Inspection on 14/11/03 for Rosewood Residential Care Home

Care Home For Older PeopleRosewood Residential Care HomeCobham Terrace, Bean Road Greenhithe Kent DA9 9JBUnannounced Inspection14th November 2003 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment Rosewood Residential Care Home Address Cobham Terrace, Bean Road, Greenhithe, Kent Email Address Name of registered provider(s)/Company (if applicable) Charing Court Investments Name of registered manager (if applicable) Mrs Tracie Alexandra Warren Type of registration Care Home No. of places registered (if applicable) 38 Tel No: 01322 385880 Fax No:Category(ies) of registration, with (number of places) Dementia - over 65 years of age (38) Registration number H060000282 Date First registered 29th July 2002 Was the home registered under the Registered Homes Act 1984 Do additional conditions of registration apply ? Date of last inspectionDate of latest registration certificate 29th July 2002 YES NO 28.5.03 If Yes Refer to Part CRosewood Residential Care HomePage 1 Date of Inspection Visit Time of Inspection Visit Name of Inspector Name of Inspector Name of Inspector 1 2 314th November 2003 10:00 am Lorraine Pumford Ruth Burnham x xID Code105215x xName of Inspector 4 Name of Lay Assessor (if applicable) Lay assessors are members of the public independent of the NCSC. They accompany inspectors on some inspections and bring a different perspective to the inspection process Name of Specialist (e.g. Interpreter/Signer) (if applicable) Name of Establishment Representative at the time of inspectionx xxKathleen Powell unregistered managerRosewood Residential Care HomePage 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspection Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Findings National Minimum Standards For Older People: Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management & Administration Part C: Part D: Part E: E.1. E.2. E.3. Compliance with additional conditions of registration (if applicable) Lay Assessors Summary (where applicable) Providers Response Providers comments Action Plan Providers AgreementRosewood Residential Care HomePage 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the National Care Standards Commission (NCSC), is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000. This document summarises the inspection findings of the NCSC in respect of Rosewood Residential Care Home. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Older People published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the NCSC regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the provider · Recommended good practice · Summary of the findings · Report of the Lay Assessor (where relevant) · Providers response and proposed action plan to address findings This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The report is based on the findings of the specified inspection dates.Rosewood Residential Care HomePage 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. Rosewood provides residential care for up to thirty eight older people. These service users may have significant levels of mental and physical infirmities at admission stage. The home has a shaft lift between the ground and first floors. Day space for service users is divided into two areas a large lounge /diner to the ground floor and a smaller unit on the first floor for more highly dependent people. There is car parking at the side of the premises this has been suspended whilst building work takes place. The home is close to public transport and local facilities.Rosewood Residential Care HomePage 5 PART A SUMMARY OF INSPECTION FINDINGSINSPECTORS SUMMARY (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.)Rosewood Residential Care HomePage 6 Two inspectors on the 14.11.03 undertook this inspection. Although some standards were met, over all a number of areas were found to be in need of improvement. As this report was made following an unannounced visit and may not cover the standards in sufficient depth for the reader to make a judgment about the home, it is recommended a copy of the last announced inspection report be also obtained. The summary contains the record of the inspection to support the reader to obtain a clearer picture of standards in the home. Choice of Home (Standards 1 ­ 6) Of these 6 standards, 5 were inspected during the previous inspection. 1 standard is not applicable to this home. Health and Personal Care (Standards 7 ­ 11) All of these 5 standards were inspected. 2 were met, 1 was partially met, 2 were not met. Where possible service users /advocates have made their views known of action to be taken following death. Some issues arose around the privacy and dignity of service users. Although staff had implemented some of the recommendations from the last inspection, staff have still not received accredited training in relation to medication. Service users receive support from health care professionals as and when required. A number of issues arose in relation to care plans. Daily Life and social Activities (Standards 12 ­ 15) 4 standards were inspected. 