Inspection on 03/07/07 for Roseview Residential Home

This inspection was carried out on 3rd July 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

Roseview Residential Home 07/08/06

Roseview Residential Home 10/11/05

Roseview Residential Home 28/07/05

Roseview Residential Home 24/01/05

Roseview Residential Home 27/07/04

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 Roseview Residential Home 17 The Limes Avenue London N11 1RE Lead Inspector Daniel Lim Key Unannounced Inspection 3rd July 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Roseview Residential Home DS0000010679.V341525.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. Roseview Residential Home DS0000010679.V341525.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roseview Residential Home Address 17 The Limes Avenue London N11 1RE 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) 020 8368 9195 020 8361 5114 Mrs Agatha Annin-Adjei Care Home 14 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (14) of places Roseview Residential Home DS0000010679.V341525.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th August 2006 Brief Description of the Service: Roseview is a care home registered to provide personal care for a maximum of fourteen older people who may either have problems associated with old age or dementia. The registered provider of the home is Mrs Agatha Annin-Adjei. The registered provider also owns other care homes in the North London area of Haringey and Barnet. The aims of the home are to enable service users to be as independent as possible and to enable them to be as confident as possible in making choices of their own. It also aims to encourage all service users to live a full and active life. The home is a large semi-detached house with an extension at the rear. The fourteen single bedrooms are located across the ground and first floors of the home. None of the bedrooms have ensuite facilities. The home has a lift. There are three lounges and a dining room on the ground floor. The laundry and kitchen are also on the ground floor. There are a total of five communal toilets, two communal bathrooms and a walk in shower. The office and remaining bedrooms are on the first floor. At the time of this inspection, the home does not have a registered manager. A trainee manager has however, been recruited and is working in the home. She is in the process of applying to The CSCI to be the registered manager. The area manager is currently the acting manager of the home. The home is situated in a residential street in New Southgate. There are restaurants, shops and transport facilities within walking distance of the home. Arnos Grove underground station is a short walk from the home. The fees charged by the home range from £460 - £560 each week. The provider must make information about the service available (including Roseview Residential Home DS0000010679.V341525.R01.S.doc Version 5.2 Page 5 reports) to service users and other stakeholders. Roseview Residential Home DS0000010679.V341525.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out on 3 July 2007 and took a total of six hours to complete. A second visit was made to the home on 4 July 2007 to view documents not available on the first day. During this inspection, the inspector was assisted by the area manager Ms Mercedes Adusei (also acting manager). The registered provider (Mrs Agatha Annin-Adjei) was present for part of this inspection. The inspector was able to interview six residents. The feedback received from them indicated that the care provided was generally satisfactory and they had been well treated by staff. Statutory records were examined. These included three residents’ case records, the maintenance records, accident records, complaints’ record and fire records of the home. These were on the whole, well maintained. The premises including residents’ bedrooms, communal bathrooms, laundry, kitchen, gardens and communal areas were inspected. These were clean and well maintained. Three staff on duty were interviewed on a range of topics associated with their work. They were generally knowledgeable regarding the care of residents. Staff records, including supervision records, evidence of CRB disclosures, references and training records were examined. In addition, the minutes of residents’ and staff meetings were examined. What the service does well: The feedback received from the six residents interviewed was positive. They stated that they had been treated with respect by staff. The arrangements for the provision of meals was satisfactory and residents were happy with the meals provided. The premises were homely, clean and well decorated. Bedrooms felt cosy. The garden was attractive and well maintained. Roseview Residential Home DS0000010679.V341525.R01.S.doc Version 5.2 Page 7 The home had a comprehensive training programme for staff. The area manager and staff interviewed were knowledgeable regarding the care of residents. Staff said they worked as a team. The area manager, registered provider and her staff co-operated fully with the inspector and the required pre-inspection information was provided promptly. What has improved since the last inspection? What they could do better: Improvements are required in the area of assessments and care planning. The registered person must ensure that comprehensive pre-admission assessments are carried out before a prospective resident is admitted into the home. Assessments carried out must be in accordance with Standard 3 of the National Minimum Standards for older people and include information on the physical, mental, social, financial, cultural and spiritual needs of the prospective resident). Roseview Residential Home DS0000010679.V341525.R01.S.doc Version 5.2 Page 8 Comprehensive care plans which address the holistic needs of residents must also be prepared to address areas assessed in Standard 