Inspection on 08/01/08 for Rosewood Lodge

This inspection was carried out on 8th January 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rosewood Lodge 23/02/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Rosewood Lodge 9 Uphill Road North Weston Super Mare North Somerset BS23 4NE Lead Inspector Patricia Hellier Key Unannounced Inspection 11:00 8th January 2008 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 Lodge DS0000067543.V355722.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 Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosewood Lodge Address 9 Uphill Road North Weston Super Mare North Somerset BS23 4NE 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) 01934 644266 01934 644266 Scosa Ltd Mrs Tina Eileen Fillingham Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd February 2007 Brief Description of the Service: Rosewood Lodge provides personal care for up to 22 people elderly people. It is set just off the sea front, with level access to the town centre, local shops and amenities. All bedrooms have en-suite facilities. All bedrooms meet the new spatial standards and many exceed them. There is a passenger lift accessing both upper floors of the home. The home has a well maintained front garden that is accessible for residents and comfortable garden furniture. The provider makes information available through an information pack. The information pack contains the Statement of Purpose and Service User guide and all relevant information about the home. The fees range between £356 and £475 a week with additional charges being made for hairdressing, chiropody, newspapers, and toiletries. This information was provided in January 2008. Rosewood Lodge DS0000067543.V355722.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 0 star. This means the people who use this service experience poor quality outcomes. This key inspection took place over 18.5 hours on three days. The Registered Manager, Mrs Fillingham, was present throughout. As part of the Key inspection we asked the pharmacist inspector to review the medicines management and practices as they were found to be poor. During the course of this Key inspection the Environmental Health Officer also carried out an inspection of this home. Before the inspection the information about the home was received from the file held in the office, surveys received from 14 people who use the service and 5 relatives. The last two inspection reports were reviewed, as there had been a Random inspection to follow-up on issues raised at the last Key inspection The completed Annual Quality Assurance Assessment (AQAA) form, from the provider was also reviewed. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We (The Commission) also reviewed all correspondence and regulatory activity since the last inspection. The accumulated evidence for this report comes from the above and also fieldwork that included discussions with 10 residents, 2 relatives, and 6 staff. Practices were observed and documents relating to care, recruitment and health and safety were reviewed. Of the 20 resident surveys sent 14 were returned. All, except one were satisfied with the care they received and said the home is clean and fresh. The one person felt that staff do not provide the agreed care in their preferred way, and that the home is fresh and clean “only on the surface”. Comments from residents were “the staff are friendly and kind”; “very satisfied with the home.” Areas of concern raised were the home is “mostly understaffed”, and “there is a need for more activities and outings”. Of the 20 relatives surveys sent 5 were returned and all felt that their relatives were well cared for by competent staff. Comments from relatives were “the staff are very pleasant and friendly”, “excellent care and consideration”. All relatives felt they were kept up to date with information regarding their relatives’ health and well being. Comments of concern were about the activities saying that an improvement the home could make would be “increased activities within the home”, and “easier wheelchair access to the garden”. Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 6 All residents and relatives spoken with told us that the home was good and the staff very kind. Comments received were “it is very homely and comfortable”; “my relative is happy and settled”; “it’s a good staff team”. What the service does well: What has improved since the last inspection? What they could do better: Residents would benefit from a fully person centred approach to assessment and care planning, which would enable their needs to be met in their preferred way. Care staff would be aware of their psychological and social needs from this approach and activities suitable to their personalities and interests, either individually or in a group, could be provided thus improving the quality of life for residents. Residents would benefit from safer medication storage and handling practices, which would protect them from potential misuse or mishandling of medications. Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 7 A planned activities programme in consultation with residents, and their relatives, would enhance the quality of life for residents and relieve their boredom and feeling of social isolation. The provision of regular training in key areas of care and protection together with supervision would enable residents to feel safer, well protected and cared for by knowledgeable and competent staff. Residents would feel more relaxed and comfortable if the staffing levels were kept under review according to the needs of the home, and there were enough to enable flexibility to routines. The implementation of a robust recruitment system would enable residents, and their relatives, to know that they are well protected from potentially harmful people being employed. Residents would be better protected if health and safety issues were addressed regularly; e.g. radiator temperatures, carpets and areas for slips trips and falls. 