Inspection on 27/04/05 for Rosewood Court

This inspection was carried out on 27th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Rosewood Court 30/01/07

Rosewood Court 10/05/06

Rosewood Court 21/03/06

Rosewood Court 18/11/05

Rosewood Court 07/09/04

Rosewood Court 22/04/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Rosewood Court Shakespeare Close Butler Street East Bradford BD3 9AR Lead Inspector Barbara Grell Unannounced From 10:10 on 27 April 2005 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 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. Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Rosewood Court Address Shakespeare Close Butler Street East Bradford BD3 9AR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01274 308308 01274 308307 Southern Cross Healthcare Care home with nursing 80 Category(ies) of Dementia - over 65 (40) Old age (40) Physical registration, with number disability (1) of places Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: That the category of PD be used for the service user named in the application signed on 5 October 2004 Date of last inspection 7 & 8 September 2004 Brief Description of the Service: Rosewood Court provides care to older people diagnosed as needing residential and nursing care including older people diagnosed with dementia. The home was purpose built as a care home. The size and layout meets current minimum standards and all rooms are single and provided with an en-suite WC and wash basin. The home is situated close to Bradford city centre and is well served with public transport from both Leeds and Bradford. There is level access into the home and two passenger lifts to the first floor. The building is split into four units each catering for up to twenty people and a total of eighty can be accommodated. Each unit has a designated specialism as follows. Residential (Aspen Unit), residential dementia care (Rowan Unit), general nursing (Willow Unit) and dementia nursing (Cedar Unit). There are two enclosed garden areas. Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this unannounced inspection on 27 April 2005 between 10:10 and 16:45. The inspection included the following: * The care assessments and care plans of seven service users/residents. * Conversations with ten service users, 4 visitors and most of the staff on duty. Staff were involved in the process both by being able to comment and being observed in undertaking their work. * Four samples of personnel files were inspected. * Training plans and records were assessed against current general and specific requirements. * Some areas of the environment were inspected this included in the main communal rooms on all Units. * The practices, procedures, storage and records pertaining to the administration of medication were inspected. * Policies and procedures as well as induction training packs were inspected. What the service does well: What has improved since the last inspection? The home came under a new management structure in February 2005 when the registered provider merged with another company. A commitment has been made to identify and make improvements as identified by internal audits. Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 6 An acting manager has been in post for three weeks and is in the process of putting together an action plan for making improvements in the home. The drug fridges are monitored in relation to temperature control to ensure that items are stored at the required temperature. Carpeting seen was in good repair and replacement has been ensured in areas identified during the previous inspection. Service users in the nursing unit were seen to be nursed in suitable height adjustable beds where needed. Twenty-two carers employed are in the process of completing NVQ level 2 training. All should complete by the end of June 2005. Staff in the home have raised funds which they have used to provide an enclosed garden area for the general residential and nursing units. Plans are in place to improve the laundry facilities. What they could do better: This report identifies a number of major shortfalls in respect of meeting core standards. Examples of poor practice were observed affecting the service users well being. Gaps and inaccuracies were identified within the assessment, care planning and monitoring systems. The service users needs, preferences and aspirations should underpin the care provided at the home. There was no evidence within the care plans seen that service users are consulted, their wishes ascertained and respected. Staff files seen were for employees recruited prior to the changes in management of the home. These showed that the recruitment, training and supervision of staff did not meet the required standards. The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. A full review must be undertaken of the staffing levels provided on each Unit. The service users dependancy level and needs must underpin this assessment. The registered person must ensure that people working in the home receive training appropriate to the work they are to perform and suitable assistance, including time off, for the purpose of obtaining further appropriate qualifications. This must include the Sector Skills Council training targets with regard to induction and foundation training and suitable updates on pressure area and wound care and administration of medicines for nurses. The specialist needs of service users must also be taken into account especially with regard to dementia care and dealing with challenging behaviour. Timescales for meeting statutory requirements made during the last inspection Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 7 have not been met. Additional requirements and recommendations have been made where necessary. 