Inspection on 01/12/08 for Rosewood Residential Care Home

This inspection was carried out on 1st December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosewood Residential Care Home 03/08/09

Rosewood Residential Care Home 03/12/07

Rosewood Residential Care Home 23/08/06

Rosewood Residential Care Home 04/10/05

Rosewood Residential Care Home 16/05/05

Rosewood Residential Care Home 20/10/04

Rosewood Residential Care Home 05/04/04

Rosewood Residential Care Home 14/11/03

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rosewood Residential Care Home Cobham Terrace, Bean Road Greenhithe Kent DA9 9JB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mark Hemmings     Date: 0 1 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Rosewood Residential Care Home Cobham Terrace, Bean Road Greenhithe Kent DA9 9JB 01322385880 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Charing Court Investments Ltd care home 43 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 43 The maximum number of service users who can be accommodated is: 43 The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - DE Date of last inspection Brief description of the care home Up to 43 people can make their home in Rosewood (the Service). Its specially arranged so that people who have difficulties with understanding things and with saying what they want, can be comfortable and safe. The building is a large detached older property. For such a big building it has only a very small garden at the back. What space is there isnt that level. The accommodation is on the ground and the first floors. There is a passenger lift between the floors. When full, six of the bedrooms can be shared by two people each. In practice, only three of these rooms are used as doubles. Each bedroom has a private wash hand basin. Fifteen of them also have a private toilet. Each bedroom has a call point. This means that people can ring for assistance. There is also a television aerial point. There are several lounge/sitting areas and there are enough bathrooms and toilets. The Service is set back a bit from a residential road. Theres a large supermarket a few minutes walk away and Bluewater Care Homes for Older People Page 4 of 33 Brief description of the care home is just down the road. There is a bus stop near by and the train station is about half a mile away. The Registered Provider is a private company. It runs a number of other residential care services in the area. People who want to find out more about the Service and about the fees charged, can speak with the Manager. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this Service is 1 Star. This means that the people who use this Service experience adequate quality outcomes. Since 1 April 2006, we have developed the way we do our inspection of care services. This inspection of the Service was an unannounced Key Inspection. We arrived at the Service at about 9 oclock and were there for about eight hours. It was a thorough look at how well things are going. We took into account detailed information provided by the Registered Provider in its self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since the last inspection. During the inspection, we spoke with the Responsible Individual. He is the sole Director of the company that Care Homes for Older People Page 6 of 33 owns the Service. So he is the most senior person around. We also spoke with one of the Area Managers and with the Manager of the Service. Other people we spoke with include the deputy manager, a senior care worker, two care workers, the cook, the kitchen domestic, the laundry manager and the activities coordinator. We spoke with five of the people who live in the Service and we spent time in the company of others. We walked around parts of the accommodation and we looked at a selection of key records and documents. What the care home does well: What has improved since the last inspection? What they could do better: Quite a lot of the paperwork is complicated and long winded. This might make it difficult for people who live in the Service to fully take part in deciding things that are about themselves. The range of social activities on offer is a bit limited. Some people might like to do new and different things. The complaints procedure is not user friendly. People who live in the Service will find it difficult to unravel. The arrangements used to support agency care workers are not adequate. As a result of this some of these temporary care workers arent quite sure about some bits of what they should be doing. This makes it much more difficult for them to make a full contribution to the work of the staff team. Morale in the Service is quite low. Some security checks for one of the care workers have not been done. This is not safe because we need to be doubly sure that all care workers are trustworthy people. Care Homes for Older People Page 8 of 33 The quality assurance system doesnt really involve the people who live in the Service. This is important because they are the experts on what it is like to live in Rosewood. They need to have a direct say in how things are going. Also, they need to be told what is going to be done to respond to any improvements they may come up with. Some of the improvements recommended in the fire risk assessment have yet to be done. This is important to ensure that the people who live in the Service can continue to enjoy a high level of fire safety protection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 1, 3 and 6. People who are thinking of moving in are asked about what support they need and how they want this to be done. People who want to stay for shorter periods are helped to go back home. Evidence: The Manager asks people who are thinking of moving in about what support they need and want. This is done so that everyone can be confident that moving into Rosewood is the right thing for them. She also talks with family members and with people