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 Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5 (6 Is not applicable) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with basic information about the home that has some inaccuracies, and are offered the opportunity to visit the home prior to admission. The home’s assessment practice is process driven, and not person centred to ensure the home can meet all the needs of prospective residents’ needs. EVIDENCE: The statement of purpose and service user guide supplied to us for inspection, and displayed in the front hall of the home, provides clear information in relation to many of the areas required, from which prospective residents, and their families, can make their choice. Not all the information is correct for example; it states that the Registered Manager is to be confirmed – she has been registered and in post for 15 months. It also states, “all staff go through the Common Induction Standards and training in mandatory areas”. The home does not adhere to this statement rendering the information inaccurate. Staffing files inspected had little evidence of mandatory training, and no Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 10 evidence of Common Induction Standards. Staff spoken with told us they had not received mandatory training in the last year. Newly employed staff spoke of a two day ‘in house’ induction, which is not at the same level as the Common Induction Standards produced by the Skills for Care Council. Two residents who returned surveys report “lack of information since change of management”. A recently admitted resident told us “I came for a visit and it seemed nice”. Also displayed in the hallway of the home for residents’ information is Care and Counsel’s Guide to care homes and a SAGA leaflet about paying for care and how this can be done. There is information about advocacy service displayed on the notice board by the stairs; for residents benefit should they feel in need of these services. Contractual arrangements have some gaps potentially giving rise to anxiety for residents and their relatives regarding payment. All but three of the residents that returned surveys were aware they had a contract of residency. Contracts for all residents were inspected, and all but three had a contractual agreement with the home. The manager did not have any explanation as to why three residents do not have a contractual agreement for their information and security of tenancy. Contracts with Social Services for residents funded by them were seen. Three residents spoken with and one relative were unaware of the contractual arrangements and how they were informed of fee increases. Four care records were inspected in depth and admission assessments reviewed. The home’s assessment documentation gave little meaningful information about the resident’s psychological or social needs, or specific reason for admission. From the documentation it is not clear if an assessment of needs is undertaken prior to admission to ensure the home can meet the prospective residents needs, or following admission. The documentation provides very basic information and does not show a person centered approach to the provision of care. Attention to detail when completing assessment forms would ensure clear information regarding all care needs are identified, to enable staff to provide person centred care. Two recently admitted residents were spoken with and said, “I came for a visit and liked it. The staff were very welcoming and kind”. They were not aware of having had an assessment of needs to see if the home could adequately meet them. One relative spoken with was also unsure about this process. Care practices observed showed that staff had a good rapport with residents and sought to meet their needs. The staff are very welcoming and keen to provide a good standard of care. During the inspection it was evident that staff do not always have the skills and experience to meet the needs of the residents, as they have not received specialist training in caring for people with cognitive impairment. Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be confident that their care plans will contain clear, person centred information to enable staff to meet their health and social care needs, in their preferred way. The system in place for the management of medicines is poor and potentially puts residents’ at risk. Residents’ respect and dignity is not always maintained by kind and caring staff. EVIDENCE: Individual records are kept for each of the residents. Four care records were inspected in depth and residents spoken with. Care plan documentation has the ability to be person centred and provide information for provision of care in this manner. Of the four records inspected none were completed fully, to provide clear information about the individuals physical, mental, psychological and social needs and their preferences for how these could be met using a person centred approach. Two care records did contain a brief social history of the individual and their present psychosocial position, but this information had not been translated into Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 12 the care plan to show the identified needs and how they could be met in the best interests of the resident. In discussion with three staff they were only able to describe the physical needs of the resident. Another care record inspected had conflicting information about the residents swallowing ability, and no plan of action identified to meet that need. Thus the resident may potentially be at risk from staff who lack knowledge regarding her identified needs, and how best to manage and meet them. In discussion with one member of staff she informed me that the resident did not have swallowing difficulties and was surprised to see it recorded in the care plan. The entry read, “enjoys food but may have trouble swallowing”; while the nutritional screening tool states “no problems swallowing”. Different members of staff had completed the documents thus inconsistent information and care is being provided. The individual when spoken with said they did feel it was difficult to swallow at times. Another care plan recorded on the falls risk assessment that the individual has a problem with balance, but there were no actions identified