1 was met, 3 were partially met. Discussion took place around the dietary requirements of older people. The inspectors requested that steps are taken to ensure that service users and staff on the first floor unit have unlimited access to a drinking water supply. Service users likes and dislikes should be included in their care plan to provide some guidance for staff. Relatives that spoke with the inspector stated they are happy with the care provided. An activity co-orinator is employed on a part time basis. Complaints and Protection (Standards 16 ­ 18) Of these 3 standards 2 were not inspected, 1 was partially met. The person in charge was asked to inform the NCSC of all accidents or incidents that affect the well being of service users. Environment (Standards 19 ­ 26) Of these 8 standards 1 was not inspected, 2 were met ,2 were partially met and 3 were not met. The laundry has facilities to deal with foul linen. The smell of urine pervaded a number of bedrooms. A number of radiators were found to be too hot to touch. The majority of bedroom furnishings do not comply with standard 24.2. A number of beds had stained sheets and pillowcases or had not been made properly. Bedrooms continue to benefit from the on going redecoration programme. Staff stated health care professionals would provide aids and adaptations following assessment. The decommissioning of one bathroom leaves only one staff assisted bath in the home. Foul waste was not being safely stored. Staffing (Standards 27 ­ 30) Of these 4 standards were metRosewood Residential Care HomePage 7 Management and Administration (Standards 31 ­ 38) Of these 8 standards 2 were met,3 were partially met and 3 were not inspected. Staff stated all information stored in relation to service users and staff complies with the Data Protection Act 1998. A programme of formal supervision of the care staff by the person in charge has commenced. Quality assurance mechanisms were not discussed on this occasion, Regulation 26 visits have just commenced. Care staff spoken with felt the change of manager had been beneficial to service users and staff. The person in charge needs to go through the NCSC registered manager process.Rosewood Residential Care HomePage 8 Requirements from last Inspection visit fully actioned? If No please list belowNOSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. No. Regulation Standard Required actions Timescale for action 1 OP9 OP9 Demonstrate that staff responsible for administrating medication are appropriately trained and competent to do so. Medication procedures comply with RPS guidance.The inspectors found that this still had not been addressed. Evidence is provided to the NCSC that the building is safe and fit for the purpose.The inspectors found that this still had not been addressed. References are taken up on all staff employed to work in the home, police checks are undertaken on all staff working in the home.The inspectors found that this still had not been addressed. Staff receive regular training in relation to action to be taken in the event of fire. Records of test to the system are regularly under taken and recorded.The inspectors found that although a fire drill took place on the 21.7.03 the fire log and test to the alarm system were not being recorded. 30.07.032OP19OP1930.07.033OP29OP2930.10.034OP36OP3630.07.03Action is being taken by the National Care Standards Commission to ensure compliance in regard to the above requirements. RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations Standard 1 OP4 Demonstrate that staff have the skills and knowledge to meet the assessed needs of service users. Page 9Rosewood Residential Care Home 2 3 4 5OP7 OP18 OP24 OP26Entries to service users records are comprehensive to enable staff to monitor service users changing needs. Staff receive training in how to protect service users and themselves from harm. Rigorous procedures are in place to ensure that service users always have clean bed linen. Steps are taken to eradicate the smell of urine; adequate number of staff are employed to maintain standards of cleanliness in the home.CONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS).Met (Yes / No)Rosewood Residential Care HomePage 10 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements and recommendations are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report, which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001 and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. No. Regulation Standard * Requirement Timescale for action 1 13(2) 18(1)© OP9 Policies and procedures are in place for the safe administation of medication .Staff receive appropriate trainning. The NCSC are informed in writing of any incident or accident that effects the well being of service users. Provide appropriate furnishings including curtains. Provide adequet numbers of assisted baths,for service users. Ensure service users bed linen is clean at all times. Take steps to minimise the risk of accidents to service users. Keep all areas free from offensive odour. Sound recruitment procedures are in place. Employ adequate number of competent staff 30.12.03237 (1)OP1830.11.033 4 5 6 7 8 916(2)© 23(2)(j) 16(2)(e) 13(4)(a) 16(2)(k) 19(1) 18(1)(a)OP19 OP20 OP24 OP25 OP26 OP29 OP2730.12.03 30.03.04 30.11.03 30.12.03 30.11.03 30.11.03 30.3 .04Rosewood Residential Care HomePage 11 RECOMMENDATIONS Identified below are areas addressed in the main body of the report, which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s) No. Refer