Inspection on 21/05/08 for Rosewood House Care Home

This inspection was carried out on 21st May 2008.

CSCI found this care home to be providing an Adequate service.

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 House Care Home 10/12/07

Rosewood House Care Home 31/01/07

Rosewood House Care Home 03/05/06

Rosewood House Care Home 23/11/04

Rosewood House Care Home 17/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Rosewood House Care Home 84a Main Road Radcliffe on Trent Nottingham NG12 2BQ Lead Inspector Linda Hirst Unannounced Inspection 21st May 2008 10:00 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 Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosewood House Care Home Address 84a Main Road Radcliffe on Trent Nottingham NG12 2BQ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered acting manager (if applicable) Type of registration No. of places registered (if applicable) 0115 933 4717 0115 933 2510 sherryseetul@btinternet.com Mr Mukesh Seetul Acting manager post vacant Care Home 17 Category(ies) of Dementia - over 65 years of age (17) registration, with number of places Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th December 2007 Brief Description of the Service: Rosewood House is an adapted and extended property sitting on the outskirts of the village of Radcliffe on Trent. The home is registered to provide residential care for up to 17 people who have Dementia and particular needs associated with this. The accommodation is over three floors and there is a lift for people who have mobility difficulties so they can get access to all areas of the home. There are gardens at the side and rear of the home and there is a car park at the front. The village of Radcliffe on Trent is a couple of minutes away by car and provides a range of facilities including shops, churches, restaurants, public houses and public transport facilities. The weekly fees vary between £290 to £334 this does not include hairdressing or chiropody. Further information about the home is available in the brochure and service user guide. The provider welcomes any telephone enquiries and a copy of the latest inspection report is available in the office and can be seen upon request. Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live at the home and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. We received this back from the acting manager in good time and the form was well completed and helped us to plan our visit and to decide what areas to look at. We also reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding what areas to look at. We sent out 4 surveys to relatives of people who live at the service, 3 to staff and 5 to visiting professionals to get their views on the service being provided. We did not receive any of these surveys back. We looked at the surveys the home has sent out to people and found that these were very positive, one person said, “I am very satisfied with the attention and with the care given to (a named person) from all the staff.” This visit was unannounced and took place over several hours, including lunchtime. The main method of inspection we use is called ‘case tracking’ which involves us choosing three people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. Part of this inspection looked at the quality of care people with dementia experience when living at Rosewood House. Because we are unable to communicate effectively with all of the people with dementia, we have used a formal way to observe people in this inspection to help us understand their experiences of life at the service. We call this, the ‘Short Observational Framework for Inspection (SOFI). This involved observing 5 people who live at the service, over two hours and recording their experiences at regular intervals. We made judgements about their state of well being, and how they Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 6 interacted with staff members, other people who use services, and the environment. We discreetly observed people in the dining rooms, during the lunchtime period. English is the first language of all of the people who live at the service living at the home at the moment. The staff team come from a wide variety of backgrounds and experiences. We spoke to three members of staff, three people who live at the service and one relative to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. What the service does well: What has improved since the last inspection? Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 7 There is a full assessment of every person who wants to live at the home and this has full details of their ethnic origin and of the people who are important in their lives. Some people have been assessed by social workers, but the acting manager has also done an assessment of their needs to be sure that the staff can meet these properly. The staff told us they are told about the needs of new people and are also given time to read the assessments so they know what they must do to support each person with their need. The care plans have been rewritten and they have much more information on the needs of the people who live at the home now. The new care plans are organised in the same way so it is easy for staff to find the information they need. The staff we spoke with said they find them easy to read now and we saw them following care plans when they work with the people living at the home. We found the arrangements for administering and recording medication have got much better and because of this, people get their medicines as their Doctor prescribed. The staff understand what they must do if any complaint is made and the arrangements for handling complaints are well organised and ensure that action is taken where needed to improve the service to the people living there. The acting manager and the owners have arranged for the staff to have a lot more training since our last visit to make sure they are good at their jobs and know what they are supposed to do. The outcomes for the people they care for have improved and their training and understanding shows in how they provide the care. The owners have appointed an acting manager and there have been several improvements in the service being provided to the people living at the home. The people living at the home, their relatives and the staff are being asked what they think of the service so that further improvements can be made. The arrangements for looking after the money people deposit have improved a lot and people’s financial interests are now properly safeguarded so that they are protected from abuse. What they could do better: We found that the acting manager needs to look again at whether giving medicines in food and drinks is the right thing to do in light of recent Laws which have been passed about people’s capacity to consent to treatment. The acting manager should make sure that all of the people who work at the home, (and those who come in to provide a service) understand that they Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 8 must respond to the people living there as adults and make