to minimise the risk to the individual on the assessment. There was no other reference to this identified need in the care records or care plan. In discussion with the resident they told us that they had recently had a fall and had to wait some time for a member of staff to come and find them. The resident was not happy with the care provided and indicated that their care needs, and how best to meet them, had not been discussed. In all four care records allergies had been recorded together with key personal, next of kin and other professional details to alert the necessary people in an emergency. Care plan documentation lacked attention to detail potentially putting residents at risk and not assisting in the provision of person centred and consistent care. Risk assessments had been completed but actions to minimise risk had not been stated, again not enabling consistency of care provision. Staff interviewed had an understanding of the residents needs but not always the knowledge to meet these needs effectively. All staff observed have a caring approach and provide care as they see fit for the individual residents. In discussion with three staff it was clear that they do not see the care plans as working documents to enable them to provide good person centred care. Care needs are conveyed by word of mouth and care records are not completed on a daily basis, which does not provide for follow up of identified problems. For example in one care plan an entry reads “fall in night, picked up by paramedics and advised to get X rays due to excess pain”. There were no further entries indicating actions taken, for the comfort and safety of the resident, for a week. Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 13 Care staff interviewed told us that they “only write in the care records if there is anything of note”. The understanding of “of note” varied between different members of staff. This practice is poor and does not provide for safe and consistent care provision for the benefit of residents health and well being. Care practices are affected by lack of information and inconsistency of care with residents needs not being fully met. None of the care plans showed resident or relative involvement. This practice needs to be implemented. Residents spoken with said, “the home is nice and the staff are good”. Care plans are reviewed on a monthly basis according to documentation, but not all updates are recorded on the care plans. All residents were neatly dressed, and attention had been paid to hair and nail care. Detailed conversations with eight of the residents confirmed they felt they received a satisfactory standard of personal care. Two residents said, “ it’s homely” another resident said, “people are very kind, we are well looked after”. Two residents spoke of “rules to be kept” and “routines to be followed”. In discussion with staff they explained that at the beginning of each shift the work is allocate in a task based, not person centred manner. E.g. one to do baths, one to do laundry. Evidence was seen of regular visits by the chiropodist and optician and residents being taken to other appointments as needed. Residents’ comments supported this. Medication storage, receipt and disposal is poorly managed. It is not possible to obtain an audit trail of medication through the home, records are incomplete and medication is not stored in accordance with legal requirements. This potentially puts residents at risk, as there is scope for the mishandling of medicines. Staff were observed administering medicines for which they have not been trained, potentially putting residents at risk through misadministration. Some people living in the home look after some of their own medicines particularly creams, ointments and inhalers, to encourage independence. At present staff administer all the other medicines. A self-medication policy is available. Risk assessment has been used in some instances to make sure that medicines are looked after safely. This should be used for everyone looking after medication themselves. Following a recent incident with one resident there is no evidence to show that a reassessment of their ability to self medicate was undertaken, or a discussion had with the individual regarding their ability and safety. The resident did not recall this being discussed with them or their relatives. We saw lunchtime medicines being given. Records were checked and signed as they were given. This helps to make sure medicines are given safely. Staff have made some handwritten additions to medication records. These have Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 14 been clearly written but must include full dosage instructions for the protection of residents. They should be signed, dated and checked by a second member of staff to reduce the risk of mistakes being made which could lead to medicines being given incorrectly. Records are made of the receipt of the medicines in the Nomad boxes but not of all other medicines. Records must be kept of the receipt of all medicines into the home to allow an audit trail to be followed to check that medicines have been given as prescribed. Since this inspection started staff have taken action to address this for the safety of residents. Records are kept of the medicines disposed of from the home. These need to be improved so that it is clear who has made the record and who has received them for disposal. This is to make sure that all medicines are disposed of safely. The home has a medicine policy and this should be available for staff to make sure that they are all aware of the correct procedures for safe handling of medicines to protect residents. The policy specifically refers to staff receiving training in medication handling. Staff said that no formal medication training had been provided for those involved with handling medicines in the home. This can mean that people’s health is put at risk because staff are not aware of current good practice in this area. Staff said that following the inspectors visit last week training has been arranged for those involved with handling medication. The interactions of the care staff observed mostly