Inspection on 29/10/09 for Rosewyn House

This inspection was carried out on 29th October 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

Rosewyn House 19/03/09

Rosewyn House 28/03/07

Rosewyn House 14/02/06

Rosewyn House 21/09/05

Rosewyn House 18/11/04

Rosewyn House 11/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Random inspection report Care homes for older people Name: Address: Rosewyn House Alverton Terrace Truro Cornwall TR1 1JE one star adequate service 19/03/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Diana Penrose Date: 2 9 1 0 2 0 0 9 Information about the care home Name of care home: Address: Rosewyn House Alverton Terrace Truro Cornwall TR1 1JE 01872279107 Telephone number: Fax number: Email address: Provider web address: rosewynhouse@gmail.com Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr William Percival Dawes,Mr Gregory Brian Murrell care home 20 Number of places (if applicable): Under 65 Over 65 20 old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 0 1 9 0 3 2 0 0 9 Rosewyn House provides care for up to twenty elderly service users. The registered providers are Mr Dawes and Mr Murrell who are actively involved in the management of the home. Mrs Spargo is the registered manager. Rosewyn House, is situated within walking distance of the centre of Truro. Rosewyn is a large old house situated in pleasant grounds. The house has two floors with access to the first floor via either a staircase or lift. There is one double bedroom and eighteen single bedrooms. No bedrooms currently have en-suite facilities. There are suitable bathroom facilities. There is a large lounge and a large separate dining room. The home is pleasantly decorated throughout. There is also a block of supported living flats next door to the home, which are also managed by the registered persons. Some of the service users from there have their meals at the home. Although the flats are not registered for Care Homes for Older People Page 2 of 13 Brief description of the care home personal care, some move in to the care home as peoples needs change. A copy of the full inspection report is available from the manager, and it is suggested a copy is requested from them or CSCI if required. The fees at the time of the inspection were 420 pounds per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. Care Homes for Older People Page 3 of 13 What we found: An Inspector visited the home to check compliance with the one requirement and eight recommendations set at the last inspection. Also to look at other issues raised in the last report and to check the progress made with care planning and pressure sore prevention following a safeguarding issue in July 2009. The Inspector was greeted by the Registered Manager who was about to go on holiday, she left the home about half an hour after the inspection commenced. The Head of Care was not on duty but came in to assist with the inspection later in the day. We spoke to people using the service, staff and visitors we also examined documentation and records and toured the building. We were told there were twenty people accommodated on the day of the inspection, one was receiving respite care. There were three care staff on duty in the morning and two in the afternoon. We were told that one of the care staff on each shift was a deputy head of care. The rota showed that two care staff were in the home overnight; one awake and one sleeping from midnight. We were told that the night staff get residents up in the mornings and serve them breakfast in their rooms. We were also told that the night get residents ready for bed at night. The care staff said they were responsible for the laundry and for preparing and providing breakfast and tea time meals; this included some cooking and washing up afterwards. A cook was employed to provide the lunchtime meal and do the baking. We were told that a domestic was employed but she does not work every day; when she was off duty the care staff emptied the bins and cleaned the hand wash basins. Domestic duties included the cleaning of five flats in the grounds of the home. Care staff were seen visiting these flats and we were told that they were checking on the elderly people who live there. Staff said they check on one person in particular as he gets confused and tends to wander. We were told they check that he has washed and shaved and they administer his medicines that are kept in the care home. We were told there is a call system to the flats and care staff hold keys so they can check the flats at night to make sure the people living there are safe. People from the flats were seen in the care home; some came in for meals and some were sitting in the lounge with the residents. People told us they can come and go as they wish and have meals when they like as it is included in their rent. The flats are not registered with the Care Quality Commission and there is no requirement for them to be registered. Staff were observed to be kind and caring when interacting with residents. Care staff were busy throughout the day and said it is always busy in the home. There did not appear to be enough staff to care for the residents, undertake domestic tasks and provide a service to people in the flats as well. Residents said that most of the staff were very kind but they were always rushing around. Everyone we talked to knew the Head of Care and said she was very caring and listened to them. Most people were aware of who the manager was but said they didnt see her very often. The kitchen was very warm, the cook told us this was due to the AGA. There was no extraction system in the kitchen. As reported in the last inspection report the Care Homes for Older People Page 4 of 13 environmental health officer inspected the kitchen in January 2009 and had strongly recommended that the home purchase a dishwasher. Care staff were working in the kitchen between their care duties, some were seen wearing plastic aprons. We were told that not all staff who handle food had received food hygiene training. We looked at the care files of four people who had moved into the home since the last inspection. All four had assessment documentation that showed their needs were assessed prior to moving into