CARE HOMES FOR OLDER PEOPLE
Rosina Lodge 76 St Augustines Avenue South Croydon Purley CR2 6JH Lead Inspector
Peter Stanley Announced Inspection 23 June 2005 9:30am 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 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. Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Rosina Lodge Address 76 St Augustines Road, South Croydon, Purley, CR2 6JH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8760 0735 020 8667 9578 Mr Balasubramaniam Balachandrun Mrs Ginige Balachandrun Care Home 19 Category(ies) of Old Age (19) registration, with number of places Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: none Date of last inspection 14 December 2004 Brief Description of the Service: Rosina Lodge provides places for up to 19 older people in a large converted detached family home in a very pleasant residential road in South Croydon. The home currently has 13 residents with 6 vacancies. The home has a pleasant grassed garden to the rear with flowerbeds. The frontage is tree-lined with conifers and tarmac’d, providing standing for a number of vehicles to park off-road under a fine spreading Canadian Redwood tree. Public transport is a walk away on the Brighton Road (frequent services) or closer (but less frequent) service is also available on Pampisford Road. The home is a threestorey building with seventeen bedrooms, two of which are for double occupation, the remainder singles. All floors are accessible, via a passenger lift. The manager’s office is sited on a half-landing between second and third floors. All main public rooms (Dining room / through Lounge and a separate smoking room) are provided at ground floor level with the addition of a small sitting / quiet room on the first floor. Both the kitchen and laundry are at ground floor level. The proprietors are hoping, in due course, to build a conservatory adding - at the same time - a covered link to the laundry (which currently has no internal access route – save for the smoking room). Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was conducted over one day and involved discussion with the owners and registered providers, Mr Balasubramaniam Balachandrun and Mrs Ginige Balachandrun. The home does not currently have a registered manager, and is being managed by the owners. While the inspector feels that the home is being managed in a competent way and, generally, in the best interests of the service users, there are areas of concern which a qualified manager, with sufficient experience, would be best placed to address. Mrs Balachandran informed the inspector that she is studying for an appropriate management qualification in residential care, which she hopes to complete by August 2005. She would then wish to consider applying herself to the CSCI (Commission for Social Care Inspection) to become the registered manager. There are eight requirements which remain to be met from the previous inspection together with nine new requirements and two recommendations from this inspection. Six of the unmet requirements are outstanding from the previous two inspections and must be addressed as a matter of urgency. These relate to Standard 18 (whistle-blowing policy), Standard 31 (management of the home), Standard 33 (quality assurance), Standard 36 (supervision), Standard 36 (policies and procedures), and Standard 38 (infection control training). What the service does well:
Generally, service users presented as settled and satisfied, there being a good atmosphere in the home. Many positive comments were made to the inspector regarding the home and the support provided. The management and staff were observed to interact with the service users in a caring, respectful and professional manner. Service users are being provided with the information they require to enable an informed choice as to where they would like to live. Prospective service users, their friend and relatives are able to visit to assess the suitability of the home. The home is able to demonstrate that service users needs are being properly assessed, and that the range of needs presented is being appropriately met. Service users are having their health, personal and social care needs set out in an individual plan of care, with review taking place on a monthly basis.
Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 6 Feedback from individual residents indicates that service users are being treated with respect and that their right to privacy is being upheld. Service users are being provided with opportunities for recreational and social activities sufficient to meet their existing needs. Service users expressed their satisfaction with the range of activities provided. Service users are encouraged to maintain contact with their family and friends and to retain links with the local community. Positive comments were received from both service users and relatives regarding the welcoming atmosphere in the home. Service users are assisted to exercise a fair degree of choice and control over their day-to-day routines and decision-making. Service users indicated that they have flexibility in their routines and are able to make decisions in regard to their day-to-day activity. Staff are perceived as being very supportive in this regard. Service users expressed favourable views regarding the quality of food provided. The meals provided offer a varied range of choice and are wholesome and nutritious. These are served at times, and in places, which are convenient to the home’s service users. The home has an appropriate complaints policy and procedure in place. Clear information for raising complaints is made available, and service users and their relatives/friends are able to raise any concerns they may have. No complaints have been raised in the last twelve months. The legal rights of service users within the home are being protected and promoted, no concerns being expressed. Service users are encouraged and assisted to vote if they wish. Service users have access to safe and comfortable communal facilities. There is a pleasant garden which is easily accessible from the lounge. Service users’ rooms were observed to be safe, comfortable and pleasantly decorated, reflecting service users’ personal identities, and being suited to their individual needs. An audit of all service users’ bedrooms has been completed, with some items of furniture having been added or replaced. Service users expressed positive views regarding their living arrangements and presented as settled and satisfied with their environment. Sufficient bathing and toilet facilities are currently in place, though any increase in the number of service users requiring assisted baths may require additional facilities to be provided. Sufficient aids and adaptations are in place to safely meet the needs of service users: the home has been assessed by an occupational therapist. Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 7 The home has the numbers and skill mix of staff sufficient to safely meet the needs presented by the home’s service users. The home is on track for meeting the target of 50 of staff with NVQ Level 2 by 2005. While the home should have a registered manager, it is presently being effectively managed by the registered providers, one of whom (Mrs Balachandran) is studying for an appropriate management qualification. The management approach was observed to be conducive to creating an open, relaxed and friendly atmosphere. Service users spoken to by the inspector indicated that the home is being run in their best interests. What has improved since the last inspection?
