Inspection on 20/10/04 for Rosewood Residential Care Home

Care Home For Older PeopleRosewood Residential Care HomeCobham Terrace, Bean Road Greenhithe Kent DA9 9JBUnannounced Inspection20 October 2004 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, DA9 9JB Email address Name of registered provider(s)/company (if applicable) Charing Cross Investments Limited Name of registered manager (if applicable) 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 05.04.04 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 2 320 October 2004 14.00 Lorraine Pumford Judi Clarke X X X Tammy SaxbyID Code105215Name of inspector 4 Name of specialist (e.g. Interpreter/Signer) (if applicable) Name of establishment representative at the time of inspectionRosewood Residential Care HomePage 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspectors Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods & 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: D.1. D.2. D.3. Compliance with Conditions (if 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 Commission for Social Care Inspection (CSCI) 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 CSCI 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 CSCI 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 · 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 38 older people who have been diagnosed with dementia. There is a smaller unit situated on the first floor for more highly dependent service users. At present an extension of 6 bedrooms and additional day space is being created with a view to increasing the occupancy to 43 people. The home has a shaft lift between the ground and first floors. 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 This unannounced inspection took place on 20th October 2004. Two inspectors were in the home for approximately 3 hours, they found that many of the National Minimum Standards had been met or partially met. The inspectors were assisted on this occasion by the head of care, some service users and staff were also spoken with and some records examined. A brief tour of the first floor was undertaken by one inspector. 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 that a copy of the last announced inspection report also be obtained. Choice of Home (Standards 1 ­ 6) Of these 6 standards 2 were met, 2 were partially met, 1 was not inspected and 1 was not applicable. Rosewood does not provide short-term intensive rehabilitation to enable service users to return home. Generally relatives make the initial contact, however when possible service users visit the home prior to admission. There is a pre admission assessment format; some discussion took place in relation to this. Service users are given a trial period of one month, a review is then held. The head of care was able to demonstrate how staff meet service users needs. A copy of the service user contract which details the terms and conditions of residency and the care and services to be provided was seen. The inspectors requested some clarification of who is responsible for the payment of incontinence pads. Health and Personal Care (Standards 7 ­ 11) Of these 5 standards 1 was met and 4 were not inspected. Records seen by the Inspectors indicated that service users wishes in respect of action to be taken following death had been completed in care plans. Staff assisting with the inspection stated that in the event of a service user requiring palliative care, support would be sought from the district nurse and hospice team. Staff stated they had not received specific training in relation to providing care for people who are dying which would clearly benefit service users and staff group. Staff stated that there is no overnight accommodation available to relatives wishing to be with a service user overnight, however the staff endeavour to support and make relatives feel as comfortable as possible. Documentation relating to staff training in administration of medication was unavailable due to current refurbishment and is due to be forwarded to the CSCI. Daily Life and social Activities (Standards 12 ­ 15) Of these 4 standards 2 were met, 1 was partially met and 1 was not inspected. Service users are able to bring in personal possessions from their own homes. Staff stated the visitors room is still not appropriately decorated and furnished for the purpose. Staff stated that there is no restrictions on the visitors to the home however, generally people are asked to avoid mealtimes. An activities co-ordinator is employed five days a week. Complaints and Protection (Standards 16 ­ 18) Of these 3 standards 1was met, 2 were not inspected. Service users names are on the electoral roll. Service users receive support from local government care and finance managers who protect their rights and finances. Environment (Standards 19 ­ 26) None of these 8 standards were inspected, as all were inspected during the announced inspection. Staffing (Standards 27 ­ 30) Rosewood Residential Care Home Page 7 Of these 4 standards 1 was, met 2 were partially met, 1 was not inspected. Issues in relation to the number of care staff are currently being discussed with the CSCI. The staff rota indicates domestic staff finish work early afternoon and that for two weekends no staff had been in the home to undertake cleaning duties, this matter needs to be addressed. Staff have received training in relation to skincare, lifting and handling, continence management, first aid and fire safety. Staff have either attended courses re caring for people with dementia or have dates for future courses. A number of staff have commenced employment since the last inspection, the inspectors spoke with two of those recently employed who had been recruited by an agency outside of the UK, staff stated that they had provided names of referees, details of previous employment and a police check had been undertaken by their country of origin. Management and Administration (Standards 31 ­ 38) Of these 8 standards 5 were met, 1 was partially met and 2 were not inspected. Documentation seen