demonstrated respect for individuals and their right to privacy. One incident of poor practice was observed when a resident, was being interviewed by a visiting professional at one end of the dining / sitting room instead of being wheeled upstairs to her room. Care staff when spoken with said, “they did not feel they could say anything to the visitor” or insist on this for the residents privacy. The resident when spoken with said she just “did as she was told”. Residents spoken to say, “the staff are kind and treat you well”. All residents spoken with felt that kind and caring staff respected their dignity and privacy. The home does have an Equality and Diversity policy that recognises the cultural and social needs and differences that are present in society. Staff said, “We get on well”. Staff were aware of the social and cultural needs and differences in society, but not always sure of the subtleties of their role in facilitating these needs for residents. Rosewood Lodge DS0000067543.V355722.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents experience limited activities and routines. Residents’ right to choice and control over their lives is respected, and encouraged. Relatives and visitor are always welcomed by friendly staff. EVIDENCE: Many residents commented on the atmosphere of the home. One person described it as nicely informal, and residents’ felt that their visitors are also helped to feel relaxed and at home. When asked about activities and their daily routine two residents said, “we just sit here, it’s very boring”. Another resident told the inspector “we have singing sometimes and occasionally there are outings”. Displayed at the bottom of the main stairs is a programme of activities for the week offering musical movement, table skittles, nails and bingo. Unfortunately this does not seem to be being offered. In the afternoon of one of the inspection days table skittles was being offered, but no other activity was seen during the three days of the inspection. Six residents spoken with said they would like more outings and activities in the home. In the survey feedback Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 16 residents and relatives also asked for this. There were no records of activities provided, or offered and cancelled, and no evidence of staff spending time with residents on a 1:1 basis. In the AQAA we are told, “the workload defines how much time we can allocate to residents”. Several visitors were seen coming and going during the inspection. Relatives spoken with said they could come any time and felt that their relatives were well looked after by friendly staff. All residents said they were satisfied with the food. Fresh fruit and vegetables are used and available for residents. No planned menus were available for inspection, but records of meals provided showed a varied diet. The cook is relatively newly appointed and while has good cooking skills is not trained in the production of a balanced and nutritious diet, to ensure the health and well being of residents with differing nutritional needs. During this key inspection the Environmental Health Officer visited and found the kitchen to be of a good hygiene standard. They told us that the cook has good knowledge and skills in running a kitchen. Records to support food safety practices are not kept and they have recommended this. Choice is not routinely offered but the cook says she is aware of residents’ preferences and choices. On the day of inspection an alternative was provided for residents who did not like the main meal offered. The dining room is homely and tables well presented. New chairs have recently been purchased for the comfort of residents. A number of staff have not received training in Food Hygiene and handling to ensure safe practice for the protection of residents. Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are confident that they are listened to and their requests acted upon. Residents may be at risk of abuse as not all staff have a clear understanding about how to safeguard residents from abuse. EVIDENCE: The home has a complaints procedure that is displayed in the hall and is contained in the service user guide. It contains timescales to inform complainants when they can expect a response. The contact information for CSCI is incorrect and needs updating to ensure residents and their relatives have access to this information, if they feel they need to complain to an independent party. Residents said that the manager and staff are very approachable and they would always raise any niggles with them. One resident who said they had done this, was satisfied with the outcome. Staff and residents spoken to, say the manager is approachable and understanding. One resident said ‘I’ve nothing to complain about, they do their best”. The manager says the home has received no complaints. There is no system arranged for the recording of complaints or niggles to show how residents views are listened to, or how they may have a say in the running of the home. Outcomes of issues raised by residents are not recorded. Residents would benefit from a system that records all issues raised by them and their relatives Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 18 showing how these concerns have been addressed and incorporated into the running and development of the home. In the AQAA the manager returned we are told that improvements have been made in the last 12 months in that “any complaints made i.e. heating not working we contact relevant people to put it right”. This has not been recorded to evidence good practice in the interests of residents. All residents spoken with said they were “happy living at the home”; and that “staff are kind and caring”. The home has a copy of the North Somerset ‘No Secrets’ Guide, and a local policy and procedure available in the home for responding to allegations of abuse. It includes a Whistle blowing policy. In discussion with staff they were all unaware of the abuse policy and could not remember having read the poster displayed at the bottom of the main stairs outlining the steps to take to protect vulnerable people from abuse. Al staff spoken with had little understanding of what abuse is and the different forms it can take. They have not received any formal training regarding Safeguarding Adults and how to whistle blow should the need arise. Staff were unaware of the above policies but were clear that if they saw anything they thought was inappropriate to a resident, they would report it to the manager. Staff must receive training in the safeguarding of adults for the protection of residents. Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 19 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): 19,20,21,22,23,24,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with homely and comfortable surroundings. Health and safety issues are not well managed. The home has suitable equipment to maximise resident independence. Infection control practices do not always protect residents from potential for cross infection. EVIDENCE: Many parts of the home are welcoming and comfortable with homely communal spaces. Residents’ rooms are personalised and comfortable. The lounges are furnished with a variety of suitable and comfortable chairs to suit residents’ needs. In the AQAA we are told that these have recently been replaced for residents comfort. Some areas of carpet in the dining room and on the last three stairs are worn thin and could pose a potential hazard for residents. A maintenance and Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 20 refurbishment plan was not available at the inspection. Outdoor space is accessible and an adequate sitting area is provided for residents’ enjoyment. Residents’ rooms are personalised and comfortable. All rooms are provided with ensuite facilities. The décor, fixtures and fittings are in satisfactory order. The home has grab rails situated at relevant points and a shaft lift that is easily used to assist resident mobility, and aid independence within the home. The home has sufficient bathroom facilities with aids for the benefit of residents. Equipment was clean and well maintained. A number of fire doors were observed wedged open and when wedges removed do not fit flush to the doorframe to provide the necessary seal for the safety of residents. (Further comment about this is made in the management section of the report). Doors to linen cupboards that are marked “Fire door keep locked”, were open and a potential fire hazard. During this Key inspection the Environmental Health Officer visited and found the radiators to be excessively hot and potentially dangerous to residents. No risk assessment were available and radiators are not thermostatically controlled or guarded to protect residents from scald injuries. Although hot water outlets to baths are thermostatically controlled there was no thermometer for checking the temperature of bath water to prevent potential scalding in all bathrooms. A thermometer was seen in one bathroom but no records appear to be kept to monitor the bathwater temperature for the safety of residents. The home was and free from offensive odours throughout. Hand washing facilities in communal areas although available were not satisfactory, with linen towels present that are key ways of spreading infection. Staff told us of a recent infectious outbreak in the home and how it was managed. Satisfactory infection control practices were described for the protection of residents. The laundry facilities were well organised. The home’s infection control policy is out of date and should be reviewed to provide best practice guidance for staff and the protection of residents. Staff interviewed and observed demonstrated good understanding of Infection Control procedures and practices and maintained a clean and hygienic environment. Staff told us that the dishwasher is not used after the evening meal for cleaning crockery and cutlery “as it takes too long” the dishes are washed by hand. This is not in the best interest of the residents in protecting them from the potential spread of infection. Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s staffing levels are sufficient to manage the care needs of residents. Residents are not protected by the recruitment practices of the home. Residents cannot be confident staff are competent to do the job. EVIDENCE: The staffing rotas were inspected to ascertain satisfactory staffing levels throughout the day. Staffing levels have been changed since the last inspection and one of the three morning care staff now undertakes a mixture of care and cleaning duties. Three members of staff told us that with the reduction of a cleaner in the mornings, and at weekends, this puts pressure on staff and some things can be a little rushed. Feedback from the resident surveys told us that resident feel the home is “mostly understaffed” and clean “on the surface only”. In discussion with residents on the day of inspection three thought there were enough staff mostly, while three did not feel that there are enough staff most of the time. Staffing levels on the day of inspection appeared satisfactory with three care staff supported by a cleaner and a cook. The manager was present in a supernumerary capacity. Staffing levels in the afternoons and evening are variable but usually consist of 2 carers with an extra carer coming in to assist with the evening meal preparation and clearing up. Care staff told us that the Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 22 work is task allocated despite having a key worker system, thus person centred care is not provided. Both staff and residents spoken with felt that there are insufficient staff at times to meet residents needs throughout the day. We received feedback that residents feel safer with more mature staff. The manager was aware of this and has recently amended the staffing rota to ensure that senior staff are available at all times. At night there is a waking and a sleeping member of staff. The manager should keep the staffing levels under review against the changing needs of the residents. Staff approached residents with directness, openness and consideration. Each of the resident’s with whom we spoke said, “how nice the staff are”. Staff interviewed said, “the home is a happy place to work, we are like