like care managers (social workers). This is done so that she can build up a really good picture of how the person can best be supported. After she has got all of this information, she can then decide if Rosewood can meet the persons needs for help. We looked at the information that has been collected for one person who has recently Care Homes for Older People Page 11 of 33 Evidence: moved into the Service. We wanted to see what sorts of things were considered. There is lots of useful information. There is stuff about practical things such as the help needed in the bathroom. But there is also other information about quality of life things. Such as how the person needs to have time to themselves so that they dont feel crowded. The Manager says that the information she gets is shared with care workers. This is done so that they know in advance about what support they will need to provide. We asked two care workers about how all of this works out in practice. They say that they are indeed told about people who are about to move in. They say that as a team they discuss how best to help the person in the first few days while they get to know them better. The Manager recognises that moving into a residential care setting is a big step for anyone to take. She says that she wants to do everything possible to put the persons mind at rest. We agree that this is really important. She says that as part of the assessment process people are invited to visit Rosewood so that they can see what the place is like first hand. She says that during these visits people can ask any questions they want. There is also some written documents that say about the Service in quite alot of detail. These are called the Service Users Guide and the Statement of Purpose. People can ask to see these if they want. The Manager is quite happy for them to take away a copy if they want to have a look at them at their leisure. People can stay for shorter periods of time, although this doesnt happen very often. These shorter stays might be because someone who supports them at home, needs some time to themselves. The Manager says that careful attention is given to helping people go back home so that their stays do not last longer than is necessary. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9 and 10. People are provided with the personal and health care they need. Some of the paperwork is complicated and not user friendly. Medicines are handled safely. People are treated with kindness and respect. Evidence: The people who live in the Service say that the care workers offer them all the assistance they need. There is a written individual plan of care for each person. These are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to staff so that they know what to do. We looked at four of these plans. They give a clear account of who needs to do what and why. For example, there is useful information about things such as helping people in the bathroom, about health care and about keeping people safe. In more detail, one person needs to be approached in a certain way so that they arent startled. Another person tends to become anxious. Care Care Homes for Older People Page 13 of 33 Evidence: workers have done sensible things to help. These include using picture cards that are designed to explain whats going and what is going to be done next. We asked three care workers about some of these things. We wanted to know what all of this written information means in practice. Whether its used or not. They know all about it and we saw them using it in practice. For example, they are patient with someone who finds it hard to make sentences. They wait for them to finish what theyve got to say. Then they check out that they have understood them right. The plans are kept up to date so that they are accurate. This involves care workers making daily notes about how things are going. There are then monthly reviews where the Manager checks out whats what and sees if any of the plans need to be altered. All in all, theres a lot of written information. Staff are spending large amounts of time writing things down. This then results in there being lots of complicated looking paperwork to wade through. The Assessment says that the information in written in simple terms. But we think that its written in a management style. As such, its very unlikely that the people who its written about will find it easy to use. Or interesting enough to spend time on. Were not surprised to hear that people dont really bother about it that much. This is a pity because its all about them. The Manager recognises this. She is about to start work on a new way of presenting information. This will use things like pictures, line drawings and photographs to make the information come alive. This stands a much greater chance of engaging people in decisions that are being made about the support they receive. We think that this is a really good idea. She hopes to complete this by 1 July 2009. Sensible steps are taken to ensure that people do not have any avoidable accidents. For example, some people are a bit unsteady on their feet. They are accompanied by a care worker so that they dont loose their balance. People are helped to keep healthy. Care workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Since our last inspection, a number of people have seen their doctors, some on more than one occasion. There have also been visits by other professionals such as district nurses, dieticians and chiropodists. The Manager is active about this and she makes sure that people get the medical attention they need. For example, at the moment she is trying to find specialist advice about how best to help someone who is having problems swallowing. None of the people manage their own medication at the moment. This is because they are not that interested in it or because they are not able to do so. Staff do it for them. There is a system to check that the correct