Inspection on 02/05/06 for Rosier Home

This inspection was carried out on 2nd May 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rosier Home 19/04/07

Rosier Home 17/11/05

Rosier Home 20/04/05

Rosier Home 02/11/04

Rosier Home 09/06/04

Similar services:

Claremont House

Oak Ridge

Coopers Mill Ltd

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Paradise Lodge

Grangewood

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Rosier Home 22-24 Harold Road Clacton On Sea Essex CO15 6AJ Lead Inspector Marion Angold Key Inspection 2nd May 2006 10:00 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 Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 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. Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Rosier Home Address 22-24 Harold Road Clacton On Sea Essex CO15 6AJ 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) 01255 427604 01255 223984 Mr Darren John Marles Miss Sonya Wase Miss Sonya Wase Care Home 16 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (16) of places Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 16 persons) The home may only accommodate six people with dementia whose names were provided to the Commission in September 2002 The total number of service users accommodated in the home must not exceed 16 persons 17th November 2005 Date of last inspection Brief Description of the Service: Rosier Home is an established care home, close to Clacton on Sea’s town centre and the seafront. The current charge for a room is £358.54. Accommodation is offered on two floors, with the top floor accessed by stairs or a passenger lift. The home was originally registered under the Care Standards Act 2000 for sixteen older people. The registration was subsequently varied in acknowledgement that the home was caring for six older people with dementia. However, this variation is for specific service users and does not permit the home to accept any new service users with dementia. Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection, covering the key National Minimum Standards, took into consideration all recent records relating to the service, including information sent to the Commission by the Providers. It also included site visits to the home on 2/5/06 and 3/5/06, a total of 15.75 hours. These visits involved speaking with residents, visitors, the providers and manager and staff, as well as a partial tour of premises, observation of care practice and the sampling of records. Where possible, the site visits focussed on the experience of a sample of five residents, a process known as case tracking. Of the 26 Standards inspected on this occasion, 7 were met, 13 presented minor shortfalls and 3, having not been met over successive inspections, warranted a rating of 1 (significant shortfalls). The providers should be aware that continued non-compliance with the Care Homes Regulations 2001 could lead to enforcement action on the part of the Commission. What the service does well: Rosier Home is run on family lines with considerable hands-on involvement from the registered providers/manager. Management and staff continue to provide a friendly atmosphere and to welcome relatives and representatives as visitors and participants at periodic residents’ meetings. It was evident from various accounts and a birthday celebration on the first inspection day, that staff went out of their way to mark special occasions, bring people together and create a sense of fun. A separate lounge was available for anyone who did not wish to participate. Two visitors, spoken with during the inspection, indicated their satisfaction with the home and the care their relatives were receiving. Service users appeared relaxed and those, who expressed a view, were positive about most aspects of the home and its ability to meet their needs. One resident said they felt able to be themselves at Rosier Home and there were good examples of residents being able to take their time over their meals and decisions and being supported in the things they wanted to do both in and outside the home. Residents were helped to exercise control over their lives and found respect for their diversity in matters of faith, relationships and lifestyles. Staff also showed understanding of how dementia changed people’s behaviour and were trying to minimise the impact of these changes on other residents and promote privacy and dignity. Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 6 Rosier Home was clean and homely and generally well maintained and decorated. All evidence indicated that the home was providing well for people’s medical needs. A community nurse said that staff were quick to identify and refer any medical concerns and to follow advice given and a visitor commented on the improvement in their relative’s health since coming to Rosier Home. Residents commented favourably about their meals, which were nutritious, varied and well presented. Celebration menus and drinks were arranged for special occasions. What has improved since the last inspection? What they could do better: The registration certificate no longer accurately reflects the number of residents who have dementia. The registered persons need to update this information for CSCI so that their certificate can be amended. They must also ensure that people they admit to the home do not have dementia. By doing so, they have been in breach of the Care Homes Regulations 2001. Although the home had designated a senior member of staff to oversee care planning and develop person-centred activities, this work had not significantly progressed since the last inspection. Care plans continued to vary in the quality of information they provided and some residents, particularly those with fairly advanced dementia, lacked stimulation. The Registered Persons should ensure that arrangements for all aspects of personal care respect the privacy and dignity of residents. In particular, residents should not have their hair done in communal areas. Some residents were still experiencing an interval in excess of 12 hours between their last food of the day and breakfast and might go to bed without a supper drink. Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 7 In the main, arrangements for administering residents’ medication were found to be satisfactory. However, the administrant must always ensure that residents are given a drink with their pills. Residents, who have difficulty chewing or swallowing, should not be subject to a restricted menu at teatime. This issue was raised at the inspection a year ago. The home must ensure that their record of complaints is complete and maintains confidentiality. Although a plumber had been working at the home, the registered persons must take prompt action to ensure that communal washing facilities upstairs are in working order. Additional radiator covers are also needed for residents’ safety. Prospective employees should be asked to supply full employment histories as part of the recruitment process. New Criminal Record Bureau disclosures must be obtained for staff returning to work at Rosier after a gap in their employment. Whilst the providers had calculated their staffing levels using a recognised tool, rosters, and comments from residents, showed that the home had sometimes struggled to maintain recommended levels at weekends. Although a number of staff had received some basic training in dementia awareness, the home needed to develop this area of expertise to meet the needs of people they are caring for. The registered providers/manager should complete the National Vocational Qualification in management and care, Level 4. Management need to reflect and report on the various processes they use to monitor the quality of care provided at Rosier Home and link their conclusions to the business plan, so that the latter covers all aspects of care and provision and reflects the home’s aims and objectives. Management still needed to demonstrate that they had consulted residents about the care they were receiving from night staff and the presence and activity of staff members’ children in the home. 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. Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 8 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 Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. NMS 6 did not apply to Rosier Home. Quality in these outcome areas is adequate. Service users’ needs were assessed before coming to the home. EVIDENCE: A sample of 5 residents’ records contained an initial assessment. These varied in detail but provided a range of basic information about the person. Assessments, completed by the referring authority, had been supplemented using the home’s assessment forms. A visitor confirmed that they had been involved in their relative’s assessment; a relatively new resident had contributed to their assessment during two trial visits to the home but did not have an initial care plan, based on their pre-admission assessment. It was evident from records and talking with a relative, that one person, recently referred to the home, as an emergency, had the early stages of dementia. Although the providers had assessed that they were able to meet the needs of this person, and the relative indicated that the placement had proved entirely suitable, the home is not registered to admit people with dementia and therefore acted in breach of the Care Homes Regulations 2001. Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in these outcome areas is adequate. The care of residents was not always based on a full written plan. Appropriate arrangements were in place for meeting the health care needs of service users. Residents benefited from the over all arrangements for the administration of medication but particular practices needed to be reviewed. Residents’ privacy and dignity were not always maintained. EVIDENCE: Care plans continued to vary in quality and content. Two of the sample contained a personal profile. One provided staff with information and instructions in relation to health, communication, behaviour, preferences and interests. It also covered aspects of diversity, such as religion and sexuality. Another care plan did not cover all the person’s needs. However, it evidenced consideration of diversity issues and appropriate consultation with a relative. Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 11 Three care plans had only been partially completed or provided vague instructions, such as ‘needs assistance with personal care’. Monthly care plan evaluations had lapsed in one case and were minimal for the others. Daily records were not linked to individual care plans; entries consisted mostly of general comments about the person’s state of health and wellbeing, their food and fluid intake or occasional activity. On the other hand, an incident, involving 2 residents was appropriately entered in both their records and cross-referenced to the staff diary, to alert those coming on shift. The registered manager acknowledged that their was an inconsistent approach to care planning and that, although they had designated a senior carer to develop this area, they still had some way to go in getting it right. Miss Wase said she would take prompt action to arrange care-planning training for all the staff, so that their care plans would reflect the work they were doing. Care plans sampled showed that the home was proactive in contacting health care professionals. A community nurse said that staff were quick to identify and refer any medical concerns and to follow advice given. They felt the home was meeting the medical needs of the people, whose cases were being managed by the Community Nursing Team. In two cases, an optician had been contacted. Care plans also evidenced regular weight monitoring. One visitor said their relative had gained weight and improved in health since coming to Rosier Home. They felt that appropriate action had been taken by the home to ensure their relative had the treatment they needed for an infection and an injury. Sampled care plans contained