Inspection on 03/12/07 for Rosewood Residential Care Home

This inspection was carried out on 3rd December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Rosewood Residential Care Home 03/08/09

Rosewood Residential Care Home 01/12/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Rosewood Residential Care Home Cobham Terrace, Bean Road Greenhithe Kent DA9 9JB Lead Inspector Elizabeth Baker Key Unannounced Inspection 3 December 2007 09:50 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosewood Residential Care Home Address Cobham Terrace, Bean Road Greenhithe Kent DA9 9JB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01322 385880 01322 385975 kathy@charinghealthcare.co.uk www.charinghealthcare.co.uk Charing Cross Investments Limited Mrs Kathleen Powell Care Home 43 Category(ies) of Dementia - over 65 years of age (43) registration, with number of places Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only (PC) to service users of the following gender: Either Whose primary needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - over 65 years of age - (MD(E)) - maximum number of places 1 Old age, not falling within any other category - (OP) maximum number of places 29 The maximum number of service users to be accommodated is 30. 2. Date of last inspection 23rd August 2006 Brief Description of the Service: Rosewood provides residential care for up to 43 older people who have been diagnosed with dementia. There is a smaller unit situated on the first floor for more highly dependent service users. An extension of six bedrooms and additional day space has recently been completed and registered. The home has a shaft lift between the ground and first floors. The home is situated in a residential area of Greenhithe. The Bluewater Shopping Complex is approximately half a mile away. The home is close to public transport and local facilities. The current fee levels range from £410.82 to £581.17 per week depending on type of room, level of care and sponsoring arrangements. Additional charges are payable for hairdressing, barber, chiropody, newspapers and toiletries. Current activities include helping in the garden, board games, gentle exercise, darts, bingo, DVD films by choice, word searches, and puzzles. External entertainers visit the home and arrangements are made for trips out to shopping centres, theatres, the coast and parks. The latest edition of the home’s inspection report is available on request at the home. Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key unannounced visit to the home for the inspection period 2007/08. Link inspector Elizabeth Baker carried out the visit on 3 December 2007. The visited lasted almost eight hours. As well as briefly touring the premises, the visit consisted of talking with some residents and staff. Two residents, one visitor and one member of staff were interviewed in private. Verbal feedback of the visit was provided to the manager during and at the end of the visit. At the time of compiling the report, in support of the visit, the Commission received survey forms about the service from 16 residents, two care managers, six relatives/advocates and five members of staff. At the Commission’s request the manager completed and returned on time the home’s first Annual Quality Assurance Assessment (AQAA). The Commission has received three complaints about the service. Two were investigated under the county’s multi-agency adult protection route and the other was investigated under the provider’s own complaints procedure. The Commission is also aware of an ongoing adult protection investigation. Some of the information gathered from above sources has been incorporated into the report. At the time of the visit 42 residents requiring personal care were residing at the home and one resident was in hospital. What the service does well: Despite having to deal with an unexpected incident resulting in a reduction in staff and changes to the day’s normal routines, staff interacted with residents in a calm and reassuring manner. To maximise staff recruitment practices the manager obtains a third reference on new applicants; liaises with the Immigration and Home Office if there are validity doubts on documents presented by overseas workers and strives to obtain references from past care service providers even if the employment was not the most recent and some years ago. The manager is keen to ensure the home complies with all standards and requirements and was receptive to advice given throughout and at the end of the visit. Additional comments from survey respondents included the service does well by “communicating, being the clients advocate, listens to clients, relatives and agencies, treats clients as individuals and works well as a team”; and “I think it is first class in all respects”; Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a site visit to this service. All residents are treated equally in that they are all provided with a contract setting out the terms, conditions and responsibilities of staying at the home. Reviewing and enhancing the Statement of Purpose and Service User Guide would provide prospective residents and their advocates with more information from which to make an informed choice about the home’s suitability. EVIDENCE: The home has a statement of purpose and service user guide. These are intended to inform prospective residents and or their advocates of the type of care, services and facilities provided at the home. The information generally follows the Commission’s guidance to providers for the composition of such documents. However details of the home’s actual bedroom accommodation does not comply because the