CARE HOMES FOR OLDER PEOPLE
Rosewell Country Home Church Hill High Littleton Bath & N E Somerset BS39 6HF Lead Inspector
Kathy Marshalsea Unannounced Inspection 15th November 2005 09:45 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 Rosewell Country Home DS0000044632.V249855.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. Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Rosewell Country Home Address Church Hill High Littleton Bath & N E Somerset BS39 6HF 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) 01761 472062 01761 479124 European Care (UK) Limited Ms Gillian Galloway Care Home 94 Category(ies) of Old age, not falling within any other category registration, with number (94), Physical disability (6) of places Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 6 Beds may be for young physically disabled persons age 18-50 years. Staffing Notice dated 18/04/2001 applies. Manager must be a RN on parts 1 of 12 of the NMC register. May accommodate up to 60 persons aged 50 years and over requiring nursing care, in the Main House. May allocate up to 34 persons aged 65 years and over requiring Personal Care only, in the Farm House May accommodate up to 40 persons aged 65 years and over requiring personal care only, in the Main House. May accommodate one named individual requiring nursing care in the `Farmhouse` until such time as her nursing needs increase to the point that the `Farmhouse` is unsuitable to meet those needs, or she chooses to move Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 5 Date of last inspection 13th July 2005 Brief Description of the Service: Rosewell Country Home is an extended farmhouse situated in the village of High Littleton. The accommodation consists of an open style conservatory entrance area, which links the Farmhouse and Main house. The conservatory area provides a focal point for the home, housing the main reception, hairdressing salon, small shop, service user seating, a piano and a small bistro. The accommodation in the farmhouse consists of single and double en-suite rooms (WC & hand basin) with 3 stair lifts and is registered for social care (residential) service users. Not all rooms in the Farmhouse have level access from the stair lifts The main house provides accommodation over three floors. There is lift access to all floors and each floor has a separate communal lounge and dining facility. Bedrooms vary in size, most are en-suite (WC & hand basin) and there are assisted bathrooms and shower rooms on each floor. The home is registered for a maximum occupancy of 94 but the usual operational maximum is lower than this because few of the 12 doublesized rooms are in shared use at any one time. The home offers respite care subject to bed availability. Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced. Two inspectors conducted the inspection due to the size of the home. One concentrated on looking at life on the residential wing and the lead inspector on the nursing wing. This was also done so the lead inspector could check upon compliance with the requirements and recommendations made at the last inspection pertaining to the nursing wings. The evidence was gathered by direct and indirect observation, talking to staff relatives and residents, reading records and case tracking some residents’ care. The inspectors were at the home for 7 hours and completed the inspection by giving feedback to the manager and residential supervisor. What the service does well: What has improved since the last inspection?
There has been a huge improvement in the management of the staff team. This has led to practices becoming resident-led rather than ritualistic. Audits are being done to promote safe practices and ensure that health is monitored closely when necessary. There has been a change in the manager’s line manager and this has proved to be beneficial. The environment on Bluebell has been greatly improved. This has benefited anyone spending any time there. The dependency levels of the residents living there have been considered. The environment is more suited to those residents who are more able; this has been achieved and has enabled the staff team to meet their resident’s needs in a timely and holistic way. This is commended.
Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 7 The home is fostering a culture of the whole team being responsible for meeting the residents’ social needs. This is a huge improvement from the last inspection where the concentration of activities was for the more able residents. A new activities organiser has been recruited which will also enhance this provision. A key worker (named nurse) system is being re-introduced, this will also be used to promote one to one time staff can spend just being with a resident or enabling them to do an activity. The home has dealt extremely well with a difficult issue surrounding the complex needs of one resident. They have sought specialist advice and relevant parties’ views before coming to the conclusion that it would be possible for them to continue caring for this resident. The cleanliness of the home has improved now that there is a full complement of domestic staff. The care plans have improved as they are now individualised and contain actions needed to meet assessed needs. The staff have worked very hard to achieve this and are to be commended for this. What they could do better:
The care plan should be a dynamic document, which will change as regular assessment of the resident reveals changing needs. The plan should be at the end of the assessment process, and include the resident, so that the goals are the resident’s own and include their abilities. Any psychological, emotional and social needs are also to be included. Life histories could be used to inform the staff about the whole person and about their life before they needed care. End of life plans are not recorded in all instances. This should be done to reassure the residents and their families that their wishes will be carried out. The health, safety and welfare of residents and staff must be promoted by safe working practices being assessed and these kept under review. Any actions needed to reduce any identifies risk must be implemented. Fire Safety tests must be implemented according to the stipulations made by Avon Fire Service. These records must be clear, up to date and available at all times. Residents financial interests must be safeguarded by ensuring that the records of monies and valuables held by the home are audited reguarly. Also purses kept must be clearly marked.
Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 8 All residents should live in a well-maintained environment and a programme of renewal of furniture and re-decoration must be produced and achieved. 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. Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 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 Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 The home is able to meet the needs of the residents and achieves this by using the skills of the current staff team and specialist services. EVIDENCE: Three residents with complex needs were case tracked during the inspection. From discussions with one resident’s family it was obvious that they are satisfied with the care that their relative is given. Staff spoken with were aware of this residents needs, and the care plan and other assessments confirmed that holistic needs have been assessed. Residents are able to make their own decisions; this has been achieved with the staff balancing their duty of care with respecting the residents’ choices. The second case involves some complex issues, which the inspector witnessed and read that are being dealt with professionally and according to best practice guidelines. The home has sought appropriate specialist advice to be able to continue to care for this resident within the home. In the third instance there has been a dramatic improvement in this residents well being. Communication is being promoted and encouraged which had not been so at previous inspections.
Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 11 In another instance the Manager had insisted on staff being trained in a condition that staff were not familiar with, before the resident was admitted to the home. Staff then felt confident to care for this person. This is commended. Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Care plans provide the basis for care to be delivered. These are being enhanced so that all aspects of health, personal and social care needs are recorded and met. Good health is promoted and there is access to health care services to meet assessed needs. Residents spoken with said that they feel respected and that their dignity is upheld. EVIDENCE: 7. At the last inspection concerns were raised and a requirement made about the quality of the care plans on the nursing wings. Since then a lot of work has been done to improve them. Each plan is now written according to each person needs, and the actions needed to meet the need are now present. Identified health risks such as being underweight are acknowledged and actions recorded to reduce the risk. This is a big improvement. In one instance the inspector could see the actions in the residents room, eg.a special cup to reduce the risk
Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 13 of scalding, a completed turn chart to reduce the risk of a pressure sore developing, and hourly safety checks to ensure that the resident hadn’t fallen. This is commended. Social care assessments were completed in 3 of the 4 residents case tracked. Wishes in the event of death were present in 2 of the 4 plans. The staff must address this. Staff do need to be careful about the language they use and ensure that it is not subjective. This was seen in one file. In some instances the review of the care plan did not include new problems recorded in the daily notes. This must be done and when appropriate lead to a short/long term plan. 8. It was possible to evidence that health care needs are being met whether by the home or other health care specialists. A monthly audit of falls is being completed to try to ascertain patterns, which could then be investigated. Accidents recorded were also in the resident’s daily notes and clear actions to be taken to reduce any further risk. In one instance of medication being prescribed for incidents of aggressive behaviour this had not been reviewed in the care plan to determine its effectiveness. There was also poor detail of how to deal with this behaviour for staff to be able to provide a consistent approach. 9. The medication systems were scrutinised by the Pharmacy Inspector. 10. One inspector spent some time talking with residents who generally commented that they felt respected and were treated well. Some comments included, “The staff are nice, the food good, I have plenty of freedom and would feel happy to complain if necessary”. “All the staff are very good and attentive, you can go anywhere, and there are no restrictions. I get up and go to bed when I like”. “Somebody always knocks before coming in my room. I don’t have to see anybody if I don’t want to. They are very good”. “I feel safe here, I benefit from people always being around”. Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 14 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): 13, 14, 15 Visitors are welcome at reasonable times and links with the local community are maintained. The home is conducted to enable residents to maximise their capacity to exercise choice and control over their lives. Residents receive a wholesome appealing diet and are able choose what they eat. EVIDENCE: 12. This standard was not inspected but since the last inspection the Activities organiser resigned. The home has made a new appointment and is waiting for the recruitment process to be completed. In the meantime the staff are to be commended for their efforts in providing activities on each wing. This has had the effect of more residents being offered the opportunity of having something interesting happen for them. The previous regime meant that some residents were not able to participate in group activities so missed out on social opportunities. Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 15 13. It was evident during the inspection, and from looking at the Visitors book that the home enjoys a large amount of visitors. One inspector spoke with some relatives one of whom visits regularly. Both were satisfied with the care given to their relative and commented on the kindness of the staff. The home has its own League of Friends who arranged events such as a Harvest Festival, a Fashion sale, a visit from a Ladies choir, and have organised a Christmas Bazaar, Timsbury Hand-Bell ringers and a Carol service for December. This is commended as the local community are coming into the home. 14. There is a residents meeting held every 3 months, this is their chosen time. The minutes from these meetings are posted in the main lobby and include actions to be taken. As mentioned previously residents spoken with during the inspection confirmed that they are able to exercise choice and control over their life in the home. 15. Both inspectors took the opportunity to have lunch with the residents in different parts of the home. Both found the meal to be well presented, and staff gave assistance in an unhurried manner making it a relaxing time. The meal was both tasty and hot and portions appropriate. There were positive comments from the residents such as, “We are always given a choice”, “They know what I like and don’t like”, “If I want something I only have to ask” Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 16 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 Residents are protected from abuse by the staff being trained and following local policies and procedures. EVIDENCE: The inspector saw records of staff that have attended training in the prevention of abuse this year. The home is to be commended for including most of the ancillary staff employed. Since the last inspection the home received an allegation of inadequate care from an external source. This was dealt with according to the local policies and the strategy meeting determined that this allegation was not upheld. The Residential supervisor is to be commended for the detailed documentation kept which proved that the allegations were unfounded. Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 17 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, 24, 25, 26 The bedroom furniture in some rooms would benefit from being replaced. Bedroom doors should be fitted with locks and lockable storage. Residents living on Bluebell have benefited from the communal space being modernised and improved. All residents have benefited from the improvement in cleanliness. EVIDENCE: 19. It was noted that the building generally was in good decorative order. Bedrooms viewed were also in good order. It was the inspector’s opinion that some bedroom furniture would benefit from being updated. 24. Some residents spoken with did not have a key to their room. They also could not recall being asked if they wished to have one. Some rooms also did
Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 18 not have lockable storage. This must be provided and residents offered the choice of having a key to their room. If this is not suitable then this needs to be shown in a risk assessment. 25. Since the last inspection there has been a big improvement in the lounge area on Bluebell. The lounge has had additional lighting, new lamps, pictures, cupboard, new glasses and beakers. The chairs have been re-arranged so that are not cramped, making it a more relaxed and welcoming area. Staff working up there said it is a much more pleasant environment. 26. The home was much cleaner than at the last inspection and the manager stated that they now have a full complement of domestic staff. It was noticed on Bluebell that the dormer windows needed to be cleaned. Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 19 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): 29, 30 Residents are protected by the home’s recruitment policy and practices. The training offered should ensure that staff are competent to do their jobs. EVIDENCE: 29. Records for four staff were checked. This confirmed that the home is using robust procedures, which are consistent. The home is recruiting for care staff at the moment. English speaking classes are offered to overseas staff and staff have taken this opportunity. 30. The Manager was able to supply the inspector with the home’s training matrix for 2005.This showed that staff have attended mandatory training sessions as well as for other relevant topics. Certificates seen showed attendance in Dementia, Care planning, Constipation, Pressure area care and Infection control. The home runs an adaptation programme for overseas staff that are trained in their own country. This is usually a 6-month course to enable them to then work as a registered nurse in the UK. 3 staff are currently on this programme, and one had just completed it. The manager stated that the training provider has commented positively about their paperwork. Rosewell Country Home DS0000044632.V249855.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): 31, 35, 38 Everyone in the home benefits from a Manager who is experienced and competent to run the home. Residents’ financial interests could be better managed by regular auditing and clear marking of purses. Fire safety would be improved by structured updates for staff and following Avon Fire Services guidelines for tests. EVIDENCE: 31. Mrs Galloway has been the registered manager of the home since it opened. Training records showed that she has attended sessions this year to keep herself up to date with current practices. She took on board comments and suggestions made at the last inspection and has achieved a great deal,
Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 21 with her team, to improve upon the management and supervision of staff since then. This has positively impacted on the safety and opportunities for all residents in the home. She is to be commended for taking the criticisms and enabling a positive outcome. 35. The records of resident’s monies and valuables were checked. The records were clear and enabled the inspector to track transactions and amounts spent. This system is not being audited regularly at the moment and must be. Monies are kept in some instances in purses, which were not labelled and must be clearly marked. There was a record of property found but unclaimed. This went back some years. Discussion took place about how to deal with these items and recommendations made. 38. Fire records were checked. It was not possible to verify that the fire fighting equipment was being checked monthly as is recommended. Also the regular checks of the emergency lighting had not included the 6 monthly prolonged test, which is required. The manager responded promptly to the need to test the fire fighting equipment, and sent a copy of the completed test records to the CSCI office showing that these had been completed the day after the inspection. Training records showed that the home is doing regular drills, including the night staff and using this as their updating sessions. After discussion it was agreed that a more robust way of ensuring staff competency, was to encourage them to watch a fire safety video while on duty, and answer questions to verify their understanding. Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 22 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 X 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X 2 3 3 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 2 X X 2 Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 23 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 OP7 Regulation 15(1) Requirement Social and personal needs must be recorded in the care plans and devised with the resident and/or their representative. This must include end of life plans. Keep the plan under review and complete a new plan when a new problem occurs. A programme of renewal of furniture must be produced and adhered to. Provide locks on doors and lockable storage in resident’s bedrooms. Records of resident’s monies must be audited and containers of money clearly marked. Safety tests of fire equipment should be done in the way described and at the intervals recommended by Avon Fire Service. Ensure staff competency by using a structured format for the fire safety updating. Timescale for action 31/03/06 2 3 4 5 6 OP7 OP24 OP24 OP35 OP38 15(2)(b) 16(2)(c) 12(4)(a) Sch.4.9. 23(4) (c)(v) 30/11/05 31/01/06 28/02/06 30/12/05 28/11/05 7 OP38 23(c), (d) 30/12/05 Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 24 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 2 3 Refer to Standard OP7 OP19 OP35 Good Practice Recommendations Ensure language used is in documentation is objective. Clean the dormer windows, particularly on Bluebell. Valuables unclaimed for some years should be advertised within the home. If they are still unclaimed then the items should be sold and money made on the sale put in the residents fund. Rosewell Country Home DS0000044632.V249855.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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