3. These must address also the mental, social, cultural and spiritual needs of residents. Care plans must be signed to indicate that residents or their representative have been consulted and agree with the plans prepared. Improvements are required in the provision of social and therapeutic activities. The registered person must ensure that residents are provided with sufficient social and therapeutic activities. To evidence that residents have access to such activities, a record must be kept. The registered person should ensure that residents are provided with appropriate social and therapeutic activities during the mornings. The placement of the resident identified to the area manager in the section on Complaints & protection must be reviewed with social services and healthcare professionals involved in her care. Improvements are required in the staffing arrangements. The registered person must ensure that the home has cleaning staff (in addition to care staff). The registered person must ensure that a previous employer’s reference is obtained for the staff member identified to the area manager. A full-time manager must be appointed who has the qualifications, skills and experience necessary for managing the care home. The registered person must inform the CSCI in writing of the date of appointment. Improvements are required in the area of Health & Safety. The registered person must arrange for a safety inspection to be carried out by a qualified professional on the electrical installations. At least one of the fire drills organised during a twelve month period must be held after dark. The fire risk assessment must be updated. 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. Roseview Residential Home DS0000010679.V341525.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 Roseview Residential Home DS0000010679.V341525.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 suggest that people moving to the home can be assured that they will be assessed to ensure that their needs can be met. These are generally undertaken satisfactorily. However, further improvements are required in specific areas related to pre-admission assessments to ensure that the required standard regarding these assessments is fully met. EVIDENCE: The six residents interviewed informed the inspector that they were generally well cared for and their care needs had been attended to. Roseview Residential Home DS0000010679.V341525.R01.S.doc Version 5.2 Page 11 Comments made by residents included, “ Yes, satisfied with the care provided”, “happy being here” and “they take good care of us”. Residents in the home were noted to be clean and appropriately dressed. A sample of four residents’ case records which was examined contained assessments. These assessments were not sufficiently comprehensive as they did not include information on cultural background and religious beliefs of prospective residents (as required in Standard 3, NMS). Standard 3 requires that comprehensive assessments are carried out prior to a service user being admitted into the home. This is to ensure that important information regarding the care needs of people who may be admitted into the home are obtained and appropriate care can be arranged. These assessments must include the cultural background and religious beliefs (in addition to assessments regarding the physical health, mental health, potential risks, social needs and financial situation). This deficiency was brought to the attention of the area manager who agreed that the required information would be obtained for future admissions. The area manager stated that the home does not provide intermediate care. Roseview Residential Home DS0000010679.V341525.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 have access to healthcare services both within the home and in the local community. There is evidence in the care plans of healthcare provided. Care plans are generally well prepared. However, there are gaps in the information provided in care plans. The arrangements for the administration of medication were satisfactory. Residents had been treated with respect and dignity and they were happy with the care provided. EVIDENCE: Roseview Residential Home DS0000010679.V341525.R01.S.doc Version 5.2 Page 13 Residents interviewed, indicated that their healthcare and personal needs had been met. They confirmed that they were well cared for. Comments made by residents included, “I get my medication from staff”, “I am well cared for by staff” and “I have seen the doctor”. Residents were clean and appropriately dressed. Those interviewed indicated that staff had treated them with respect and dignity. The sample of case records examined was up to date and regular reviews had been carried out. These reviews were done monthly. The care plans addressed the physical and personal care needs of residents. These plans were not sufficiently comprehensive as they did not contain care plans addressing the religious and cultural needs of residents. This is required to ensure that the holistic needs of residents are identified and attended to. The care plans examined had not been signed by either residents or their representatives. These must be signed to indicate that residents or their representative have been consulted and agree with the plans prepared. There was evidence in the records to indicate that residents have access to healthcare and specialist community services. A record of medical and healthcare visits / appointments had been kept. These included GP, chiropody, dental and optician’s appointments. The records of GP visits indicated that medication prescribed had been reviewed. The case records of a resident with a weight problem were examined in detail. There was evidence that this resident’s weight had been closely monitored by the home and a referral had been made to the dietitian. The arrangements for the administration