the Service: Rosetrees is a large purpose-built care home registered to provide personal care for a maximum of fifty-seven older people, some of whom may have dementia. The home was opened in 2001 and is run by Jewish Care. The stated aims of the home are to provide appropriate individual care for older members of the Jewish community who either choose or circumstances require them to live in residential care. The home is a large detached three-storey building with fifty seven bedrooms. All bedrooms are for single occupancy and have en-suite facilities. There are two lifts serving all floors. There are communal toilets and assisted bathrooms on each of the three floors. The kitchen, office, reception and main lounge / diner are on the ground floor. Additional lounges and staff areas are located on the other two floors. There is a car park at the side of the building. The gardens are located at the front and side of the home and are accessible to residents. The home is located in a private road off Colney Hatch Lane which is close to local shops, public transport and other community services along Friern Barnet Road. The fee charged by the home is £706 per week. The provider must make information available about the service, including inspection reports, to service users and other stakeholders. Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out on 10th & 11 October 2007 and took a total of nine hours to complete. The inspectors (Daniel Lim & Sue Mitchell, Regulation Manager) were able to interview a total of seven residents and three relatives. The feedback received from them indicated that they were satisfied with the care provided to residents. A record of compliments received from their relatives in appreciation for the care provided was available for inspection. Statutory records were examined. These included six residents’ case records, the maintenance records, accident records, complaints’ record, financial records and fire records of the home. Six staff on duty were interviewed on a range of topics associated with their work. They were noted to be knowledgeable. Staff records, including supervision records, contracts, application forms, evidence of CRB disclosures, references and training records were examined. These indicated that staff were carefully recruited. The minutes of staff and residents’ meeting were also examined. There nwas evidence that changes had been communicated and residents and staff had been consulted regarding the management of the home. The home’s physiotherapist and visiting community nurse were interviewed. They indicated that staff maintained close liaison with them and their instructions regarding the healthcare of residents had been followed. The premises including bedrooms, bathrooms, lounges, treatment rooms, kitchen, laundry and communal areas were inspected. These areas were clean and well maintained. What the service does well: The home is a pleasant place to live in with care and attention paid to individual rooms and the environment as a whole. Staff are well trained to support residents in their daily living. They were knowledgeable regarding their roles and responsibilities.There is particular focus on providing training in dementia care which enhances residents’ way of life in the home. There is a comprehensive and varied range of activities, which take into account the religious and ethnic background of residents. Residents were observed to be able to move around freely. They were clean and Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 6 appropriately dressed. One resident interviewed knew whom her keyworker was and that her care plan was clearly written on the wall in her room for staff to follow. The home provides wholesome and nourishing kosher meals in a pleasant and calm environment. There is a varied choice of main dish and residents were satisfied with the meals provided. The feedback received from residents and relatives interviewed was that residents had been treated with respect and dignity. Elatives and visitors are made very welcome by staff. The home had a comprehensive programme of social and therapeutic activities which were appropriate and met the physical, cultural and spiritual needs of residents. Residents were satisfied with the food provided. This reflected their preferences, their religious and cultural background. Consultation meetings had been held for residents and relatives. There was evidence that their preferences had been noted and responded to. What has improved since the last inspection? The care of the resident (identified to the manager) during the last inspection had been reviewed. There had been an increase in staffing levels in accordance with the findings of the staffing review carried out by the manager. Arrangements were in place to ensure that the GP / doctor is informed and requested to examine a resident following an allegation of abuse where an assault / injury has occurred. The planned provision of a dedicated dementia care unit in the home is expected to provide additional stability and focus for the people living there. Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 7 What they could do better: The registered person must ensure that comprehensive assessments (including risk assessments) are carried out on service users admitted into the home. . This is to ensure that staff are fully informed of the condition of prospective residents and the care arrangements which need to be in place to meet the needs of residents. The registered person must provide evidence that residents (or their representatives) have been consulted regarding their care plans. This ensures that they are fully informed and able to participate in care planning. Care plans must be reviewed monthly and key assessments (including falls & moving and handling) must be reviewed regularly. This is to ensure that the plans and assessments prepared are up to date and reflect any changes affecting the resident. The registered person must ensure that pressure area change of position charts are fully completed to indicate that the required care has been given. Weight monitoring charts for residents identified as needing them must be completed weekly or