Inspection on 18/06/05 for Rosna House Residential Home

This inspection was carried out on 18th June 2005.

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

Rosna House Residential Home 27/02/09

Rosna House Residential Home 27/02/07

Rosna House Residential Home 30/11/05

Rosna House Residential Home 23/02/05

Rosna House Residential Home 30/09/04

Rosna House Residential Home 17/10/03

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

CARE HOME ADULTS 18-65 Rosna House Residential Home 339 Stone Road Stafford Staffordshire ST16 1LB Lead Inspector Wendy Grainger Unannounced 18 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Rosna House Residential Home Address 339 Stone Road Staffordshire ST16 6LB 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) 01785 245696 01785 4974451 Rosna House Limited Mr Michael John Huxley Care Home 8 Category(ies) of 8 MD registration, with number of places Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: MD - REGISTERED FOR 8 - 4 OF WHOM MAY BE OVER THE AGE OF 65 ON ADMISSION Date of last inspection 23 February 2005 Brief Description of the Service: Rosna is a large semi-detached Victorian house located approximantely one mile from the centre of the town of Stafford. The town can be accessed via the local public transport route from outside the home. The gardens to the home were well maintained, the drive was very colourful with numerous baskets and pots of flowers. Accommodation for the residents was located on two floors; the first floor can be accessed via the stairs. Within the ground floor accommodation is a lounge, conzervatory, dining room, laundry and kitchen. There are six single bedroms with one shared, no ensuites were available. Bathing and toilet facilities were sited throughout the home. The accomodation provided a home for up to eight people with mental health needs. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over part of the day on the 4th July 2005 with the provider and the registered care manager. Four of the five residents were seen and spoken with. The physical environment was well maintained and comfortable. The staff and residents were coming to terms with two of their friends passing away. Staff was supporting each individual. The residents spoken with indicated that they were happy with their home and the care and support they received. One resident told the inspector that as the only female she sometimes felt a little alone, she also told the inspector that she had been successful in reducing her smoking habit by half. She enjoyed the television and the “soaps”. The provider and registered care manager fully co-operated with the inspection; some documents required were not available, the care manager took notes and will produce the paperwork at the announced inspection later in the year. Advice and suggestions were part of the inspection for the streamlining or easy reference to training. What the service does well: What has improved since the last inspection? New tile style flooring had been fitted in the dining room A large display cupboard had been purchased for the dining room. One new staff member is waiting to commence employment. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 6 What they could do better: There were a number of areas where either documents could not be evidenced or located. The care manager had been completing his Registered Managers Award and some records were not current. This inspection identified a number of requirements and recommendations, namely: Care plans seen were not signed and or dated, the format used was somewhat limiting for information and action to be taken. Two bottles of liquid one being Milton were left in the kitchen without the correct labelling. No references could be located for one member of staff. The care manager had not complied with the previous requirement for planned supervision of the staff. The records for the prevention and practices in respect of fire were poor and not current. Hazardous items i.e. shampoos should not be left in bathrooms. As recommended under good practice guidelines. Paper towels in all communal areas should replace hand towels. Which should reduce infection and control risks. Risk assessments were in the form of a list, there was no area for the action plan. The previous requirement of current rotas had not been complied with since May 2005. The weekly menu was incomplete; there were no records of the required temperatures. Food in the freezers and fridge required dating. Discussed with the management was the need to date the creams prescribed for individual residents. Also discussed was for the management to discuss with the pharmacist to provide an alternative container for medication to replace the wallet type system. All these areas were discussed with the provider and registered care manager at the feedback. The registered care manager took note of the issues of concern. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 7 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. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,4,5 The Statement of Purpose and displayed inspection report would provide the required information when considering a placement. EVIDENCE: There had been no new residents for sometime. The recently placed temporary person had moved on to another home. The home used an assessment document. Possible placements were invited and or brought to the home by social workers. Visitors were welcome without an appointment. Each of the present residents had been at the home for sometime and had been provided with a contract of the terms and conditions of the home. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9,10. The registered care manager and provider had not carried out a review of the care plans, and risk assessments; to ensure that they were in line with the homes policies and Standards. Residents were offered opportunities and encouraged to have a normal life style within and external to the home. EVIDENCE: Care plans for each of the residents were in place, the new format being used was somewhat limited to continue with a written action plan following the identification of individuals needs. The two care plans evidenced identified that the person responsible for collating the information had not signed the plan; neither had the resident. The home did not operate a key worker system having a very small staff group the provider and registered care manager worked hands on. The home did not have daily reports; issues when relevant were recorded, as were medical intervention reports and medication changes. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 11 Management respect the rights of the residents to go into the community, smoke and maintain friendships. The format for the assessment of risk taking was a list; this was discussed as to providing sufficient written space for the action plan. Two forms were left with the provider for consideration. Records were maintained within the office, accessed only by people authorised to inspect them. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15,16,17 Resident’s personal development and social interests were promoted via various activities/interests. Staff were aware of the support required; promoting an individuals privacy and dignity The management catered for the residents on a daily basis there was no evidence of a completed weekly menu and no records were evidenced as to the required temperatures. EVIDENCE: One resident undertakes voluntary work in the town of Stafford; no resident was in formal employment. Educational opportunities were available via the local day centre, drop-in centre, college; each of the residents decides with the support of the staff as to what they would prefer. During the inspection one resident told the inspector that he was to have gone fishing today with the registered care manager. This hobby was confirmed within his care plan information. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 13 Medication reviews were undertaken at the surgery on average quarterly. Residents attend in person. Some residents collected their medication from the pharmacy. Some of the residents have a family with whom they maintained contact; others did not maintain contact with their family. The management at Rosna operated an open door policy visitors were welcome at any time. The daily routines of the home promoted individuals independence, each of the residents were encouraged as part of their care plan to undertake the organization of their personal bedrooms, keeping them tidy. The routine of the day during the inspection was that two residents washed up after lunch. One resident had gone into town; one resident was unwell and waited for the general practitioner. Routines were flexible to suit individual’s life styles. The inspector had concerns in respect of the organisation of the kitchen area and menus. The menus were not current and completed on a weekend. There was no evidence of the required temperatures for fridges, freezers and food prepared. The inspector was told that the home did have a food probe maintained in the office in the event it was taken. The registered care manager told the inspector that they did not have medi-wipes to clean the probe; they used warm water when the probe was used. Some items of food were not dated or wrapped correctly within the freezer and fridge; this practice could result in freezer burn on the food. There was a requirement to address these issues. The main meal of the day was prepared in the evening, as the menus were not current the registered care manager suggested egg and chips for tea. One resident when asked by the inspector what he would prefer replied he had what ever was given and eat it. One resident told the inspector that they often had spaghetti with egg & chips. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 Arrangements to meet the health and mental needs of individuals were in place and working in the best way for the benefit of the residents. Residents were supported in their lifestyle by the staff. Promoting independence and dignity. The home had openness with the residents who discussed the deaths of recent residents easily and fondly. EVIDENCE: The present residents need prompting for their personal care needs; they did not require daily intervention. One resident was likely to become frailer due to a medical condition. This was discussed with the registered care manager as to clearly identifying his needs in the care plan. Rising and retiring is at a time to suit individuals, one resident confirmed that she watches all the “soaps” but did not mind football with the other residents. No resident was self medicating; the staff were protected with policies and procedures. The provider and registered care manager had undertaken a oneday training course; one other member of the staff was taking this training at Cannock College. Discussed with the management that there was a more in Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 15 depth learning course on the safekeeping and handling of medicines available. When contraindication of medicines was part of the inspection process. Each of the residents were registered with a general practitioner of their choice, they attend surgery alone and medication would be reviewed on a regular basis. The general practitioner was observed to call to see one person today. The medication prescribed was collected before the inspection was completed. There was a need to date the creams prescribed and used. Arrangements were in place for the District Nursing service to call when applicable. Staff monitored for any changes in the behaviour or physical deterioration and address as necessary. Recently the home had experienced two residents taken to hospital and then passed away. The residents spoke openly and fondly about the last person who was buried last week. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 The home had a satisfactory complaints system, residents were aware of the documentation within the Service Users Guide. Via the training and experience residents were protected from abuse. EVIDENCE: The home or Commission had received no complaints against the care provided. Each of the residents spoken with had the ability to communicate freely. The management encouraged openness. Via the staff induction and in house training residents were protected from any form of abuse. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,30. The overall qualities of the furnishings were satisfactory, both in the lounges and bedrooms. Staff ensured that the environment was safe for the lifestyles of the residents. EVIDENCE: The ground floor of the home was seen on this inspection, the décor within the home was clean and fresh. A resident confirmed his room had been decorated last year. Bedrooms on the ground floor were for single occupancy; within the home there was one shared bedroom empty at this time. Regulation 25.5 indicates that shared bedrooms should be phased out by 1st April 2004 unless the two people in the room choose to continue sharing. This was pointed out to the provider and registered care manager. Bedrooms were personalised and remained decorated with personal items i.e. Christmas cards; staff respected this choice. The management were required to exchange the hand towels for paper towels in the communal areas to reduce the risk of cross infection. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 18 Staff should monitor and encourage the residents to return their personal shampoos etc to their bedrooms or have them secured. The home was maintained in a clean hygienic manner, the environment was homely and the lounge comfortable as were the bedrooms seen. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,34,35,36, The home had not complied with previous requirements from the last inspection. Residents need to be aware of the staff on duty on a daily basis and any changes made to the rota. The management needs to support the staff with constructive supervision. The management were aware of the guidelines to follow when employing new staff. EVIDENCE: Each of the staff were provided with a contract of employment, the required booklets and documents as evidenced in one persons personal file. The file seen did not have any references. The registered care manager told the inspector that they had been on file but could not locate them. Another member of the staff was waiting to be employed following a satisfactory Criminal Records Bureau check. No members of the staff were on duty at the time of the inspection with the exception of management. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 20 At the time of the inspection the one vacancy in the staffing level meant that the registered care manager and provider were covering the vacant shifts. At any one time there was one person on duty covering four-hour shifts. The provider sleeps within the home but they employ a waking night staff. The registered care manager was fully aware of the need to complete the required checks prior to employing staff, thus ensuring the residents were protected. Mandatory training was provided for the staff, one person was waiting to commence NVQ in Care level II. Other staff and the registered care manager had NVQ II. At this time Moving & Handling was not required. The management were considering exploring this training. The previous report made a requirement for the registered care manager to introduce staff supervision for all the staff at least six times a year. There had been limited progress with regard to this requirement. The previous report made a requirement that a copy of the duty rota actually worked must be kept in the home. This inspection identified that the rota had not been current since May 2005. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,42 Management continue to increase formal training to benefit operation of home. The home was unable to access records that were required for the home. The practise of decanting hazardous liquids into unmarked bottles could endanger the residence. EVIDENCE: The registered care manager had almost completed his Registered Care Managers Award NVQ Level IV. Registered some thirteen years ago he is also part of the in house training provided. Recently he had taken a day course for the prevention and awareness of fire. The quality assurance records were not evidenced; the registered care manager only confirmed the standard verbally and by a short uncompleted report of a meeting with not all the residents. There was a need to firm up this standard and to maintain full records. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 22 The provider and registered care manager had current First Aid training; one other person is to take the training. The inspector was concerned when evidencing the records for fire, that there were inadequate records maintained on the procedures and practices. Within the kitchen area were two unlabelled bottles, one was Milton the other a liquid that had been decanted into a spray bottle. Liquids that could be hazardous to residents should not be decanted or left in unlabelled bottles, it should be stored away safely and or left in the container it arrives in or labelled correctly. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 2 2 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Rosna House Residential Home Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x 2 x E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 24 yes 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 30 Regulation 13 Requirement The regisitered person shall make suitable arrangements to prevent infection, and the spread of infection at the care home. Records of the food provided for residents in suffcient detail to enable any person inspecting to assess the diet. to maintain the required temperatures and to ensure that food placed in the fridge/ freezer was correctly lablelled and stored. To ensure that at all times two written references were maintained on the file Outstanding from the previous report. A copy of the duty rota actually worked must be kept in the home The registered person shall ensure that persons working at the care home are appropriately supervised. Out standing from the previous report. The registered person shall make arrangements for the persons working at the home to receive suitable training in fire prevention and for the maintainence of all the fire equippment Timescale for action on going 2. 17 schedule 4 on going 3. 4. 34 33 schedule 2 schedule 4 18 on going on going 5. 36 on going. 6. 42 23 on going Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 25 7. 42 a) The registered person shall ensure that all parts of the home that residents had access to are so far as possible free from hazards to their safety on going 8. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard on goingon going6 6 20 Good Practice Recommendations To consider a more structured format for the identified risk assessment. To ensure that the care plans were signed,dated and with the agreement of the residents To date the prescribed creams when opened. Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rosna House Residential Home E51-E09 S4997 Rosna House V236080 180605 Stage 4.doc Version 1.40 Page 27 - 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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