of medication were examined. The home had the required policies and procedures and staff had been trained in the administration of medication. No record of the fridge temperatures had been kept. The area manager explained that this was because no medication needed to be kept in the fridge and it was not in use. Daily temperature records of the cubicle where medication was stored had been kept. These were satisfactory. Medication administration charts (MAR) were appropriately filled in. The case records of a resident with challenging behaviour was examined in detail. It contained a care plan and risk assessment providing staff with guidance on how the resident’s behaviour is to be managed. The MAR charts indicated that the required medication had been administered to this resident. Roseview Residential Home DS0000010679.V341525.R01.S.doc Version 5.2 Page 14 The case records of another resident with diabetes was also examined in detail. It contained a care plan with guidance on how the resident’s diabetes is to be managed. The MAR charts indicated that the required diabetic tablets had been administered. The chef and staff who were interviewed were aware of the dietary requirements of those with diabetes. Roseview Residential Home DS0000010679.V341525.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 an adequate outcome in this area. This judgement has been made from evidence gathered both during and before the visit to this service. Staff are aware of the need to support residents and assist them in remaining as independent as possible. There is evidence that residents and their representatives are consulted regarding the management of the home. The arrangements for the provision of meals is satisfactory and meals provided, meet the dietary needs of residents. Appropriate activities had been provided. However, further improvements are required to ensure that residents have access to more activities. EVIDENCE: Residents interviewed stated that they were happy with the meals provided. Comments made included “food is alright”, “there is choice” and “nice food”. Roseview Residential Home DS0000010679.V341525.R01.S.doc Version 5.2 Page 16 The menu which was provided indicated that the meals were varied and balanced and residents had a choice of main dish. The kitchen was inspected. A first aid box, fire blanket and fire extinguisher were in place. Staff had received training in food hygiene and the certificates were available for inspection. Following a requirement made in the last inspection report, it was noted that staff put on protective clothing when entering the kitchen. The home had a programme of weekly activities which was on display in the office. This included music, bingo, games, music, cookery, outings and gardening. However, it was observed that no organised social or therapeutic activities for residents took place during the morning of this inspection (3/7/07) and most of the residents sat in the lounge throughout the morning. One resident stated that it was boring and there was a lack of activities. Two others interviewed felt they had sufficient activities. The area manager explained that some residents preferred to sit in the lounge and others preferred to go out later. She further reassured the inspector that activities were organised in the afternoons. The area manager explained that there was a programme of daily activities and some residents had assisted in food preparation and gone on outings. This was confirmed by two residents interviewed. The inspector noted that records are not routinely kept of activities which residents had engaged in. This was discussed with the area manager. To ensure and evidence that all residents are provided with adequate social and therapeutic activities, such a record is needed. The area manager agreed that this would be done. In addition, a recommendation is made for activities to be provided in the mornings to ensure that residents have access to stimulating and therapeutic activities. Residents who were interviewed stated that they had been visited by their relatives. Roseview Residential Home DS0000010679.V341525.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 arrangements for responding to complaints and for adult protection were generally satisfactory. The home has an open culture that allows residents to express their views and concerns in a safe and understanding environment. The home has a complaints procedure that meets the National Minimum Standards and Regulations. Staff have an adequate understanding of adult protection procedures and they had received training around safeguarding adults. This ensures that residents are well treated and protected from abuse. Residents say they are well treated and satisfied with the service provision. EVIDENCE: One complaint had been documented in the complaints book since the last inspection. This had been promptly responded within the required timescale. Roseview Residential Home DS0000010679.V341525.R01.S.doc Version 5.2 Page 18 The four residents who were interviewed indicated that they had been well treated. 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 which indicated that the home aimed to ensure that all residents are treated with respect and dignity. The manager and staff who were interviewed were aware of the procedure to be followed when responding to allegations of abuse. There was documented evidence in the staff records to indicate that staff had been provided with adult protection training. One adult protection issue which was brought to the attention of CSCI last year, had been reported to the relevant social services department. The proper procedures had been followed and the matter has now been resolved. One of the residents complained that she was unhappy living in the home as she wanted to return to her own home. The manager explained that she and the social worker concerned were aware of this and she was placed in the home for her own protection. As this resident was not on a restriction order or a guardianship order, her placement must be reviewed with social services and healthcare professionals involved in her care to determine if she should be permitted to return home, continue to remain in the home or if a restriction order is required. The manager agreed that this would be done. The home must refer to and pay particular attention to The Mental Capacity Act, 2007 regarding the rights of this resident. A record of compliments received by the home had been kept. These indicated that relatives were satisfied with the care provided and they thought highly of staff. Roseview Residential Home DS0000010679.V341525.