Each service user is being provided with a copy of their contract or terms and conditions at the point of moving into the home. The format has now been been revised so as to make it more comprehensible and user-friendly. The service users guide has been revised so as to provide more comprehensive information to existing and potential service users about the home. All current service users need, however, to be given a revised guide. In order to ensure safe medication practice, an outstanding requirement for accredited medication training has now been partially met, with training having been undertaken by all but two care staff; however, this still has to be evidenced with the relevant staff training certificates. The home has now registered under the Data Protection Act 1998 and has a policy on access to files which is consistent with the requirements of the Act. The home has recently developed a written gifts policy which clearly states that staff are prohibited from being involved in, or from being a beneficiary, of service users’ wills. The home has complied with an immediate requirement from the last inspection for staff to attend statutory Vulnerable Adult training and familiarise themselves with the local adult protection procedures. One staff member has, however, still to attend this training. Staff are now being provided with the necessary induction and training with which to achieve competence in their work roles. The induction programme has been developed (to meet TOPPS specifications) so as to include training on key policies, procedures and practice (including safe working practices). Following a requirement from the last announced inspection (on 21/7/04) an annual staff training plan has now been developed.
Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 8 What they could do better:
While risk assessments of service users are being completed, training in carrying these out needs to be extended to all care staff if service users are to be appropriately safeguarded. An appropriate policy and procedures are in place for medication. While service users were generally evidenced to be protected by these procedures, the procedure for risk assessing any service user who self-medicates has not been followed for one service user, and must be adhered to forthwith. The home’s policies, procedures and practice indicate that service users are being protected from abuse. Following a requirement from the last inspection, a copy of the Local Authority’s Vulnerable Adult Procedures has now been obtained. However, to ensure safety, the home’s procedure for reporting allegations must be amended to include the Local Authority’s guidance. While the home presents as clean, pleasant and hygienic, a requirement for staff to receive infection control training has still to be met. Whilst the home has appropriate recruitment policy and procedures in place, a CRB (Criminal Records Bureau) check has not been obtained for one appointment. This is potentially compromising the protection and safety of service users. The registered providers have been advised that no future appointment can be made an up-to-date CRB certificate has been obtained. The home is failing to provide regular supervision for staff. This is detrimental to the support and development of staff, and is potentially compromising the protection and safety of service users. A structured format for recording all aspects of supervision needs to be developed which includes policy, practice and training issues. A system of annual staff appraisal also needs to be developed, to identify performance and training objectives for each staff member and the extent to which these have been met over the twelve month period. The home is beginning to develop its quality assurance processes, with service users views being canvassed. The home needs to develop these processes further, to evidence a wide range of feedback from service users’ relatives, professionals and other stakeholders, and to complete an audit. The home also needs to demonstrate the link with forward planning by putting in place an annual development plan. Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 9 The home needs to evidence that it is annually reviewing its policies and procedures. These must be signed and dated, and a policies and procedures checklist maintained. Generally, the inspector is satisfied that the health, safety and welfare of service users and staff are being appropriately promoted and protected, with all safety checks and certification being in place. However, a requirement for staff to undertake infection control training has yet to be met. 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. Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 10 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 Standards Statutory Requirements Identified During the Inspection Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 11 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 standard(s) 1, 2, 3, 4, 5 and 6 Service users are being provided with the information they require to enable an informed choice as to where they would like to live. Following revision of the service users guide, amended copies must be provided to all the home’s service users. Each service user is being provided with a copy of their contract or terms and conditions at the point of moving into the home. The format has been revised so as to make it more comprehensible for service users. The home is able to demonstrate that service users needs are being properly assessed, and that the range of needs presented is being appropriately met. Prospective service users, their friend and relatives are able to visit to assess the suitability of the home. EVIDENCE: Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 12 The home has compiled a statement of purpose outlining the aims and objectives of the home, and the facilities and services it provided. This has now been expanded to include all the information detailed in Schedule 1 of the Care Homes Regulations (2001). The home has developed a service user’s guide; this has been expanded to include all elements of Standard 1.2. The registered person must ensure that a copy of the revised service users’ guide is provided to every service user. A requirement applies. The home has developed a contract which is more user