to Good Practice Recommendations Standard * 1 OP7 Service users care plans are easily accessible so care staff know the needs of service users and how they are to be met. Appropriate privacy screening is provided in double rooms.Staff ensure service users privacy and dignity is respected at all times. Service users wear their own cloths at all times. Records seen by the inspector did not indicate service users are able to maximise their right to exercise personal autonomy and choice. Staff providing meals are awere of the additional nutrional needs of older people. Service users are provided with the minium standard of furniture and fitings unless the risk assessment states it would be detremental to the service user. All members of staff receive appropriate induction training. A suitably qualified trainer undertakes training of staff.2OP103OP14 OP155OP246OP30* Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. OP10 refers to Standard 10.Rosewood Residential Care HomePage 12 PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct Observation Indirect Observation Sampling · Pre-inspection Questionnaire · Records · Care Plans / Care Pathways · Meals · Activities · Other (Specify) `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting Professionals survey / feedback Tour of Premises Formal Interviews Document reading Additional Inspection Information: Number of Service Users spoken to at time of inspection Number of Relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the Responsible Individual seen CRB check for the Manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total number of care staff employed (excluding managers) Total number of staff with nursing qualifications employed Date of Inspection Time of Inspection Duration Of Inspection (hrs) YES YES NO YES YES YES NO NA YES NO YES NO YES NO NO NO NO YES NO YES 5 X X NA NA YES YES 7 0 14.11.03 10.00 7.00Rosewood Residential Care HomePage 13 The following pages summarise the key findings and evidence from this inspection, together with the NCSC assessment of the extent to which the National Minimum Standards for Care homes for older persons have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No shortfalls) (Minor shortfalls) (Major shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.Rosewood Residential Care HomePage 14 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · · 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.Standard 1 (1.1 ­ 1.3) The registered person produces and makes available to service users an up to date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities and terms and conditions of the home; and provides a service users guide to the home for current and prospective residents. The statement of purpose clearly sets out the physical environmental standards met by a home in relation to standards 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10: a summary of this information appears in the homes service users guide Range of fees charged From (£) X To (£) XAny charges for extrasYES Standard met? 0If yes, please state what the extras are:x Key findings/Evidence Not inspectedRosewood Residential Care HomePage 15 Standard 2 (2.1 ­ 2.2) Each service user is provided with a statement of terms and conditions at the point of moving into the home (or contract if purchasing their care privately). 0 Key findings/Evidence Standard met? Not inspectedStandard 3 (3.1 ­ 3.5) New service users are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. 0 Key findings/Evidence Standard met? Not inspected.Standard 4 (4.1 - 4.4) The registered person is able to demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 0 Key findings/Evidence Standard met? Not inspectedStandard 5 (5.1 ­ 5.3) The registered person ensures that prospective service users are invited to visit the home and to move in on a trial basis, before they and / or their representatives make a decision to stay; unplanned admissions are avoided where possible. 0 Key findings/Evidence Standard met? Not inspectedRosewood Residential Care HomePage 16 Standard 6 (6.1 - 6.5) Where service users are admitted only for intermediate care, dedicated accommodation is provided together with specialised facilities, equipment and staff to deliver short-term intensive rehabilitation and enable service users to return home. 9 Key findings/Evidence Standard met? Not applicableRosewood Residential Care HomePage 17 Health and Personal CareThe intended outcomes for the following set of standards are: · · · · · The service users health, personal and social care needs are set out in an individual plan of care. Service users make decisions about their lives with assistance as needed. Service users, where appropriate, are responsible for their own medication, and are protected by the homes 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.Standard 7 (7.1 ­ 7.6) A service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. 