by the inspectors indicated that not all policies and procedures required to be available for inspection could be located, the inspector agreed to send further guidance in relation to this subject. Some relevant policies and procedures were found after a search, attached to the notice board, the inspectors discussed the possibility of collating all the information in a staff handbook, which can be used for easy reference on a day-to-day basis. Staff stated they receive supervision from the person in charge on a regular basis; this covers issues of general practice and future training needs. The head of care stated she would also be responsible for undertaking supervision in the future; the inspectors advised she needs to complete relevant training and obtain a qualification before undertaking this task formally. A sample of service users personal allowance accounts were examined, records tallied with the amount of money being held. At present some service users receive their personal allowance via cheques which are made payable in the first instance to the company, the inspectors drew to the staffs attention regulation 20 of the Care Standards Act 2000. Staff felt that the care team were working well together which over a period of time had improved the atmosphere within the staff group. New members of staff felt they received good support.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. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard Required actions Timescale for action 1 2 OP19 OP26 19.5 26.1 The building complies with Fire safety requirements. Work still being undertaken. The home is kept free of unpleasant odour and staff follow cleaning procedures that maximise infection control. Situation remains the same. Staffing levels comply with The Department of Health Minimum Standards. Not achieved within timescale, current proposal to be agreed on the 3.11.04 30.05.04/ 01.12.04 30.04.04/ 01.12.04 30.06.04/ 01.12.043OP2727.1Action is being taken by the Commission for Social Care Inspection 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 StandardCONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS). Rosewood Residential Care HomeMet (Yes / No) Page 9 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 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. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard * Requirement Timescale for action 1 5. (1) OP2 Clarify who is responsible for purchasing incontinence pads. Where appropriate amend documentation. The registered person should not pay any money into an account that is not in the name of the service user. 30.11.04220. (1)(a)OP3530.01.05RECOMMENDATIONS 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). The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Refer to Good Practice Recommendations Standard * 1 2 OP3 OP37 Needs identified in the assessment are followed up. Policies and procedures are in place pertaining to documentation provided with this report.Rosewood Residential Care HomePage 11 * 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 NO NA YES YES NO NO NA YES NO YES NO YES NO NA NA NA YES NO YES 5 X X NO NO YES YES 22 X 20/10/04 14.15 3Rosewood Residential Care HomePage 13 The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Care homes for older people 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 extras If yes, please state what the extras are: Key findings/Evidence Not inspected.YES Standard met? 0Rosewood 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). 2 Key findings/Evidence Standard met? The inspectors were shown a copy of the service user contract which details the terms and conditions of residency and the care and services to be provided. The inspectors noted the document indicated service users paid for their own incontinence pads, a member of staff assisting with the inspection stated that this was not the case as any continence pads or relevant equipment were provided by the NHS. The inspectors requested this matter be clearly addressed within the contract. Standard 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. 2 Key findings/Evidence Standard met? An assessment of need is completed prior to the service users admission; this includes all points in 3.3 of this standard. In one instance the inspectors observed a box ticked to indicate a persons weight was average, however further examination of records indicated the person, who was admitted to the home last month, had not been weighed since her admission. The inspectors were shown a nutritional assessment, which used a numerical scoring system; there was no Key to indicate if a high or low score was a cause for concern. 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. 3 Key findings/Evidence Standard met? Further examination of records indicated a service user was experiencing difficulties with mealtimes, in this instance there was a guidance to staff on how to manage the situation and a record was being kept indicating the person was regularly weighed. All staff working in the home have received training in relation to caring for people with dementia, staff still completing their induction stated they have received dates for training in relation to this. Standard 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. 3 Key findings/Evidence Standard met? Staff stated generally initial contact with the home is made by service users relatives, some service users have had the opportunity to make a pre- admission visits for themselves, however due to service users diagnosis, coming and going for short periods of time caused further confusion for most individuals. Staff stated that service users were given an initial trial period of a month, a review is then held with the service user and their relatives/advocate and the care manager before the prospective service user is offered a permanent place.Rosewood 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? This standard does not apply to Rosewood.Rosewood 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. 0 Key findings/Evidence Standard met? Not inspected.