a list of medication and what it was for. The member of staff observed administering medication knew the background to new medication entered on the Medication Administration Record. Their method of administering and recording the lunchtime medication was mostly satisfactory. However, when a resident did not take hold of the dispensing cup offered them, the member of staff placed the tablet with their fingers in the resident’s mouth. They also did not provide a drink with the tablet, which started dissolving on the resident’s tongue. The controlled drugs register had been signed by two staff, as required, but was falling apart, had pages, or parts of pages torn out and some missing entries. Discussions with staff and management, and observation during the inspection, showed that appropriate action was being taken to support residents to live together harmoniously and meet their need for relationships. Some of this work was reflected in the sample of care plans. Staff showed understanding of how dementia changed people’s behaviour and inhibitions in relationships and were trying to minimise the impact of these changes on other residents and promote privacy and dignity. One resident said they felt able to be themselves living at Rosier Home. Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 12 It was noted that screening was available in shared rooms to promote privacy but one person, who was not able to verbalise their wishes and feelings, had their hair set during the inspection in a communal area. Comments received about the providers’ children spending time in the home were positive. One member of staff, said that they continued to focus on the needs of residents, as the children were not their responsibility. Management were advised to continue monitoring this situation closely to ensure that the interests of residents were not affected. It is also recommended that they refer to the presence of children in the Statement of Purpose and Service Users Guide. Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in these outcome areas is good. Residents’ needs and preferences were taken into account in the organisation of daily schedules and activities but some residents lacked stimulation or meaningful occupation. The home welcomed and supported visitors. Residents were helped to exercise control over their lives and found respect for their diversity. Mealtimes were usually a positive experience but adjustments were needed to the tea and supper arrangements for some residents. EVIDENCE: It was evident from observation and their comments that residents, who were able to voice their wishes, had a choice about when they went to bed. Several residents remained in one of the lounges during the evening; others had gone to their rooms. A care plan for a resident with mild dementia, listed their preferred daily routines, including usual time of going to bed. Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 14 A senior carer, with responsibility for developing person-centred activities, had not made significant progress in this area. One person said that the member of staff, who had contributed most in terms of activities, had left, although there was usually music or something going on. However, records showed that activities were intermittent: A singer had entertained residents on 4/4/06; one person had been taken into town on 13/4/06 and a sing-along had taken place on 29/4/06. Earlier records showed occasional outings and entertainment in the home and one session of ceramic painting. A visitor reported that their relative had been taken to a restaurant. They also reported that their relative so enjoyed the company and having nice staff around, that they did not need much more in the way of activity. It was evident from observation that some residents, who sat together, to some extent, entertained themselves, talking or watching television. One afternoon of the inspection was taken up with a birthday celebration, organised by staff, and including a buffet tea, home made birthday cake, sherry and karaoke. It was evident that birthdays were usually marked in some way by the home, providing a social activity. A couple of residents said how much they enjoyed this. In a different context, one person said they did not like the music played by the home or what was on television; they preferred classical music and old films. This should be possible to arrange, especially as the home has three communal rooms. One person was bedfast and another with advanced dementia spent most of the day sitting in their room unoccupied. Clearly, they did not participate in the community life of the home. Although staff went in to attend to their physical needs and feed them, there was no plan for ensuring that they were regularly monitored and not overlooked by staff, when they were busy. The person in bed had a radio on a their side but, on the whole, these people lacked stimulation. Discussion with a relative showed that the home had consulted them about how they could support the resident’s religious beliefs and values. Both the resident and relative showed that they were satisfied with the outcome. Comments from visitors showed that they felt welcomed and involved. All relatives and representatives were invited by letter to periodic residents’ meetings. Residents indicated that they enjoyed their meals. Larder and freezers were well stocked with a variety of foods and basic ingredients. Breakfast records indicated variety and choice, including different cereals, toast and cooked options. A member of staff was overheard offering residents a choice for tea and the buffet tea, on the first day of inspection, also provided choice. The lunch menu was varied, and included meals cooked from basic ingredients, fresh vegetables and puddings. Records and discussions showed that a choice was not routinely offered for lunch but that alternatives were available to cater Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 15 for people’s dislikes and dietary requirements. A menu board had been