in accordance with the care plan. The registered person must ensure that all allegations of abuse are reported to CSCI and Social Services. The home’s adult protection procedures must be followed when responding to allegations of abuse. In addition, the preferences of residents regarding the gender of care staff who provide them with personal care must be responded to. A gender preference policy in the area of the provision of personal care for residents must be provided. Staff must be provided with training in the management of adults with challenging behaviour, adult protection, infection control and food hygiene. This is to ensure that they are fully trained and able to meet the needs of residents. The new manager must submit an application for registration to become the registered manager of the home. Improvements are required in the area if health & safety. Weekly fire alarm tests must be carried out and these must be documented to evidence that they have been done. The electrical installations must be inspected and the certificate must be made available for inspection. This is required to ensure that the electrical installations are sound. The registered provider should ensure that the organisation provide support for the management team to ensure that care plan formats are reviewed and staff are trained to complete daily records in a meaningful way and write monthly care plan evaluations/reviews Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 8 There should be a review of how activities with residents are recorded so that there is consistency in recording. The weekly health and safety checks of the home should include checks on fire alarm monitoring tests carried out. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 People who use this service experience an adequate outcome in this area. This judgement has been made from evidence gathered both during and before the visit to this service. Evidence suggests that people who use the service can be assured that they will be assessed to ensure that their needs can be met by the home. These are generally undertaken satisfactorily. However, further improvements are required in specific areas to ensure that the required standard regarding these assessments is fully met. EVIDENCE: The feedback received from residents and relatives interviewed is that residents had been treated with respect and they were satisfied with the care provided by the home. Comments made by them included, Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 11 “They definitely treat me with respect” “Staff are wonderful” and “staff are so kind” The case records of two new residents who were admitted into the home since the last inspection of 6th February 2007 were examined. Assessments had been carried out prior to their admission. These included details of personal care needs, preferences, medical and social background. However, other essential information such as a moving & handling assessment and a falls risk assessment were not recorded. Both did not have any details of the skin condition of prospective residents (such as a pressure sore or waterlow assessment). These deficiencies were discussed with the manager and a requirement is made to ensure that comprehensive assessments are documented before residents are admitted. This is to ensure that staff are fully informed of the condition of prospective residents and the care arrangements which need to be in place to meet the needs of residents. The Statement of Purpose needs to be updated when the refurbishment to the first floor dementia care unit has been finished to inform prospective residents and their families of this new facility within the home. The manager informed the inspector that she was aware of the deficiency and would ensure that improvements are made. She also stated that the home does not provide intermediate care. Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People who use this service experience an adequate outcome in this area. This judgement has been made from evidence gathered both during and before the visit to this service. Residents had access to healthcare services both within the home and in the local community. There was evidence in the case records of healthcare treatment and interventions. Individual care plans had been provided. However, the quality of these plans was inconsistent and there were gaps in the information provided. The arrangements for the administration of medication were satisfactory and medication records were up to date. Staff were aware of the need to treat individuals with respect and dignity and residents confirmed that were well treated. EVIDENCE: Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 13 The home’s physiotherapist and visiting community nurse were interviewed. They indicated that the healthcare needs of their clients had been met and staff maintained good liaison with them. They were also able to confirm that their instructions regarding the specific healthcare of residents had been followed. The physiotherapist explained that she came in once a week to work with residents, show care staff how to mobilise residents and follow exercise programmes. There were details of her intervention and care plan guidance on residents’ files examined. The case records examined contained details of how the healthcare needs of residents had been met and included appointments with doctors, speech therapist, dentists, art therapist, physiotherapist, community psychiatric nurse and chiropodists. Residents interviewed indicated that they had access to the doctor when required. The GP visits weekly and one relative said that he is very approachable and willing to hear from relatives directly if they have any concerns. The care plans were examined in detail. Some aspects of the care plans and information about residents were detailed, clearly presented and recorded. There was evidence that some residents had been consulted and they (or their representatives) had signed their care plans. To ensure that all residents or their relatives have been consulted and agree to the care plans prepared, a requirement is made accordingly. The manager agreed that this would be done. The care