Inspection on 03/05/07 for Rosina Lodge

This inspection was carried out on 3rd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Rosina Lodge 04/05/06

Rosina Lodge 09/01/06

Rosina Lodge 23/06/05

Rosina Lodge 14/12/04

Rosina Lodge 21/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Rosina Lodge 76 St Augustine`s Avenue South Croydon Surrey CR2 6JH Lead Inspector Peter Stanley Key Unannounced Inspection 3rd May 2007 9:30am 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 Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosina Lodge Address 76 St Augustine`s Avenue South Croydon Surrey CR2 6JH 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) 020 8760 0735 020 8760 0735 rosina@blueyonder.co.uk Mr Balasubramaniam Balachandran Ginige Pearl Srimatie Balachandran Ginige Pearl Srimatie Balachandran Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th May 2006 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 has a pleasant grassed garden to the rear with flowerbeds. The frontage is tree-lined with conifers, and provides parking space for a number of vehicles. Public transport is a walk away on the Brighton Road (frequent services). A closer (but less frequent) service is available on Pampisford Road. The home is a three-storey 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 the second and third floors. All main public rooms (Dining room/ through Lounge and a separate smoking room) are provided at ground floor level with a small quiet sitting room on the first floor. The home has, in 2007, adopted a no smoking policy and no longer accepts admissions from individuals who smoke. The smoking room has been converted into a small sitting room. This provides a facility for residents to receive visitors in relative privacy, and is also used for staff supervision and training. Both the kitchen and laundry are at ground floor level. The proprietors are hoping, in due course, to build a conservatory at the rear of the property. Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There are currently 17 residents at this home, with 2 vacancies. This unannounced inspection was conducted over one day and involved discussion with the registered providers, Mr Balachandran, and Mrs Balachandran, who has recently become the registered manager, having completed studies for the necessary residential management qualifications. The inspector spoke to a large number of residents during the course of this inspection, and case-tracked two recent admissions to the home. He also spoke to staff members on duty, and observed staff’s interactions with residents. The inspector examined documentation including residents’ care plans, risk assessments, activity charts and daily logs, medication records, staff supervision and training records, policies and procedures, staff rotas and logs relating to incidents, accidents and complaints. The inspector carried out a full inspection of the premises and completed checks relating to health and safety. The inspector also received completed questionnaires from five residents and two relatives. These indicated generally favourable views regarding the home, though one relative felt that the home was understaffed at times. This is an issue that was followed up on this inspection, and for which the staffing requirement for the afternoons, (currently 2 care staff) was felt to be insufficient in providing the necessary level of monitoring, engagement with residents and capacity to meet residents’ support needs. A requirement, for 3 care staff to be on duty throughout the day, from 8am to 6pm (rather than from 8am to 2pm) has therefore been applied. Feedback from residents has been generally favourable, with residents presenting as settled, and satisfied with the home and the care provided. Questionnaires, which had been completed by relatives, indicated a generally high level of satisfaction with the home. Generally, the home has continued to make good progress over the last year, with 10 of the 14 requirements issued at the last key inspection having been met by the time of the last (random) inspection on 20.11.06. All but one of the remaining requirements have now been met at this inspection. From this inspection there are four new requirements, making five in all. The inspector would like to extend his thanks to the registered providers Mr and Mrs Balachandrun, and to residents and staff at Rosina Lodge, for their assistance in facilitating this inspection. What the service does well: Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 6 Residents are being provided with all the information they require to enable an informed choice as to where they would like to live. Each resident is being provided with a copy of his or her contract or terms and conditions at the point of moving into the home. The home is able to demonstrate that it is assessing the needs of prospective residents, and that care management assessments are being obtained prior to admission. The home is able to demonstrate that the range of needs presented by residents is being appropriately met. Prospective residents, their relatives and friends, are able to visit to assess the suitability of the home. Residents are having their health, personal care and social needs set out in an individual plan of care, with review taking place on a monthly basis. The health care needs of residents are being fully met. Residents are being safeguarded by the home’s medication policies and procedures. All staff have completed accredited medication training. Residents feel that that they are being treated with respect and that their right to privacy is being maintained. The views and wishes of residents, and those of their relatives, regarding the eventuality of their illness and death, are being respected. The health care needs of residents are being fully met. Residents are being safeguarded by the home’s medication policies and procedures. All staff have completed accredited medication training. Residents feel that that they are being treated with respect and that their right to privacy is being maintained. The views and wishes of residents, and those of their relatives, regarding the eventuality of their illness and death, are being respected. are being provided with opportunities for recreational and social activities sufficient to meet their existing needs. Residents are encouraged to maintain contact with their family and friends and to retain links with the local community. Residents are assisted to exercise a fair degree of choice and control over their day-to-day routines and decision-making. Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 7 The meals provided are wholesome and appealing and are served at times, and in places, which are convenient for residents. Residents are living in a safe, well-maintained environment, with access to safe and comfortable facilities. Residents’ rooms present as being safe, comfortable and pleasantly decorated, reflecting individual residents’ personal identities, and being suited to their individual needs. Residents have access to safe and comfortable communal facilities. Sufficient bathing, washing and toilet facilities are being provided for the home’s residents. Residents’ safety is being assured through the provision of sufficient aids and adaptations. Residents are living in a home that presents as being clean, pleasant and hygienic. Residents are being safeguarded by satisfactory recruitment policy and procedures. Criminal records checks are being completed before the recruitment of any new staff. Generally, staff are being provided with the necessary induction and training with which to perform their work duties competently, and to safely meet the needs of residents. Generally, the home is being well managed, and in a way that demonstrates that it is being run in the best interests of residents. The home is consulting widely with residents, relatives and other stakeholders, and is beginning to evidence the home’s ability to meet its aims and objectives. Through the regular and appropriate supervision of staff, good practice is being promoted and the welfare and best interests of residents protected. The interests of residents are being safeguarded by the home’s record keeping, with records being kept secure, up to date and accurate. The health, safety and welfare of residents and staff are being appropriately promoted and protected. What has improved since the last inspection? Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 8 A copy of the most recent inspection report is now being included in the service user pack. The requirement for risk assessment training has now been fully met, all staff who had not previously completed this training, having now done so. All staff have now undertaken medication training. All staff have now undertaken adult protection training. Meetings with residents have, over the last 12 months, been held on a regular two-monthly basis, and inspection of the minutes indicates that issues affecting the welfare and daily lives of the residents are being openly discussed. A Policies and Procedures checklist, detailing the date of adoption and review of each policy and procedure, has now been compiled and included in the Policies and Procedures manual. Staff now sign to indicate that they have read and understood key policies and procedures, together with any updates relating to them, meeting a recommendation from the last report. Up-to-date 12-monthly servicing of the Home’s portable electrical appliances has now been completed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 9 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 Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 to 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are being provided with all the information they require to enable an informed choice as to where they would like to live. Each resident is being provided with a copy of their contract or terms and conditions at the point of moving into the home. The home is able to demonstrate that it is assessing the needs of prospective residents, and that care management assessments are being obtained prior to admission. The home is able to demonstrate that the range of needs presented by residents is being appropriately met. Prospective residents, their relatives and friends, are able to visit to assess the suitability of the home. Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 11 EVIDENCE: The home has compiled a statement of purpose, which outlines the aims and objectives of the home, and the facilities and services it provided. This includes all the information detailed in Schedule 1 of the Care Homes Regulations (2001). The home has developed a service user’s guide; this includes all elements of Standard 1.2. All service users have been issued with a revised copy of the home’s service users’ guide. A copy of the most recent inspection report is now being included in the service user pack. Both the statement of purpose and the service users’ guide have been reviewed and updated, on 24.10.06. The home has developed a contract, which is written in an appropriate and user-friendly format. The inspector examined the files for two recent admissions and found contracts to be in place. Contracts are signed by the service user or his representative, and state the number of the room to be occupied. The inspector examined the files for the two residents admitted within the last 12 months and found that all relevant care management assessments had been obtained from the referring agency. The relevant pre-admission assessments, risk assessments and care plans had also been completed by the home. Evidence from care reviews indicates that residents are being involved in decisions relating to their care and that their needs are being satisfactorily identified and addressed. A