hung in the dining room since the last inspection, although the cook said that residents still came to ask what was for lunch and she would speak with them individually, when the planned meal was not a universal favourite. However, two residents continued to be given cake covered in yoghurt for tea, an issue that had been raised with the home at a previous inspection. A member of staff said this was because they had difficulty chewing. Arrangements should be made for these people to enjoy a range of foods at every meal and for tea menus to include fruit and salad options. Two residents said they did not get a supper drink every night, which meant the last drink they had was at teatime. One of the night duty staff said that residents were always offered a drink. However, this could not be corroborated because the record of what residents had eaten and drunk for supper had been discontinued. Information sent to CSCI indicated that residents were offered a choice of drinks at suppertime. Given that tea was usually served from 4.30 pm, the interval between the last meal of the day and breakfast exceeded 12 hours. One visitor commented that their relative was a very slow eater and was allowed to eat their meal at their own pace and not hurried. They had gained weight since coming to Rosier Home. This relaxed attitude to meals was observed during the inspection, several residents staying on after the others to finish in their own time. Comments from a resident and a relative indicated that they did not mind the children of staff being around. However, one person said they did not like the smell of smoke left by night staff in the downstairs lounge. The registered persons should continue to monitor these situations to ensure they do not infringe the rights of residents. It was evident from discussion with a relative that the home had taken advice from them in the matter of supporting a resident to practice their faith and that both the relative and the resident concerned were satisfied with the outcome. Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 16 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in these outcome areas is adequate. The home could be more proactive in seeking and recording residents’ comments about the service and protecting them from abuse. EVIDENCE: The home has taken a proactive approach to complaints by holding periodic residents’ meetings, to which relatives and representatives were invited. However, the minutes of the last meeting were not available for inspection. The last entry in the complaints log was on 20/6/05. Prior to this there had been 5 complaints in 2005 and 9 in 2004. One resident spoke to the inspector about a complaint they had made. This was not recorded in the complaints log. Complaints, which had been made known to CSCI during this period, were also not included in the log. In the interests of data protection, the registered persons must ensure that each complaint is entered on a separate page. The complaints log showed that in June 2005 a relative had commented on the difficulty of access to Rosier Home for anyone using a wheelchair. Mr Marles said they had researched the possibility of a ramp at the front and found it would mean losing most of their limited parking area. Following the inspection, the registered persons took action to improve existing wheelchair access at the back of the property. Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 17 The home’s protection of vulnerable adults procedures had been reviewed in September 2005 and were found to be satisfactory at the last inspection. However, not all staff had received training in this area. Two frequent visitors to the home, spoke of their satisfaction with the care provided and confidence that their relatives were happy. Residents also showed by their manner and comments that they liked being at Rosier Home and had a good rapport with staff on duty. However, the inspector continued to receive comments, which showed that people had reservations about the conduct and attitude of some of the night staff and preferred the way day staff treated residents. Management were advised that they must demonstrate how they are monitoring and addressing this situation. Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 25 and 26 Quality in these outcome areas is adequate. The home continued to provide a comfortable and clean environment for residents. Work being done to enhance residents’ safety needed to be finished. EVIDENCE: The home was generally clean, fresh, comfortable and homely. Visitors and residents expressed satisfaction with the accommodation. One person said they had been able to bring in things from home. Relatives had raised with the providers the issue of wheelchair access. Wheelchair access was available at the back of the property and the registered persons were advised to include this information in the Service Users Guide. Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 19 Mr Marles was working to a plan to maintain the home in a good state of repair and decoration. One of the night staff was involved in this work, both on and off duty. However, at the time of the inspection, taps were not working in the upstairs bathroom and toilet and one hand basin had a cupboard in front of it, making it inaccessible. This meant a lack of facilities for washing hands. Mr Marles said the plumber, employed in February to fit pre-set valves to all the water outlets and ensure compliance with the Water Supply (Water Fittings) Regulations 1999, was still working on these areas. Although a number of radiators in the home were covered, two bedrooms sampled did not have covers but warning notices in place. A radiator alongside the toilet in the upstairs bathroom was also not covered and presented a risk to residents, especially as the toilet frame, of necessity, was very close to the radiator. Mr Marles explained that residents seldom used this bathroom, preferring the one downstairs, but for the number of residents, the home should have at 2 fully serviceable bathrooms. The home employed a cleaner on a daily basis and all areas inspected were clean and fresh. The laundry was appointed with suitable machines, a sluice and separate hand-washing facilities. The floor was due for replacement and the old one taken up in readiness. Records showed that some staff had attended refresher courses in infection control this year. Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in these outcome areas is adequate. Staffing levels were not always maintained at weekends. Aspects of the home’s recruitment procedures did not fully protect residents. Staff received training and demonstrated competence at work although it was evident that the approach and conduct of night staff remained an issue. EVIDENCE: Two staff were on duty throughout the inspection, with an additional person in the afternoon of the first day of inspection and support from management, a cleaner and a cook. Miss Wase explained that their staffing levels, calculated according to Department of Health guidelines, reflected the fact that they had 2 vacancies and that the dependency levels of current residents were not as high over all as they had been. However, the home was still caring for 3 residents, described by the community nurse as having borderline nursing needs, as well as others with dementia. Moreover, the rota for April showed that, on at least 3 occasions at weekends, staffing levels had been at a minimum, with only 2 on duty in the morning, either including the cook or the manager. Although, in one visitor’s experience, there were always staff around, a resident Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 21 commented that weekend staffing levels could be low and this could mean residents having to wait to be taken to the toilet. Miss Wase outlined difficulties that had presented with staff being off sick and on maternity leave, one person leaving at short notice and a disappointing response to their efforts to recruit new staff; existing staff had been doing extra shifts with additional support from management. Four staff had completed National Vocational Qualification in care at Level 2 and one of these had achieved Level 3. Two staff were involved in Level 2 training. This would bring the ratio of care staff with NVQ 2 to 50 , to meet National Minimum Standard 28. Rosier Home was continuing to take on staff, who had worked at the home before, without carrying out the employment procedures, required by regulation. One member of staff had been working on and off at Rosier since November 2001, having last left their employment in October 2004, returning a year later. Their references dated back to 2001 and their Criminal Records Bureau (CRB) check was completed in June 2004. Two other staff, who had come back to work at Rosier Home, now had up to date CRB disclosures. Relatives thought that staff were competent at their jobs. Discussion took place with management about the training needs of staff. Records showed that, in the last year, staff had received training in infection control, fire safety, moving and handling and health and safety. Some had also attended trainings sessions on dementia awareness, protection of vulnerable adults and bereavement. Miss Wase showed evidence that First Aid training was in hand and said they would arrange a course in care planning as well as ongoing training in dementia care. Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in these outcome areas is adequate. The registered persons could improve their monitoring of outcomes for residents and make the content of staff supervision more relevant to their roles. Arrangements for safeguarding resident’s money were satisfactory, although greater care is needed in processing receipts to ensure a clear audit trail. Arrangements for the health, safety and welfare of service users were mostly satisfactory as sampled, although some work in this area was still in progress. EVIDENCE: Mr Marles and Miss Wase continued to share the management of Rosier Home, being each present, or on call, half the week. Miss Wase explained that they Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 23 both withdrawn from training for the National Vocational Qualification in care and management, Level 4, due to problems with the training providers. She said they were in the process of approaching a different company on recommendation and would inform CSCI as soon as they had a date to start. Management were advised that they should also undertake training in dementia care at an appropriate level to lead the service forward, given that Rosier Home continues to care for a number of residents with dementia. They had identified a daylong course on management and the care of dementia for themselves and senior staff. Mr Marles said that they were not acting as appointees for any of the current residents. However, they were holding in a safe various personal money for residents, to cover incidental expenses. The records, receipts and balances were inspected for 4 of the sample of residents. Two of these showed intermittent deductions of £5.00 for a singer, who regularly came to the home to entertain the residents. Mr Marles stated that residents contribute only if they have taken part in the entertainment. One resident, asked about this, was aware of how much personal allowance they were due each week and that they paid towards to cost of the singer. The records, receipts and balances were consistent in three out of the four sampled. In one case, 2 debits for toiletries were not accounted for with receipts. One relative said they were issued with a receipt for the money they deposited for incidental expenses and had been told how some of that money had been spent. They were fully satisfied with the arrangement. The handling of personal money for another resident is being investigated outside of this inspection. Management continued to obtain feedback on their service through residents/relatives’ meetings and staff meetings. They also maintained a high profile in the home throughout the