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, 20, 21, 22, 23, 24, 25, 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. People who use the service say they are happy with the accommodation provided. Roseview Residential Home DS0000010679.V341525.R01.S.doc Version 5.2 Page 20 EVIDENCE: The bedrooms and communal areas inspected were clean and well furnished. Bedrooms inspected appeared cosy and had been personalised by residents with their own pictures and ornaments. No offensive odours were detected Residents who were interviewed stated that they were happy with the accommodation provided and their bedrooms had been kept clean. The laundry room was inspected and noted to be well equipped. A special washing machine with a sluice cycle had been allocated for the laundering of soiled linen. One staff member was however, not fully aware of the need to wash soiled linen at a temperature of at least 65 C for at least 10 min. This was brought to the attention of the area manager who immediately arranged for the instructions to be posted on the wall in the laundry and for staff to be informed of the arrangements for washing soiled linen. One of the toilets on the ground floor next to the lounge did not have a lock. The area manager explained that this particular toilet was for the exclusive use of residents with dementia who are at risk of locking themselves in the toilet. She pointed out that there were other toilets on the ground floor with locks fitted. A new mobile hoist had been purchased. Other specialist equipment available included a walk in shower and two wheelchairs. Ramps are installed at the front of the home and at the back for access into garden. The gardens were attractive, colourful and seating had been provided. Roseview Residential Home DS0000010679.V341525.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 an adequate outcome in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People who use the service are generally satisfied with the care they receive to meet their needs. However, there is a need to review staffing arrangements. The service recognises the importance of training and tries to deliver a programme that meets the statutory requirements and the National Minimum Standards. Staff were knowledgeable regarding their responsibilities and what they were meant to do. The service has a good recruitment procedure that, with one exception, is followed in practice. EVIDENCE: Three staff who were on duty were interviewed on a range of topics associated with their work (such as fire safety, adult protection, care of residents with dementia and mental illness, equality & diversity, staffing arrangements, team Roseview Residential Home DS0000010679.V341525.R01.S.doc Version 5.2 Page 22 work). They were noted to be knowledgeable regarding their roles and responsibilities. They stated that they had been instructed to treat all residents with respect and dignity regardless of their race, religion or sexual orientation. Residents who were interviewed indicated that staff were respectful and they had been well treated. The duty rota was examined. Staffing levels were normally as follows: Am- 2 care staff Pm- 2 care staff Night- 2 (one on waking night duty) The area manager was supernumerary. Ancillary staff working at the home were : one kitchen staff (full time) Cleaning duties were sometimes carried out by care staff. A requirement made for the home to be provided with a cleaner had not yet been complied with. This appointment is necessary to ensure that staff are not detracted from their care duties by being involved in cleaning. The area manager and responsible individual however, reassured the inspector that a cleaner would be recruited. The training records examined, indicated that staff had been provided with the required training (such as health & safety, care of residents with mental illness, fire training, food hygiene and adult protection). The recruitment records of three new staff examined, indicated that the required recruitment procedures (including obtaining of satisfactory CRB disclosures and two references) had been followed. One of the staff records had a personal reference and a second reference from the staff member’s GP No previous employer’s reference was available for inspection. This was discussed with the manager. To ensure that staff appointed are carefully recruited, the ex-employer’s reference must be obtained. If this is not possible, an explanation must be provided. The manager agreed to request that the staff concerned provide this reference. Staff on duty stated that they were happy working in the home, and they worked as a team. Roseview Residential Home DS0000010679.V341525.