plans of a resident with a pressure sore were examined in detail. A pressure area care plan had been prepared. Change of position monitoring charts had been provided. These charts had however, not been filled in to evidence that residents had been turned as required in the care plan examined. It was further noted that care plans had not been reviewed monthly. To ensure that the plans prepared are up to date and reflect any changes affecting the resident, care plans must be reviewed monthly. One of the inspectors spent time on the first floor examining care documentation and interviewing staff. On this floor, a number of the residents had dementia. Two of their case records were examined in detail. Assessments had been carried out on all aspects of each resident’s health, emotional, social, spiritual and physical care. This is good practice as it enables staff to have an understanding about a resident’s life history. The records also contained consent forms for bedrails in place. However, the care plans had not been consistently evaluated or reviewed on a monthly basis. One resident’s dependency profile had not been completed for September. Although staff informed the inspector that they had had support in one to one meetings regarding the completion of care plans, it is strongly recommended that the registered person review the care plan formats and staff are trained to complete daily records, monthly reviews and evaluations. Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 14 The case records of the resident who had nutritional problems included a comprehensive assessment and guidelines from the speech and language therapist. Staff on duty (first floor) were very clear about how the particular dietary needs of this resident were to be met and they stated that they tempted her to eat her favourite foods. However, the resident concerned had not been weighed weekly although this was part of her care plan. Furthermore, this resident’s moving and handling assessment had not been carried out since March 2007. The falls risk assessment was last reviewed in June 2007. It is essential that such key assessments are carried out on a regular basis to ensure that they reflect the current care needs of each resident. The daily records provided sparse and insufficient information about the resident’s lifestyle and activities during the day. Work is needed to ensure that care staff improve their recording of residents’ daily life and activities in a more meaningful way. The inspector noted that staff at handover were knowledgeable and knew about their residents’ individual needs, likes and dislikes and activities. One resident interviewed knew whom her keyworker was and that her care plan was clearly written on the wall in her room for staff to follow. The medication charts were examined. These indicated that medication had been administered as prescribed. The temperature records of the fridge and room where medication was stored had been recorded daily. These were satisfactory. The home had a comprehensive policy and procedure for the administration of medication. Residents were able to confirm that they had been given their daily medication. The inspectors observed that staff were respectful towards residents, showing them care and consideration throughout the day. They were observed to have time to chat with individuals. Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People who use this service experience a good outcome in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The daily life, meal arrangements and routines of residents were on the whole, well organised. The service has a strong commitment to enabling residents to remain as independent as possible and engage in meaningful activities. Personal and family relationships are being maintained. For those individuals needing support at mealtimes, staff had been able to provide assistance. Residents are involved in meaningful daytime activities, which reflect their cultural and religious background. EVIDENCE: The provision of social activities was discussed with residents by both inspectors. Residents stated that they were satisfied with the activities provided. The activities co-ordinator was also interviewed. She stated that she interviews each resident regarding their hobbies and interests and a list of activities organised is made available to residents. This list of daily activities is on display on each floor and included reminiscence and story telling sessions, Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 16 outings to theatre shows, bingo, music, entertainment sessions, religious services, birthday celebrations and art and crafts sessions. On the day of inspection, the activities co-ordinator was noted to be busy setting up interviews with the residents to discuss their wartime memories so that a display board could be set up for Remembrance Sunday.The home had a large number of volunteers and some of them were seen to be actively engaging residents in activities such as cards. A record of activities that residents had engaged in had been kept in the case records. However, some of these were noted to be disorganised and not filled in regularly. There is therefore a need to review how activities are recorded so that there is consistency in recording. One of the inspectors sampled a meal with residents in the dining area. This area was pleasant and spacious with and tables laid out for four or less residents. She noted that the majority of residents came down for their meals. Some people have favourite places to sit. Residents were observed to be offered a choice of main dish. This was done by showing them a sample of each choice. The inspector was informed that this was done because many people couldn’t remember what they ordered. A relative confirmed this and agreed it was much easier as residents could see the meal and ask for an alternative if they wished. Residents appeared to enjoy their meals and were clear about what they would like to eat. The meal was unhurried with residents seen to be taking their time and chatting to each other. Some residents with feeding difficulties were observed to be discreetly supported to have their meals. The food