Inspection on 03/08/09 for Rosewood Residential Care Home

This inspection was carried out on 3rd August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosewood Residential Care Home 01/12/08

Rosewood Residential Care Home 03/12/07

Rosewood Residential Care Home 23/08/06

Rosewood Residential Care Home 04/10/05

Rosewood Residential Care Home 16/05/05

Rosewood Residential Care Home 20/10/04

Rosewood Residential Care Home 05/04/04

Rosewood Residential Care Home 14/11/03

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Rosewood Residential Care Home Cobham Terrace, Bean Road Greenhithe Kent DA9 9JB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Gary Bartlett     Date: 0 3 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Rosewood Residential Care Home Cobham Terrace, Bean Road Greenhithe Kent DA9 9JB 01322385880 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.charinghealthcare.co.uk Charing Court Investments Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 43 The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - DE Date of last inspection Brief description of the care home Rosewood provides accommodation for up to 43 older people with dementia and there is 24 hour staff cover. The building is a large detached older property with a small garden at the back. The accommodation is on the ground and the first floors. There is a passenger lift between the floors. When full, six of the bedrooms can be shared by two people each. In practice, only three of these rooms are used for shared accomodation. Fifteen bedrooms have a private toilet. There are several lounge/sitting areas. The Service is set back from a residential road and there is a large supermarket a few minutes walk Care Homes for Older People Page 4 of 30 Over 65 0 43 0 1 1 2 2 0 0 8 Brief description of the care home away and Bluewater is a short distance away. Public transport is nearby. Current fees range from £420 to £575 per week. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection was conducted by Gary Bartlett, Inspector, who was in Rosewood on Monday, 3rd August 2009 from 9.30 a.m. until 8.10 pm. During that time the Inspector spoke with some residents, 2 visitors and some staff. Parts of the Home and some records were inspected and care practices observed. We made reference to records made available to us by the local authority through recent Safeguarding meetings. The Care Homes Regulations 2001 and the National Minimum Standards for Care Homes for Older People refer to people who use the service as service users. People living at Rosewood prefer to be referred to as residents. Accordingly this shall be done in the text of this report. The Inspector would like to thank everyone involved for their contribution to the Care Homes for Older People Page 6 of 30 inspection. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Four requirements are made as a result of this inspection. These are in respect of more accurate care planning, better risk assessments, improved staff shift patterns and clearer evidence of staff training. These will better promote residents needs and safety. The inspection also identified areas where some staff members are not adhering to procedures or good practice guidelines. The provider has implemented immediate measures for more robust management of the day to day running of the home and supplied us with an action plan detailing further improvements. This demonstrates a willingness to work with us and a recognition of their responsibilities. The Manager agreed to make it clearer that prospective residents are asked if they have specific needs in respect of spiritual beliefs, culture or sexuality. This information can be very important in getting a complete understanding of prospective residents needs and assessing if the home is able to meet them in the way in which individuals prefer. The Manager said she will ensure all hand written entries on the Medication Record Administration Record (MAR) sheets are double signed to help confirm accuracy and will change storage arrangements so the medicines room is not accessed unnecessarily. The provider has undertaken to ensure the routines and activities of the home are conducted in a way which meets the residents preferences and promotes independence as far as is practicable. Also, to provide appropriate activities for residents at times when the Activities Coordinator is not in attendance. The Manager acknowledges the need to be able to more clearly show the home is acting in the interests of those who are unable to make informed decisions themselves. Care Homes for Older People Page 8 of 30 There should be better prioritisation in making needed improvements to the environment, so as to provide a comfortable and safe environment. The use of shared bedrooms should be reviewed in view of the mental and physical frailty of the residents and their associated behaviours and care needs. Those who share bedrooms are not able to make a positive choice to share with full understanding of the implications. The provider agrees to improve communication with other health care professionals and to include them in future quality assurance processes. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An assessment of peoples health and personal care needs is made before they move into Rosewood. Evidence: The organisation has policies and procedures for their home managers to follow when assessing and admitting a resident to the home. If practical, the Manager visits the prospective resident in their home or hospital to help ensure the necessary information is obtained and that it is up to date and accurate. A pro forma is used to record this information which is used as a basis for the care plan. Whilst the forms seen include facilities for the assessments of personal support, health care needs and social interests, it is not evident the Manager asks prospective residents if they have specific needs in respect of spiritual beliefs, culture or sexuality. The Manager agreed to make it clearer that this is being done as this information can be very important in getting a complete understanding of prospective residents needs and assessing if the home is able to meet them in the way in which individuals prefer. Care Homes for Older People Page 11 of 30 Evidence: Residents families, advocates, and relevant health care professionals are involved in the assessment process. Residents said they or their families had been able to visit Rosewood before moving in. Some relatives who were visiting confirmed this and said staff are very helpful in assisting new residents to settle in. It is important Rosewood has a staff group that has the skills and knowledge needed for them to be able to meet the residents care needs. Although the home offers care to people with dementia, the training records show that some ancillary staff have not had dementia training. These staff are in regular contact with the residents, so they must also be able to understand the residents conditions and how best to promote individuals welfare. Such training may have prevented some instances of poor interaction that were observed. The home does not offer intermediate care. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improved care planning would better promote residents health and welfare. Residents are not always safeguarded by consistent risk assessment processes. Evidence: Each resident has a care plan. It is important that the care plans provide easily accessible information to identify individuals current care needs and are directive so staff know how the needs are to be met. This is especially so, as Rosewood is currently dependant on agency staff to maintain staffing levels. Four care plans were inspected in detail. These and the daily records are not consistently detailed or up to date. Two of the care plans do not have clear up to date and accurate information about the individuals needs and preferences. One of the care plans has not been updated to include a change in the persons health and 2 of the care plans do not show that relevant parties such as relatives and care Managers are being informed of or consulted about incidents or changes. Although the care plans include review dates, it is not always clear who was involved in the review or what changes have been made. Care Homes for Older People Page 13 of 30 Evidence: The minutes of recent Safeguarding meetings record concerns expressed by Care Managers about the lack of clarity in care plans and a failure by the home to consult with them. The minutes also record the view that residents are not always safeguarded by the risk assessments. The risk assessments for falls in all four care plans inspected are not specific to the individuals abilities. In two care plans, the risk assessments have not been reviewed as a result of falls. Two of the residents whose care plans were inspected have been displaying behaviours that could compromise the safety of themselves and others. Accordingly, risk assessments have been written, but these are for daytime hours only. The home must ensure it uses robust processes to minimise risks as far as is practicable. Although the care plans are not consistently completed or updated as required, the permanent staff spoken with have a good understanding of service users needs and their individual preferences. It is also evident that residents have regular access to health care professionals such as District Nurses and GPs. Records show that staff administering medications have been trained and signed off as being competent to do so. Medicines were seen to be given in accordance with good practice guidelines. The Medication Record Administration Record (MAR) sheets inspected had been generally completed appropriately. The Manager undertook to ensure all hand written entries on the Medication Record Administration Record (MAR) sheets are double signed to help confirm accuracy. The medicines room is clean and adequately maintained. The Manager agreed to find an alternative place, other than the medicines room, in which to store continence pads, laundry bags and the sweat trolley. This negated the need to issue Immediate Requirement Notices. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents would benefit from more opportunity to exercise choice and autonomy in their routines of daily living and participation in activities. Evidence: Because of residents mental frailties, it is often difficult to consult them about providing a flexible lifestyle that meets their wishes. Consequently, it is essential for the home to promote close links with relatives, the provision of independent advocacy and provide help with communication skills by staff. Staff say they are aware of the need to plan the routines and activities of the home in a way which meets the choice and wishes of residents. From observation, this is not always done in a way that encourages residents independence and choice. For example, a staff member was seen to give residents their morning drink without consulting them first. The Manager explained that staff know the residents preferences, but this does not acknowledge the need to be flexible and to promote autonomy. It is not always clear that the events recorded in the daily records are reflective of individuals preferences. For example, a resident was seen to be in his pyjamas at 4.30 p.m. which a staff member said this was due to