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 an adequate outcome in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The acting manager (area manager) had a clear understanding of the key principles and focus of the service. She works continuously to improve services and provide an increased quality of life for residents. The home does not have a full time manager, but a trainee manager has been recruited. The home has a quality assurance and monitoring process and residents and their representatives and staff are being listened to. Roseview Residential Home DS0000010679.V341525.R01.S.doc Version 5.2 Page 24 Effort had been made to ensure the safety and welfare of residents in the home. Further improvements are however, required in the area of Health & Safety. EVIDENCE: The home does not have a registered manager. The inspector was however, informed that a senior carer has now been appointed as trainee manager. She has applied to be the home’s registered manager. The acting manager was knowledgeable regarding her responsibilities and the needs of residents. Staff interviewed were of the view that she was approachable and caring. There was evidence that staff and residents had been consulted regarding the running of the home and changes had been communicated to them. The minutes of these meetings were available for inspection. The fire log book was examined. The weekly fire alarm tests had been carried out and evidence was provided. Fire drills and fire training had been documented. None of the drills had been carried out after dark. A requirement is made for this to be done. The home has a comprehensive fire risk assessment. This would however, have to be updated to indicate that deficiencies identified had been rectified. Windows inspected had been fitted with window restrictors. Those rooms without a restrictor had been risk assessed as not requiring them. Safety inspections had been carried out on the portable appliances, gas installations, lift and hoists. Significant incidents are promptly reported to CSCI via Regulation 37 report forms. The five year electrical installations safety inspection was due in June 2007. The manager explained that quotes will be obtained and the safety inspection would be carried out soon. A requirement is nevertheless, made for this to be done. The home had a current certificate of insurance. The accounts of two residents whose money were kept by the home were examined and noted to be satisfactory. The home had an effective quality assurance and monitoring system. Roseview Residential Home DS0000010679.V341525.R01.S.doc Version 5.2 Page 25 A recent consumer survey report of the services provided by the home was available for examination. This was positive and the satisfaction level was high. Roseview Residential Home DS0000010679.V341525.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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score N/a X 3 X 3 X x 2 Roseview Residential Home DS0000010679.V341525.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 OP3 14(1)(2) The registered person must ensure that comprehensive preadmission assessments are carried out before a prospective resident is admitted into the home. This must be in accordance with Standard 3 of the National Minimum Standards for older people and include information on the physical, mental, social, financial, cultural and spiritual needs of the prospective resident). 2 OP7 15(1)(2) The registered person must provide comprehensive care plans which address the holistic needs of residents (this must include mental, social, cultural and spiritual needs). This requirement is restated. The previous unmet timescale was 07/10/06 01/09/07 Standard Regulation Requirement Timescale for action 13/08/07 Roseview Residential Home DS0000010679.V341525.R01.S.doc Version 5.2 Page 28 3. OP7 15(1)(2) The registered person must ensure that care plans are signed to indicate that residents or their representative have been consulted and agree with the plans prepared. 13/09/07 4 OP12 16(2)(m) (n) 01/09/07 The registered person must ensure that residents are provided with sufficient social and therapeutic activities. To evidence that residents have access to such activities, a record must be kept. 5 OP18 13(6) The registered person must ensure that the placement of the resident identified to the area manager in the section on Complaints & protection is reviewed with social services and healthcare professionals involved in her care. 21/08/07 6 OP27 18(1) The registered person must ensure that the home has cleaning staff in addition to the care staff at the home. This requirement is restated. The previous unmet timescale was 13/11/06 13/11/07 7 OP29 13(6) 19(1)(5) 19(4)(b)). The registered person must ensure that a previous employer’s reference is obtained for the staff member identified to her. 03/09/07 8 OP31 8 (1)(2) The registered person must ensure that a full-time manager DS0000010679.V341525.R01.S.doc 30/09/07 Roseview Residential Home Version 5.2 Page 29 is appointed who has the qualifications, skills and experience necessary for managing the care home. The registered person must inform the CSCI in writing of the date of appointment. (This requirement has been partially met and is restated) 9 OP38 13(4) 23 (2)(a) (b)(c) The registered person must arrange for a safety inspection to be carried out by a qualified professional on the electrical installations. 31/08/07 OP38 23(4) The registered person must ensure that at least one of the fire drills organised during a twelve month period is done after dark. 31/08/07 OP38 23(4) The registered person must ensure that the fire risk assessment is updated. 31/08/07 10 11 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Roseview Residential Home DS0000010679.V341525.R01.S.doc Version 5.2 Page 30 No. 1 Refer to Standard OP12 Good Practice Recommendations The registered person should ensure that residents are provided with appropriate social and therapeutic activities during the mornings. Roseview Residential Home DS0000010679.V341525.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Harrow Area Office 4th Floor, Aspect Gate 166 College Road Harrow London 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 Roseview Residential Home DS0000010679.V341525.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!