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. Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 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 standard(s) 3, 4 and 5. The home does not provide intermediate care. Gaps within the assessment processes have led to admissions outside the homes registration categories. Poor admission and assessment practices may lead to needs remaining unmet and putting service users at risk. EVIDENCE: The service user guide was not in a prominent position and was found under magazines on a low coffee table. The most recent admissions had been assessed by a member of the staff team prior to admission. Pre admission assessments are of varying quality. Some had insufficient detail with regard to diagnosis and needs. The lack of clear information has led to service users being admitted to the home outside of the homes agreed categories and numbers of registration. Staffing levels and skills do not reflect the skill level needed to provide appropriate care and monitoring to service users. There are fifteen individuals in the home who are seen to be outside of the registration categories in respect of diagnosis. Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 10 There was no evidence that the expectations had been discussed with the prospective service user/residents or their family or friends. There is no evidence that the prospective service users psychological and social needs are considered in the pre assessment process. Many assessments seen were undated and or unsigned by the person completing the record. One visitor stated that they had visited the home prior to admission. One of the pre admission assessments showed that the service users relatives had been to look round the home. Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 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 standard(s) 7, 8, 9,and 10 There are gaps within the assessment and care planning processes leading to inappropriate or lack of input from staff. Examples of poor planning and practice were observed leading to distressing situations for the service users involved. Problems with the Nomad cassettes continue since the last inspection putting service users at risk of drug errors. The service users special dementia needs are poorly assessed and care planning in this respect is poor. Challenging behaviours are not properly recorded and staff are unable to address incidents appropriately at times leading to much distress on both parts. EVIDENCE: For one newly admitted service user there was no care plan in place at all. For others these varied in quality. Care plans show gaps where assessed needs are not addressed and not included in the care plan. This especially includes the service users needs with regard to their dementia care including any triggers for aggression, problems with service users wandering and leaving the building or other challenging behaviour. Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 12 Other gaps noted in recording included the lack of intake charts where service users have been identified as being at risk with regard to their good nutrition and hydration. One service user had been assessed by a dietician and a diet plan put in place. As the nutritional intake is not recorded there is no evidence that the nutritional plan is followed. In one case the service user was on continuous bed rest and records seen provided no reason why this was the case. One service user was seen on an air mattress. Turns records were kept. However these showed that up to date pressure relieving techniques were not being used. There was no care plan in place in respect of pressure sore prevention and monitoring in this case putting the service user at risk. Another skin viability assessment was inaccurate. This may be evidence that staff are in need of training. Falls assessments are undertaken. When bed rails are fitted service users or their relatives usually sign a risk assessment. However in one case this information was omitted from the file. It is unclear how often and who is responsible for the regular cleansing of equipment including wheelchairs and other walking aids. Problems are ongoing since the last inspection in respect of the Nomad Cassettes in use as these are not tamper proof. Tablets were observed not to be correctly placed within the compartments. The drug fridges were observed to be working and temperature checks undertaken. There is little evidence within the documentation that service users individual preferences or personalities are considered when planning the care to be provided. There was only one good example of a life history and social care assessment. The service users relative had completed this and this kind of input is seen as good practice. The care plans seen had not been signed by the service users or an advocate as required. Person centred care is not achieved leading to individuality not being respected and observed. Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 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 standard(s) 12, 13, 14 & 15 Service users and visitors are satisfied with the open visiting arrangements. The programme of activities must be extended to include a broader range of activities and the planning of activities should be based on the interests, skills and abilities of service users and these must firstly be ascertained. Some service users continue to state that they are bored. In the sample of records seen there was no evidence that the wishes and preferences of service users are known and routines therefore cannot be based on the person’s previous or chosen lifestyle that way. Where there are concerns in respect of hydration or dietary intake appropriate records must be kept in order to show that an adequate and appropriate diet has been provided. Service users individual preferences must be ascertained and acted upon. EVIDENCE: An activities co-ordinator has been appointed to provide for part time input. Bingo and occasional entertainment is arranged. The service users special needs or previous interests are poorly assessed and recorded. Beauty treatments benefited the female service users. There were no specific interests arranged for the men. On the other hand some service users commented on being bored but hoped that the recently appointed co-ordinator would have an impact. Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 14 Service users can invite visitors into their own room. A number of visitors said that they were happy with the visiting arrangements and these are not restricted. Visitors were offered refreshments. There was little evidence that service users are involved in any decisionmaking and service users are not encouraged or enabled to maximise autonomy or choice. The mealtime was observed. Staff stated that the day’s menu is discussed during the morning and a choice of food offered. But some of the service users spoken to did not know what was on the menu that day. In general service users were allowed to eat their meals unrushed. The assistance provided by staff was appropriate. However, two service users had their meals in separate lounges and were in need of supervision and encouragement that could not be provided in an appropriate manner whilst supervising other service users in the dining room, leading to delay between courses. The daily recordings of intake must be ensured when risks have been identified. The service users felt that the meals are mostly good however individual preferences such as a distaste for gravy or other foodstuffs is not always considered leading to dissatisfaction. Service users felt that this area was affected by regular and ongoing staff changes. Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 15 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 standard(s) Standards not assessed on this occasion. EVIDENCE: Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 16 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 standard(s) 19, 20, 22,26 There are areas that require cosmetic upgrade. Some areas on the first floor have been newly decorated providing a brighter environment. Fire safety requirements and recommendations made by the fire safety officer have not been met yet. The gardens at the rear of the home provide a poor environment and only one area is freely accessible to service users. There is insufficient garden furniture provided and generally the outlook from windows is onto poorly maintained areas. There were no focal points and there is a lack of flowers, shrubs and trees. The lawnmower was broken and had not been repaired or replaced when being reported out of order leading to overgrown grassed areas around the building. Hence there is little opportunity for service users to enjoy the outside. This resulted in increased agitations in a number of service users. A number of staff have been involved in developing a second secure garden area and have brought in their own gardening equipment for this purpose to clear the area. Staff and service users have been fund-raising and some of the money was spend on fencing. This commitment is commendable. The fencing should be paid for by the organisation and the resident fund reimbursed in this respect. Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 17 EVIDENCE: The environment is poorly maintained and paintwork chipped and discoloured in places. A desk in one unit was so wobbly that this posed a risk to staff and service users when using or leaning on it. This was removed during the inspection. The home’s management have yet to confirm that the items detailed within the fire safety report dated 10 May 2005 have been fully addressed in ensuring the service users safety Service users within dementia care units would have to be supervised to go outside, including any gardens. This lead some service users to become distressed with one service user finding a way onto the car park. This situation was poorly handled leading to an increased distress of the service user until handled better by a qualified nurse who had benefited from dementia training. Distress would be decreased if service users could freely walk outside into the secure gardens. Digital locks are fitted to entry/exits doors to ensure the service users safety. The manager provided a list of equipment available. This includes one stand aid, three Oxford hoists, one Samhall turner, nine handling belts, eight slide sheets, 10 handling slings for Oxford hoist, three turn tables. Hoist slings should be service user specific to ensure that there is no risk of cross infection. It is unclear from handling assessments and practices observed that this aspect is considered and practises should be reviewed around managing the risks of cross infection when using hoist slings. Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 &30 Staffing levels were not appropriate to the numbers and needs of service users. A full review must be undertaken of the staffing levels provided on each Unit. The service users dependancy level and needs must underpin this assessment. Staffing numbers must be maintained at levels suitable to the numbers, needs and dependencies of service users. The lack of training has lead to poor and inaccurate assessments, care planning and care practices in the home. Staff have to rely on common sense rather than hard knowledge and skills which can increase the risk to service users. The recruitment practices do not ensure the safety of service users. EVIDENCE: On the residential unit staffing levels have been reduced recently by one carer in the morning. Staff said that this did not allow for individual attention and chats, indeed staff felt that they now had to rush tasks for them to be completed. The operations manager said that the home was working towards previously agreed staffing levels and that they aim to be above this. Staff have been moved to different units in order to increase staffing on the nursing units and the operations manager said that overall levels have remained the same. The staffing levels are lower during the afternoon and evening even though this is a time when many service users require additional input. On the day of Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 19 the inspection residents and staff said that staffing levels were not adequate and it was seen, particularly on the dementia units that staff were hard pressed to meet residents needs. Only a small number of staff have received training in dementia care that is appropriate to the service users care needs. Most staff spoken to were unable to discuss current good practice in dementia care. Service user centred care practices or principles were not fully understood or part of the working practices. Some staff on the dementia units felt that they had had inadequate training in dealing with challenging behaviour. There are a number of qualified nurses employed ensuring that one nurse is on duty at all times within each of the two nursing units. The qualified nurses have identified training needs in dementia care and dealing with challenging behaviours as well as needing refresher training in medicine administration and wound care. Training must be provided in the use of the assessment tools when needed. One care worker has achieved NVQ level 2. Twenty-two carers are in the process of completing this training by the end of June 2005. The induction training is provided over a period of three days and varies for nurses and carers. The induction training materials and check list does not include the principle to encourage service users rights to be involved and to make choices but emphasise “daily routine of the home” and the care planning sections omits any expectation to involve service users and or advocates reaffirming the lack of person centred practice. The induction and foundation training must be reviewed to make sure that it is to the Sector Skills Council standards for care workers. Recruitment practises in the past have not been robust. The newly appointed manager has identified that there are major shortfalls in this area and is conducting an audit an audit of all staff files to make sure that all required information and checks are in place. Four recruitment files were audited. All had gaps in adequately vetting the prospective staff member including lack of two written references, CRB clearance, NMC register check, ID verification, POVA check, work permit and or visa in respect of foreign staff. The manager was advised that these practices put service users at risk, as employees may not be suitable to work with vulnerable adults. Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36 &37 A new manager is now in post. The previous lack of leadership has had a detrimental impact on the organisation and running of the home. Strong leadership is essential in order to promote the health safety and well being of service users and staff. EVIDENCE: There has been no manager registered with CSCI since autumn 2003, acting managers have been in post. This has had a negative impact on the management of the home. An acting manager had been in post for only three weeks on the day of inspection. They have started to identify shortfalls within the recording and practices in the home. She has commenced meetings with Unit seniors and is undertaking reviews of the assessments and care planning undertaken by staff in order to ensure improvement. Incidents of poor practice reported or observed are being addressed and staff supervision systems are being implemented again as this had lapsed during the past twelve months. Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 21 The wider organisation allows staff to move between Units at Rosewood Court as well as moves to other of its registered facilities. This should be monitored in order to make sure that service users receive continuity of care as much as possible. Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 1 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 3 COMPLAINTS AND PROTECTION 1 1 2 3 x x x x STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 2 1 x x x 2 1 x Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 23 YES Are there any outstanding requirements from the last inspection? 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 3 Regulation 15 Requirement The registered person must ensure that all pre-admission documentation is completed and signed and dated. (Outstanding from previous inspection) The registered person must not provide accommodation to service users outside of the registered categories and agreed numbers for those categories. The registered person must be able to demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. Where service users are identified as not within the home agreed regsitration categories provision must be made to reassess their care needs. A plan of care must be in place for each service user, which details clearly how all assessed health, personal and social care needs will be met. These must evidence all actions taken and provide an accurate picture of the service users medical, physical and social well-being. Staff must be trained in writing J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Timescale for action 31.10.05 2. 