1 Key findings/Evidence Standard met? This standard was addressed during the announced inspection and progress reviewed during this unannounced inspection, the inspectors found entries remained vague. The risk assessment had been updated for a vulnerable service user who had left the house unsupervised. Records indicated safety checks being undertaken by staff were being completed. During the course of conversation with care staff the inspectors ascertained care plans for service users accommodated on the first floor are kept on the ground floor, staff acknowledged this meant they frequently did not get to see the care plans for the people they were caring for. The inspector also ascertained only senior staff are responsible for the daily recording, relying on information staff can remember or have written in a staff communication book. Staff stated they had not received training in completing this task. The person in charge stated these issues would be addressed. Standard 8 (8.1 ­ 8.13) The registered person promotes and maintains service users health and ensures access to health care services to meet assessed needs. Number of incidents where service users have been taken to Accident and Emergency during last 12 months Number of service users with pressure sores at time of inspection (from information taken from care notes)X 00 Key findings/Evidence Standard met? Figures relating to the number of service users admitted to A&E were not available at the time of writing this report.Rosewood Residential Care HomePage 18 Standard 9 (9.1 ­ 9.11) The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. 1 Key findings/Evidence Standard Met? The person in charge stated to date she had been unable to secure any training for staff in relation to the safe handling of medication. A random sample of medication records was examined. The inspector observed since the last inspection, staff had begun to sign and date entries which had been added by hand. One service user had been prescribed Temazepan half of four 10mgm tablet for eight nights. Records seen by the inspectors indicated staff had signed to indicate six doses were given however; the other two doses were not in the box and the record indicated they had not been given. The person in charge was asked to investigate what had happened and to arrange for a regular audit of medication and medication records. Standard 10 (10.1 ­ 10.7) The arrangements for health and personal care ensure that service users privacy and dignity are respected at all times, and with particular regard to: personal care giving, including nursing, bathing, washing, using the toilet or commode, consultation with and examination by health and social care professionals, consultation with legal and financial advisors, maintaining social contacts with relatives and friends, entering bedrooms, toilets and bathrooms, and following death. 2 Key findings/Evidence Standard met? The inspectors observed there are no privacy screens around sinks in double bedrooms. During the course of the inspection the inspectors observed a member of staff walking around the lounge combing female service users hair with the same brush. During the tour of the home the inspectors observed all the bedrooms except one down a corridor were occupied by male service users, the inspectors were concerned the female person was potentially vulnerable as the bedroom is situated furthest from day areas and there is no lock to the bedroom door. Staff stated night staff were based in the immediate area and could monitor movement of service users. The inspector observed the majority of service users clothing is now appropriately named. Net pants were found not to be named these should also be the sole property of a named individual. Standard 11 (11.1 ­ 11.12). Care and comfort are given to service users who are dying, their death is handled with dignity and propriety, and their spiritual needs, rites and functions observed. 3 Key findings/Evidence Standard met? Were possible service users /advocates have made their views known of action to be taken following death.Rosewood Residential Care HomePage 19 Daily Life and Social ActivitiesThe intended outcomes for the following set of standards are: · · · · 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.Standard 12 (12.1 ­ 12.4) The routines of daily living and activities made available are flexible and varied to suit service users expectations, preferences and capacities. 3 Key findings/Evidence Standard met? An activities co-ordinator is employed to work 25 hours per week. The inspector discussed the possibility of the person benefiting from some dementia training. Service users have access to puzzles, dominos and craft activities. Some service users attend the community Alzheimers club.Standard 13 (13.1 ­ 13.6) Service users are able to have visitors at any reasonable time and links with the local community are developed and/or maintained in accordance with service users preferences 2 Key findings/Evidence Standard met? Relatives spoken with stated they are happy with the care service users receive in Rosewood. The room for private conversation is situated on a mezzanine level of the stairs to the first floor. On the day of the inspection this room was dirty, the inspector observed food had been dropped and trodden into the carpet, the room has no natural light and the ceiling extractor was clogged with dust. The room would also benefit from redecoration. Standard 14 (14.1 ­ 14.5) The registered person conducts the home so as to maximise service users capacity to exercise personal autonomy and choice. 