friendly, being written in an appropriate format/language. The contract must be signed by the service user or his representative and state the number of the room to be occupied. Since there have not been any admissions since the last inspection, it was not possible to evidence these on individual service users’ files. Hence this will be monitored again on the next inspection and the requirement remains to be met. The home is required to obtain a full care management assessment and care plan from any service user’s referred by a local authority. In respect of service user’s who are fee paying the registered persons undertake an assessment with the service user, relative or delegated representative and relevant professionals that have been party to the referral. As there have not been any new admissions it was not possible to evidence whether these procedures are currently being followed. Previous sampling of service users admitted to the home have indicated that full assessments have been completed. The home’s capacity to meet the assessed needs of individuals admitted to the home are evidenced as being met. Staff possess the relevant skills and experience with which to deliver the service to a satisfactory standard. A key worker system is in operation. The GP visits the home and other medical professionals attend when needed. The changing care needs of service users are being monitored. Following a requirement from the last announced inspection, care plans are being reviewed on a monthly basis. The specific social and cultural needs of service users are being identified and addressed. Service users spoken to by the inspector indicated that they are happy with the care and support provided and feel that their needs are being satisfactorily met. Prospective users are invited to visit the home and to move in on a trial basis, based on their needs and choice. Staff visit prospective service users in their own home or current setting wherever possible, so as to gain as full a picture as possible of their needs and lifestyle. The Registered Providers are keen to ensure that new service users are compatible with existing service users. The home does not accept emergency admissions or provide intermediate care. Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 13 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 standard(s) 7, 8, 9, 10 and 11 Service users are having their health, personal and social care needs set out in an individual plan of care, with review taking place on a monthly basis. While risk assessments are being completed, training in carrying these out must be extended to all staff if service users are to be appropriately safeguarded. An appropriate policy and procedures are in place for medication. While service users were generally evidenced to be protected by these procedures, the procedure for risk assessing any service user who self-medicates has not been followed for one service user, and must be ensured forthwith. While accredited medication training has been extended to all but two care staff, this remains to be evidenced with the relevant staff training certificates. Service users are being treated with respect and their privacy is being maintained. Following a requirement from the last inspection, the home is now recording service users’ wishes regarding the eventuality of the service user’s serious illness or death. The home’s policy and procedures indicate that the views and wishes of service users and their relatives are being respected. EVIDENCE:
Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 14 Care plans are compiled on the basis of the initial assessment prior to admission, on admission and during residency. A number of care plans were sampled – these now include a photograph of the service user. These set out the individual needs of each service user and how the home aims to meet these. Care plans and risk assessments are now being reviewed and recorded on a monthly basis. While risk assessments are being carried out by key workers, not all staff have received relevant training in carrying these out. A requirement applies. All service user plans need to be signed and drawn up with the involvement of the service user and/or his/her representative. Arrangements are in place for users to be asked whether they wish to see their care plan. Service users are evidenced to have their health care needs met. Each service user file contains details of all visits to/from the district nurse, GP, hospital and other appointments. The manager states that the home has a very good relationship with the local surgery, with two GP’s visiting on a regular basis. The registered person advised that the GP is called immediately if any healthcare concerns arise. The care plans include a health section. This lists all the healthcare professionals that are involved with the service users. This includes the GP, district nurse, CPN, physiotherapist, dentist, optician or chiropodist. When the service user is seen by the health professional this is documented on a chart. Weight charts are used for those service users where there is concern in this area. A section to include action taken in the event of weight changes has been added. The home has a medication policy in place. Blister packs are used and kept in a locked cupboard. No controlled drugs were in use at the home at the time of inspection. The inspector examined a number of service user’s medication records and found these to be in order. Following a concern from the last inspection MAR sheets are now being kept up-to-date and accurate, with staff signing the MAR sheets to indicate that medication has been given. The receipts and disposals record was also examined and found to be satisfactory. The pharmacist visits regularly to do a medication audit. On his most recent visit, on 11 February 2005, he found the home’s recording to be satisfactory. No issues were identified. There is a requirement from the last inspection for all staff who administer medication to complete accredited medication training. The registered person advised the inspector that all but two staff completed this training on 10 January 2005 but are still awaiting the certificates from Boots Pharmacy. The inspector was advised that the other two staff are scheduled to do training in
Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 15 July 2005. The requirement remains until it has been evidenced that all staff at the home have completed their accredited medication training. A requirement from the last inspection relating to the risk assessment of any service user who self-medicates was discussed. The registered person advised that one service user no longer self-administers any medication apart from a skin cream. The GP has put in writing that he is happy for the service user to collect his prescription and obtain the skin cream from the pharmacy. A risk assessment must, however, be put in place to cover this service user and any other service user for whom this may apply. Each bedroom has a lockable facility. In addition there are also concerns that relatives could bring medication into the home without advising the staff – the registered providers have agreed to include this in the homes contract. Staff were observed to respect the privacy and dignity of service users, and to be interacting in a respectful and professional manner. Service users spoken to by the inspector felt their privacy was respected and indicated that they are able to see visitors in their own rooms if they wish. In the shared rooms curtains are available to screen off the shared areas when care is being given. Following a requirement from the last inspection the home is now recording service users’ wishes concerning the eventuality of their serious illness or death. These are being noted on a separate record, but a summary of these needs to be recorded in the service user’s care plan. The home has a policy on death and dying. The service users family and friends are involved (if that is what the service user desires) in planning and dealing with infirmity, terminal illness and death. A Catholic priest visits regularly and contact has been made with a Church of England minister. Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 16 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 standard(s) 12, 13, 14 and 15 Service users are being provided with opportunities for recreational and social activities sufficient to meet their existing needs. Service users expressed their satisfaction with the range of activities provided. Service users are encouraged to maintain contact with their family and friends and to retain links with the local community. Service users are assisted to exercise a fair degree of choice and control over their day-to-day routines and decision-making. The meals provided are wholesome and appealing and are served at times, and in places, which are convenient to them. EVIDENCE: Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 17 The home offers a range of activities which includes bingo sessions, painting, ,and music/movement therapy. There are also various local church activities which service users attend, summer barbecues in the garden, and organised outings to places of interest. During the inspection some service users were gathered in the ground floor communal lounge where they were interacting positively with staff. Service users spoken to by the inspector indicated that they enjoy considerable flexibility in their routines and are able to visit the local shops, parks and community facilities. There are no restrictions unless there are concerns regarding a service user’s own personal safety. Staff often accompany service users when accessing activities in the community. The registered person advised that the home is hoping to arrange a day trip to the sea-side during the summer. Visitors to the home are actively encouraged and welcomed. Feedback received from relatives’ comments cards was very positive, indicating that the home has a welcoming atmosphere and that relatives are able to visit when they wish. Service users spoken to by the inspector indicated that their visitors are made to feel welcome and that privacy for visits is respected. Service users spoken to during the visit expressed their satisfaction with the way the home is run, and indicated that they are able to exercise a fair measure of personal autonomy and choice. Service users’ meetings are being held. Two service users are entirely involved in dealing with their own financial affairs, including collecting their pensions. Others have assistance, generally from relatives or close friends. The registered person advised the inspector that one service user has a Court of Protection order, not wishing to have anyone else involved in administering their monies and assets. The home handles monies for service users only when a local authority has an agreement that the home will act as the ‘conduit’ for the payment of personal allowance. Advocacy services are known of and publicised at the home. The home has developed an access to files policy. The home is now committed to the principles and conditions of the Data Protection Act 1998, having complied with a requirement to register under the Act; from 11.1.05. Several positive comments regarding the quality of the food were expressed by service users. The home provides a well-balanced and nutritional diet. This is evidenced in the home’s menus and in the observation of food being prepared and served to service users. The menus are changed on a regular basis and the food on offer is discussed with service users. Three meals a day are available, together with morning and afternoon teas. A copy of the day’s menu is placed on the notice board with alternatives being available if required. The dining room is able to seat all the residents comfortably. The home keeps a detailed record of all food consumed by the service users. Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 18 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 standard(s) 16, 17 and 18 The home has an appropriate complaints policy and procedure in place. Clear information for raising complaints is made available, and service users and their relatives/friends are able to raise any concerns they may have. The legal rights of service users within the home are evidenced to be protected and promoted. Service users are encouraged and assisted to vote if they wish. The home’s policies, procedures and practice indicate that, generally, service users are being protected from abuse. A copy of the Local Authority’s Procedure on the Protection of Vulnerable Adults has now been obtained. To ensure safety, however, the home’s procedure for reporting allegations must be amended to include the Local Authority’s guidance. The home has complied with an immediate requirement from the last inspection for staff to attend statutory Adult Protection training. EVIDENCE: Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 19 The home has a policy and complaints procedure. This has been revised to meet the standard. The complaints procedure is clear and simple and includes the stages and time scales for complaints to be managed. The procedure has been amended so as to state that a complaint can be referred to the CSCI at any time. The outcome of any complaint and action taken is now clearly stated in the complaints book. No complaints have been recorded since the last inspection. The registered person has advised that all complaints are taken seriously and would be dealt with promptly and effectively. The home also has a concerns and compliments book which it keeps on display for visitors. No recent entries have been recorded. All service users are registered to vote and are supported where necessary to attend the polling station. Many have exercised their right to (the new easier process of) postal voting. The home holds information on advocacy services should they be required. Both Mind and Age Concern, in Croydon, provide this service. The home has now obtained a copy of the Local Authority’s Procedure on the Protection of Vulnerable Adults. The home’s internal adult protection procedures must, however, be amended and updated to include the Local Authority’s guidance. The home has a Whistle Blowing Policy in place for staff to reference should the need arise. This needs to be developed to ensure it complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets. Following an immediate requirement from the last inspection all but one new staff member have attended Adult Protection training. Training has been provided by an accredited agency (‘Safer Staff Training and Recruitment’) on 25.1.05. The registered person is making arrangements for the new staff member to be placed on a waiting-list to undertake training. She also confirmed that she is considering undertaking an accredited training course on adult protection such as ‘Training for Trainers’, which can then be cascaded down for the benefit of all staff. The home has now developed a written policy prohibiting staff from being involved in or becoming a beneficiary of service users’ wills. Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 20 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 standard(s) 19, 20, 21, 22, 23, 24, 25 and 26 Service users are evidenced to live in a safe, well-maintained environment, with access to safe and comfortable facilities. Risk assessment of the home and individuals are in place for their protection. The home has now complied with a requirement for drawing up a planned programme of maintenance and development for the home. Service users have access to safe and comfortable communal facilities. Service users expressed presented as settled and satisfied with their environment. Sufficient bathing and toilet facilities are currently in place, though any increase in the number of service users requiring assisted baths may require additional facilities to be provided. Sufficient aids and adaptations are in place to safely meet the needs of service users. Service users’ rooms were observed to be safe, comfortable and pleasantly decorated, reflecting service users’ personal identities, and being suited to their individual needs. An audit of all service users’ bedrooms has been completed, with some items of furniture having been added or replaced. Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 21 While the home presents as clean, pleasant and hygienic, a requirement for staff to receive infection control training has still to be met. EVIDENCE: The home has now complied with a requirement for drawing up a planned programme of maintenance and development for the home. The registered persons are planning to build on a conservatory to the house, providing a new space to accommodate the few smokers at the home. The present smoking room would then be converted into an office. At the same time a link corridor will be provided across the front of the house to create an internal link with the laundry - an essential measure required to ensure best practice with regard to infection control. The home has been inspected by the Environmental Health inspector on 8 February 2005. The registered persons must supply a copy of the report of the said inspection and ensure that all recommendations have been acted upon. If the plan to build a conservatory does not go ahead the registered persons will need to consult further with the Environmental Health Department to ensure that the current laundry meets all current regulations. The communal areas appeared very pleasant and homely. There is a spacious lounge which is divided into two distinct areas, with a separate dining area. The lounge and dining room overlook a pleasant garden. This is used by the service users in the summer months. Service users spoken to by the inspector presented as very satisfied with their environment and the communal facilities provided. There are four bathrooms and five toilets spread throughout the home. No ensuite toilet or bathing facilities are available for service users. There are sufficient assisted baths provided at the home. It is accepted that not more than two assisted baths would be able to be given at any one time, as staffing would not allow this. At the present time there are 13 service users in the home, 10 of whom require assistance with washing and bathing. With two staff on duty (and three at peak times) this is currently sufficient, but could become more problematic should the current numbers of service users requiring assistance increase. A mechanical sluice / pan sterilising machine is separately located in its own room on the first floor, enabling access from all areas, without risk of crossinfection. The home has been assessed by an occupational therapist on 24 July 2004, and all requirements from this assessment have now been met. These include
Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 22 placing restrictors on all upstairs windows, completing risk assessments for all service users who use the stairs, and the placing of warning signs on all doors that open outwards. The home has stair rails and rails fitted along corridors. There is a passenger lift to all floors. The home has a loop system for the television and telephone. Raised toilet seats, commodes and adapted bath chairs were in evidence throughout the home. The bedrooms looked at were observed to be comfortable and personalised to reflect individual preferences. Service users are able to bring personal possessions and items of furniture with them to the home. Lockable spaces are provided. Service users spoken to were happy with their rooms and felt that these met their needs. One service user offered to show the inspector his room. This was pleasantly arranged and was personalised with photos and mementoes. The service user showed the inspector his collection of model aeroplanes which he had constructed himself. Two requirements regarding the furniture provided in service users’ rooms have now been met. Since the last inspection, when some worn furniture was identified, and the fire safety of some items was queried, a fire officer has visited and an audit of service users’ rooms been carried out by the owners. Some of the furniture has as a result been replaced with service users being consulted regarding any additions or replacements required. The owners stated that all items not considered to be fire resistant have now been disposed of. The inspector did, however, identify the need for one worn-looking armchair in Room 11 to be replaced. A small bedside table and table lamp are required for Room 16, and a table lamp (or wall mounted lamp) are required for Room 11. All other rooms are now providing a table lamp or wall mounted lamp in accordance with a previous requirement. Service users rooms were found to be well ventilated and to be at a comfortable temperature. Service users are able to control the temperature of their own rooms using temperature thermostats on their radiators. All radiators are covered for safety reasons. The lighting throughout the home is adequate, all rooms having natural light and opening windows. Thermostatic valves on baths control the heat of hot water outflow, and regular weekly checks of water temperatures are being maintained. All areas in the home presented as being clean and tidy and free from any offensive odours. Laundry facilities are currently entered by a door outside near the kitchen door or through a door in the service user’s smoking room in bad weather. The registered persons are planning to build an extension and relocate the smoking room and construct a walkway that will provide covered access to the laundry. While the laundry appears adequate for the needs of the service users, the wall finishes are not readily cleanable and the laundry room
Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 23 itself requires refurbishment. An infection control policy is in place. A requirement for staff to receive infection control training has still to be met (see standard 38). All COSHH items were observed to be securely stored in locked cupboards. Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 24 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 The home has the numbers and skill mix of staff sufficient to safely meet the needs presented by the home’s service users. The home is on track for meeting the target of 50 of staff with NVQ Level 2 by 2005. Whilst the home has appropriate recruitment policy and procedures in place, a CRB (Criminal Records Bureau) check has not been obtained for one appointment. This is potentially compromising the protection and safety of service users. Generally, staff are now being provided with the necessary induction and training with which to perform their work duties competently, and safely meet the needs of service users. An annual staff training plan has now been developed. EVIDENCE: Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 25 A minimum of two staff are provided at any time, day or night (both waking staff), with at least three staff being present at peak times in the morning. Staff undertake domestic tasks as well as caring responsibilities. The extra staffing in the morning allows for some ancillary work without reducing from the two care staff being available to service users at all times. The proprietors’ hours are generally supernumerary to the rota, unless either is ‘filling in’ for a staff absence. Staffing levels are closely monitored enabling existing staff to be approached to provide cover for vacant shifts. The inspector understands that six members of the current staff team of thirteen have achieved NVQ level 2 or above in care qualification, and that two others are nearing completion. This is in line with the 50 requirement which is required. The registered providers are keen to ensure that all staff have the opportunity of obtaining an NVQ qualification. Staff records evidence qualifications obtained by staff. These include statutory training in food hygiene, manual handling and first aid. Training in fire awareness, risk assessment, medication and adult protection have taken place within the last twelve months with updated food hygiene training, and training in infection control and manual handling being planned. Statutory adult protection training is, however, required for all staff. A requirement from the last announced inspection for an annual staff training plan to be developed has now been met. The inspector examined the staff files of two new staff members and found that one CRB (Criminal Records Bureau) check was not in place. The inspector informed the registered provider that no new staff appointed by the home may commence duties until an up-to-date and valid CRB check has been received. Another staff file did not include a photograph of the staff member as required in Schedule 2 of the regulations. All other identity and employment checks were found to have been satisfactorily completed. These included the full name, address, date of birth, copies of Birth Certificates and passports (if any), two written references from previous employers, and the dates when employment commenced. Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 26 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 36 and 38 While the home should have a registered manager, it is presently being effectively managed by the registered providers, one of whom (Mrs Balachandran) is studying for an appropriate management qualifications. The management approach was observed to be conducive to creating an open, relaxed and friendly atmosphere. Service users feel that the home is being run in their best interests. The home is failing to provide regular supervision for staff. This is detrimental to the support and development of staff, and is potentially compromising the protection and safety of service users. A structured format for recording all aspects of supervision needs to be developed. A system of annual staff appraisal also needs to be developed, to identify performance and training objectives for each staff member and the extent to which these have been met. Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 27 The home must evidence that it is annually reviewing its policies and procedures. These must be signed and dated on a policies and procedures checklist. The home is beginning to develop its quality assurance processes, with service users views being canvassed. The home needs to develop these processes further, to evidence a wide range of feedback from service users’ relatives, professionals and other stakeholders, and to complete an audit. The home also needs to demonstrate the link with forward planning by putting in place an annual development plan. The home has the accounting and financial procedures in place with which to demonstrate its financial viability. Generally, the inspector is satisfied that the health, safety and welfare of service users and staff are being appropriately promoted and protected, with all safety checks and certification being in place. However, a requirement for staff to undertake infection control training has yet to be met. EVIDENCE: The registered persons took over the home in June 2003 with a registered manager of their selection joining them at the point of transfer to their ownership. This did not work out and the two proprietors have been managing the home. A further appointment was made in January 2005 but again this did not work out and the manager was asked to leave. Mrs Balachandran has a BSc in Print Technology Management & Research, and has skills in Counselling and Complementary Therapies - she has completed the CMS (Certificate in Management Studies) and is hoping to complete studies leading to the RMA (Registered Manager’s Award) and NVQ by the end of July 2006. Mr Balachandran is a qualified Chartered Management Accountant. Although the registered providers have experience in management, a registered manager will need to be appointed as neither has the background in residential care management, nor specific client-group knowledge. Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 28 The management approach of the registered providers is one that creates a positive and inclusive atmosphere. Both staff and service users are, wherever possible, encouraged to participate in the day-to-day operation of the home and to express their views through service user and staff meetings. The inspector observed that the providers and staff interacted well with one another and with service users. Service users expressed positive views regarding the proprietors and their management of the home. The inspector sampled some staff files and found that staff supervision is still not taking place on a regular basis, with only one or two sessions having taken place in the last six months. This needs to be taking place on at least a two monthly basis. The practice of the home is for one of the registered providers and the senior care officer to supervise the staff. There is also a need to develop a structured format for recording supervision. Supervision needs to cover all aspects of practice, philosophy of care in the home and career development needs of the staff as a minimum. The inspector recommends that the format of supervision is addressed as not all of these areas are being covered. A system of annual staff appraisal also needs to be developed, to identify performance and training objectives for each staff member and the extent to which these have been met. An appraisal format should be developed to record the appraisal. There is an unmet requirement from the last inspection for the home to evidence that it is annually reviewing its policies and procedures. These must be signed and dated on a policies and procedures checklist. There is an outstanding requirement for the home to develop an effective quality assurance system. This should ensure that the home is meeting its aims, objectives and statement of purpose. Since the last inspection the home has been developing its quality assurance processes. A questionnaire has been devised and completed with the home’s service users. Questionnaires still need to be developed for the relatives/friends of service users, and one for visiting care managers and other professionals. The home is yet to carry out an annual audit, the results of which should be sent to the CSCI, local office. In addition the home has still to put in place an annual development plan. Suitable accounting and financial procedures are adopted to demonstrate current financial viability. Audited accounts are available to be inspected upon request by the CSCI. The registered persons ensure that the service users who wish to control their own money can do so. Those who are unable to do so have either a relative or a designated representative to assist and support them as required. Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 29 The home has now completed a fire risk assessment (on 15.6.05). Staff have received fire awareness training (on 13.1.05), following an immediate requirement being served by the inspector. All maintenance checks including gas, electrical equipment, hoist servicing, lift maintenance and legionella have been inspected and are up to date. The home’s lift is inspected every six months in line with the LOLER regulations 1998. Emergency lighting has been inspected on 7.3.05 and records are available for inspection. Risk assessments for safe working practices have now been completed. Health and safety risk assessments have been carried out for areas of risk including the premises, manual handling, drugs, COSSH and waste disposal, on 19.6.05. All staff have received approved manual handling and food hygiene training, and five staff have attended a one day first aid course. Infection control training for staff has not yet been undertaken. The inspector was assured by the providers that training has been arranged (with JPR Training Co.) and that the home is awaiting dates on which this will take place. The home has purchased a TOPSS approved induction pack for all new staff. This has now been put into place and evidences that each staff member has completed induction training including health and safety, the values and principles of care, resident care, and key policies and procedures. Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 2 3 1 3 3 1 x 2 Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 31 No Are there any outstanding requirements from the last inspection? 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. Standard OP1 Regulation 5(2) Requirement The registered person must ensure that a copy of the revised service users’ guide is provided to every service user. The registered person must ensure that the terms and conditions between the home and service user is held alongside the local authority three-way contracts (2.2). The home’s contract must be written in a user-friendly format, state the number of the room to be occupied, and be signed by the service user or his representative. Training in carrying out risk assessments is required for all staff. A risk assessment in relation to self-medication must be completed with any service user who administers their own medication (including skin creams), following consultation with the GP, care manager and next of kin. The registered person must ensure that all staff who administer medication completes the current accredited training Timescale for action 1.10.05 2. OP2 5(1)(b) ( c) Time-scale extended to 1.10.05 3. 4. OP 7, OP30 OP9 13(4)c, 18(1)c 13(2) 1.10.05 1.08.05 5. OP9 13(2) Time-scale extended to 1.08.05
Page 32 Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 6. OP18 13(6) 7. OP19 23(2) & (5) course. Details of which must be sent to the CSCI, local office. The home’s internal adult protection procedures must be amended and updated to include the Local Authoritys Vulnerable Adults guidance. The registered persons must forward to the CSCI a copy of the environmental health report relating to the inspection of the home, and ensure that all stated recommendations have been carried out. One worn-looking armchair in Room 11 must be replaced. A small bedside table and table lamp are required for Room 16, and a table lamp (or wall mounted lamp) are required for Room 11. The registered person must obtain an up-to-date CRB check for a staff member who has recently commenced employment at the home. A copy must be forwarded to the CSCI, Croydon office. The responsible person must ensure that a new CRB (Criminal Records Bureau) check is obtained prior to the recruitment of any new care staff. The registered person must ensure that all identity and employment checks, including a photograph, are completed prior to any new staff member commencing employment at the home. The registered persons must appoint a qualified manager to manage the home without further delay; or, if a manager is employed without NVQ at Level 4 in care, they must commit to completing the Course (31.1, 2, 1.09.05 1.09.05 8. OP24 16(2)c 1.09.05 9. OP29 19(1)(b) Sch.2, No.7 1.08.05 10. OP29 19(1)(b) Sch.2 1.08.05 11. OP31 9(1) (2) and 10(1) Time-scale extended to 1.10.05 Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 33 12. OP33 24(1)(2)( 3) 13. OP36 18(2) 14. OP18 13(6) 15. OP36 12(1) 16. OP38 13(3) 4 5). Any registered manager must have at least two years experience in a senior management capacity in the managing of a relevant care setting within the past five years. (Previous timescales of 31/10/04 and 31/3/05 not met) The registered persons must ensure a quality audit system, including an annual development plan is in place to assess whether the aims and objectives of the home have been met and:The home must implement a professionally recognised quality assurance or ‘join up’ their own quality assurance tools into a cyclic quality assurance system. (Previous timescales of 31/10/04 and 31/3/05 not met) The registered persons must ensure all staff receives supervision in line with the standard. Supervision must cover all aspects of practice, philosophy of care in the home and career development needs of the staff as a minimum. (Previous timescales of 31/09/04 and 31/03/05 not met) The registered persons must develop the homes whistle blowing policy to ensure it complies with the Public Disclosure Act 1998 and the Department of Health Guidance ‘No Secrets’. (Previous timescales of 31/09/04 and 31/1/05 not met) Policies and procedures adopted by the home must be reviewed by the registered persons. They must be signed and dated at the point of adoption. (Timescale of 31/10/04 and 31/3/05 not met) The registered persons must ensure key staff undertake Time-scale extended to 1.10.05 Time-scale extended to 1.08.05 Time-scale extended to 1.09.05 Time-scale extended to 1.10.05 Time-scale extended
Page 34 Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 17. OP36 18(1)a & (2) infection control training, (standard 38.2) (Timescale of 30/09/04 and 31/3/05 not met) A system of annual staff appraisal must be developed. An appraisal format should be developed to record the appraisal. The appraisal should identify performance and training objectives for each staff member and the extent to which these have been met over the twelve month period. to 1.10.05 1.10.05 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. Refer to Standard OP36 Good Practice Recommendations Supervision needs to cover all aspects of practice, philosophy of care in the home and career development needs of the staff as a minimum. The inspector recommends that the format of supervision is developed so as to ensure that all of these areas are being covered. A policies and procedures, checklist detailing the dates when each was put in place, and reviewed, should be put in place. 2. 3. OP36 Rosina Lodge G53 S43469 rosinalodge V197708 230605 stage4 .doc Version 1.30 Page 35 Commission for Social Care Inspection 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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