was Kosher and cooked in the main kitchen based in Lady Sarah Cohen House next door. Snacks and breakfast were prepared by staff from the kitchenettes on each floor and served in lounges on the same floors. The ground floor kitchen of Rosetrees was inspected and found to be very clean. It was not used for preparation of meals but mainly used for washing up dishes and setting up the trolleys for meals in the dining area. The menu was on display and seen to offer two starters, two main meals a vegetarian alternative as well as two choices of dessert and fruit. Drinks and biscuits were offered throughout the day to residents and their visitors. All residents have a nutritional needs assessment and special diets are provided. There was documented evidence in the visitors’ book that residents had been visited by their friends and relatives. This was also confirmed by residents and relatives interviewed. Relatives stated that staff were friendly and welcoming. Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 People who use this service experience an adequate outcome in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The home has an open culture that allows residents to express their views and concerns in a safe and understanding environment. Residents and others involved with the service say they have been well treated. The service keeps a full record of complaints and this includes details of investigations and action taken. Staff have received training and they have knowledge of adult protection issues. However, the procedures for responding to adult protection have not always been followed. EVIDENCE: The home had an up to date policy and procedure for adult protection. The manager and her staff were aware of the procedure to follow when responding to allegations of abuse. There was documented evidence that some staff had been provided with adult protection training and when interviewed, they were aware of the procedures to follow when responding to allegations or incidents of abuse. Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 18 Allegations of abuse were made by two residents. One of these had been promptly responded to and recommendations had been made following strategy meetings held. These had been responded to by the home. Associated with the findings of the investigations was the need for the home to have a residents’ gender preference policy to ensure that the preferences of residents regarding the gender of their carers (who provide personal care) is responded to. This was discussed with the manager and a requirement is made accordingly. The second allegation of abuse had not been responded to in accordance with the adult protection procedures of the home. CSCI and social services had not been promptly notified and the suspension of the staff member implicated concerned had not been discussed with the social services department concerned. This was discussed with the manager. This deficiency may have compromised the safety and protection of residents. A requirement is therefore made for the registered person to ensure that the required adult protection procedures are adhered to. The home had a complaints’ procedure and residents and their representatives were aware of this procedure. There was evidence to indicate that complaints recorded had been taken seriously and promptly responded to. The issue of equalities and diversity was discussed with the manager and her staff. Staff indicated that they had been instructed to treat all residents sensitively and with respect regardless of disability, gender, race, religion or sexual orientation. The home had an equalities and diversity statement on display in the reception area. Residents who were interviewed indicated that they had not been subject to any discrimination and they had been well treated by staff. A record of compliments received by the home had been kept. These indicated that relatives were satisfied with the care provided. Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 People who use this service experience a good outcome in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. It is clean, tidy and well maintained. Appropriate aids and equipment had been provided. The premises are homely, comfortable and cheerfully decorated. People who use the service can personalise their bedrooms. They stated that they were happy with the accommodation provided. EVIDENCE: Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 20 The home was well furnished and decorated to a high standard throughout. All bedrooms are ensuite with a shower and toilet. Additional bathrooms are available on each floor. Some resident’s bedrooms inspected were noted to be tastefully furnished and personalised with residents’ own furniture, souvenirs and photos of their families and themselves when they were younger. All bedroom doors had residents’ names on them as well as a photo of the resident. Staff explained that this was to help residents orientate themselves and assist them in finding their own rooms. One resident informed one of the inspectors that a famous photographer had taken her photo when she was younger. The home had a large pavilion, which is used as a dining area and for social activities. This area is bright, airy, with comfortable seating and views to the garden. Residents were observed to use this area throughout the day as well as other small comfortable sitting areas where they gathered to chat to each other. There is a lounge on the second floor, which has a wide screen for showing films. The manager and her deputy informed the inspectors that plans were in place to develop the first floor into a dedicated dementia care unit for twenty people. There would be a dedicated staff team who would have dementia care training. Some refurbishment was scheduled to take place at the end of this October to extend the lounge/ dining and kitchenette areas. Two bedrooms would be removed to make space for a larger area for dining and activities on the floor. The residents would generally stay on this floor. The manager stated that relatives and residents had been consulted and a few residents who did not have dementia were to move to other floors. One relative confirmed that she and her mother had been consulted and they had chosen to stay on the first floor, which had been agreed. Plans of the refurbishment were sent to the Commission following the inspection. A risk assessment was also sent regarding the safety of residents and staff during the works. The manager was informed that a variation to the registration certificate would need to be completed as the home was reducing its numbers by two beds. The home was very clean throughout with no odours. There is a full time domestic staff team employed to provide meals, cleaning and laundry duties. The laundry is situated in Lady Sarah Cohen House next door. There were no issues regarding missing clothing raised with the inspectors. Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People who use this service experience good outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The service has a well developed recruitment procedure that has the needs of people who use the service at it’s core. There is a good level of staffing at all times to support the needs of residents using the service in an individualised and person centred way. Management prioritise training and facilitate staff members to undertake essential training and qualifications. Staff meetings are used for the involvement of staff in the development of the service and care of residents. People who use the service and their representatives expressed confidence in the staff who care for them. Improvements are however, required in ensuring that staff work as a team and all the required training is provided. EVIDENCE: Staff were highly regarded by residents and relatives interviewed. Comments made by them included the following: “ staff are excellent” “my mother is well cared for” Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 22 “they are wonderful” and “they help us and are very polite” Seven staff who were on duty were interviewed on a range of topics associated with their work. They were noted to be knowledgeable regarding their roles and responsibilities and the care to be provided to residents. Staff interviewed stated that they had been instructed to treat all residents with respect and dignity regardless of their race, religion or sexual orientation. The home had a mission statement to this effect. Residents and relatives who were interviewed indicated that staff were respectful and they had been well treated. One of the inspectors had discussions with staff on the first floor during their handover. They were able to give a detailed description of individual residents’ needs that had changed that day or for things to be aware of on shift. Staff indicated that they had received plenty of training to carry out their role and support people with dementia as well as other mandatory training. The duty rota was examined and staffing levels were discussed with the manager. The rota indicated that in addition to the manager and her deputy and ancillary staff, there was normally at least 11 care staff during the morning shift, 5 care staff on waking duty during the night shifts. Ancillary staff working at the home consisted of kitchen staff, cleaners and a maintenance person. Laundry staff are based in the laundry at lady Sarah Cohen House. Staff interviewed said that there were sufficient staff available to support the residents since an increase earlier that year. Some staff however complained that there was a lack of teamwork and staff did not always work closely as a team. The manager stated that she was aware that there had been such staff problems and effort had been made to address this. She added that special support and meetings had already been provided. The training records examined, indicated that staff had been provided with the required training (such as health & safety, moving & handling, care of residents with dementia. fire training and adult protection). Training on Jewish culture was provided during the staff induction period. Over 50 of care staff had been provided with the required NVQ training. Staff also said that the organisation was providing literacy courses for staff prior to them going on to NVQ training. One person said she was due to start NVQ 3 training. Not all care staff had received training in certain essential topics (infection control and food hygiene). The registered person must therefore ensure that staff receive training in these topics. Recruitment records examined indicated that the required recruitment procedures (including obtaining of satisfactory CRB disclosures and two references) had been followed. This ensures that staff recruited are appropriate and residents are protected. Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 People who use this service experience good outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The manager had an understanding of the key principles and focus of the service. She is working to improve services and provide an increased quality of life for residents. There is a strong ethos of being open and transparent in the running of the home. The service is user focussed and works in partnership with residents and their representatives. The manager is aware of the need to promote safety. Arrangements were in place to ensure the safety and welfare of residents in the home. However, further improvements are required. EVIDENCE: Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 24 The manager had recently been appointed. She stated that she had received her RMA (registered manager’s award) and was in the process of applying for her registration with CSCI. She was generally knowledgeable regarding her responsibilities and the needs of residents. She was supported by a deputy manager. There was evidence that staff and residents meetings had been held. The minutes of these meetings were available for inspection. These indicated that relatives had been kept informed of changes affecting the home. Fire records were checked and found to be in order in the main. The required fire drills and fire training had been documented. Fire drills are being carried out very regularly and include drills during the night. Staff also receive very regular fire safety training. The weekly fire