2 Key findings/Evidence Standard met? The sample of care plans seen by the inspector did not indicate service users likes and dislikes. Records did not indicate if service users were being encouraged to make decisions for themselves. Staff stated they knew service users preferred choice of dress and appearance. Service users seen by the inspectors were appropriately dressed. It was evident those who wished to had been able to bring in personal items including items of furniture for their bedrooms.Rosewood Residential Care HomePage 20 Standard 15 (15.1 ­ 15.9) The registered person ensures that service users receive a varied, appealing, wholesome and nutritious diet which is suited to individual, assessed and recorded requirements and that meals are taken in a congenial setting and at flexible times. 2 Key findings/Evidence Standard met? One of the inspectors met with the cook on duty. This person has no catering qualifications, and was not aware of the additional nutritional needs of older people, i.e. service users should routinely be provided with full fat milk (unless a doctor states other wise), which helps with skin integrity. Further training and guidance should be sort from documents listed in Appendix 2, Bibliography of the National Minimum Standards for Older People. The person in charge stated snacks are available through out the day and night. In light of service users impaired understanding and communication difficulties some discussion took place around staff promoting snacks rather than waiting for service users to ask. The inspector observed the fifteen service users and staff on the first floor unit do not have access to mains drinking water, a large jug of water was seen (uncovered) on top of the medication cabinet. Staff stated everything they needed was brought up from the kitchen. The inspectors were of the opinion steps should be taken to provide a ready supply of drinking water to the unit. The inspector observed a member of care staff standing over,rather than sitting beside, a service user who needed help with eating. Tea being poured from a catering size teapot by staff had milk already added, this is an out dated institutional practise that detracts from a home like environment.Rosewood Residential Care HomePage 21 Complaints and ProtectionThe intended outcomes for the following set of standards are: · · · 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.Standard 16 (16.1 ­ 16.4) The registered person ensures that there is a simple clear and accessible complaints procedure which includes the stages and time-scales for the process and that complaints are dealt with promptly and effectively. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to NCSC Percentage of complaints responded to within 28 days Key findings/Evidence Not inspected X X X X X X X 0Standard met?Standard 17 (17.1 ­ 17.3) Service users have their legal rights protected, are enabled to exercise their legal rights directly and participate in the civic process if they wish. 0 Key findings/Evidence Standard met?Rosewood Residential Care HomePage 22 Standard 18 (18.1 ­ 18.6) The registered person ensures that service users are safeguarded from physical, financial, or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, inhuman or degrading treatment through deliberate intent, negligence or ignorance, in accordance with written policies. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets No. of staff referred for inclusion on POVA lists YES X2 Key findings/Evidence Standard met? An inspector observed an entry in a service users file which indicated they had been assaulted by another resident, the inspector also observed a resident acting in a threatening manner towards a peer. The person in charge was asked to inform the NCSC in accordance with Regulation 37 of The Care Homes Regulations 2001. Also to advise service users Care Manager so it could be established if a formal review or an Adult Protection planning meeting was necessary.Rosewood Residential Care HomePage 23 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · · 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.Standard 19 (19.1 ­ 19.6) The location and layout of the home is suitable for its stated purpose; it is accessible, safe and well maintained; meets service users individual and collective needs in a comfortable and homely way and has been designed with reference to relevant guidance. 2 Key findings/Evidence Standard met? The first floor unit still has substandard furniture. Windows to the dining room and corridor are still without window dressings.The inspector found the fronts missing of a number of chests of draws, a wardrobe door was also broken . Documentation was given to the inspectors to indicate some items are on order. There is a CCTV system to the front, stairs and corridors in the home. Bedrooms continue to benefit from the on going redecoration programme. Standard 20. (20.1 ­ 20.7) In all newly built homes and first time registrations the home provides sitting, recreational and dining space (referred to collectively as communal space) apart from service users private accommodation and excluding corridors and entrance hall amounting to at least 4.1 sq. metres for each service user. 3 Key findings/Evidence Standard met? Using the pre Care Standards Act 2000 standards Minimum space requirement for approx twenty-three service users on the ground floor and fifteen on the first floor there is adequate space. At the time of writing this report plans for the extension to the side have not been seen.Rosewood Residential Care HomePage 24 Standard 21 (21.1 ­ 21.8) Toilet, washing and bathing facilities are provided to meet the needs of service users. 