sample of service users’ care plans evidenced that care plans are being regularly reviewed on a monthly basis. An appropriate induction and training programme is in place, which is helping to ensure that staff possess the relevant skills and experience with which to deliver the service to a satisfactory standard. A key worker system is in operation. Prospective residents, their friends and relatives, 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 DS0000043469.V337717.R01.S.doc Version 5.2 Page 12 Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 to 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are having their health, personal care and social needs set out in an individual plan of care, with review taking place on a monthly basis. The health care needs of residents are being fully met. Residents are being safeguarded by the home’s medication policies and procedures. All staff have completed accredited medication training. Residents feel that that they are being treated with respect and that their right to privacy is being maintained. The views and wishes of residents, and those of their relatives, regarding the eventuality of their illness and death, are being respected. EVIDENCE: Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 14 Care plans are being compiled on the basis of the initial assessment prior to admission, on admission and during residency. Two residents have been admitted to the home within the last 12 months. The inspector examined the care plans. These included a photograph of the individual and detailed the person’s individual needs and how the home aims to meet these. Sampling of care plans indicate that these are being reviewed and recorded on a monthly basis. The requirement for risk assessment training has now been fully met, all staff who had not previously completed this training, having now done so (on 27.6.06). Two new staff have also completed this training. The home is attached to a GP practice, which has registered 13 of the home’s residents. The practice has not, however, been able to accept some of the more recent admissions and these have been allocated to a GP from a different practice. There are no longer any regular routine visits to the home, and GPs and district nurses attend residents as and when required. While not ideal, this is a health care issue that is outside of the Home’s control. Other health care professionals, including a chiropodist, visit on a periodic basis. Generally, service users who spoke to the inspector were satisfied with the health care that they have received. Three residents are presently receiving visits from a district nurse. No significant health care concerns were identified. The home monitors residents’ weight and maintains weight charts. One resident who is currently overweight has received advice from a dietician, and her dietary needs are being closely monitored. The home has a medication policy in place. Blister packs are used and kept in a locked cupboard in the providers’ office. No controlled drugs were in use at the home at the time of inspection. The inspector has found that the home is satisfactorily maintaining the medication records of residents. MAR sheets are being kept up-to-date and accurate, with staff signing these to indicate that medication has been given. A recent photograph of the person receiving medication is being attached to each resident’s MAR sheet. The home maintains a satisfactory receipts and disposals record. The pharmacist’s most recent visit on 10 February 2006 found the home’s recording to be satisfactory. An up-to-date audit is, however, overdue, and must be arranged as a priority. A requirement applies. A requirement from the last inspection, for all staff that administer medication to complete accredited medication training, has now been met. Training has been evidenced with certificates. Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 15 There is good provision for enabling residents to maintain their privacy. Residents are able to see visitors in the privacy of their own rooms, or in the relative privacy of a small sitting room on the first floor. There is also another small room (previously a smoking room) which is now set aside for meetings, and in which residents can receive visitors. In the two double bedrooms curtains are available to screen off the shared areas when care is being given. The inspector spoke to a number of residents regarding their feelings as to whether staff are respectful of their privacy and dignity. Feedback received indicated that, generally, their privacy is being respected and that staff are polite and caring in their interaction with residents. The inspector observed good interactions between staff and residents, with care and consideration being shown. This represents an apparent improvement from the last key inspection, which had indicated that some staff were not always as respectful as they might be, and that staff attitudes could, at times, be negative. Further monitoring of practice in this area will, however, be maintained. The home has a policy on death and dying. The home is recording residents’ wishes concerning the eventuality of their serious illness or death. These are being noted on a separate record, with a summary of these needs being recorded in the resident’s care plan. The family and friends of residents are involved (if that is the resident’s wish) in planning and dealing with infirmity, terminal illness and death. A Church of England minister visits regularly and there is the opportunity for residents who wish for contact with a Catholic priest, to do so. The religious and spiritual needs of residents from other faiths are addressed in accordance with the expressed wishes of the individual. Since the last inspection, there has been one death of a resident at the home. The inspector understands that the family were fully consulted and involved in the period leading up to the admission and death (in hospital) of the person disturbed. The home has arranged bereavement training (on 24/5/06), thus enabling staff to offer appropriate support to residents when bereavement or loss occurs. Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11 to 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are being provided with opportunities for recreational and social activities sufficient to meet their existing needs. Residents are encouraged to maintain contact with their family and friends and to retain links with the local community. Residents 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 for residents. EVIDENCE: Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 17 The home offers a range of activities that includes bingo sessions, painting, and music/movement therapy. There are visiting entertainers who visit twice a month, which includes musical sessions and sing-a-longs. There is also an exercise session organised by staff at least 3 times a week. During the inspection some residents were gathered in the ground floor communal lounge where they were interacting positively with staff. The inspector canvassed the views of a number of residents regarding their daily routines and activities. Feedback indicated that, generally, residents enjoy considerable flexibility in their routines and are able to visit the local shops, parks and community facilities if they wish. There are no restrictions unless there are concerns regarding a service user’s own personal safety. If available, staff will accompany residents when accessing activities in the community. Some feedback indicated that some residents would welcome more informal activity and input from staff. The inspector did, however, observe staff doing some one-to-one interaction, engaging residents with word puzzles. The manager advised that the home is planning occasional input from paid helpers to initiate activities including the potting of plants. There are also various local church activities which residents attend, summer barbecues in the garden, and organised outings to places of interest. Visitors to the home are actively encouraged and welcomed. Feedback received from residents and relatives indicates that the home is welcoming to visitors and that relatives and friends are able to visit when they wish, with privacy for visits being respected. The inspector was informed that a Christmas party was held for residents, to which relatives and friends were invited, and that this proved to be a success. The inspector canvassed views regarding the ability of residents to exercise autonomy and choice. Views expressed indicated that residents are generally satisfied with the way that the home is being run, that they are being consulted regarding issues that affect them, and that they feel able to exercise choice and make decisions regarding their daily lives. A requirement from the previous key inspection, for regular service users’ meetings to be held, has been met, with meetings being evidenced to have taken place on a regular two-monthly basis. The inspector was advised that three residents are entirely involved in dealing with their own financial affairs, which includes collecting their pensions. Others have assistance, generally from relatives or close friends. The home handles monies for residents only when a local authority has an agreement that the home will act as the ‘conduit’ for the payment of personal allowance. Records are being maintained on behalf of four residents where relatives periodically provide monies for personal expenditure. These were examined and found to be in order. Advocacy services are known of and publicised at the home. Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 18 Feedback received indicates that residents generally enjoy the food that is served, and that there is a reasonably good choice of dishes. The home’s menus evidence that the diet is well balanced and nutritional. 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 pleasantly laid out and is able to seat all the residents comfortably. The home keeps a detailed record of the food that is provided, and caters for any special dietary needs that are required including vegetarian and ethnic minority tastes. There are currently 2 residents who are vegetarians and 4 residents who are diabetic and require low sugar diets. Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 to 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives can be assured that the home has an appropriate complaints policy and procedure in place, and that their complaints will be listened to, taken seriously and acted upon. The legal rights of residents within the home are being protected and promoted. The protection of residents is being safeguarded by the home’s adult protection, policies and training. EVIDENCE: There is no record of any complaint having been made since the last key inspection. The home has an appropriate complaints policy and procedure in place. A complaints book at the home details the outcome of any complaint and what action (if any) was taken. The complaints procedure is clear and Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 20 simple and includes the stages and time scales for complaints to be managed. The procedure states that a complaint can, if necessary, be referred to the CSCI at any time. The home aims to protect residents’ legal rights by involving family and friends in respect of their contracts, benefits and monies, and in discussing any issues at reviews. All residents are registered to vote, and are supported where necessary to vote, usually by postal vote, or by attending the polling station. Most of the residents have exercised their right to vote in the local council elections. The home holds information on advocacy services should they be required. Both Mind and Age Concern, in Croydon, provide this service. No adult protection allegations or concerns have been recorded. Views expressed to the inspector indicates that residents feel safe and secure in this home, and that staff are generally perceived as being caring and considerate. The home’s internal adult protection policy and procedures have now been amended and updated so as to be consistent with the Local Authoritys Vulnerable Adults guidance. Contact details for the CSCI, Croydon Social Services and the Police have now been included. The home has a Whistle Blowing Policy in place for staff to reference should the need arise. This has been developed to ensure it complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets. A requirement, for all staff at the home to undertake statutory adult protection training, has now been met. Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 to 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are living in a safe, well-maintained environment, with access to safe and comfortable facilities. Residents’ rooms present as being safe, comfortable and pleasantly decorated, reflecting individual residents’ personal identities, and being suited to their individual needs. Residents have access to safe and comfortable communal facilities. Sufficient bathing, washing and toilet facilities are being provided for the home’s residents. Residents’ safety is being assured through the provision of sufficient aids and adaptations. Residents are living in a home that presents as being clean, pleasant and hygienic. Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 22 EVIDENCE: The inspector completed an inspection of the premises. The home presents as being well maintained and decorated, and as providing a pleasant and congenial environment. A maintenance and development programme is in place, regarding the renewal of the fabric and decoration of the home. This includes ongoing redecoration and re-carpeting of residents’ bedrooms, and of the home’s communal areas including corridors and the lounge and dining areas. The communal areas present as very pleasant and homely. There is a spacious lounge, which is divided into two distinct areas, with a separate homely dining area. The lounge overlooks a pleasant garden, which is used by residents in the summer months. There are plans to build a conservatory at the rear of the home which, when completed, will provide an additional communal area for residents to sit and enjoy views overlooking the garden. The home has adopted a No Smoking policy. A separate room previously used as a smoking room has now been converted into a small quiet sitting room where residents can receive visitors. There are four bathrooms and five toilets spread throughout the home. No ensuite toilet or bathing facilities are available. 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 the level of staffing would not currently allow this. The inspector has made a requirement for at least three staff to be on duty throughout the day, from 8am to 6pm (rather than from 8am to 2pm as at present). Views expressed indicate that residents feel settled and satisfied with the home environment and with the facilities provided, and that individual and collective needs are being adequately met. There are 15 single and 2 double rooms, both of which are currently being used as single rooms. A number of rooms were viewed. The inspector spoke with three residents and one visiting relative, who were in their rooms. Views expressed indicated that residents were happy with their rooms, and that these met their individual needs. The rooms seen by the inspector presented as being adequately furnished and pleasantly decorated. These reflected residents’ individual tastes and identities, and included personal photos and mementoes. Residents are able to bring personal possessions and items of furniture with them to the home. Lockable spaces are provided. Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 23 Residents’ rooms were observed to be well ventilated and to be kept at a comfortable temperature. Residents 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. Following a requirement from the previous inspection, magnetic doorstops have now been fitted to those service users’ rooms (Rooms 20, 21 and 27), which were previously being kept wedged open (in accordance with residents individual wishes). The home has recently been assessed by an occupational therapist, on 17 March 2007, and was found to provide ‘an appropriate, well-maintained environment’ for the home’s residents. There were no recommendations. Following a previous OT assessment in July 2004, the home placed restrictors on all upstairs windows, completed risk assessments for all service users who use the stairs, and placed 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. There is a loop system for the television and telephone. Raised toilet seats, commodes and adapted bath chairs are in evidence throughout the home. Arjo hoists are in regular use to assist with bathing. These are being regularly serviced on a six-monthly basis, most recently on 22 February 2007. The home has received a recent inspection from Environmental Health (on 6 Feb 2007), which proved satisfactory. The home generally presents as being clean, pleasant and hygienic, with kitchen, washing/toilet and communal areas being maintained to a satisfactory standard. All COSHH items were observed to be securely stored in locked cupboards. 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. An infection control policy is in place, and infection control training is provided for staff. This does, however, need to be updated, for which a requirement applies. Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally, the home has the numbers and skill mix of staff sufficient to meet the needs presented by the home’s residents, and to ensure their safety. However, there is a need for the number of staff on duty to be maintained at three throughout the day if residents’ needs are to be more fully met. Residents are being safeguarded by satisfactory recruitment policy and procedures. Criminal records checks are being completed before the recruitment of any new staff. Generally, staff are being provided with the necessary induction and training with which to perform their work duties competently, and to safely meet the needs of residents. EVIDENCE: Generally, the home was evidenced to have the numbers and skill mix of staff sufficient to safely meet the needs presented by the home’s service users. The inspector checked the staff rota. A minimum of two staff is being provided at all times, day or night (both waking staff), with at least three staff being present at peak times in the morning. The extra staffing in the morning allows Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 25 for some ancillary work without reducing from the two care staff being available to service users at all times. The inspector was, however, aware from observation, and his discussion with residents, that staffing can be a bit thin in the afternoons. This limits the amount of time that can be given to engaging residents in activities. The inspector is also aware that a number of residents have become increasingly frail or disabled, and have a relatively high level of care need. The inspector is therefore making it a requirement for the home to have at least three staff on duty throughout the day, from 8am to 6pm, rather than from 8am to 2pm as at present. The inspector examined the staff file for two new staff members and found that all the necessary recruitment and identity checks had been completed together with the necessary criminal records checks (CRB and POVA). Staff files include a photograph of the staff member as required in Schedule 2 of the regulations. Given past concerns regarding the completion of CRB and POVA checks, there will be continuing close monitoring on future inspections. An induction pack, which evidences the induction training that each new staff member is completing, has been put in place. This includes health and safety, the values and principles of care, resident care, and key policies and procedures (including adult protection). The registered providers are keen to ensure that all staff have the opportunity to develop their knowledge and skills and to obtain an NVQ qualification. 9 out of 13 staff have obtained an NVQ Level 2 qualification, representing 69 of the total staff complement as at 3/04/07. There is evidence of a commitment to developing staff training, this being evidenced in an annual staff training plan. Staff records evidence that qualifications have been obtained by staff. There has been recent training for staff in First Aid and Fire Safety (23.1.07), Manual Handling (5.4.07), Medication (20.2.07), with training in Food Hygiene being planned (last held 16.7.05). Training for staff in bereavement and loss was held on 24.5.06. The inspector identified a need for staff to undertake updated training in risk assessment, for which a recommendation applies. Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally, the home is being well managed, and in a way that demonstrates that it is being run in the best interests of residents. The home is consulting widely with residents, relatives and other stakeholders, and is beginning to evidence the home’s ability to meet its aims and objectives. Through the regular and appropriate supervision of staff, good practice is being promoted and the welfare and best interests of residents protected. The interests of residents are being safeguarded by the home’s record keeping, with records being kept secure, up to date and accurate. The health, safety and welfare of residents and staff are being appropriately promoted and protected. Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 27 EVIDENCE: The registered persons, Mr and Mrs Balachandran, took over the ownership of the home in June 2003. As required at the last key inspection, Mrs Balachandran has now completed her Registered Managers Award and NVQ Level 4 (certificated on 20.9.06), and has been registered with the CSCI, becoming the Home’s registered manager. In the period since taking over the day to day management of Rosina Lodge, early in 2005, Mrs Balachandran has gained substantial experience of managing the home, and has demonstrated a high level of commitment and competence in fulfilling this role. From the evidence of this inspection, and the feedback received from both residents and staff, the home is being managed in a competent, caring and open way. The inspector was able to evidence the involvement of residents in the consultation and decision-making processes within the home. Meetings with residents have, over the last 12 months, been held on a regular twomonthly basis, and inspection of the minutes indicates that issues affecting the welfare and daily lives of the residents are being openly discussed. The inspector spoke with a large number of residents. Views expressed indicated that residents feel that they are being consulted regarding their daily activities and any decisions that affect them. Feedback from staff members indicates that staff are generally happy working in the home, and that the management style is perceived as being supportive and enabling. There are regular monthly staff meetings, and staff handover meetings between shifts. The home has continued to develop its quality assurance processes. The inspector has been shown questionnaires that have been completed with the home’s residents, the relatives/friends of residents, and ones for visiting care managers and other professionals. Since the last key inspection, the home has put in place a quality assurance audit report. This has been adapted from the Mulberry House format. The report has been made available to service users, their relatives and other stakeholders, and a copy forwarded to the CSCI, local office. In addition the home has put in place an annual development plan. However, in its present form, this provides insufficient information. The Plan must be developed so as to collate all the feedback and information gathered from surveys and other sources, identify those areas where the aims and objectives of the home (as detailed in the Statement of Purpose) are not being fully met, and the actions/plans proposed to address any deficiencies or improvements required. The requirement therefore still applies. Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 28 The home is able to demonstrate its financial viability. Audited accounts for the year ending 31/7/06 are currently being prepared, and a current Business Plan has been published. No concerns have been expressed. A Policies and Procedures checklist, detailing the date of adoption and review of each policy and procedure, has now been compiled and included in the Policies and Procedures manual. All policies and procedures have been reviewed within the last 12 months (in February 2007). Staff now sign to indicate that they have read and understood key policies and procedures, together with any updates relating to them, meeting a recommendation from the last report. Mrs Balachandran has stated that key policies and changes are discussed in staff meetings, and within induction, training and supervision sessions. The no smoking policy needs to be updated, and references to the changes included in the Statement of Purpose and Service User Guide. The registered persons ensure that those residents 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. The home maintains records of financial expenditure for three service users; these have been examined and found to be satisfactorily maintained. The inspector sampled some staff files and found that staff supervision is taking place on a regular two-monthly basis. The registered manager and two senior care workers are undertaking the supervision of staff. Supervision training has been provided. A structured format for recording supervision has been developed to ensure that all relevant issues relating to practice, performance and training/development are covered within supervision. The home is also completing annual staff appraisals, these being evidenced during the inspection. New staff are receiving two appraisals within their first 12 months. All maintenance checks including gas safety, portable electrical appliances, water supply/legionella, fire safety, food hygiene, lift and hoist servicing checks have been completed and are up to date. The home’s lift is inspected every three months in line with the LOLER regulations 1998. 6-monthly inspections of emergency lighting, fire alarms, fire safety equipment and the emergency call system have been completed. Renewal of the 3-year inspection for electrical installation and wiring is due for renewal in June 2007. Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 29 Risk assessments for safe working practices have been completed and updated on 3.2.07. Health and safety risk assessments have been carried out for areas of risk including the premises, manual handling, drugs, COSSH and waste disposal. The accidents and incidents record was examined and found to have been satisfactorily maintained. 12 incidents and accidents were recorded over the last 12 months. No concerns were identified. Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 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 Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 3 3 3 Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 31 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 Standard OP9 Regulation 12(1)(a), 13(2) Requirement Medication. The home must arrange an upto-date medication audit by the home’s pharmacist. This is essential in safeguarding the home’s residents, and must be completed at least 12 monthly. Infection control. All staff must receive up-to-date training in infection control. This is essential in helping to safeguard residents from any risk of infection within the home . Staffing. The home must have at least three staff on duty throughout the day, from 8am to 6pm. (rather than from 8am to 2pm as at present). This is to ensure that there are sufficient staff on duty in the afternoons with which to ensure Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 32 Timescale for action 31/07/07 2 OP26 12(1)(a), 30/09/07 3 OP27 18(1)(a) 31/05/07 that residents’ social and care needs are being fully met. 4 OP33 24(1)(2) &(3) Quality assurance. The registered persons must produce an annual Development Plan. The Development Plan should collate all the feedback and information gathered from surveys and other sources, and identify those areas where the aims and objectives of the home are not being fully met, and the actions/plans proposed to address any deficiencies or improvements required. A copy of the Development Plan should be made available to residents, their representatives and other interested parties, and a copy forwarded to the CSCI. Partly met from previous inspection. Time-scale extended. No Smoking Policy. The no smoking policy needs to be updated, and references to the changes included in the Statement of Purpose and Service User Guide. The policy needs to be amended so that staff, residents, relatives, and prospective users are clear as to the Home’s position regarding its ban on smoking. Rule. 30/09/07 5 OP37 12(1)(a) 31/07/07 Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 33 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 OP30 Good Practice Recommendations Staff need to undertake updated training in risk assessment Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rosina Lodge DS0000043469.V337717.R01.S.doc Version 5.2 Page 35 - 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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