Inspection on 30/11/05 for Roseville

This inspection was carried out on 30th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Roseville 01/11/07

Roseville 23/08/06

Roseville 24/02/06

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Roseville Marine Gardens Preston Paignton Devon TQ3 2NT Lead Inspector Michelle Finniear Announced Inspection 30th November 2005 09:15 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 Roseville DS0000065294.V270350.R01.S.doc Version 5.0 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. Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Roseville Address Marine Gardens Preston Paignton Devon TQ3 2NT 01278 741279 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) Underhill Care Ltd Mrs Dianne Bradley Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (22), of places Physical disability over 65 years of age (22) Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28/2/05 Brief Description of the Service: Roseville is a detached property situated in a level residential area, approximately 200 yards from the sea front and quite near to some local shops. The home cares for up to 22 service users aged 65 or over, who may have varying levels of physical and/or mental frailty. The home benefits from having level access to the ground floor, where the communal rooms are situated, and the garden. There is a shaft passenger lift to the first floor. All bedrooms are single rooms, and all have en suite toilet and washbasin facilities. There is a car parking area at the front of the building. Since the last inspection the home has changed ownership and the manager has become registered as the person in day to day control of the home. Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over 6 hours on a Wednesday in November 2005. The inspection was announced, which means that the home received prior notice of the date and time. This was the first Inspection carried out with the newly registered manager, and the new owners of the home, who had only been registered for approximately three weeks. The new management has plans for improving the service and accommodation provided and has already implemented several positive changes. Examples of this include the ordering of a new lounge carpet, provision of a new service user accessible vehicle for outings and appointments, new fencing which will enclose the garden making it safer for service users and all new bedding and towels. To complete the inspection a tour was made of the home; four service users were interviewed and time was spent with other service users with greater frailty; two members of staff and three visitors were spoken to; time was spent with the homes management and various records were inspected, such as care plans, the fire log book, and medication records. Discussion was also held on staff training and recruitment. Prior to the inspection eight relatives and service users completed comment cards about the home, and the home manager completed a pre-inspection questionnaire. What the service does well: Roseville has a comprehensive programme of activity for service users, which will be enhanced by the provision of a vehicle. On the day of the inspection service users had opportunities to participate in a Christmas Quiz, a bingo session and a sing along in the morning. In the afternoon there was a painting group run by a relative in the dining room, where service users were making Christmas decorations. The day before there had been a talk on local history, which was mentioned as being particularly interesting. This high level of organised activity is commendable. The home has now enrolled all of their staff on NVQ programmes, which is also commendable. An NVQ is a recognised award to demonstrate the level of skill and competency of the staff group. Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 6 The home is a comfortable living environment. The majority of the rooms have ensuite facilities, many with showers and baths as well as toilets and wash hand basins. Service users confirmed that the home was “ a nice place to live”, that it was “a lovely place, very clean, nice staff” and that “They look after me really well”. A relative confirmed that staff were “very approachable”. What has improved since the last inspection? What they could do better: The service user guide and statement of purpose must be updated to reflect the current circumstances of the home. The Statement of purpose and Service user guide are important as they give clear information for service users about what they can expect to receive from the home and what services can be provided. Medication requiring refrigeration must be kept in a lockable fridge or container. A record of the signatures of staff recording the administration must be obtained. Where there is a variable dosage prescribed the actual dosage given must be recorded. This is to protect service users from errors in medication storage or administration, and to enable a full audit trail. The old keyholes in the fire doors must be repaired to preserve the integrity of the fire protection, and protect service users from the risks of fire. The window restraints fitted to ensure service user safety from falling from windows must be kept in place during the day. The separation of clean and dirty laundry must be achieved to ensure service users are protected from any risks of cross infection. Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 7 It is recommended that the home increase the detail in service user care plans to include service users wishes on how they wish their care to be delivered. This is to ensure that if service users memory loss becomes greater and they can no longer give this information, it is still available and recorded. 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. Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3, 4, 5, 6 Service users and potential service users receive good clear information about the home, in sufficient detail to enable them to judge whether the home is the right place for them. The home gathers sufficient information before admission to be able to make a decision about whether they can meet the service user needs. EVIDENCE: The home has a statement of purpose and a service user guide which has been issued to each service user at the point of admission. Prior to this the home has a small brochure. All documentation is under review and will need to be amended in the near future to reflect the changing position of the home. The service user guide is to be re-written in plain language with supporting photographs illustrating the text, to make it easier for service users to understand. The service user guide is important as it gives clear information for service users about what they can expect to receive from the home and what services can be provided. An examination was made of four service user files, including a recent admission. Discussion was also held on the process involved. The file for the Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 10 most recent admission included a pre-admission assessment completed by the home, covering the majority of areas of care. Two other recent admissions had come about as a result of the service user knowing the home through attending for day care and respite care, so the home had a good awareness prior to admission of the service users needs and how to address them. Other service users files examined also included this pre-admission assessment process, and evidence was also seen in some files of a Social Services Preadmission care plan having been undertaken. Pre-admission assessments are important as they ensure that the home is the right place for the service user, and that the home can meet their needs. The service user and their supporters are encouraged to visit the home prior to admission; wherever possible they are also met by the homes staff in their previous accommodation, which may be in their home or a hospital setting. The home then confirms that they are able to meet the service users needs in writing and agrees terms and conditions, including fees, prior to admission. The home does not cater for intermediate care. This means that the home does not provide specialist programmes for rehabilitation as a primary function. Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 Roseville has a clear and consistent system for the planning of care, ensuring staff have the information to satisfactorily deliver care to service users in the way in which they have indicated they wish it to be delivered. Minor attention was required to medication systems, which are due to be replaced shortly. EVIDENCE: Five service user plans were selected at random for examination. Then, in the case of one service user an in-depth discussion was held with a senior carer about the actual care being delivered. This discussion correlated directly to the information in the care plan, however contained more detail as to the individual aspects of care, such as how the person liked to be shaved. This demonstrated that plans were generally an accurate reflection of the care being given, but could benefit from more detail being included. Care plans are reviewed monthly, or more frequently if required and this is recorded within the plans. Accurate and up-to-date care plans are important in ensuring that service users needs can be addressed consistently by all staff. Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 12 Evidence could be seen also in files of service users health care needs being met. This included not only visits from general practitioners and district nursing staff, but also access to professionals such as opticians and podiatrists. Two service users spoken to confirmed that this was the case. The home has equipment for supporting the moving and handling needs of service users, including mobile hoists, pressure relieving equipment and an assisted bath. This ensures the home can meet the needs of the people who live there, without risking injury to staff or service users through having to lift them. The home uses a monitored dosage system for the administration of medication, which means that the pharmacist dispenses the medication in a series of blister packs for the home to use when administering. This means that staff can easily see whether medication has been given, and reduces the risk of errors. Service users who choose to self- administer and are deemed capable to do so have lockable storage in their rooms, so that they can maintain medication safely. Service users medication administered by the home is maintained in a locked metal filing cabinet and a metal cupboard, however both will be replaced soon when a new medication system is implemented. Then the home will have a dedicated mobile trolley for storage and easier administration. The medication cupboard was inspected and found to be clear of excess stock, and the records seen were recorded appropriately to ensure a full audit trail could be carried out. The home is however advised to ensure that where prescriptions indicate a variable dose, i.e. “one or two tablets when required”, that the number actually given is recorded; that sample initialled signatures should be obtained and some medication requiring refrigeration, currently kept in an unlocked box in the refrigerator is safely secured. Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Dietary needs of service users are well catered for with a balanced and varied selection of food available. EVIDENCE: Discussion was held with the home manager and the homes cook concerning the menu plans. The meal being served on the day of the inspection was Scotch Broth followed by a choice of home made cheese and tomato quiche, chips and vegetables or omelette or salad. Dessert was a jam sponge and custard. Service users were offered juice, tea and coffee throughout the day, and fruit was freely available and offered also. Service users spoken to were complimentary about the meals served both in quality and quantity, and the meal sampled was excellent. Service users have been consulted on the change of menus wherever possible and for those not able to express an opinion their responses to meals had been observed to see which were most favoured. Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Procedures are in place to protect service users from abuse and abusive practices. EVIDENCE: The homes policy on Adult protection was seen. The policy is based on the locally issued Alerters guidance, which in turn is a development from the Government documentation “No Secrets”. The policy contains easy to follow flowcharts for anyone to follow if they have concerns over potential abuse, as well as clarifications on what might constitute abusive practice. The manager confirmed she has trained all staff in the protection of vulnerable adults policy and procedures, and that they would have access at all times to the policy manual to follow. An issue of concern about a member of night staff was dealt with appropriately by the home. The member of staff was dismissed. This action demonstrated the manager will not tolerate poor or dangerous practice occurring and a willingness to ensure service users are protected. Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Roseville provides a comfortable for service users to live in. EVIDENCE: A tour was made of the home, including service user rooms, the kitchen and the laundry. Roseville is situated close to local shops and the sea front at Paignton. The home has a full passenger lift to access the first floor, and there is some dedicated private parking with on street parking nearby. This means service users who are physically able can maintain contacts with the local community, and can have access to both floors of the home. There is a level garden to the side. Service user rooms very in size and shape, with the majority having en suite facilities consisting of a bath or shower and a toilet. This means service users have adequate private space. All rooms are currently for single occupancy, but Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 16 discussions were held on whether a large room could be made available for shared occupancy if needed. All areas of the home seen on this inspection were clean, warm and comfortable, with service user rooms personalised with items of their own furniture and pictures. Two rooms had an odour problem which the staff work hard to resolve. Appropriate arrangements are made for the disposal of clinical