1 Key findings/Evidence Standard met? During the tour of the home the inspectors observed one assisted bathroom was decommissioned due to refurbishment, two bathrooms are domestic in design and would be unsafe for the majority of frail elderly people to use, leaving one bathroom on the first floor, which has a hoist, for the majority of residents to use. The handyman stated it would be at least another week before completion. Some bedrooms have en-suite w/c and wash hand basins. Standard 22 (22.1 ­ 22.8) The registered person demonstrates that an assessment of the premises and facilities has been made by suitably qualified persons including a qualified occupational therapist, with specialist knowledge of the client groups catered for and provides evidence that the recommended disability equipment has been secured or provided and environmental adaptations made to meet the needs of service users. 3 Key findings/Evidence Standard met? The person in charge stated assessments for aids and adapations would be undertaken by health care proffesionals upon referral by the district nurse or GP.Rosewood Residential Care HomePage 25 Standard 23 (23.1 ­ 23.11) The home provides accommodation for each service user which meets minimum space as prescribed Total number of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1 April 2003) - single bedrooms below 10 sq.m usable space or additional compensatory space Total number of wheelchair users accommodated for in rooms at least 12sq.m Total number of wheelchair users accommodated for in rooms at less than 12sq.m Total number of shared rooms at least 16 sq.m Total number shared rooms less than 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total number of single bedrooms Total number of single rooms with en suite Total number of double rooms Total number of double rooms with en suite Key findings/Evidence Not inspected NO NO NO X X X X Standard met? 0 X XX X X XRosewood Residential Care HomePage 26 Standard 24 (24.1 ­ 24.8) The home provides private accommodation for each service user, which is furnished and equipped to assure comfort and privacy and meets the assessed needs of the service user. 1 Key findings/Evidence Standard met? The inspector observed the majority of bedrooms do not have the minimum furniture or fitting specified in standard 24.2. Service users should be provided with items listed unless their risk assessment states it would be detrimental for the individual to have a specific item. Bedroom doors have not been provided with suitable locks openable from the out side in an emergency. Some bedrooms do not have carpet. Although beds had been made for the day the inspector found a number of beds had stained sheets and pillowcases. In some instances quilts had been pulled over sheets that had not been straightened since the service user had got out of bed. The inspectors observed service users have a cupboard with a lockable facility. Standard 25 (25.1 ­ 25 8) The heating, lighting, water supply and ventilation of service users accommodation meet the relevant environmental health and safety requirements and the needs of individual service users. 2 Key findings/Evidence Standard met? On the day of the inspection all areas of the home were found to heated. A number of radiators were not covered and found to be too hot to touch; the handyman stated some covers had been fitted to corridor radiators. The inspectors asked the person in charge to undertake a risk assessment to prioritise this task as the risk assessment could indicate the bedroom of a service user with mobility difficulties may be a higher priority than a radiator in a corridor. Standard 26 (26.1 ­ 26.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection in accordance with relevant legislation and published professional guidance. 1 Key findings/Evidence Standard met? On the day of the inspection the smell of urine pervaded a number of bedrooms, the inspectors were advised the carpet would be replaced as part of the refurbishment programme. An audit should be undertaken and where necessary carpets effected should be replaced whether the room is due for decoration or not. The laundry is situated in the basement. The person undertaking this task stated the washing machines have a foul waste cycle. Laundry bins and service users laundry baskets were broken and potentially hazardous. The Laundry person stated new ones are on order. A open yellow foul waste sack containing used incontinent pads was found lying on a bathroom floor.Rosewood Residential Care HomePage 27 Rosewood Residential Care HomePage 28 StaffingThe intended outcomes for the following set of standards are: · · · · 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 homes recruitment policy and practices. Staff are trained and competent to do their jobs.Standard 27 (27.1 ­ 27.7) Staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed need of the service users, the size, the layout and purpose of the home, at all times. Number of staff /hours in respect of service user needs based on guidance recommended by Department of Health. Personal Nursing Care No. service users High No. staff hours 0 20 0 needs allocated No. service users Medium needs No. service users Low needs No. of staff hours required No. of full time equivalent first level registered nurses No. of care staff No. of ancillary staff Key findings/Evidence 34 4 746 No. staff hours allocated No. staff hours allocated No. of staff hours provided 612 64 549.45 0 0 00 17 6 Standard met? 1Rosewood Residential Care HomePage 29 On the day of inspection the person in charge stated she held an NVQ1,this level of qualification is insufficent to be in charge of a staff group and of residents of such a high dependency.The staff rota was inspected.This indicated that one person was working seven twelve hour day shifts consecutively. The member of staff stated this was her personal choice, the inspectors expresses concern in relation to a persons ability to provide constistant standards of care under such a demanding work schedule. A person has recently been recruited to undertake a twilight shift in the home during the busy evening shift. Additional staff are employed to undertake cooking, laundry and cleaning. Discussion took place around management /senior cover in the home. The manager stated she was contracted to work a minimum of 40 hrs per week and then provided additional on call cover, this was generally split between herself and the head of care, however if either are on leave the other has to provide continuous cover. The inspectors voiced concern at the amount of pressure this could involve. Alternative ways of providing cover were discussed i.e. the possibility of company managers operating an on call rota to cover a group of homes, managers had quality time away from the home without constant pressure. Using the Department of Health Staffing Formula there is a significant shortfall in staff that needs to be addressed. Standard 28 (28.1 ­ 28.3) A minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) is achieved by 2005, excluding the registered manager and/or care manager, and in care homes providing nursing, excluding those members of care staff who are registered nurses. No. care staff (excluding registered nurses) with NVQ level 2 or equivalent of care staff with NVQ level 2 Key findings/Evidence 3 X Standard met? 0Rosewood Residential Care HomePage 30 Standard 29 (29.1 ­ 29.6) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 1 Key findings/Evidence Standard met? Although previously inspected this standard was reviewed again. The documentation of three members of staff recently employed was examined. Two had been employed via an agency that recruits personnel from outside the UK. Documentation was seen to confirm one person had a midwifery qualification, the CV indicated this person had no experience of caring for older people, the person in charge stated at the interview the applicant stated she had worked with older people, their was no evidence to support this as no record of the interview had been retained. A half completed application form was seen for another person which indicated she had no previous experience, again there was no record of the interview to indicate how the person demonstrated the competence to fulfil the role. The person in charge stated CRB checks had still not been sent off. The inspectors advised the person in charge copies of staff members declaration forms, stating they have committed no offences, should be sent to the NCSC Maidstone until CRB checks have been processed. Letters of good conduct are required for non-UK staff members from their Embassy if they have not been resident long enough to obtain a CRB check. Standard 30 (30.1 ­ 30.4) The registered person ensures that there is a staff training and development programme, which meets the National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 2 Key findings/Evidence Standard met? The person in charge has being preparing a training matrix for staff. A record of staff qualifications had been collated .The person in charge stated copies of certificates were available for inspection. Discussion took place around the need for the company to ensure trainers could validate their competence and certificates issued indicated the competence achieved rather than just a certificate of attendance. The induction format was also seen, this indicated blocks of subjects had been covered and signed of by the person in charge, discussion took place around the need for each competence to be signed of by the member of staff and supervisor at the time achieved, the person in charge was also advised to prioritise the induction programme.Rosewood Residential Care HomePage 31 Management and AdministrationThe intended outcomes for the following set of standards are: · · · · · · · · 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 homes record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected.Standard 31 (31.1 ­ 31.8) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. 