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. No. of incidents where service users have been taken to Accident and Emergency during last 12 months No. of service users with pressure sores at time of inspection (from information taken from care notes) Key findings/Evidence Not inspected. X X Standard met? 0Rosewood 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. 0 Key findings/Evidence Standard Met? Staff assisting with the inspection stated that all staff responsible for managing medication have received appropriate training from a qualified competent person. On the day of the inspection certificates could not be found due to the current refurbishment programme, staff stated that copies would be faxed to the CSCI in the near future. At time of writing this report these certificates have not arrived therefore this standard has been awarded a rating as not inspected. The lead inspector will liaise with the person in charge following on from this inspection. 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. 0 Key findings/Evidence Standard met? Not inspected.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? Records seen by the Inspectors indicated that service users wishes in respect of action to be taken following death had been completed in care plans. Staff assisting with the inspection stated that in the event of a service user requiring palliative care, support would be sought from the district nurse and hospice team. Staff stated they had not received specific training in relation to providing care for people who are dying which would clearly benefit service users and staff group. Staff stated that there is no overnight accommodation available to relatives wishing to be with a service user overnight, however the staff endeavour to support and make relatives feel as comfortable as possible.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 five days a week from 10am until 3 pm, staff stated that some care staff and the activities co-ordinator had attended a training course relating to appropriate activities for service users with dementia. Discussion took place around ascertaining service users hobbies and interests prior to the service user being admitted, rather than relying on relatives who are asked to complete a life history after admission.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? Staff stated the visitors room was still not appropriately decorated and furnished for the purpose. Staff stated there was no restrictions on visitors to the home, however generally people are asked to avoid mealtimes. Staff stated that some service users attended the local day centre for people with Alzheimers, however at present the group is seeking new premises. Staff stated they do enable service users to spend time in the community by taking residents a to local public house, cafe and shops. 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. 3 Key findings/Evidence Standard met? Staff stated generally service users have support from relatives and friends, however in the event of this not being the case, outside agencies would be contacted to act as an advocate on behalf of any individual requiring additional support. Service users are able to bring in personal possessions from their own homes if they wish. None of the current service user group is able to manage their finances independently; this issue is covered in greater detail in standard 34.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. 0 Key findings/Evidence Standard met? Not inspected.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 CSCI 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. 3 Key findings/Evidence Standard met? Service users names are on the electoral roll. Service users receive support from local government care and finance managers who protect their rights and finances.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 Key findings/Evidence Not inspected. Standard met? YES X 0Rosewood 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. 0 Key findings/Evidence Standard met? Not inspected.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. 0 Key findings/Evidence Standard met? Not inspected.Standard 21 (21.1 ­ 21.8) Toilet, washing and bathing facilities are provided to meet the needs of service users. 0 Key findings/Evidence Standard met? Not inspected.Rosewood Residential Care HomePage 24 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. 0 Key findings/Evidence Standard met? Not inspected.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 YES 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. 0 Key findings/Evidence Standard met? Not inspected.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. 0 Key findings/Evidence Standard met? Not inspected.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. 0 Key findings/Evidence Standard met? Not inspected.Rosewood Residential Care HomePage 27 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 X X X 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 X X X No. staff hours allocated No. staff hours allocated No. of staff hours provided X X X X X XX X X2 Key findings/Evidence Standard met? Issues in relation to the number of care staff are currently being discussed with the CSCI. The staff rota indicated that domestic staff finish work early afternoon and that for two weekends no staff had been in the home to undertake cleaning duties, this matter needs to be addressed.Rosewood Residential Care HomePage 28 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 the 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 Not inspected. X X Standard met? 0Standard 29 (29.1 ­ 29.6) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 3 Key findings/Evidence Standard met? The person in charge of the home on a day-to-day basis is still actively seeking to recruit members of care staff. A number of staff have commenced employment since the last inspection, the inspectors spoke with two of those recently employed who had been recruited by an agency outside of the UK, staff stated they had provided names of referees, details of previous employment and a police check had been undertaken by their country of origin. 