one big family”. Recruitment practices for new staff employed are poor and potentially put residents at risk. Application forms were incomplete and had not been dated or signed. All three files inspected showed the employment to have commenced prior to receipt of a POVA first, or satisfactory Criminal Record Bureau check thus potentially putting residents at risk. Following the inspection the provider has submitted new documentation for the recruitment of staff, which, if accurately completed, looks as though it will provide the necessary safeguards for the protection of residents. All three files did not contain evidence of qualifications obtained. None of the records inspected had evidence of induction or mandatory training, and no supervision records were available. One relatively new member of staff told the inspector that she had received an induction, which covered Fire and Health and Safety issues. It is recommended that staff undertake the Common Induction Standards programme to ensure they have the skills and knowledge to meet residents’ needs and work to the homes Statement of Purpose. The home currently has 33 of staff with an NVQ qualification. Four further staff are undertaking the qualification, but this has not been progressed very far in the last year due to supplier difficulties. Thus only a small number of staff have received appropriate training to ensure they have the skills and knowledge to meet residents needs. Training in the last year has been minimal. Staff have not received annual mandatory training in Fire procedures, Manual Handling, Safeguarding Adults or infection control. There are no records of specialist training received in the last year. Two staff interviewed said they had not received training in the administration of medicines and Food Handling and Hygiene since their Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 23 employment at the home more than a year ago. Staff said they had not received training in specialist areas to meet resident needs. Training must be provided to ensure a competent staff team to meet residents’ needs. The manager informed us after the inspection of planned training to provide staff with some mandatory training updates in the next 2 months. Rosewood Lodge DS0000067543.V355722.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): 31,32,33,35,36,37,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are not safeguarded by robust management structures that ensure the home is run in their best interests. Residents are not clear how their views are incorporated into the running of the home. Residents can be confident that their monies are handled safely by the home. Residents do not always live in a safe environment. EVIDENCE: The manager is qualified for the job, having undertaken a management qualification, and has a number of years experience working in this home. She has been the manager for 15 months and tells us in the AQAA returned that she would “benefit from training and supervision”. She seeks to give leadership, guidance and direction to staff but the information is not always up Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 25 to date, to ensure that staff are knowledgeable and competent to meet residents’ needs. Attention to detail in communication is not evidenced and this affects care practices. Management structures and systems are poor to ensure the safety and smooth running of the home for residents as demonstrated throughout this report. The AQAA returned is brief and gives very little information about the service and there appears to be a lack of understanding of the AQAA and the changed approach to care home inspection, focussing on resident outcomes. Residents feel the manager is approachable, available and seeks to ensure all their needs are met. One resident said she ‘can’t do enough’, ‘she is always helping”. Staff interviewed stated that they felt supported by an approachable manager. Policies and practice guidance are provided in the home but they have not been reviewed and updated in the last three years, thus current good practice is not contained within them to provide clear guidance on best practice for the benefit of resident. They are not signed and are not all tailored to the homes needs, but have information this is not relevant having been obtained from another organisation. The home does have a formal quality assurance system but the results are not collated into a report format, showing how the results of surveys and other responses are incorporated into the running and development of the home. Residents’ pocket monies held by the home were inspected and all three records and monies tallied. Clear records and receipts were present and all entries are supported by two signatures for any transaction, to ensure the safeguarding of all concerned. The manager said supervision for staff is provided through observation and joint working. Records inspected showed no supervision had been undertaken in the last six months to assess staff’s skills and abilities to meet resident needs. The manager told us that she has not provided supervision and is aware that this is a gap in the service provision for the benefit of residents. All staff interviewed said they had not received supervision for six to nine months or more however the manager is approachable and if they complain or raise concerns or issues with her, she responds. Supervision of staff is required to ensure that staff have the skills and knowledge to meet the resident in a competent and safe manner and in accordance with the aims and objectives of the home. Supervision records need to show that supervision is provided regularly and includes discussion regarding care practices and training needs. The home records and stored securely and used in accordance with the Data protection Act 1998. A number of records e.g. the care plans, staff files are Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 26 not accurately maintained and up to date and this affects the effective and efficient running of the business. Clear, accurate and up to date records should be maintained for efficient running of the home and the benefit of residents. A