2 Key findings/Evidence Standard met? The person appointed in July to run the home has an NVQ 4 qualification in care and management. It is necessary for this person to go through the NCSC fit person process to become the legally registered person in charge of the home on a day-to-day basis.Standard 32 (32.1 ­ 32.7) The registered manager ensures that the management approach of the home creates an open, positive and inclusive atmosphere. 3 Key findings/Evidence Standard met? Care staff spoken with felt the change of manager had been beneficial to service users and staff. Staff voiced the opinion they were aware the home was seen to have not reached a high standard, however felt the person in charge was working to address this positively. Staff stated they felt staff meetings were helpful and productive and the atmosphere was more inclusive.Rosewood Residential Care HomePage 32 Standard 33 (33.1 ­ 33.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. 2 Key findings/Evidence Standard met? The inspectors did not discuss company quality assurance mechanisms on this occasion. The inspectors voiced concern no evidence of monthly visits by a representative of the company to monitor standards in the home have been sent to the NCSC since April 2002.The inspectors were advised the company had recruited a person to monitor quality issues, a copy of a November Home Audit Report was handed to the inspectors. Standard 34 (34.1 ­ 34.5) Suitable accounting and financial procedures are adopted to demonstrate current financial viability and to ensure that there is effective and efficient management of the business. 0 Key findings/Evidence Standard met? Not inspectedStandard 35 (35.1 ­ 35.6) The registered manager ensures that service users control their own money except where they state that they do not wish to or they lack capacity and that safeguards are in place to protect the interests of the service user. Number of service users subject to Power of Attorney processes Number of service users subject to Enduring Power of Attorney processes Number of service users subject to Guardianship Orders Key findings/Evidence Not inspected. Standard met? 0 X X XRosewood Residential Care HomePage 33 Standard 36 (36.1 ­ 36.5) The registered person ensures that the employment policies and procedures adopted by the home and its induction, training and supervision arrangements are put into practice. 2 Key findings/Evidence Standard met? Staff spokenwith stated supervision sessions were commencing .The person in charge stated she was in the process of setting up files for each member of staff and will be meeting individual people to monitor care practise and discuss training and development issues.The inspectors where concerned when asked the person in charge stated she had only received supervision formally on a couple of occasions since commencing in July of this year. Standard 37 (37.1 ­ 37.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 3 Key findings/Evidence Standard met? Staff stated all information stored in relation to service users and staff complies with the Data Protection Act 1998.Standard 38 (38.1 ­ 38.9) The registered manager ensures so far as is reasonably practicable, the health, safety and welfare of service users and staff. 0 Key findings/Evidence Standard met? Not inspected.Rosewood Residential Care HomePage 34 PART C(where applicable)COMPLIANCE WITH CONDITIONSCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceLead Inspector Second Inspector Locality Manager DateLorraine Pumford Ruth Burnham Monica Hanscomb 18th December 2003Signature Signature SignatureRosewood Residential Care HomePage 35 PART D(where applicable)LAY ASSESSORS SUMMARYLay Assessor Date Public reportsSignatureIt should be noted that all NCSC inspection reports are public documents.Rosewood Residential Care HomePage 36 PART EE.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.We would welcome comments on the content of this report relating to the Inspection conducted on 14th November 2003 and any factual inaccuracies: Please limit your comments to one side of A4 if possibleRosewood Residential Care HomePage 37 Action taken by the NCSC in response to provider comments: Amendments to the report were necessary NOComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurateNOYESNote: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. E.2 Please provide the Commission with a written Action Plan by 15th January 2004, which indicates how requirements are to be addressed and stating a clear timescale for completion. This will be kept on file and made available on request. You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required YESAction plan was received at the point of publicationYESAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planYESOther: enter details here Rosewood Residential Care HomePage 38 E.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.E.3.1 I Mrs Tracie Alexandra Warren of Rosewood Residential Care Home confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or E.3.2 I Mrs Tracie Alexandra Warren of Rosewood Residential Care Home am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) for the following reasons: P.I.C. 4/2/04 Kathleen Elizabeth PowellPrint Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.Rosewood Residential Care HomePage 39 - 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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