medicines are received from the chemist. Care Homes for Older People Page 14 of 33 Evidence: Once in the Service, they are stored securely. There is a procedure for administering medicines. This is designed to double check that the right medicines are given to the right people at the right time. There is a record that is completed on each occasion that a medicine is given. We examined three sets of these records. They are correctly completed. We looked at two medicines in more detail to see if the remaining stock matches what should be there. Again, we found things to be in order. Since our last inspection, an incident happened when one person took another persons medicine. The Manager quickly sought medical advice. Then care workers kept an eye out to make sure that the person was okay. Since then the Manager has looked into how it all happened. She has taken steps to make it doesnt happen again. We asked a number of people what they think of the care workers. They praise them saying that they are courteous and attentive. One person summarises the general mood when they say the staff are really good, just like family. They have a laugh and a joke like its at home. Care workers are relaxed and informal in how they are. Things are orderly without being too much so. When people want to use the bathroom, they are helped to leave the lounge without drawing attention to themselves. Then they are helped in the bathroom with the door closed so that they can have privacy. People are helped to wear neat and clean clothes so that they can present themselves how they want. They are given their post promptly. Also, they are helped to deal with it if something is difficult for them. People can use the phone if they want. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 14 and 15. There are some interesting things for people to do, but some of them might want to do more. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: There is an activities coordinator. Each weekday she is around to do small group activities such as games and artwork. She also does individual things with people who dont like groups. We looked at the records of who is doing what. Over the course of a week, she is seeing about half of the people who live in the Service. There is also someone who comes in from outside to take larger groups. She was there when we were in the Service. We saw her doing question and answer quizzes with about 10 people. The Service has access to a vehicle and there are trips out now and then. The last one was in November 2008. It involved a trip to a local garden centre and then people had a drive around the area. There is a balance to be struck between people being able to do interesting things and Care Homes for Older People Page 16 of 33 Evidence: not being jollied into doing what they dont really want to do. The Assessment says that the Service does really well in relation to social activities. Were not quite so sure that the balance in Rosewood is right at the moment. We made a point of noting what people were doing when we were there. Most people for most of the time werent doing that much. There was quite a lot of sitting around and not being engaged in things. At one point some people were sitting at a table where some large playing cards had been put out for them. However, there was no member of staff with them. People werent quite sure what to do with the cards. They ended up fiddling about with them in a sort of aimless and lost way. We asked some people about what they do. Most people didnt comment or were neutral. Those who did say something definite werent that positive. For example, one person said, I dont do much now, I sit here and watch. I wouldnt mind going out more. Another person said,its a bit boring really I suppose. All in all, we think that more might need to be done. We have asked the Manager to speak with each person to find out if they would like to do new and different things. She is going to do this by 1 April 2009. We are pleased to note that she is already on with this. Shortly after our visit, the Manager told us that she has asked the activities coordinator to change how she records who has done what activities. This will give a much clearer picture of whats going on for each person. The Manager can then take this into account when she is having a chat with each person about what they might like to do. People are helped to keep in touch with members of their families, if this is necessary and if this is what they want. Family members and friends are welcome to call to the Service at any reasonable time. The Manager keeps in touch with family members so that they know how things are going. For example, if someone is not well or if they are admitted to hospital. The Registered Provider doesnt get involved in handling peoples financial affairs. For example, running bank accounts or signing for things in someones name. Its a good idea not to get involved in this way. This is because it avoids conflicts of interests. These can sometimes lead to complicated misunderstandings about who has the right to do what. Instead, most people get help from members of their family or from the local authority. People say that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant affair. One person summarises the general view when they said, the meals are really good and we always have enough to eat. We have plenty and we have a good cook. There is a choice of dish at each meal time. We looked at the records of the meals provided over a two day period to see if people are actually having different things. They are. We also looked at the variety of meals provided over a period of two or three days. There is reasonable Care Homes for Older People Page 17 of 33 Evidence: balance, the main lunchtime dishes including things like shepherds pie, ocean pie, chicken chasseur, sausages, roast beef and sliced ham. We asked about how early in the day breakfasts are served. We wanted to know that theyre not too early. Care workers say that they start from about 7 oclock in the morning and go on until about 10 oclock. When we were in the dining room we saw several people finishing their breakfasts at about half past nine. Care workers say that people can have drinks and snacks throughout the night. This is because they have access to the kitchen and to anything they need. This is a good idea. Otherwise,it can be a long time for some people between the late evening milky drink and breakfast the next day. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 16 and 18. The complaints procedure is not user friendly. People are safeguarded from being bullied or taken advantage of. Evidence: We asked people about making complaints. No one has felt the need to do this so far. They indicate by their relaxed manner that they will feel quite okay about doing so should there be a need in the future. There is a written complaints procedure. This explains how to go about making a complaint or raising a concern about something. Unfortunately, the procedure is not written in a user friendly way. This mean that most of the people who live in the Service wont really find it that useful. Theres not much point having a procedure about making complaints if people who live in the Service find it hard to understand. The Manager is now going to do a much more user fiendly version. She is going to use pictures and diagrams to say what needs to be said. She is going to do this by 1 March 2009. The Registered Provider has not received any formal complaints since our last inspection visit. We havent either. Its very important that people are confident that they are safe from being taken Care Homes for Older People Page 19 of 33 Evidence: advantage of. For example, that theyre not going to be bullied or pushed around. The Assessment commits the Registered Provider to guarding against this. We asked some care workers about this matter. They know what to look out for. Things that might show that somethings not right. None of them have any concerns about how things are going. The people who live in the Service say and indicate that they feel safe in Rosewood. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 19, 22, 25 and 26. The accommodation in general is homely and comfortable. However, some of the bathrooms and toilets are rather bare. There are some fire safety things that need to be sorted out. There are things to help people get about. Evidence: On the outside, the building is generally well maintained. On the inside, the accommodation including the bedrooms is homely. The decoration, carpets and the furnishings are reasonable. There are one or two areas where plasterwork and doors have been scuffed and look a bit unsightly. This is a pity because it takes away from the overall standard achieved. Theres a very large through-lounge. Its sheer size makes it feel a bit impersonal. Were pleased to hear from the Area Manager that this room is going to be divided into several smaller lounges. Theres a rather unusual set up whereby the Managers office is upstairs and looks out over the lounge. When youre sitting downstairs you can see people moving about in the office above you. Its quite off putting because it feels like someones watching you. The Area Manager says that vertical blinds will now be put up at the window. We think that this is a good idea. The bathrooms and the toilets are clean but rather bare. More could be done to make Care Homes for Older People Page 21 of 33 Evidence: them into welcoming spaces. Things such as pictures and plants might make a real difference. The premises are fitted with an automatic fire detection system. This provides a high level of fire safety protection. It is understood that the Kent Fire and Rescue Service says that the system meets the national standard. The Registered Provider has done something called a fire risk assessment. This means that it has looked around the Service to make sure that there is nothing that might reduce the level of protection in place. We looked at the assessment. It says that several things need attending to. One of them was marked for immediate attention. We had a look to see if it had been done and it hadnt. However, after our visit the matter was quickly put right. The other things are going to be done by 1 March 2009. Its useful for the assessment to be sent to the Kent Fire and Rescue Service. This is so that it can check that what the assessment says is okay. The Manager is going to do this by 1 April 2009. By that time it should be able to tell the fire people that all of the improvements noted above have been seen to. The local Department of Environmental Health inspected the kitchen in April this year. It said that two minor things needed to be put right. The cook says that both of these have since been done. The kitchen is well equipped, clean and well organised. The cook does sensible things to ensure good food hygiene. For example, once food is opened it is covered. Then a date is written on it to make sure that things are not allowed to hang around too long. She regularly checks the fridge and the freezer to make sure that they are cold enough. She also checks the temperatures of certain cooked foods. This is done to make sure that they are properly cooked through. People who need it are helped to get about. There are banister rails in corridors. At key places there are assistance poles. These are fitted to the wall and they are there for people to hold onto for extra support. There is a passenger lift that gives step-free access around the accommodation. Some people need help in the bathroom. For them there is a walk in shower. There is also a bath that has a fixed hoist. This means that someone who has difficulty standing can sit down in special chair. This then mechanically lifts in and out of the bath. Some people also need help in their bedroom. There is a mobile hoist that can be