alarm tests had been carried out and evidence was provided. The inspectors noted that the last two fire alarm tests had not been documented. This was discussed with the manager who promptly consulted with the maintenance person. He provided confirmation that the tests had been carried out and the logbook was promptly signed. The manager stated that she carried out weekly health and safety checks. It is recommended that part of this check should include checks on fire alarm monitoring tests carried out. As part of the new guidance managers have undergone training in the use of “ski sheets” used to assist in the evacuation of residents in the event of fire. A number of ski sheets had been delivered to the home that week. Certificates of worthiness for all appliances and equipment used in the home were provided. These were up to date. Safety inspections had also been carried out on the gas installations, lift and hoists. However, the safety certificate for the electrical installations was not available for inspection. This is required to ensure that the electrical installations are sound. The organisation’s Health and Safety person also visited the home during this inspection and discussed a number of issues with the inspectors. The fire risk assessment was noted to be just out of date but inspectors were informed in some detail as to what Jewish Care were doing to update the assessments across the organisation taking into consideration new guidance from the fire authority. It was agreed that the Commission would be informed when the risk assessment was completed and this would be assessed at the next key inspection. With one exception, the inspectors noted that significant incidents had been reported to CSCI via Regulation 37 report forms. The home had a current certificate of insurance. The accounts of four residents whose money were kept by the home were examined and noted to be satisfactory. Receipts had been provided for items or services purchased on behalf of residents. Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 25 The home had a quality assurance and monitoring system. An audit of the care provided had been carried out two months ago and recommendations had been made for improving the care provided. The manager informed the inspector that she was in the process of rectifying deficiencies identified. A further consumer survey was in the process of being implemented. The forms were available for inspection in the office (the previous survey was done a year ago). Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1) The registered person must ensure that comprehensive assessments (including risk assessments ) are carried out on service users admitted into the home. This is to ensure that staff are fully informed of the condition of prospective residents and the care arrangements which need to be in place to meet the needs of residents. 2 OP7 15(1)(2) The registered person must provide evidence that residents (or their representatives) have been consulted regarding their care plans. This evidence could be in the form of signed care plans. 3 OP8 15(1)(2) The registered person must ensure that all care plans are reviewed monthly. Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 28 Requirement Timescale for action 21/11/07 13/12/07 01/12/07 (This requirement is restated from the previous inspection) 4. OP8 14(2) 15(1)(2) The registered person must ensure that key assessments (including falls & moving and handling) are reviewed regularly. This is to ensure that each resident’s changing needs are recorded and the care plan updated to reflect any changes. 5 OP7 12(1) The registered person must ensure that pressure area change of position charts are fully completed to indicate that the required care has been given. 6 OP7 12(1) The registered person must ensure that weight monitoring charts for residents identified as needing them are completed weekly or in accordance with the care plan. 7 OP18 12(1) 37 8 OP18 12(1)(3) The registered person must ensure that the preferences of residents regarding the gender of care staff who provide them with personal care are responded to. A gender preference policy in the area of the provision of personal care for residents must be provided. Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 29 01/12/07 13/11/07 13/11/07 13/11/07 The registered person must ensure that all allegations of abuse are reported to CSCI and Social Services. 01/12/07 9 OP18 12(1) 13(6) 37 The registered person must ensure that the home’s adult protection procedures are followed when responding to allegations of abuse. 13/11/07 10 OP30 18(1)(c) The registered person must ensure that staff undertake training in : - infection control - food hygiene 01/02/08 11 OP31 9(1)(2) The registered person must ensure that the new manager submits an application for registration to become the registered manager of the home. 21/11/07 12 OP38 23(4) The registered person must ensure that weekly fire alarm tests are carried out and these must be documented to evidence that it has been done. 14/11/07 13 OP38 23(1)(2) (a)(b)(c) 21/12/07 The registered person must ensure that the electrical installations are inspected and a certificate is available for inspection. Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The registered provider will need to update the Statement of Purpose to reflect the decrease in number of beds and that there is a dedicated dementia care unit on the premises. The registered provider should ensure that the organisation provide support for the management team to ensure that care plan formats are reviewed and staff are trained to complete daily records in a meaningful way and write monthly care plan evaluations/reviews The registered person should review how activities with residents are recorded so that there is consistency in recording. The registered person should ensure that the weekly health and safety checks of the home include checks on fire alarm monitoring tests carried out. 2 OP7 3 OP12 4 OP38 Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rosetrees DS0000010523.V345643.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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