the home. The documentation had improved since the last inspection and there was information from external health and social care professionals included in the care files. A total of five care files were inspected and showed a general improvement in the care planning system since the last inspection; religious and social care plans were seen in some files. The system in use on the day of this inspection was based on the activities of daily living but was inconsistent; some people had more care plans than others and there was a variation in the activities included. Some care was detailed under the incorrect activity, for example catheter information was recorded under nutrition in one file. The care plans lacked detail to fully inform and direct staff on the specific care to be provided. Words such as encourage and monitor were used without further explanation to ensure staff were all working in the same way. Care planning was discussed with the Head of Care who was grasping the person centred approach and keen to ensure that the plans were specific to the individual. Some risk assessments were seen in the care files, the scoring and the relevancy needs to be recorded in the care plans. Daily records were seen and other tick sheets completed by care staff. We were told that only one person per shift writes in the daily records whether they had administered the care or not. The records were variable in content, a catheter bag was recorded as being empty at night; staff told us that the bed was wet so there was no reason for concern however this was not recorded. One persons wasp stings changed to bee stings further into the records and then there was no more information as to whether they were healed or not. It is good practice for those administering care to be responsible and record their actions. The Head of Care told us she would like to implement a Keyworker system, which she said should address this issue. The Head of Care told us that she had distributed questionnaires to gather information from residents on their preferences and this included times for getting up and going to bed. The questionnaires were seen but the information had not been transferred into the care planning system. The Head of Care told us there were no night care plans in place yet. Handwritten instructions on the medicine administration records were seen to have two signatures recorded. We were shown the new controlled drugs cupboard that complies with legislation. An oxygen cylinder is stored in a room off of the staff office; there is now an oxygen warning sign on the door and a no smoking sign on the office door. A hoist was seen in one residents room and staff told us that a Community Nurse had shown them how to use it. We were also told that staff had received moving and handling training. A recommendation was made in the last inspection report to review the activities and entertainment on offer. We were told that the only review was the questionnaires Care Homes for Older People Page 5 of 13 previously mentioned. The manager said that trips out are regular but some people do not want to go. She said some residents have a daily newspaper and one person likes to knit. She told us that residents do not want to do activities and that is their choice. Residents told us they enjoy the trips out but the mini bus can only take seven people so quite often they have to stay home. We were told that music for health is provided and in house games, bingo and manicures are on offer sometimes. We were told that carol singing takes place at Christmas but there were no other activities such as making Christmas cards or decorations for example. We were told that no specific activities take place for Easter, Mothers Day, Valentines Day or any other special occasions. One resident said she would appreciate staff just having time for a chat. We were told there was no activities co-ordinator employed and no one is responsible for organising activities or social events. A notice was seen in one corridor stating the days for trips and Music for Health sessions during September and October. One resident told us they had seen a notice about events but it must have been old as no one knew about them. The television was on in the lounge during this inspection but not all of the residents seemed to be watching it. One resident said there is no choice of programme as one resident always has the remote control. Activity records were seen in the care files. They consisted of a dated list that included bus trips, Music for Health, visitor and the hairdresser. There was no information on the level of participation, enjoyment, emotional responses or what people gained from the activity, if anything. There were institutional practices in the home that border on abuse. The daily routines were regimented and did not reflect the views of people using the service. One resident told us that they all have to sit in the dining room and wait until the medicines are given out before they have their lunch and evening meal. She said this prolongs the meal time and some people like to watch the news or other television programmes but have to miss them. There was a memo in the staff office regarding medicines stating that all residents must be seated in the dining room before the medicines are administered and included some residents names. Residents told us they do not eat in the lounge as they have to go to the dining room but some said they have their tea in their bedroom. Only one person was observed eating her meal in the lounge. There were notices in the staff office of the daily routines to be carried out by day and night staff. We were told these were written by the registered manager. These included the times for putting specific people to bed and when to administer certain peoples medicines. It also included when to give people their drinks as well as other domestic tasks that care staff were to carry out at specific times of the day. There was a memo to staff explaining that the routines were there so that everyone does the same and they were not to be changed or done differently when the manager was away. The memo was signed by the registered manager. Other memos and notices were seen that told staff what