week, overseeing and steering the service through their involvement. However, they had not developed an integrated system for quality monitoring that was linked to a plan for addressing requirements and meeting objectives in relation to all aspects of provision. Staff supervision was shared between the providers. Records showed that supervision had lapsed for a period but started again in March 2006, with dates planned ahead for the year. It was of some concern that one member of staff, who had been subject to disciplinary proceedings had gone nearly 6 months without formal supervision and that the content of the record did not suggest that the providers were using supervision to deal in depth with the person’s professional development. Information sent to CSCI prior to the inspection showed that electrical and fire installations, emergency lighting, the water system, lifts and hoists had been checked for safety. Records inspected showed that management were monitoring the safety of the environment and identifying risks that needed to be addressed. Since the last inspection, for example, three strip lights had been fitted to improve the quality of light in the hall upstairs. Carpet tiles, Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 24 identified as presenting a hazard, had been replaced and the security of the premises enhanced with a new gate. To meet a requirement made at previous inspections, pre-set valves had been fitted to ensure water used by residents was close to 43oC. Domestic staff had been instructed to run water weekly from disused outlets. A community nurse confirmed that the home had implemented recent moving and handling training and arrangements had been made for staff to update other mandatory training. The need for additional radiator covers was addressed under NMS 26. Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 25 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X 2 X X X 1 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X 2 2 X 3 Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? YES 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 OP3OP31 OP3OP7 Regulation CSA 2000 S.15 15, 12 Requirement The registered persons must not admit service users outside of their registration category. The Registered Persons must ensure that all service users have a detailed plan as to how the home is meeting their needs. THIS REQUIREMENT HAS EXCEEDED AGREED TIMESCALES FOR ACTION SINCE JULY 2002. The Registered Persons must ensure that the home’s procedures for administering medication are in line with the requirements of related legislation and guidelines. The Registered Persons must ensure that all complaints are logged and that the log meets the requirements for confidentiality. The Registered Persons must ensure that toilet and bathroom facilities are available in sufficient numbers and in good working order. The Registered Persons must ensure that once risks to the health and safety of service DS0000017922.V293938.R04.S.doc Timescale for action 30/06/06 31/07/06 3. OP9 13 30/06/06 4. OP16 17, 22 30/06/06 5. OP21 23 30/06/06 6. OP25 13, 16 30/06/06 Rosier Home Version 5.1 Page 27 7. OP27 18 8. OP29 19,Sch 2 & 17,Sch 4 9. OP33 24 10. OP35 17 (2) Sched 4 (9) users have been identified early action is taken to eliminate them. THIS REQUIREMENT HAS EXCEEDED AGREED TIMESCALES FOR ACTION SINCE JULY 2002. The Registered Persons must ensure that staffing levels are always adequate to meet the needs of residents. The Registered Persons must ensure that they carry out all the required recruitment procedures for staff returning to work with them after a break in employment. THIS REQUIREMENT HAS EXCEEDED THE TIMESCALE FOR ACTION, AGREED FOLLOWING THE LAST INSPECTION. The Registered Persons must continue to develop their methods for reviewing and improving the quality of care in the home. This must lead to a report that is supplied to the Commission and made available to service users. THIS REQUIREMENT HAS EXCEEDED AGREED TIMESCALES FOR ACTION SINCE JULY 2002. The Registered Persons must ensure there is a clear audit trail for transactions involving residents’ money. 30/06/06 30/06/05 31/08/06 30/08/06 Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 28 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. 2. Refer to Standard OP7OP12 OP10 Good Practice Recommendations Care plans should have clearly defined goals and actions based on each of the service users’ assessed needs. The Registered Persons should ensure that arrangements for all aspects of personal care respect the privacy and dignity of residents. In particular, residents should not have their hair done in communal areas. The Registered Persons should ensure that the interval between the last meal of the day and breakfast does not exceed 12 hours and that residents, who need feeding, do not have a limited menu. It is recommended that more salad and fruit be introduced as options for tea. It is recommended that the home arrange protection of vulnerable adults training for all remaining staff. The Registered Persons should obtain full employment histories for potential staff, so that any gaps can be explored. The Registered Persons should ensure that they achieve the National Vocational Qualification, Level 4, in management and care and attend periodic training to update their knowledge and competencies for managing a care home for the elderly. The Registered Persons should develop their business plan to cover all aspects of provision and ensure they are achieving the aims and objectives of the home. The Registered Persons should ensure that supervision addresses all aspects of the individual’s practice and how this fits with the home’s philosophy of care. 3. OP15 4. 5. 6. OP18 OP29 OP31 7. 8. OP10OP33 OP36 Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 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 Rosier Home DS0000017922.V293938.R04.S.doc Version 5.1 Page 30 - 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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