sure this is followed through in their work. The timing of meals may need reviewing so people are not feeling hungry and the people needing a soft diet could have their food blended separately rather than together to maintain the colour of food and encourage people’s appetite. The staff do not understand that they must blow the whistle on poor practice and they do not know whom they should tell. This means they may not be referring safeguarding incidents in line with locally agreed ways of working and people living at the service may not be properly protected from harm. The number of staff on duty could be higher to make sure that the needs of all of the people living at the home can be met safely and that they are properly supervised at all times. The acting manager has not yet applied to be registered and this is against the Law. She has assured us that she will make an application to us so that we can be certain that the home is being run by someone who is fit to do this. The Fire Safety Officer has raised a lot of issues which need attention to make sure that the people who live at the home are safe from the risk of fire. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who want to live at the home are given information and a full assessment before they move in so they can be assured that their needs can be met at the service. EVIDENCE: We looked at the file of the person who was most recently admitted to the service and found that a full needs assessment had taken place to ensure that their needs could be met at the home. The staff we spoke with confirmed that every person who comes to live at the home is assessed by the acting manager first and they are told to read the care plans and given verbal handovers to make sure their needs can be met. People living at the service and their relatives said their needs were assessed before a place was offered Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 11 and one person we spoke with was aiming to move on and back into the community following a short stay at the service. Intermediate care is not provided at the service and this standard is not applicable. Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at the service have their needs assessed and met in a kind and sensitive way, but the principles of respect and dignity are not always practiced. EVIDENCE: The acting manager has updated all but three of the care plans and put these into a new consistent format to make it easy for the staff to get access to the information they need. Two of the plans we looked at were not yet in this new format and it was harder to find the information which was needed, but the acting manager is planning to do these next. Our observations showed that staff are providing support in line with the care plans in place, and in our interviews with them they showed a good understanding of the individual needs of the people they support. They told us that the care plans are easy to read and help them to respond to people in a consistent way. Relatives told us Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 13 that the care being provided has been discussed and agreed with them, and one person said, “I am really happy with the way they look after her.” People living at the service, staff and relatives all agree that health care needs are, “very well taken care of.” We spoke with one person who has the equipment needed to make sure staff move him safely and make sure his skin is in good condition. The staff told us that some people have help from a physiotherapist, others from a speech and language therapist and they said they “have good relationships with the Doctor and District Nurses.” During our observations we heard one person (whose care plan shows they have a high risk of pressure sores developing) complain that their bottom was sore, but we did not see staff assist with any positional changes and when we looked at the daily records this had not been reported by staff. The person concerned does not have any pressure sores at the moment, but the communication in this area needs to improve to make sure that people get the monitoring, support and care they need. We watched the staff give out the medication. This was done safely and with care, we looked at the Medication Administration Record sheets and these were well recorded, we saw staff check whether people want their medication if it is given as required. A relative told us that one person is given medication in her food and drink, he was happy with this arrangement and said when the person lived at home they spat out their tablets all the time. When we interviewed staff we found that this has been checked with the Pharmacist, and there is a care plan and risk assessment in place which covers this practice. The acting manager has also downloaded guidance on giving medicines covertly and staff who administer medication told us they stay with the person until they have taken their medication and destroy any excess immediately. However, this is not best practice and the care plan may need reviewing or rewriting with consideration for the Mental Capacity Act 2005. We observed staff engaging with five people who have Dementia in the main lounge and we found them to be patient, kind and sensitive to people’s needs. When we spoke with them they gave us good examples of how they show respect for people and maintain their dignity. Some of the behaviours they were supporting people with were quite challenging, but the staff handled most situations well. We saw them making sure people were properly covered, supporting them sensitively and discreetly and taking time to engage with people even if they could not respond. We saw one incident where the hairdresser who visits the home was overheard lying to a person to get her to have her hair done, and this should be addressed with her. We also saw a staff member describe the conduct of a person living at the home as “naughty,” and another told us that, working with people with Dementia is “like dealing in child psychology,” understanding that Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 14 their responses can be child like. Although these views were not reflected in how they delivered care to the people living at the service it is essential that the staff understand that people who have Dementia are adults and not children. Relatives and the people living at the service told us the staff are very kind and patient, one said, “you can’t fault the staff, they are lovely and the owner is very hot on things, she makes sure that people treat the people who live at the service well. The staff are very, very patient and they deal with some difficult people and situations.” A relative told us he has never seen anyone behave in an unkind manner towards any of the people living at the service. Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use services can make choices about their life style. The recreational activities meet individual’s needs and expectations. EVIDENCE: We found that a company comes in to do activities every week (E.g. exercise and orientation work) the rest of the time the staff lead on activities and we saw them doing exercise with people living at the home. The staff record who joins in and how people respond to activities, many people joined in happily but we saw a member of staff wake people up several times to engage in activities, some people got very annoyed at being woken and staff need to take a view on whether to leave people who are asleep. Relatives said that there are regular singalongs and activities provided by staff and staff told us that there are plans to organise trips out in the summer months. During our observations the radio and the television were on at the same time in the same room. This was very distracting and loud, but we found that Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 16 people who live at the service could not listen to the television as the sound was too low and the music too distracting. The acting manager needs to consider whether this would have an impact of some of the people living at the home and decide whether any action is needed. Relatives and people living at the home said that they could have visitors whenever they want, and we saw people coming and going throughout the day. Staff told us they welcome visitors and try hard to keep relatives up to date on their loved ones, and one relative said he is encouraged to stay for a meal with his partner. One person who lives at the service told us he prefers his own company and he said the staff respect this and bring his meals to him in his bedroom. People living at the service were seen being given choices about whether to join in with activities, and about whether to chat with staff. One person told us he could live his life as he chooses and he said the staff are very good at promoting his independence. There is information about advocacy services around the home if people need this. The staff told us that people who live at the service get up early and they give them breakfast, but several people were heard commenting that they were hungry and it may be that there is too long a wait between breakfast and lunch. The staff we spoke with said that they have respect for people’s decisions and they gave us examples of this and a relative told us he feels the staff respect people’s choices. We observed lunch and found that people were assisted to eat in a caring way and at a relaxed pace. The staff sat beside people and told them what they were eating and asked them if they wanted more. People living at the service, their relatives and the staff all feel the food is very good, one relative commented that it is, “first class.” The food was nicely presented and people are offered good quantities of food, with alternatives being available. Some people have soft diets but the food is blended together rather than separately which would preserve the different colour and texture of individual foods. The staff told us they are very careful and watch for signs of weight loss, they said they monitor food and fluid intake in such circumstances and have just called the Doctor in to see a person who is losing weight. Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 17 Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure. The staff are not aware of their responsibility to blow the whistle on poor practice and this compromises their ability to protect people from harm and abuse. EVIDENCE: We found a complaints procedure is displayed in each bedroom and on the notice board of the home. There have not been any complaints made directly to the Commission for Social Care Inspection since our last visit, and we found that only one has been made to the service about issues of cleanliness and tidiness of a specific bedroom. The complaint was upheld and appropriately handled. The staff we spoke with have had training on dealing with complaints and knew what action they have to take. Both relatives and staff said they feel very confident that the acting manager would respond to any complaints promptly and professionally. There have not been any safeguarding referrals since the last inspection of the service. The acting manager is updating the safeguarding policy and this is needed, as it does not offer clear guidance to staff on how to respond if a safeguarding incident occurs, on making referrals and preserving evidence. A Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 19 relative told us that he feels the people living at the service are “safe and well cared for,” he said he has never seen anyone respond in an unkind manner towards the people at the home and he had confidence that the acting manager and owner would not tolerate inappropriate behaviour. The staff we interviewed said they have had training on safeguarding and discussions with the acting manager, but they were very unclear about their responsibility to blow the whistle on poor practice, who to, and how this would feed in to the local procedures. Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at the service live in a safe, well-maintained clean and comfortable environment. EVIDENCE: We did a partial tour of the home and looked at all communal areas and a sample of bedrooms. The home was clean, tidy and well maintained throughout with a high priority given to the control of infection. The people living at the service, their relatives and the staff said the home is clean tidy and that any repairs are done quickly, the records we looked at on maintenance support this view. During our observation two people mentioned to staff that they were cold and the windows were open in the lounge and dining room throughout the visit, Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 21 and it did feel cold whilst sitting, the staff we spoke with said the home is too hot and it may be that they are not aware of how cold the rooms can feel to people living at the home. A thermometer in the communal areas may give a more accurate guide to the temperature. Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff in the home have good access to training and are skilled at providing care to people in line with their needs. There are not enough staff to support the people who use the service in meeting their needs and to support the smooth running of the service. EVIDENCE: We looked at the staff rota which shows that the day shifts are staffed by three people, the staff we spoke with told us that one person needs three staff to assist him, and this was confirmed by the person and by the care plan for him. This would potentially leave the other people living at the service unattended for a significant amount of time. We observed three staff supporting the people living in the home during our visit and it was clear from what we saw that this is the minimum number needed to support people with their current needs. The staff were frequently called upon to stop misunderstandings and arguments developing and were very busy supporting people with their needs. One person living at the service commented that he has to wait for help, “especially in a morning, everyone seems to get up at the same time, and I need a lot of help from them,” a relative also told us there are some times when there don’t seem to be enough staff on, but he said the staff work really Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 23 hard with the people who live at the service and they seem competent at their jobs. We looked at the staff files and found that these contain all of the documentation and information required by Law to make sure people are suitable to work with vulnerable people. The service has not achieved the target of 50 of staff trained to National Vocational Qualification Level 2 but with the people who are currently undertaking the training they will achieve this. Two of the staff we spoke with said they are doing their National Vocational Qualification training now. The staff we spoke with told us they have, “good training and supervision.” They told us they have done Basic Food Hygiene, Health and Safety, Fire, Infection Control, Moving and Handling and they feel, “all training is important. We saw evidence of certificates in these courses in the staff files. Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home is improving the outcomes for the people living there, but action must be taken to address the issues we have raised in our report and to make sure the service runs in the best interests of the people who live at the home. EVIDENCE: The owners have appointed an acting manager and the management of the service has improved a lot. The acting manager has not yet applied to become registered as is legally required and failing to do so is an offence. The staff we spoke with told us the acting manager is, “very good. She has good systems, Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 25 is approachable and makes you feel welcome. She is very good with the people who live at the service, she is like one of their daughters.” Good progress has been made towards improving the service and outcomes for the people living there but there are still some issues which need to be resolved (OP7, OP8, OP18 and OP27). The staff we spoke with told us that there are regular surveys for people living at the home to give their views on the care being provided, they have filled in staff ones and a relative we spoke with told us he is asked to complete these. We looked at the responses from these questionnaires and found them to be very positive about the service, comments included, “an excellent revisit as I have not been here for a while,” (from a Community Psychiatric Nurse), “there is an excellent service to people who live at the service, very clean and cared for home, I have seen some of the best infection control procedures ever in this home. The interaction between staff is excellent,” (from a trainer visiting the home) and, “my relative always seems to be happy. I am happy she is being well cared for.” We saw evidence of other audits beginning in terms of maintenance, medication and staff files. We looked at the arrangements for looking after money on behalf of people who live at the home. The records and the balances all tally and receipts of expenditure are kept. The staff we spoke with said they have no input with financial matters and the relative said that his loved one is under a legal order. We looked at all of the information the acting manager sent us about the servicing and checks on equipment. We found that the Fire Safety Officer raised several issues of concern following his last visit some of these matters have been addressed and the owner told us that the other issues would be addressed within the timescales set. The staff told us they have the training and equipment they need to do their jobs safely. Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1), 14(2)(a) & (b) Requirement Timescale for action 18/07/08 2. OP8 13(4)(c) 3. OP18 13(6) 4. OP27 18(1)(a) Staff must be able to understand the care planning system in use and care plans must clearly describe how resident needs are to be met and where a need is identified a care plan must be written for this so that staff know how to meet people who live at the service’ needs. Timescale of 1/3/08 not met, but we have agreed to extend the timescale as the requirement is almost met. Staff must make a record and 30/06/08 take action when people tell them their skin is sore, especially if they have been assessed as being at risk of developing pressure sores to prevent their development. 18/07/08 Staff must understand their responsibility to blow the whistle on poor practice, who they should tell and how this feeds in to the local safeguarding procedures to ensure people living at the service are protected from abuse. the dependency needs of the 18/07/08 DS0000008796.V364873.R01.S.doc Version 5.2 Rosewood House Care Home Page 28 5. OP31 S11(1) Care Standards Act 2000 6. OP38 23(4) people who live at the home must be reviewed and you must be able to demonstrate how your staffing levels are appropriate to meet these needs. The acting manager must apply to become registered with the Commission for Social Care Inspection so we can be assured that there is a person who is fit and competent in charge of the home. Timescale of 1/4/08 not met. We are repeating this requirement as part of the previous requirement was met but it is an offence to manage a service without being registered. The issues raised by the Fire Safety Officer in their report must be addressed within the timescales they have set to ensure the safety of the people living at the service. 30/06/08 18/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations The care plan about giving medication covertly should be reviewed in light of the Mental Capacity Act 2005 to make sure you have properly determined whether the person has capacity to consent to or refuse treatment. A discussion should take place with the hairdresser about the identified incident to make sure that people living at the service are not being coerced into doing things they would not choose to. Staff should understand and respond to people as adults at all times to show respect for their personal dignity. Consideration should be given as to whether it is advisable to wake people from sleep to partake in activities and DS0000008796.V364873.R01.S.doc Version 5.2 Page 29 2 OP10 3. 4. OP10 OP12 Rosewood House Care Home 5. 6. 7. OP15 OP15 OP25 whether it is appropriate to have the television and the radio on at the same time and whether this has an effect on the mood and behaviour of people living at the service. The times people are eating should be reviewed to decide whether the gaps between meals are too long for the people living at the home, causing them to be hungry. People who need soft diets should have their food blended separately to maintain the different colour and texture of food and promote appetite. There should be an accurate means of deciding whether the temperature of the communal rooms is adequate to ensure the comfort and safety of people living at the service. Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rosewood House Care Home DS0000008796.V364873.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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