the person liking an early bedtime. The persons care plan did not show this. Nor does the plan show that Care Homes for Older People Page 15 of 30 Evidence: getting up at 5.00 a.m., as written in daily records, is through choice. Since the inspection, we have been told by the home that further staff training and and monitoring of practices will be provided. The home employs an Activities Coordinator who works five days per week, including some weekends, to do small group activities such as games and artwork. She also does individual things with people who do not like to be in groups. The Activities Coordinator was on leave on the day of the inspection and alternative arrangements had not been made. As a result, most residents were seen to be sitting at the dining tables with little to do in the morning. Although two staff members were sitting amongst them writing daily care records, there was very little interaction observed. The situation improved in the afternoon when staff had more time to be with the residents and engage with some of them in card games etc. When we asked some residents about what they do, most were neutral. Three residents were positive but another two were negative, saying things like, I dont do a lot really and I dont know that there is very much for me to do. Accordingly, it is strongly recommended the home looks at providing appropriate activities for residents at times when the Activities Coordinator is not in attendance. There are not currently any residents who have expressed a desire to regularly attend religious services or practices. A senior staff described how they would be supported should they choose to do so. The visitors book records regular visits by families, friends and others. The design of Rosewood provides seating areas within various communal areas where residents can entertain their visitors, in addition to the privacy of their own room. There are currently restrictions on visits by an individual as a result of complaints made by others. Whilst the home may have acted in the interests of the wider group, poor recording does not show it has taken into account the wishes of the resident concerned or liaised with their Care Manager. After lengthy discussion, the Manager acknowledges the need to be able to clearly show the home is acting in the interests of those who are unable to make informed decisions themselves. Residents said they enjoy the meals and have plenty to eat. The Manager stated there are always alternatives and the menus seen are varied. Lunch is taken in a relaxed atmosphere and staff offer assistance in a discreet and sensitive manner. Care Homes for Older People Page 16 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recent developments to the homes safeguarding policies and procedures better protect residents. Evidence: The complaints procedure is readily available to people who use the service. Since the last inspection, this has been made available in a format more easily understood. The Home keeps a record of all complaints received by them, the result of the investigation and how the complaint has been resolved. The homes records show it has not received any complaints in the last twelve months. There have been three recent safeguarding alerts, one of which remains open, in respect of Rosewood. The minutes of recent Safeguarding meetings indicate the local authority has concerns the Manager has not kept them informed of incidents and can not show she has made Protection of Vulnerable Adults (POVA) referrals when necessary. As a result of these concerns, Charing Healthcare has arranged for Safeguarding training for its home managers to take place on 18 August 2009. A new Safeguarding policy has been written and will form part of this training. In the meantime, additional managerial support is being provided at Rosewood. Records seen indicate most of the homes staff have had POVA and safeguarding training earlier this year. Care Homes for Older People Page 17 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst Rosewood provides a generally comfortable home in which to live, more effective monitoring of the environment and prioritising of repairs would improve residents quality of life. Evidence: Rosewood is a large detached, older property. The accommodation within the home is on the ground and first floors which are served by a passenger lift. The home is set back from a residential road. Theres a large supermarket a few minutes walk away and Bluewater shopping centre is a short distance. There is a bus stop near by and a mainline railway station is approximately a half mile away. Externally, the building is generally well maintained. There is a very small garden on different levels. This does not make for easy access by people with mobility difficulties. Part of the garden has been fenced off giving the impression of a corral. The Manager stated she wants to change this and make access to all parts of the garden easier. On the inside, the accommodation is being redecorated and refurbished to make it more homely. Many of the vacant bedrooms have been redecorated and refurbished to a high standard. An occupied bedroom is not so inviting as wall paper is coming away. The Manager is aware of this, saying there has been a problem with damp on the walls, but it is not a recent problem, so would appear to have not regarded it as a Care Homes for Older People Page 18 of 30 Evidence: priority over the empty bedrooms. Residents say they like their bedrooms and those seen are generally well furnished, many with items of residents own furniture. When the home is full, six of the bedrooms can be shared by two people. The Manager said that in practice, only three of these