to do. The registered manager has adopted a style of management that is dictatorial and does not take into account the views of residents or staff. This style compromises personal choice and individualised care. Comments include The manager is very strict but will do anything for you, Coffee, meals and tea are all at set times, We have got used to the routines now and I am not sure what would happen if I asked to change the routine. Care Homes for Older People Page 6 of 13 We were told that one staff meeting had taken place since the last inspection but the minutes were not available for inspection. We were told that no resident or relatives meetings take place. We saw supervision records for staff; we were told the sessions take place every two months. We were told that the deputy heads of care were responsible for supervising some staff but that no one had received formal training in this area; only that provided by the Head of Care. We saw one staff file which was that of a new employee it contained the records required by legislation apart from a recent photograph. The POVA first check was received on the day before this person commenced work but the full CRB disclosure had not been received, we were told this person was supervised on each shift but there was no written evidence as to who was responsible for this. The Head of Care showed us her job description, which had been produced since the last inspection. It was very basic and lacked detail considering the amount of responsibility she appears to have. We were shown certificates for Human Rights awareness training which included safeguarding, Deprivation of Liberties and the Mental Capacity Act, we also saw certificates for recently attended infection control training. The registered manager had attended these training sessions. The manager told us she had attended another course on Deprivation of Liberties but had not undertaken any management courses. The manager must keep up to date on the law and management practices relevant to her role. It is recommended that she undertake the Leadership and Management for Care Services Award. What the care home does well: What they could do better: Incorporate a management style that allows the people using the service and staff to air their views and be included in the running of the home. The Registered Persons must ensure that practices within the home reflect the personal choice and preferences of people using the service and are not routines to suit the management or staff. Consultation with people using the service regarding social activities and events should take place to ensure that they are occupied and can do things they enjoy. Improve the care planning system to be person centred and direct staff more fully on the Care Homes for Older People Page 7 of 13 care to be provided. Review the staffing arrangements to ensure there are sufficient skilled staff on duty at all times to meet all of the needs of people using the service. This should include the staffing arrangements for domestic and kitchen duties and training provision as necessary. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 13 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 13 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, 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 12 16 The people using the service 25/01/2010 must be consulted about their social and religious interests and be consulted about the programme of activities arranged by or on behalf of the care home. This will ensure that arrangements are made to provide activities in relation to recreation, fitness and training and to enable people using the service to engage in local, social and community activities according to their wishes. 2 14 12 The registered persons must 25/01/2010 ensure that the wishes and feelings of people using the service are taken into account when providing care and making provision for their health and welfare. This will ensure that people using the service are able to have a choice and make decisions with respect to the care they are to receive and Care Homes for Older People Page 10 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 their health and welfare. 3 19 27 When a new worker is 30/11/2009 employed following receipt of a satisfactory POVA check but awaiting a full CRB disclosure, a member of staff who is appropriately qualified and experienced, must be appointed to supervise the new worker pending receipt of the CRB disclosure. As far as is practicable, the staff member must be on duty at the same time as the new worker and the new worker must not escort any service user away from the care home premises unless accompanied by the staff member. This will ensure that new staff are appropriately supervised to safeguard people using the service. 4 27 18 A review of the management, staffing levels and deployment of all staff must be conducted with appropriate action taken for any shortfalls or issues arising. To ensure that the care home is able to promote and make proper provision for the health and welfare of people using the service. To include their care, and where appropriate, treatment, education and supervision. 25/01/2010 Care Homes for Older People Page 11 of 13 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 1 7 Daily records should be written by the person providing the care to ensure that details are correct and that staff take responsibility for their actions. Care plans should be reviewed and updated to ensure they are person centred and fully direct staff on the individual care to be provided. The job description for the head of care should be reviewed and detail her role and responsibilities. The registered manager should undertake the Leadership and Management for Care Services Award to ensure she is keeping herself up to date on management issues. Staff should always wear appropriate protective clothing, especially when working in the kitchen, to prevent the risk of cross infection. A dishwasher should be installed to ensure that dishes are washed appropriately and at temperatures that reduce the risk of infection. 2 7 3 4 27 31 5 38 6 38 Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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