waste, which ensures service users are protected from unpleasant odours or risks of cross infection. At the time of the inspection the home was using a contract laundry service, but this is to change, and new linens and towels have been purchased. Discussion was held on the movement of soiled linen throughout the home, and consideration is to be given to the use of dispersible bags to ensure that there is no risk from cross infection. The front door of the home is kept locked, and there is a code number to exit. One service user has their own exit door from their bedroom, which means that they are not disadvantaged by the door being kept closed. Discussion was held on window restriction on rooms above the lower ground floor. Restrictors were fitted, but had been removed in some cases to allow for the rooms to be fully aired. It was agreed these must remain attached. This is to protect the service users from accidentally falling from a window. All service user rooms are fitted with call bells. The home has a communal bathroom on the first floor. A communal toilet is situated near to both the ground floor lounge and the dining room, which means service users do not have to move far from these areas to find facilities. There is a lounge, with television, on the ground floor of the home for service user use, and a small lounge area on the first floor which may be used if service users wish to see visitors in private outside their rooms. Service users bedroom doors have been fitted with locks, however when some older style locks were removed holes have been left in the door, which compromises the integrity of the Fire doors. This must be repaired without delay. Discussion has been held on the provision of additional lounge space. During the course of the inspection service users were enjoying a painting group in the dining room. The homes laundry is to the rear of the home and has been fitted with a new washing machine and tumble dryer since the last inspection. The washing machine is capable of achieving a sluicing cycle for foul linen. This means service users can be protected from any risk of cross infection and their clothes kept clean. Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 17 Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 The staffing levels at Roseville are appropriate for the number and dependency levels of the service users. EVIDENCE: Discussion was held with the home manager and registered owner in relation to the staffing levels at the home, and examination was made of the staff Rota. This staffing rota demonstrated that on a usual weekday the home would have a staffing complement of five care staff in the morning in addition to the manager, with three staff on duty during the afternoon. The night time situation currently is that there are two waking night staff, however it is understood that this may be reviewed in the near future to have one staff member who may sleep between the central hours of the night shift, but who would be available to support the waking staff member if required. These staffing levels are supplemented by additional staff who carry out activities with service users, as well as domestic and ancillary staff such as catering and cleaning staff. During the course of the morning service users were supported in their activities by an additional person, and during the afternoon the painting group was run by a relative of a service user at the home. The manager confirmed that she had flexibility to increase staffing levels if service user need was identified, and stated that she felt the staffing levels were appropriate for the service users at the home. Service users were complimentary about the staff employed, however one relative/visitor identified that they felt there were times when they need extra help, Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 19 especially at bedtime. Another relative confirmed the view that there were not always sufficient numbers of staff on duty. These comments were passed to the owner and manager for their attention. Discussion was also held with the manager in relation to the staffs recruitment and retention policies and procedures. To staff files for the most recently appointed members of staff were examined, and were found to contain all the required records and checks such as references, I completed at medical form, and a completed criminal records bureau check. In the case of staff recruited from abroad this documentation had been provided through an agency. There was evidence of a full induction and foundation training plan having been followed through with new staff, and it is commendable that all care staff employed will be commencing their NVQ’s the day following the inspection. Those who have already completed an NVQ will be commencing the next grade. The home will then have eight staff undertaking NVQ level 2, three staff doing level 3, and two undertaking NVQ level 4. Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These are areas were not inspected on this occasion. EVIDENCE: These areas were not fully inspected on this occasion, but have been on previous inspections. The standards will be seen at the next inspection which will be unannounced and will fall prior to April 2006. This was considered to be appropriate in this instance because some management systems are under review from the previous owner, and a full health and safety audit is due to be carried out within the week of following this inspection by a private specialist company. The home will then have a full assessment of health and safety risks at the home, and a prioritised complement of risk assessments to work with. Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 21 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 x 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x x Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? NO 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 OP1 Regulation 4, 5 Requirement Timescale for action 28/02/06 2 OP9 13 3 OP19 23, 13 4 OP26 13 The service user guide and statement of purpose must be updated to reflect the current circumstances of the home. Medication requiring refrigeration 15/12/05 must be kept in a lockable fridge or container. A record of the signatures of staff recording the administration must be obtained. Where there is a variable dosage prescribed the actual dosage given must be recorded. The old keyholes in the fire doors 15/12/05 must be repaired to preserve the integrity of the fire protection. The window restraints fitted to ensure service user safety from falling from windows must be kept in place. The separation of clean and dirty 15/12/05 laundry must be achieved to ensure service users are protected from any risks of cross infection. Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 23 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 OP7 Good Practice Recommendations It is recommended that the home increase the detail in service user care plans to include service users wishes on how they wish their care to be delivered. Roseville DS0000065294.V270350.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 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. 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