4 12 31.10.05 3. 7 15 30.11.05 Rosewood Court Version 1.30 Page 24 4. 8 12 5. 9 13 6. 10 18 7. 14 12, 15 8. 19 23 9. 19 23 care plans and appropriate systems put in place to ensure this. The care plans must be kept under review and reflect changing care needs. The service user and their representatives must to be involved in this process. (The timescale for meeting this standard has not been met from previous inspections.) Appropriate assessments and systems to monitor service users health and psychological care needs must be carried out, this must include pressure area and nutritional care. Records must be kept. (The timescale for meeting this standard has not been met from previous inspections.) The registered person must ensure that the home operates a safe, robust medicines control system, with particular regard to the monitored dosage system in current use. The registered person must make sure that service users privacy and dignity are respected. The registered person must conduct the home so as to maximise service users capacity to exercise personal autonomy and choice. The registered person shall ascertain and take into account the service users wishes and feelings. The registered person must provide an action plan detailing how and when the requirements made in the fire report dated 10 May 2005 will be met. The registered person shall having regard to the number and needs of service users ensure that the external grounds are suitable for, and safe for use by, 30.11.05 31.10.05 31.10.05 31.10.05 1 July 2005 This has been met. 31.3.06 Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 25 10. 19 23 11. 26 13, 16 12. 27 18 13. 29 19 service users are provided and appropriately maintained. The gardens must be landscaped and furniture provided. The communal rooms situated on the ground floor need to be upgraded in respect of furniture and decorative order. The laundry facilities must be improved in line with the providers action plan of developping areas for soiled and clean items. The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. A full review must be undertaken of the staffing levels provided on each Unit. The service users dependancy level and needs must underpin this assessment. CSCI to be informed of the outcome and action taken. The registered person must ensure that the home operates a thorough recruitment procedure. All documents required to be kept and detailed in schedule 2 must be available for each employee and show the prospective employee to be suitable to work with vulnerable adults. All processes must be completed prior to a new employee commencing work at the home. Where documents are missing these must be obtained or copy documents requested and added to personnel files. (Item outstanding from the previous inspection.) 31.3.06 31.3.06 31.10.05 31.10.05 Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 26 14. 30 12, 18 15. 32 12 16. 36 18 17. 37 7, 15, 17 The registered person must ensure that people working in the home receive training appropriate to the work they are to perform and suitable assistance, including time off, for the purpose of obtaining further appropriate qualifications. This must include the Sector Skills Council training targets with regard to induction and foundation training and suitable updates on pressure area and wound care and administration of medicines for nurses. The specialist needs of service users must also be taken into account especially with regard to dementia care and dealing with challenging behaviour. The registered person shall ensure that the home is conducted as to make proper provision for the health and welfare of service users. The registered person shall so far as is practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare. The registered person shall take into account the service users wishes and feelings The registered person must ensure that the employment policies and procedures adopted by the home and its induction, training and supervision are put into practice. Steps must be taken to ensure that staff receive formal supervision at least six times per year from staff who have trained to do so. The registered person must ensure that statutory records are kept as required are acurate and up to date. 31.3.06 30.11.05 30.11.05 30.11.05 18. Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 27 19. 20. 21. 22. 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. 2. Refer to Standard 1 12 Good Practice Recommendations The registered person should review how residents and other interested parties access information about the home and copies of the service user guide. The registered person should assess and consult service users with regard to their recreational needs and preferences and ensure that an appropriate activities and stimulation are provided for based on such an assessment. Service users should be appropriately informed of any planned activities. The registered person must ensure that 50 of care staff are qualified to NVQ level 2 or above by 31.12.05. (Item ongoing since last inspection.) The manager should develop strategies for enabling staff, service users and other stakeholders to affect the way in which the service is delivered. 3. 4. 28 32 Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 28 Commission for Social Care Inspection Aire House Town Street Rodley LS13 1HP 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. Extracts may not be used or reproduced without the express permission of CSCI Rosewood Court J52 S34033 Rosewood Court V223739 270405 stage 4 AMENDED.doc Version 1.30 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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