clear management structure needs to be put in place to ensure the smooth running of the home when the manager is not present. Certain incidents relating to the health and welfare of resident’s in the home must be notified to the Commission. There have been three instances in recent months where this has not happened, and the manager was unaware of her responsibly to do this, for the benefit and protection of residents. Records inspected showed regular safety and fire checks are carried out. Certificates of safety checks, servicing of equipment and other required safety inspections were seen showing that all required measures have been taken to maintain a safe environment for the benefit of residents. There are a number of issues relating to the fire safety in the home with at least ten bedrooms doors being ill-fitting fire doors, and a lack of fire training for staff. A number of fire doors throughout the home were wedged open. Staff spoken to confirmed that they had not received regular fire instruction or drills in the last year. The manager said that she had provided fire training, at the last staff meeting. Although this was minuted the content and names of staff were not recorded to evidence this for the safety of residents. The home has a fire risk assessment in place. . Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 27 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 1 2 1 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 1 2 3 3 3 3 3 2 1 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 2 3 2 X 3 1 1 1 Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 28 NO 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 OP1 Regulation 4 Requirement The registered person must provide a clear statement of purpose with full and accurate information for the benefit of prospective residents. The registered person must not provide accommodation to a resident unless an assessment of all needs has been completed, in consultation with the resident or their representative, prior to admission to ensure that the home can meet their needs. Timescale for action 21/02/08 2. OP3 14.1 21/02/08 3. OP7 15 The registered person must 21/02/08 prepare a written plan that details fully how all the resident’s health and welfare needs are to be met, for their safety and quality of life. Care needs must be kept under review and all changes noted with actions to maintain the health and welfare of the residents. The registered person must ensure that all resident or their relatives are consulted and Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 29 involved in reviewing the care plans. 4. OP9 13.2 The registered person must make arrangements for the recording, safekeeping, safe administration and disposal of medicines in the home. This refers to: -Keeping all medicines secure -Keeping records of all medicines received into the home -Keeping accurate records of Controlled Drugs -Providing training for all staff involved with handling medicines to make sure they can carry out this task safely. The registered person must make suitable arrangements to ensure that the home is conducted in a way that respects resident’s privacy and dignity. To provide staff training in the knowledge and skills of safeguarding adults and the best way of reporting any instances. The registered person must ensure that there are adequate hand washing facilities for maintaining good infection control practices within the home. The registered person must ensure that all required information and checks must be undertaken prior to a person commencing employment at the home for the protection of residents An Immediate Requirement was issued. Staff must be provided with the appropriate training for the work DS0000067543.V355722.R01.S.doc 21/02/08 5. OP10 12.4 (a) 21/02/08 6. OP18 13.6 28/02/08 7. OP26 13.3 21/02/08 8. OP29 19.1 Schedule 2 08/01/08 9. OP30 18.1 (c) 28/02/08 Page 30 Rosewood Lodge Version 5.2 they are to perform and to enable them to adequately meet residents needs. 10. OP36 18.2 The registered person must ensure that persons working in the home are appropriately supervised to ensure they have the skills and knowledge to meet residents’ needs. The registered person must give notice to the commission without delay of any of the notifiable instance listed in the regulation for the protection of residents. The registered person must make suitable arrangements for containing fires and ensuring that persons working at the home have suitable training in fire prevention. 21/02/08 11. OP37 37 31/01/08 12. OP38 23.4 31/01/08 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. 2. 3. Refer to Standard OP8 OP12 OP15 Good Practice Recommendations The registered person should ensure that residents experience consultation about decisions in relation the their health and welfare. The registered person should ensure that residents are offered activities regularly and this can be evidenced. The registered person should ensure that clear written records of the management of food are maintained for the safety of residents. The registered person should ensure that the current details of the local CSCI office are included in the complaint procedure fro the benefit of residents. DS0000067543.V355722.R01.S.doc Version 5.2 Page 31 4. OP16 Rosewood Lodge 5. 6. OP19 OP25 The registered person should ensure the refurbishment of identified areas of the home for the benefit of residents. All radiators should be of a low surface heat or controlled in some way to protect residents from potential scald injuries. Staffing levels should be kept under review to ensure there are sufficient staff to meet residents needs. Staff are facilitated and encouraged to complete training to the level of NVQ 2 to ensure they have the necessary skills and knowledge to meet resident’s needs. The development of a robust management system to ensure the home meets its stated purpose for the benefit of residents. 7. 8. OP27 OP28 9. OP31 Rosewood Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Lodge DS0000067543.V355722.R01.S.doc Version 5.2 Page 33 - 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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