precise bedroom sizes are not recorded. Adding details of the home’s toileting and bathing facilities may further enhance the document. This is because some of the current facilities may not be wholly suitable for all residents requiring assistance with this need. A comment card Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 9 respondent indicated it would be beneficial to know whether care staff have the right skills and experience to look after people properly as are placing the care of relative in their hands. The statement of purpose refers to staff skills. Sadly the information is not always getting through to those who would like to know. For equality purposes the home provides all residents with a contract setting out the terms and conditions of staying at the home. This is good practice. The manager generally visits prospective residents in their current place of occupation to determine whether the home is suitable to meet their assessed needs. Not all prospective residents are able to visit the home prior to admission. Where this is the case, their relatives or advocates do so on their behalf. Information is also sought from other agencies, where a sponsor is involved in the placement. Advocates are invited to personalise the new resident’s room with individual items to help minimise any anxieties the new resident may have. The home is not registered for intermediate care. Standard 6 is not applicable. Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Residents who use the service experience adequate outcomes. This judgement has been made using a range of evidence including a site visit to this service. However, despite the amount of available information contained in the care records, it can be difficult to establish the actual care required and that delivered in a coherent way, which may potentially place residents at risk. EVIDENCE: Care records of three residents were inspected. Records contained a care plan and a range of supporting risk assessments, including skin integrity, falls, nutrition, mental health and smoking. Care plans are reviewed monthly. It is the home’s practice to re-write the care plans totally every six months. Relatives and their advocates are invited to be involved in the care reviews. However a comment card respondent indicated this was not their experience and commented they would like regular meetings to discuss the welfare of their relative without having to always ask. Daily reports are maintained and generally provided a mix of statements. Body maps are used to record injuries suffered by residents. One was in place for a resident who had recently sustained a facial injury. Care records referred to contact with GPs, district nurses and chiropodists. Palliative care support is obtained from the Ellenor Nurses when there is an assessed need. The manager has been in long Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 11 running discussions with the Continence Advisor in order to obtain the best outcome for a particular resident. A fluid balance sheet was seen in a particular record. However although it recorded details of the input, there were no details of the output. Weights are regularly checked. However the current records could make it difficult in obtaining a quick review of weight changes being obtained. A number of risk assessments had not been signed as required by the form. This included smoking and disorientation. A completed inventory scheduled was not signed or dated. To assist care staff in writing and recording care plans, a care plan summary has been produced. The care plan components generally follow the activities for daily living model. References to certain problems are sometimes recorded in several sections, as opposed to having a specific section, which prevents the reader obtaining a quick and complete picture. For example it was difficult to determine how a resident’s emotional needs were being meet because there was no specific plan. As part of the ongoing AP investigation, investigators have identified care records did not always provide full information about residents’ health condition. This includes a resident at high risk of neuropathic ulcers whose toenail was observed protruding through her slipper and damage on whose foot was not recorded. And for another resident specific care plans for diabetes and swallowing difficulties were not available. Whilst acknowledging Rosewood is not a nursing home, residents’ dependencies are now generally greater and the home must ensure that appropriate care records are available to all care staff to reflect all identified problems, as well as demonstrating how the care is being delivered. The home has a clinical room in which medicines and District Nurses’ notes are stored. However on the day of the visit the room was cluttered with a number of full black sacks, a resident’s pouffe and two suitcases. A dining room chair, awaiting repair had also been put into this room. The situation could preclude effective cleaning of a clinical environment. It was also noted that the door to the room is not lockable when not in use. Medicine Administration Record charts seen were generally kept to a standard required. However where a handwritten change to a prescriber’s direction had been made it could not be identified who made the change and on whose authority. Pain assessment charts are kept to monitor the effectiveness of treatment plans, including details of the actual amounts of variable dose medication administered. It has not been the home’s practice to date containers of limited life preparations such as eye drops on opening. Doing so helps to minimise potential errors of using