CARE HOMES FOR OLDER PEOPLE
Rosewood House 55 Westbury Road Westbury On Trym Bristol BS9 3AS Lead Inspector
Vanessa Carter Announced Inspection 27th February 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 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. Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Rosewood House Address 55 Westbury Road Westbury On Trym Bristol BS9 3AS 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) 0117 9622331 0117 9691973 Ablecare Homes Miss Rebecca Louise Kingston Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. May accommodate up to 17 persons aged 65 years and over, requiring personal care. 31st August 2005 Date of last inspection Brief Description of the Service: Rosewood residential care home is registered with the Commission for Social Care Inspection to provide accommodation and personal care for 17 service users aged 65 years and above. The home is located in a residential suburb within the city limits and the accommodation is arranged over three floors. The property has been adapted to meet the needs of the residents with a chair lift providing access to rooms on the upper floor. There is level access out into the well-kept rear courtyard. Accommodation is offered in single rooms with six of the rooms having patio doors leading out into the rear garden. Although registered for 17 persons, the home accommodates only 16 persons. The home is one of a group of four homes owned and operated by Ablecare Homes; the business is owned and operated by the Willcox family. Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report follows a planned inspection to the home that took place over a 7½-hour period. This was a full inspection with the majority of standards being assessed. Evidence has been gained from: • Information provided by the manager in the pre-inspection questionnaire • a tour of the home • speaking with a number of the residents, • speaking with the home manager and the director for Ablecare Homes • speaking with a number of care assistants. The service provided at Rosewood House is good, with the residents being well cared for and the staff being enthusiastic and conscientious about their jobs. What the service does well: What has improved since the last inspection?
A number of requirements were issued following the last inspection. The home has improved their care planning and risk assessment processes, and this will ensure that the residents receive the care they need. Improvements have been made to the homes fire-training procedures meaning that staff would be better prepared should there be a fire in the home. Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 Page 6 What they could do better: 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 House DS0000026515.V274987.R01.S.doc Version 5.1 Page 7 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 Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 Page 8 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 and 5 The homes written information and admissions procedures, ensures that prospective residents are able to make an informed choice about the home and placement is only offered to those whose needs can be met. EVIDENCE: The home’s statement of purpose and service user guide is comprehensive and contains all the information as listed in the national minimum standards. The document would enable a prospective resident and their representatives to make an informed choice about coming to live at Rosewood House. The document is kept in the home, in the main reception area. A copy will have been provided to all service users, and includes a sample copy of the contract of terms and conditions. The home has had a number of admissions in the last month and the preadmission procedures were examined. Documentation evidenced that an assessment had been undertaken prior to placement being offered and arranged. Where appropriate, health needs assessments and social services care plans had been obtained.
Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 Page 9 The home offers placement to older people who need assistance with their personal needs. Should a resident also have nursing care needs, they are supported by the district nursing services, who will visit the home. The home does not admit anyone with dementia as their primary need, however, will continue to care for those who develop mild memory problems and confusion. The home will continue to care for a person with confusion for as long as they are able to meet their needs and whilst there is no detrimental affect upon the other residents. The home currently has 15 people in residence, and arrangements are in hand for one further person to be admitted. The relatives of this person visited the home during the course of the inspection. One resident said that their daughter had chosen the home for her to live in, whilst another said that she had previously known the home. Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 Page 10 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 and 10 Improvements have been made to the homes care planning processes and this will mean that residents can be assured their needs will be met. The home has safe medication procedures, so residents will receive the medications as prescribed by their GP. EVIDENCE: The care planning files for four people were looked at, and evidenced that the home looks to address each persons needs on an individual basis. The home records the overall objective of the care plan, the options explored, and the views of the service user and carers. The plans are comprehensive and detail the assistance required with personal care, mobility, safety issues, mental and emotional needs, any health needs and social networks and daily living needs. Where possible the resident had signed their agreement to the plans. There was evidence that the plans had been reviewed on a regular basis and amended where necessary. The home have shown compliance with a requirements following the last inspection. The plans were written in such a style that it was easy to get a clear picture of the residents needs and what actions the staff are required to take.
Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 Page 11 The home maintains a record of any visits by healthcare professionals. The district nursing services are regular visitors to the home to assist with dressing and blood tests. They are also assisting one of the residents to become independent in administering their daily injection, and working with the staff to support the resident. Examination of the daily records evidenced that the GP is called whenever necessary. One resident was waiting the arrival of the GP on the day of inspection. Residents confirmed they were happy with the standard of care provided and felt they were well looked after. A look at the homes procedure for ordering, receipt, storage, administration and disposal of medications, evidenced good and safe working practice. The CSCI pharmacist has not visited the home however the home has good lines of communication with the pharmacist who supplies their medications. The majority of medications are supplied in blister packs, and those that are not, are stored in individually named containers. This is good practice. Oxygen cylinders are stored in the medicine cupboard therefore the home must display official signage to indicate this, and make a note in the fire log. It is important that the fire department know where oxygen is located in the home, in the event of a fire occurring. Residents are cared for with respect to their dignity and their privacy. Personal care is provided in private and staff were observed to knock on doors before entering a room. During the course of the visit, all the staff were observed interacting well with the residents, being friendly and attentive. Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 Page 12 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): 12, 13, 14 and 15 The residents have the opportunity to participate in a range of activities, and are encouraged to maintain contact with family and friends. They are able to spend their time as they wish. The meals provided are of a very good quality EVIDENCE: The home arranges a range of activities for the residents, and they are able to choose whether to participate or not. Examples include music sessions, board games, quizzes, bingo and visits from the hairdresser. One resident said, “this was the highlight of her week and she enjoyed having her hair set – just like being at home”. Garden parties, barbeques and trips out further a-field, are organised in the summer months, in conjunction with the three other Abelcare homes. Some residents go out to local clubs to maintain contacts with old friends and to continue with favourite pastimes. Some of the residents were in the lounge area; some were in the dining room, whilst others had remained in their bedrooms. One resident said she liked the peace and quiet of her room but liked to come down for meal times. It is evident that the residents are able to choose where they like to spend their time and most were seen to be moving independently around the home and out into the garden.
Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 Page 13 The home has an open visiting policy and visitors are able to visit at any reasonable time of day. They are asked to sign in at the visitor’s book. One person said they have a daily visitor. The lunchtime meal served on the day of inspection was well cooked and tasty. The previous inspector had been concerned that the staff serves out the vegetables and this was discussed with the three residents at the table. One said, “it makes me feel like royalty”. The serving dishes remain on the table so if they want to help themselves to more, they are able to do so independently. At least one resident likes to help out in the home with general tasks and risk assessments had been undertaken, to ensure the safety is maintained of not only the resident, but also the staff team and other residents. Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 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): 16 and 18 The homes complaints procedure and staff awareness of adult protection issues ensures that the residents are able to raise issues of concern and are protected from harm. EVIDENCE: The complaints procedure is displayed in the main reception area and also included in the home’s statement of purpose and resident guide. Residents spoken with during the inspection said they all felt able to raise concerns, with any of the staff team or the home manager. Generally the comments were that there was “nothing to complain about”. One resident said she might “grumble” but the staff are always attentive. A review of the complaints record indicate that all complaints are taken seriously and appropriate responses are taken to resolve any issues that arise. The last complaint recorded was in September 2005 - CSCI have not received any. Alongside the complaints log, the home keeps copies of all compliments received – this section had many notes from grateful relatives. The home has a policy on the Protection of Vulnerable Adults (POVA) and also copies of the Bristol City Council “No Secrets” guidelines. There is clear guidance available for staff to follow if abuse is suspected, alleged or witnessed. Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 Page 15 The home manager attended a POVA training course arranged by the local authority in June 2005, but plans for other staff to attend, were cancelled by the training provider, at the last minute. Since this inspection, the provider has advised that the training has been rescheduled. Discussion with staff evidenced that they have a good awareness of abuse issues and their responsibilities in such matters, however they all stated that they had not had formal abuse awareness training. One staff member said there was information in the home for them to read about the subject, and that it was her duty to ensure that the residents are safe. It is essential that the whole staff team attend training so that they are fully aware of the procedures to take should they suspect or witness abusive care practices. A requirement notice has been issued in respect of this. A copy of the homes whistle blowing policy is displayed on the staff notice board Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Residents live in a home that is comfortable, well furnished and well maintained, and meets their needs. The home is warm, well lit and is kept clean and tidy. Some minor improvements to one room would enhance the environment for the resident. EVIDENCE: Rosewood House is located in a suburban area of Bristol adjacent to the wellknown Durdham Downs. It over looks the playing fields of the Badminton School and is round the corner from local shops and other amenities. The living accommodation is arranged over three floors, and a central stair lift enables those residents with impaired mobility, to access the whole home. The home is well maintained throughout and decorated tastefully. The home has one large lounge on the ground floor, at the front of the home. The dining room is at the back of the home, next to the kitchen, and leading to the corridor of the five courtyard bedrooms. Outside and to the rear, there is a very pleasant courtyard garden. Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 Page 17 A recommendation made following the last inspection, that the home review the patio door locking system, has been considered, but no action has been taken. The home manager and director are of the opinion that changes are not required and that those residents in the courtyard bedrooms are not at risk of becoming trapped in their bedrooms, any more so then the other residents. The need to maintain the security of the building outweighs the need to have a second route of access into the rooms. There are toilet and bathing facilities located throughout the home, in sufficient numbers to meet the needs of the residents. Each of the resident’s bedrooms have en-suite facilities – some have just a toilet and wash hand basin, whilst others have full bathroom. Each of the rooms had been personalised by the residents and one lady said she particularly liked her “unusual” room. The individual rooms were well furnished and homely, but the carpet in one room needs attention as it is rucked. There was a malodour in the room, and the condition of the carpet must be reviewed and then be either refitted, or replaced. The home was warm, well lit, clean and tidy, and free from any malodour, apart from the room previously referred to. Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 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, 28, 29 and 30 Residents are cared for by a kind, sensitive and caring staff team, who are competent and able to meet their needs. EVIDENCE: The staffing levels at the home are adequate to meet the needs of the current residents, many of whom are still fairly independent. The home has dedicated staff for catering and domestic duties, and Abelcare homes have a maintenance team who cover the four homes. The staff rota’s show that each morning there are two care staff, two in the afternoon and evening, and over night one waking member of staff and one sleeping night staff. The manager is included in the care staff numbers but has supernumerary hours to complete administrative duties, including the supervision of staff. On the day of inspection a person on “work experience” was working at the home and being supervised by a member of staff. Staff spoken with, were enthusiastic and able to demonstrate a good awareness of each of the residents specific needs. Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 Page 19 The home has a number of staff who are working towards an NVQ Level 2 in Care, but the home manager and two others have already achieved the award. One staff member spoken with said she was enjoying the course and felt it was improving her practice. The home’s deputy manager already has obtained an equivalent of level 2 and has started to work on NVQ level 3. Of the care staff team only 17 have achieved an NVQ award but 33 are working towards. The home must achieve the minimum ration 50 of trained members of care staff. The home follows robust recruitment procedures to ensure they employ the right people for the home, and that the staff will have the necessary qualities. Examination of three personnel files evidenced that the home ask for applications forms to be completed, two written references to be provided and CRB and POVAfirst checks completed prior to employment. A personnel file is in place for each staff member that contains evidence of an induction and training development. The induction programme for new staff is comprehensive. It is expected that the new recruit will have completed the programme within the first 12 weeks of employment. As part of this programme they have to attend Manual handling, Health & Safety, First Aid, Protection of Vulnerable Adults and Food Hygiene courses, however the two programmes examined did not record that this had been achieved despite having been “signed off”. The programmes should also include details re how competence has been determined, and the recruit should sign as well as the assessor. The home has a training plan for 2006 that includes all the mandatory training courses plus others of a specific health nature. The training files contained copies of certificates of attendance on courses Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 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, 32, 33, 35, 36, 37 and 38 Residents live in a home that is well managed and run in their best interests. The home is safe and their health, safety & welfare is promoted and protected. EVIDENCE: The home manager has been in post for one year, has completed the registered managers process conducted by the CSCI, and has already commenced the registered managers award. She will undertake the skills assessor award (A1) as part of the course. The manager was cooperative during the inspection process and demonstrated her competence in the management of the home. Observations of the working practices, and the interactions between manager, residents and staff, evidenced that the home is run in the resident’s best interests, their views are important, that they are listened to and any concerns are acted upon.
Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 Page 21 Abelcare Homes have just sent out their annual ‘customer service satisfaction’ questionnaire. The director completes monthly reports for CSCI, visiting the home on a regular basis and monitoring the standards of resident and staff satisfaction and dealing with any management issues. The home holds monies for a number of residents. An examination of the accounts for a sample of residents were checked and tallied with amounts held. One staff member stated that they have received 1:1 supervision with the manager, but most issues are discussed on a less formal basis. It is evident that there is a high level of support from the manager on a day-to-day basis, but arrangements must be in place for staff to have supervision at least six times per year, with the opportunity of discussing training and development needs. The records were not inspected on this visit. The homes standard of record keeping is good and any information or written records, requested during the inspection were readily available. The home’s records are kept securely in the manager’s office. Policies and procedures are in place to ensure that both the residents and staff health, welfare & safety are promoted. Staff are requested to sign to acknowledge understanding of the policies and procedures. The fire log showed that all the necessary checks have been undertaken of the fire alarm system, fire fighting equipment, and emergency lighting. All but one member of staff have taken part in a recent fire drill but the manager had already been aware of this and gave assurance that this would be addressed. Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 3 3 Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 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. 2. 3. Standard OP9 OP18 OP24 Regulation 13(2) 13(6) 16(2)(c) Requirement Display official signage to indicate oxygen storage. The entire staff team must receive POVA training, or refresher training if appropriate. The one carpet (as identified to the manager) should be reviewed and either refitted or replaced. Review the implementation of the Induction training programme. (The previous timescale of Timescale for action 27/03/06 27/08/06 27/03/06 4. OP30 18(1)(c) 27/04/06 30/11/05 has not been met) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rosewood House DS0000026515.V274987.R01.S.doc Version 5.1 Page 24 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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