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. 3 Key findings/Evidence Standard met? The member of staff assisting with the inspection stated a number of staff were now enrolled on NVQ training courses. New members of staff spoken with stated they had undergone a period of induction prior to working as part of the staff team. Staff stated that during the period of induction they had received training in relation to skincare, lifting and handling, continence management, first aid and fire safety. Members of staff stated they were due to undertake courses relating to the care of people with dementia in the near future. When the inspectors arrived in the home a training session was concluding in the main lounge, this was discussed with the person in charge, the inspectors were concerned that this was an intrusion into the service users space and also not a conducive environment for staff training.Rosewood Residential Care HomePage 29 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. 0 Key findings/Evidence Standard met? Not inspected.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? Staff spoken with felt that the person in charge of the home on a day-to-day basis was approachable. Staff felt the care team were working well together which over a period of time had improved the atmosphere within the staff group. New members of staff felt they received good support. A copy of the Code of Practice published by the General Social Care Council was seen. The inspectors discussed the possibility of each member of staff bein given a copy along with their contract and job description.Rosewood Residential Care HomePage 30 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. 0 Key findings/Evidence Standard met? Not inspected.Standard 34 (34.1 ­ 34.5) Suitable accounting and financial procedures are adopted to demonstrate current financial viability and to ensure there is effective and efficient management of the business. 3 Key findings/Evidence Standard met? A copy of the homes insurance policy was seen. Staff stated that there is a business and financial plan for the establishment; these were not inspected on this occasion.Standard 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 X X X2 Key findings/Evidence Standard met? A sample of service users personal allowance accounts were examined, records tallied with the amount of money being held. Staff stated that a receipt was given to relatives when the money was deposited with the home for safekeeping. From discussion it is apparent that when the person in charge and head of care are not on duty an alternative method of holding money needs to be found. Staff stated at present some service users received their personal allowance via cheques which are made payable in the first instance to the company, the inspectors drew to the staffs attention regulation 20 of the Care Standards Act 2000.Rosewood Residential Care HomePage 31 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. 3 Key findings/Evidence Standard met? All staff spoken with stated that they received supervision from the person in charge on a regular basis, which covers issues of general practice and future training needs. The head of care stated she would also be responsible for undertaking supervision in the future, the inspectors advised she needs to complete relevant training and obtain a qualification before undertaking this task formally. 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. 2 Key findings/Evidence Standard met? Documentation seen by the inspectors indicated that not all policies and procedures required to be available for inspection could be located, the inspectors agreed to send further guidance in relation to this subject. Some relevant policies and procedures were found after a search attached to the notice board, the inspectors discussed the possibility of collating all information in a staff handbook which can be used for easy reference on a day-to-day basis.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 32 PART C(where applicable)COMPLIANCE WITH CONDITIONSCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceRosewood Residential Care HomePage 33 Lead InspectorLorraine PumfordSignatureSecond Inspector Regulation Manager Linda RibbandsSignature SignatureDate26.10.04Rosewood Residential Care HomePage 34 Public reports It should be noted that all CSCI inspection reports are public documents.Rosewood Residential Care HomePage 35 PART DD.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 20th October 2004 and any factual inaccuracies: Please limit your comments to one side of A4 if possibleRosewood Residential Care HomePage 36 Action taken by the CSCI in response to provider comments: Amendments to the report were necessary YESComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection reportYESProvider 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 accurate Note: 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. Please provide the Commission with a written Action Plan by 25/11/04, 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 YES D.2Action plan was received at the point of publicationNOAction 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 planOther: enter details here Rosewood Residential Care HomePage 37 D.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.D.3.1 I, Mr C Osman of Charing Cross Investments Ltd, 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 D.3.2 I, Mr C Osman of Charing Cross Investments Ltd, 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:Print 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 38 Rosewood Residential Care Home / 20 October 2004Commission for Social Care Inspection 33 Greycoat Street London SW1P 2QF Telephone: 020 7979 2000 Fax: 020 7979 2111 National Enquiry Line: 0845 015 0120 www.csci.org.ukS0000023994.V178429.R01© This report may only be used in its entirety. 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