rooms are used for shared accommodation. The use of shared bedrooms should be reviewed in view of the mental and physical frailty of the residents and their associated behaviours and care needs. Those who share bedrooms are not able to make a positive choice to share with full understanding of the implications. Each bedroom has a wash hand basin and fifteen of them also have en-suite facilities comprising a toilet. Staff members say the toilet and bathing facilities are adequate for the current number and needs of residents at the home. The temperature of the hot water was tested by hand at several outlets and found to be safe. It was seen that the staff call system is not accessible from the toilet in bathroom 14. Consequently, a person using the toilet may not be able to easily summon help in an emergency. It could also compromise a residents privacy and dignity by them not being able to summon staff for assistance when they are ready for it. The Manager undertook to have a call point fitted within easy reach of the toilet as soon as possible. The Manager also agreed to have the broken seat attachment points of the toilet in this room repaired or replaced. The last inspection report notes the Managers office looks out over the lounge and this is off-putting for people sitting downstairs because it feels like someone is watching them. In response to this, vertical blinds have been fitted to the office window. The blinds were open at the time of the inspection and the many items left on the widow sill indicate the blinds are rarely closed, if ever. The Manager stated the she likes to keep an eye on things and the blinds are closed when she has meetings in the office to provide more privacy. This is missing the point that the blinds were to be provided for the benefit of people in the lounge by making them feel more comfortable. There are large communal areas in which residents may sit during the day. They may be put off from doing so when the chair cushions are left upright after having been cleaned at night. A large number of residents were seen to remain at the dining room tables between meals. This may be through choice but staff members were not seen to encourage them to sit in other parts of the home. Throughout the day, a radio in Care Homes for Older People Page 19 of 30 Evidence: the dining room is on and tuned to a commercial station playing pop music. It is not evident that residents are asked about their preference or that staff give consideration as to whether this creates a suitable ambience for people with confusion and mental frailties. The Manager said she would address this. The Manager also said she would make sure the strip lights in the two offices and laundry are fitted with the secondary covers they need to help ensure the safety of people in those areas. These deficits, with others listed above, should be picked up by the environmental checks that the Manager states are done regularly. Either the checks are not robust enough or there is not a prioritising of things that clearly need attention. This compromises residents safety and comfort. Since our site visit, we have received an action plan from the provider that includes proposals to address this. Care Homes for Older People Page 20 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment processes are robust so only appropriate people work at the home. It is not evident there are always sufficient, competent staff to meet the needs of residents. Evidence: Residents and their relatives say they like the staff, that they are friendly and helpful. The recruitment and retention of staff is problematic for the home and there is a reliance on the use of agency staff to maintain staffing levels. The home also asks its own staff to work additional hours to maintain adequate staffing levels. The staff roster seen shows that some staff are working long, consecutive shift patterns. This could compromise staff competency through fatigue and thereby put residents at risk. Indeed, if a senior staff member works a long day, they have to do four medication rounds. One senior staff member was scheduled to work three consecutive long days, do a training day and then work another long day. When a staff member telephoned the home to tell them she would not be able to attend work, the Manager asked the senior to change her shifts so she would then have had to work five consecutive long days. We advised the Manager this was not appropriate. The Manager did not demonstrate an awareness that if she knows a staff member is working elsewhere, she should be monitoring the hours the person is working in total to ensure the persons competency. Mr. Osman, the Responsible Individual for the Care Homes for Older People Page 21 of 30 Evidence: home, has since told us that he has implemented measures to try and avoid staff having to work excessive hours. The staff rosters do not indicate a nominated person in charge of some night shifts when a senior is not on duty. This should be done to clarify lines of responsibility. The Home has robust recruitment procedures to make sure only appropriate people work there. To maximise staff recruitment practices the Manager obtains a third reference on new applicants. She strives to obtain references from past care service providers, even if the employment was not the most recent and some years ago. The Manager also liaises with the Immigration and Home Office if there are validity doubts on documents presented by applicants from other countries. This is good practice. New staff are required to undertake an induction programme. The induction books show the programme is based on Skills for Care. The Manager says there is also an induction programme