used there. There are also special things that can be used when helping people get into and out of chairs and things to help them change position in bed. We asked people how warm the accommodation is kept. They say that they are always comfortable even during the coldest weather. The radiators are fitted with guards. This has been done so that there is less chance that someone will burn themselves if they fall against them. The accommodation was comfortably warm when we were there. Care Homes for Older People Page 22 of 33 Evidence: The hot water taps are fitted with thermostatic valves. These are designed to reduce the temperature to a level that is not likely to scald someone. We tested a few taps and the temperature seems alright to us. The laundry has a commercial grade washing machine. This has an extra cycle for items that need an especially hot wash. There is also a large dryer. The laundry is organised and clean. We spoke with the laundry manager. She said that each persons clothes are marked so that they dont get given back to the wrong person. This is a sensible and really important thing to do. Everyone has the right to wear only their own clothes. New rules have been brought out to make sure that used water from the washing machine and from the dishwasher doesnt leak back into the main pipework. It looks like the Registered Provider already complies with the rules. However, to double check this the Manager is going to contact the local water supply company. Shes going to do this by 1 April 2009. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 27, 28, 29 and 30. There are enough staff around. However, alot of agency staff are having to be used. There are some shortfalls in the recruitment system. Care workers know what they are doing. Evidence: From early in the morning until later in the evening there are six care workers and one senior care worker on duty. At night time, there are three people on waking duty. During the day there are other staff around. For example, there is the cook and there are housekeepers.We looked at the written roster for a recent period of seven complete days. All of the shifts described to us have been filled. The Manager says that there are seven vacant care worker posts at the moment. This is quite a high number. It was caused when some staff who come from overseas all left together to move onto other employment. The Manager says that its proved very difficult to find replacements because of the local employment market. This means that some shifts are having to be filled by care workers doing overtime or by the use of agency staff. These latter people are care workers who are employed by an agency. They can be sent on request to any one of a number of residential care services. If Care Homes for Older People Page 24 of 33 Evidence: they dont have a proper introduction to somewhere they go to work, they can end up being on duty and not really being too clear about what to do. The Manager says that she has tried to deal with this by using the same agency staff as much as possible. Also, when they have first worked in the Service, she has given them a brief introduction to things. However, these things are not always working as planned. We saw care workers having to spend time explaining things to agency staff. Such as how someone wants to be helped in the bathroom and what to do after that. We looked at how many agency shifts there had been in the seven day period we spoke about earlier. There was a total of 30 separate shifts. This is indeed a lot. The Manager says that she is looking to appoint new permanent care workers as soon as possible. In the meantime, we think that more needs to be done to support agency staff and to enable them to make a full contribution to the work of the staff team. We say more about this in the next section of this report. Its very important that only honest and trustworthy people are employed as care workers. With this in mind, the Registered Provider completes a number of security checks on new care workers. These include things such as confirming their identity and doing a police check. We looked at the records for two care workers who have been appointed since our last inspection. Most of the required checks have been completed. However, for Care Worker A three more references are needed. This is because the rules have been changed about exactly what references have to be got. The Manager is going to get these by 1 February 2009. She is also going to double check that all of the references that are now needed have been obtained for all care workers employed in the last two years. She is going to do this by 1 April 2009. New care workers receive introductory training before they work on their own. We asked two care workers about their introductory training. They say that it was very useful. They say that they were introduced to the people who live in the Service and that they were told about each persons needs for support. The Manager says that after their introduction, care workers are provided with ongoing training. This is designed to develop further their ability to provide a high quality residential care experience. The Assessment says that all staff are fully trained. We looked at some of the records of this extended training provided for care workers. These show that care workers have done various bits of training on relevant things. Such as helping people to move about safely and about keeping people safe. However, there are quite a few gaps. Were not quite sure if its just that the records arent up to date or if the people concerned just havent got round to doing the training concerned. For example, according to the records, eight care workers havent done a course on basic first aid and seven people havent done a course on individual plans of care. Going on the records again, there is no indication that a course on dementia care is Care Homes for Older People Page 25 of 33 Evidence: considered to be a necessary thing for all care workers to do. This is rather odd given the particular needs of the people who live in the Service. All in all, we think that bits of the training arrangements need looking at again. Therefore, we are pleased to note that the Registered Provider hopes to introduce a new system that should sort this out. This will involve looking in an organized way at the skills and knowledge of each care worker. This information will then be used to decide what training courses they might need to do in the future. This assessment is going to be done using a version of a national model of good practice. We think that this is an excellent idea. This is because it will focus on what care workers actually know rather than the courses they have gone along to. And because it will build upon the skills that they actually need and have to use if they are going to be able to successfully support people. The Manager and the Area Manager say that they hope to see this review done by 1 July 2009. We think that this is a reasonable timescale given the amount of work it will involve. We are also pleased to hear from the Area Manager that a number of relevant training courses have been held since our visit. These include first aid, how to support people who have reduced mobility and how to keep people safe. A further course on how to support people who have dementia is planned for February 2009. There is a total of 18 care workers. Of this number, seven have completed a National Vocational Qualification (NVQ) at Level 2 or 3 in health and personal care. Four more are on with doing it. Two care workers are doing a special qualification that is designed for working with people who have difficulty understanding things and who have problems expressing themselves. All of these qualifications are a very good idea. This is because they help care workers to deliver high quality residential care services. We spoke with three care workers to find out about their knowledge and skills. They know a lot about how each of the people who use the Service like to be supported. They also know about important points of detail. For example, they know about helping older people to take care of their skin and about the important contribution good hygiene makes to health and safety. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 31, 33, 35, 36 and 38. Things are generally well managed. However, more needs to be done to support agency staff. People are asked what they think, but this needs to be a bit more organised. People are helped to buy what they want. There are sensible health and safety things. Evidence: The Manager runs things on a day to day basis. She knows whats going on. She has both of the formal qualifications we ask for. This is important because these qualifications are designed to support managers in reliably providing good quality residential care services. Recently, the Registered Provider has appointed two new Area Managers. They are still working out who is going to be doing what. However, we are pleased to note that one Care Homes for Older People Page 27 of 33 Evidence: or other of them will have a direct presence in the Service. This is so that they can support the Manager by introducing a number of systems that will be used across all of the Registered Providers services. For example, the skills review thing that we spoke about above. The care workers say that there is good team work between them. However, everyone accepts that morale in the Service lately has been quite seriously dented. This has been down to people working lots of overtime. Also, there has been the unsettling effect of lots of agency people being around and sometimes having to be shown while on the job what to do. This latter problem now needs to be addressed. All agency staff should have a proper introduction to the Service before they begin work. This should include being told about the main support needs of the people who live in the Service. Also, they should be told about how work is allocated in the team. This is so that they have a good understanding of what they are expected to do. There is a Requirement about this at the end of this Report. Since our visit to the Service, the Area Manager has told us that she has begun preparing a new introductory pack that all agency staff will see before they begin work. This pack will contain information that will help them to understand what their duties are and how they should go about them. There are handover meetings at the beginning and end of each shift. These are held so that care workers can be kept up to date with developments. There are team meetings every now and then. We looked at the records of the last one that was held in September this year. Lots of useful things were discussed. For example, the importance of putting peoples clothes away carefully so that they dont get creased. Its really important that the people who live in the Service have their say on how things are going. After all, theyre the experts because they live there. There also needs to be a system for getting what staff think. This is because they know in detail how things work in practice rather than in theory. At the moment, most of the Registered Providers efforts are focused on finding out what relatives think. They are sent a questionnaire each year and then the results are used to do a quality report. A copy of this is available in the Service. We looked at it in some detail. In general, the relatives in question are saying positive things about the Service. For example, everyone says that staff are helpful, that staff get on well with people who live in the Service and that people eat well. One relative says, Very good and (the) resident is happy and well. We are pleased with the care received. Another says, I have no complaints and neither does the resident. I am glad that the resident has settled in and I have peace of mind that s/he is