the preparation contrary to the manufacturer’s instructions. It was also identified on this visit that the home does not have a copy of the Royal Pharmaceutical Society of Great Britain guidelines The Handling of Medicines in Social Care (2007). The home should be able to access a copy by calling 020 Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 12 7572 2409. This document provides managers with additional information on the storage and administration of medicines. Information in respect of death and dying is recorded. This currently contains practical information such as undertakers and contacts. The manager is aware of the importance of also obtaining and recording spiritual and cultural needs and preferences of residents. To assist in this, training is being sought from the local palliative care team. Residents were appropriately dressed for the time of day and season and to the level of detail where this is important to them. Staff were seen interacting with residents in a calm and re-assuring way. This was particularly important given the unexpected activities going on at the home at the time of the visit. Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a site visit to this service. Although the home has a range of activities and accesses transport for external trips, some residents may not experience what they really want or desire. EVIDENCE: The home offers a range of activities for residents to take part in if that is their wish. The AQAA records that current internal activities include helping in the garden, board games, gentle exercise, darts, bingo, films by choice, word searches, and puzzles. Information provided at the visit indicates external trips having been made or are about to take place to the Bluewater Shopping Complex, cafes and the Orchard Theatre in Dartford, Herne Bay, Howletts Zoo and parks. External entertainers visit the home for sing-a-longs and accordion playing. Although the home has a designated activities co-ordinator, care staff are encouraged to sit and spend time with residents for chats or help with reading newspapers. Residents are supported in going shopping for new clothes and a trip to a shoe shop in Welling has been arranged for two particular residents requiring special fittings. Despite this one resident indicated they would like more physical activities and a comment card respondent added they would like their relative to be included in outings more. Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 14 Bedrooms seen had been individualised with personal effects. Other than exceptional circumstances, the home has an open visiting policy and relatives are generally appreciative of this. Although regular religious services do not take place at the home, some residents are supported in receiving spiritual input from a Catholic Priest. Religious lay people of various denominations also visit particular residents. Saying Grace before meals is important to one particular resident and staff assist the resident to do this. Dining room areas are available for residents to take their meals if that is their wish. Comments received about the meals included “meals are lovely – no complaints” and “food is OK”. Currently details of the main lunchtime meal are displayed on a notice board in the dining room. The manager is in the midst of devising pictorial menus, which should offer better assistance for residents when choosing their meals. A selection of sandwiches is available throughout the night for those residents who may choose to have something to eat at this time. Toast, cakes and hot drinks would also be available. Residents are regularly weighed and special diets are catered for. The Commission’s publications - Highlight of the day? – improving meals for older people in care homes (March 2006) and Real Voices, Real Choice – the qualified people expect from care services (March 2006) which are available from the Commission’s website may prove useful to the home when reviewing future menus and activities. Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a site visit to this service. Generally residents and advocates know how to make a complaint and are assured their concerns will be dealt with. EVIDENCE: A complaints notice is displayed in the entrance hallway and a copy was seen in the care records inspected. This is good practice. However the notice does not actually provide the reader with the telephone number of the Commission or the contact address of the provider, should a complainant wish to make contact via either of these routes. The manager raises concerns with health and social care agencies and other professionals on behalf of residents when she feels there is a need to. Residents spoken with indicated they knew what to do if they had a concern. The home maintains a record of formal complaints. Complainants are provided with a response of the investigation. However it has not been the home’s practice to record centrally details of all “informal” complaints and or “niggles”. Having such a system may provide the home with a more effective way of auditing trends for quality assurance purposes. The county’s adult protection procedures are available for staff reference purposes. The training matrix indicates that some staff received adult protection training during 2007. Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 25 and 26. Residents who use the service experience adequate outcomes. This judgement has been made using a range of evidence including a site visit to this service. Further improvements to the environment will enhance all residents’ quality of life. Cleaning practices and cover need to be reviewed to ensure residents are not subjected to any potential cross infection risks. . EVIDENCE: An environmental inspection of the home’s kitchen and some associated records was carried out in June 2007. This resulted in a positive report and some recommendations being made. The manager said the work has since been done. As is required under the Regulatory Reform (Fire Safety) Order 2005, a fire safety audit of the home was carried out. The manager reported that the resultant assessment was satisfactory for this purpose. Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 17 Although the home does not have large gardens for residents to walk around, there is a large, secluded patio area, which is easily accessible from the ground floor lounge area. With the passage of time and continuous wear and tear the decorative state of parts of the home is now looking tired. Numerous doors and doorframes are contact damaged by wheelchair or other mobility aids, giving the home an institutional feel. Carpets in the ground floor day room and corridors are worn. On the surface the home appeared clean throughout. However the level of detail of cleaning in some areas was not as good. This included wall/floor junctions in some WCs and bathrooms and a dirty grab rail in a particular toilet. Many armchairs were seen with dirty backs and arms. Discounting the extra items being stored in the laundry due to the unexpected incident, the room was in a poor decorative state, which precludes effective cleaning. Soap and paper towel dispensers were not available in a particular bathroom and toilet. The manager said these had not been installed to minimise potential hazards to a client occupying a nearby bedroom, but that an alternative solution had been acquired. The home has a range of toilets, bathrooms and shower rooms. Grab rails and other pieces of support are provided to assist residents with their personal hygiene needs when using these facilities. However because of the confinements of some of the rooms, not all toilets are suitable for residents requiring assistance. Indeed one resident recently suffered an injury when their head came into contact with the toilet roll holder. A comment card respondent added in their opinion the care home could improve by having wider doorways. One assisted bathroom was out of use because the assisted device had been removed in preparation of the replacement being installed. However the situation left the floor in a condition, which prevented effective cleaning. The bath panel in this room was not properly secured, potentially placing residents and staff at risk. Not all bathrooms and WCs are fitted with locks for residents to maximise privacy to residents. And a toilet door handle was broken, preventing it being effectively shut when in use. On arrival the home was noted to be warm. However during the visit to the first floor lounge the temperature was notably cooler and uncomfortable. Indeed a resident remarked “its cold in here”. It was then established there was actually a problem with the radiator. When brought to the maintenance man’s attention, the matter was put right. Unfortunately because of various reasons care staff had not realised this. Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a site visit to this service. Good systems are now in place for the recruitment and appointment of staff, minimising potential risks to residents. EVIDENCE: As well as care staff, staff are employed for cooking, activities, cleaning, laundry and maintenance. Staff rosters are maintained and indicate the home is staffed 24 hours a day. Despite the unexpected incident, resulting in a reduced workforce, and the unannounced visit, care staff were seen carrying out their duties in an unhurried manner. The AQAA records that three carers are now trained to NVQ level II or above in care and that 40 are now working towards this. The home’s induction generally follows the Skills for Care training programme, which should equip newly appointed staff to better understand and meet the health and personal care needs of residents. The staff member interviewed said they had received training on subjects including diabetic control, first aid, food hygiene, COSHH, Mental Health Capacity Act awareness and a 3-day dementia care course. The training matrix supplied at the visit records staff having received training during 2007 including diabetes, nutrition, infection control, fire and adult protection. Sadly despite this a recent incident occurred which may have been prevented or minimised if care staff had used the training knowledge they had received and acted in a more proactive way. Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 19 The sample of personnel files inspected demonstrated that requisite checks and responses had been appropriately sought and supplied. Indeed the manager also seeks an additional reference, records verbal information received and contacts former care home employers, even if the employment ceased sometime ago. In addition where the manager has doubts about the validity of documents and ID provided in support of applicants from overseas, advice is sought from the Border and Immigration Agency. This is good practice. A comment card respondent added that although they have been employed at the home for some years, it wasn’t until the current manager came into post that a CRB was actually carried out. Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Residents who use the service experience adequate outcomes. This judgement has been made using a range of evidence including a site visit to this service. Despite the manager having a good understanding of what needs to be done to improve the home for the benefit of residents, and evidence she is striving to achieve this, some records and practices are not well managed, potentially placing some residents at risk. EVIDENCE: The manager was appointed as manager in 2003 and has successfully completed the Registered Managers Award Course. Residents, staff and the visitor spoke openly about their experiences at the home. Good interaction was seen between the manager, staff and visitors. Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 21 The manager, who is supernumerary and is supported by a deputy manager, also likes to spend time on the floor to keep up to date with what is happening around the home. Staff meetings take place and informal meetings with residents are held. Although relatives meetings do not take place, a newsletter is sent out on a regular basis informing them of forthcoming events and celebrations. The provider carries out annual surveys and the home is provided with an analysis of the findings when available. Themed audits are also undertaken at the home. The provider’s representative recently carried out a medication audit and in the main was satisfied with the systems and practices. The manager said action had been taken to address issues identified as requiring attention. The manager reported that the home’s policies were reviewed in 2007. The manager has collated other information and guidance, to supplement those issued by the provider. Clinical procedures are also available and the manager said these include guidance for caring for residents with diabetes. The home manages monies on behalf of all residents. The monies are held separately, receipts obtained for items purchased or services provided on behalf of residents, and regular audits carried out. The provider has recently revised its personnel forms for the recruitment and appointment of staff. This includes a lengthy application form, which provides ample space for recording employment histories and details of any unexplained gaps. However the form does not actually state that full employment history is required, which may deter some applicants providing this level of information, as is now required by regulation. The home notifies the Commission of incidents and accidents affecting residents’ welfare as is required by regulation. Subsequent information provided by the manager indicates that generally the home’s equipment is serviced and tested as recommended by the manufacturer. Because the age of the home’s gas boilers precludes a servicing contract, new boilers are to be installed in the spring of 2008. During the visit a number of health and safety risks were identified in areas accessed by residents. This included the unsecured bath panel; two small loose batteries left beside a TV, and several cans of airfreshner left within easy reach of residents. Whilst acknowledging this visit coincided with an event generating increased activity with a reduced workforce, for residents’ safety staff must be vigilant so any unnecessary risks are quickly identified and minimised. Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X 3 3 X X 2 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 X 2 2 Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP1 OP7 Regulation 4(1)(c) sch 1, para 16 15 Requirement The actual number and size of bedrooms must be included in the Statement of Purpose Care plans must provide a clear and coherent picture of all assessed needs, problems and preferences, together with the action to be taken. Care plans must be reviewed with input from the resident and or their representatives, including relatives, if that is their wish The current facilities for storing medicines and sundry “nursing” aids must be reviewed for security and hygiene purposes. The home complaints procedure must include the Commission’s telephone number The home must kept in a good decorative state throughout All rooms used by residents must kept at temperatures which keep them warm and comfortable at all times. All bathrooms and toilets, as well as the laundry must be kept to a standard which minimises cross DS0000023994.V352963.R01.S.doc Timescale for action 31/03/08 31/12/07 3 OP7 15(2)(c) 31/01/08 4 OP9 13(2) 31/01/08 5 6 7 OP16 OP19 OP25 22(7)(a) 23(2)(d) 23(2)(p) 31/01/08 30/04/08 15/12/07 8 OP26 13(3) 15/12/07 Rosewood Residential Care Home Version 5.2 Page 24 9 OP38 13(4) infection risks to residents All residents must be protected from unnecessary risks to their wellbeing. 15/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 1 2 3 4 5 6 7 Refer to Standard OP8 OP9 Good Practice Recommendations Residents’ risk assessments and supporting charts must be completed appropriately. It is strongly recommended that the date of limited life preparations is recorded on the container at the point of opening Full details of changes to the prescriber’s directions must be clearly recorded on the medication administration record chart All residents must be provided with occupation and activities as per their preferred choice. It is strongly recommended that the address of the provider is included in the home’s complaints procedure 50 of care staff must be trained to NVQ level II of equipment. All residents’ records must be completed as required by the form, dated and signed. For clarity purposes it is strongly recommended that the home’s application form clearly states that full employment history details are required OP9 OP12 OP16 OP28 OP37 OP37 Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rosewood Residential Care Home DS0000023994.V352963.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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