for agency staff to complete on their first shift at the home. These records were not inspected on this occasion. The Manager spoke of ongoing training for staff. Training records are a collection of disparate documents and the training matrix used to give a management overview of staff training needs is not up to date. Consequently it is difficult for the home to present clear evidence that each shift comprises staff with the necessary skills mix to meet residents needs. As recorded earlier in this report, the training records show that some ancillary staff members have not had dementia training. All staff who are in regular contact with the residents must be able to understand the residents conditions to a degree for them to be able to promote their welfare. Such training may have prevented some instances of poor interaction that were observed. Care Homes for Older People Page 22 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recently introduced actions for more effective day to day management of Rosewood better protect the interests of the people living there. Evidence: The Manager was appointed in 2003 and has completed the Registered Managers Award Course. The minutes of recent Safeguarding Meetings record the local authority and Police members in attendance do not have confidence in the manager. In response to this, the provider has implemented an action plan for more robust management of the day to day running of the home. They have also supplied us with an action plan in response to deficits noted during our inspection. This demonstrates a willingness to work with us and recognition of their responsibilities. The improvements include more effective care planning and risk assessments, daily staff supervision, improved communication and clearer lines of accountability, better promotion of peoples choices and further staff training. Had these actions not been taken, the judgment for the management of Rosewood would have been poor. Care Homes for Older People Page 23 of 30 Evidence: Feedback from residents and their relatives indicate there is a good atmosphere at the home. The minutes of recent Safeguarding Meetings note concerns about records of monies held on residents behalf. The organisations action plan includes this. We inspected the records of monies held on behalf of four residents and found them to be satisfactory. The Manager described how head office operates a quality assurance system which elicits views from residents and their relatives. The provider has stated this is to be expanded to include health care professionals and Care Managers. The Staff Communication book contains personal information about residents collectively. This compromises confidentiality. The Manager said she will ensure a more suitable method of passing this information on will be introduced immediately. This negated the need for us to issue an Immediate Requirement notice. The standard of cleanliness in the kitchen and surrounding area is satisfactory. There are records of fire systems checks and fire drills and training and staff spoken with have a sound understanding of emergency procedures. The Manager stated all records of maintenance and safety checks are up to date and that the organisation regularly reviews policies and procedures to ensure they comply with current legislation and good practice advice. These were not inspected on this occasion. Care Homes for Older People Page 24 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 17 The registered person shall maintain records as specified in Schedules 3 and 4 It is a legal requirement for the registered person to keep the service users plan under review. Service users individual plans and records must be up to date, consistent and specific in detail of information required. All service users must have an accurate care plan by the given timescale, if not sooner, which is maintained thereafter. 06/11/2009 2 7 13 The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. 09/10/2009 Care Homes for Older People Page 26 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action It is a legal requirement for the care home to minimise risks as far as is practicable. Risk assessments must be more comprehensive and recorded in response to incidents and changes in service users welfare. Comprehensive risk assessments must be in place by the given timescale, if not sooner, and maintained thereafter. 3 27 18 The registered person shall, 02/10/2009 having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate to the health and welfare of service users. It is a legal requirement to ensure staff at the home are competent. The home must be able to provide evidence that staff are not working long consecutive shift patterns that may compromise staff members competency through fatigue Care Homes for Older People Page 27 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action and thereby put people at risk. This evidence must be received by the Commission by the given timescale. 4 30 18 The registered person shall, 02/10/2009 having regard to the size of the care home, the statement of purpose and numbers and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training. It is a legal responsibility to ensure the home has a staff group with the necessary knowledge and skills to meet service users needs. A detailed training analysis must be made for every staff member that includes training they have undertaken, training courses booked and details of the training providers and any accreditation they may have. A copy of this must be received by the Commission by the given timescale. Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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