receiving the very best care. However, other people have some reservations. For example, one says, I would like to see the able residents sitting in the fresh air more. Exercise should be done at least once a week to stop residents from getting stiff and sitting all day. Another says, I feel that Care Homes for Older People Page 28 of 33 Evidence: Rosewood is understaffed particularly at meal times. There is a newsletter sent out to the relatives. This is a good idea. It summarises what people have said in their questionnaires and it says what is going to be done about suggested improvements. All of this sort of thing is useful, but its not quite what we mean when we talk about quality assurance. In the case of Rosewood, we mean having a system that uses a number of imaginative things to give everyone who lives there the chance to say what they think about their home. It also means having a way to tell people what is going to be done to introduce any improvements that may have been suggested. There has already been some progress towards this in that the Manager has asked people who live in the Service what they think of the catering arrangemets. The Manager and the Area Manager say that they will look into this general subject so that the quality assurance system can be extended in the way needed. This will also include steps being taken to ask members of staff to contribute their experiences of what it is like to work in the Service. This is going to be done in time for us to be told about the results of all these when the Registered Provider sends us its next Annual Quality Assurance Assessment in 2009. The Manager and the care workers help people to manage their personal spending monies. They have been asked to do this so that money doesnt get lost and so that each person has enough to buy the things that they want. The system involves staff holding small amounts of money for people and then using it to buy things for them. For example, paying for toiletries or paying for someone to see the visiting hairstylist. The system needs to be clear and well recorded to show that everything is above board. We looked at the records for one person. These show that reasonable things have been paid for such as the person seeing the chiropodist. The individual amounts spent add up and the paper balance tallies with the cash balance. Everything seems to be okay. Regular checks are completed to ensure that the Services fire safety equipment remains in good working order. This includes a weekly test of the fire alarm bells. More detailed checks are completed every now and then by an engineer. There are regular fire drills. There is also an annual fire safety lecture when staff are shown again what to do if the alarms go off. This is very important. This is because the level of protection provided in the Service largely depends upon staff doing the right thing. Because of this, the training will now need to be provided more frequently. The Manager is going to make the necessary arrangements. The new system will involve double checking every six months that each member of staff knows what to do. This is going to be done by 1 February 2009. The first members of staff to go through this new system Care Homes for Older People Page 29 of 33 Evidence: will be the two people who missed the last annual training session. There are up to date reports from engineers about the gas appliances, the electrical wiring, the hoists and the lift. These say that they are safe to use. We looked at the record of accidents that have occurred in the Service since the last inspection. There have been quite alot. But most have been minor bumps and bruises. The Manager and the Area Manager keep an eye on who has had an accident and what happened. This is done so that they can do something if there is a particular problem that causing the accidents. We dont think that theres anything obvious that needs to be sorted out at the moment. Each month the Manager sends a written report to the Registered Provider about things that she thinks need to be done. For example, stuff about repairs and issues that will need to be sorted out in the foreseeable future. We looked at the most recent report. Its very detailed. The information there is relevant. For example, the Manager draws attention to the fact that the health authority wont be supplying specialist mattresses in the future. These are used by people who are prone to developing sore skin. She rightly says that alternative arrangements to supply these items will need to be made in good time. The reports have a system of colouring overdue matters in red. Were a bit concerned to see quite alot of red in the report. Were wondering if there are some communication problems between the Service and the Registered Providers head office where the reports are sent to. The Area Manager says that in future things will get done without too much delay and without the need for any more red ink. The handyman checks the premises each week. Hes looking for things that arent working right and for things that might cause someone to have an accident. The records show that he checks out down-to- earth things. For example are light shades clean, are electrical fuses blowing all the time, are bannister rails secure and are tumble drier vents clear. The Manager says that there are no obvious hazards around the premises. We didnt notice any. Care Homes for Older People Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 31 18 The Registered Provider 01/04/2009 must ensure that suitable arrangements are in place to ensure that agency care workers have a proper introduction to the Service before they start work. This is necessary to enable agency care workers to make a full contribution to supporting the people who live in the Service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 33 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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