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Inspection on 18/05/05 for Rosset Holt Home

Also see our care home review for Rosset Holt Home for more information

This inspection was carried out on 18th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents spoken with generally liked the staff and felt they worked hard. Residents considered the Home to be comfortable and enjoyed strong community links and spiritual support.

What has improved since the last inspection?

Lockable cupboards had been provided for all self-medicating residents and the staff call system had been made accessible in all parts of the home used by residents. The walls of the staff toilet had been made good to promote infection control. The dining room and stairs had been re-carpeted and some rooms had been redecorated. The staff supervision programme had been implemented.

What the care home could do better:

Care planning and risk assessments must improve so staff know what to do for each resident. The hot water supply must be improved to make the Home more safe and comfortable for residents. Failure to do this may result in enforcement action. To ensure quality of care and residents` safety, staff training must be improved and all staff must complete the induction programme and participate in fire practices. An appropriate clinical waste bin must be provided.

CARE HOMES FOR OLDER PEOPLE Rosset Holt Home Pembury Road Tunbridge Wells Kent TN2 3RB Lead Inspector Gary Bartlett Unannounced 18 May 2005 09:00 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. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Rosset Holt Home Address Pembury Road Tunbridge Wells Kent TN2 3RB 01892 526077 01892 526077 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) Keychange Charity Mrs Marilyn Rose Luck CRH Care Home 18 Category(ies) of Old age (18) registration, with number of places Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26 October 2004 Brief Description of the Service: Rosset Holt is a large detached property on two floors and stands in its own grounds. The Home is owned by the Keychange Charity and offers accommodation to older people with Christian beliefs. It is registered for 18 service users and all rooms are currently used for single occupancy although some are large enough to be used for shared occupancy if required. Six bedrooms have en-suite facilities. There are staff call points and television points in all bedrooms. The Home is equipped with a shaft-lift.Rosset Holt is located on the outskirts of Tunbridge Wells where there are the usual facilities of a town. There is access to public transport close by and the nearest Doctors surgery is a very short walk away. Space for car parking is available and there are spacious gardens for residents to use. The Home’s senior staffing team comprises the Manager and a Deputy Manager. The Home employs care staff that work a roster that gives 24-hour cover. The Home also employs other staff for catering, domestic and maintenance tasks. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission was represented by Gary Bartlett, Regulatory Inspector who was in Rosset Holt between 9.00 a.m. and 4.45 pm. During that time some residents, a visitor and staff agreed to speak with the Inspector. Parts of the Home and some records were inspected. The focus of the inspection was to assess progress made to meet notified required and recommended actions in the last inspection report, gaining evidence against standards from records, observation and discussion. What the service does well: What has improved since the last inspection? Lockable cupboards had been provided for all self-medicating residents and the staff call system had been made accessible in all parts of the home used by residents. The walls of the staff toilet had been made good to promote infection control. The dining room and stairs had been re-carpeted and some rooms had been redecorated. The staff supervision programme had been implemented. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 6 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. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 7 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 Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 8 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) These Standards were not inspected EVIDENCE: Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 9 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 and 11 Limited progress had been made on improving care plans and risk assessments to ensure the residents’ health care needs were identified and met. These shortfalls have the potential to place residents at risk. EVIDENCE: Two care plans were inspected in detail one of a permanent resident and the other of someone having respite care. There were some improvements in the plans but not all parts were being used and adequate risk assessments had not been written as a result of recent incidents. The scope and content of risk assessments needed to be more comprehensive, especially considering that some residents regularly left the Home independently. These were matters highlighted in previous inspection reports. There were some very good examples of daily records of care. The care plan for respite care consisted of a cover sheet and the placing authorities care plan only. Records seen and discussion with staff and residents indicated that residents were able to have access to Doctors, Community Nurses, Dentists, Chiropodists etc as and when required. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 10 The Deputy Manager was seen to dispense medicines in accordance with current guidelines. Storage of medicines was not inspected although the Inspector was told that all self-medicating residents now had lockable cupboards. Residents felt that overall staff were kind and gentle, this was confirmed by observation. Carers were seen to be very considerate of the age and dignity of residents and to treat them with courtesy. Privacy was maintained through lockable toilet and bathroom doors. Most staff had still not been trained in care for the dying or bereavement. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 11 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 and 13 Residents had some choices about their daily lives, were able to have visitors at any reasonable time and enjoyed continued links with the local community where this was their preference. EVIDENCE: Residents spoke of visiting friends, community centres, church events and of going shopping etc and said they were able to receive visitors at any reasonable time. Some residents indicated they were happy with the daily routines and flexibility offered. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 12 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) These Standards were not inspected. EVIDENCE: Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 13 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, 23, 24, 25 and 26 Residents enjoyed a warm, clean and comfortable environment and some improvements to the décor had been made. However, the Home still did not provide an adequate hot water supply to all residents’ bedrooms causing the occupants inconvenience and discomfort as well as compromising their independence. Residents’ health was put at risk through the Home’s continued failure to provide an adequate clinical waste bin. EVIDENCE: At the time of inspection those parts of the Home inspected were clean and free from unpleasant odours. There was a large, well tended, garden with ramped access from the dining room. The worn dining room and stairs carpet had been replaced. Several residents said they were happy with their rooms. Parts of the Home were being decorated. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 14 As at previous inspections, some residents and a senior staff member spoke of the problems with the hot water supply in some areas and a wish to see it resolved. The Deputy Manager gave assurance that until such time, staff strived to minimise the risk of injury from excessively hot water and to provide hot water where required. It was observed that the wall of the staff toilet had been repaired to maintain infection control but the clinical waste bin could still not be properly closed. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 15 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) 30 Residents are potentially at risk as there is not a comprehensive training programme to ensure staff could fulfil the aims of the Home or were competent in the principles of care and safe working principles. EVIDENCE: Residents spoke highly of the staff. However, the record of training undertaken by all staff gave a clear indication that there was a great deal of mandatory training and updates required. Residents were potentially at risk through this. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 16 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) 33, 36, 37 and 38 The Home was not being managed to ensure residents’ safety. The Home must be more proactive in seeking residents’ views. EVIDENCE: The Manager had commenced studies to obtain the Registered Managers Award and a programme of formal supervision for all staff had been implemented which should contribute to providing better care. Although it had been recommended residents’ meetings be held more regularly, none had been held since the last inspection on October 2004, thereby denying residents the opportunity to collectively be involved in the running of the Home. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 17 Where required, radiator guards had been fitted to safeguard residents’ safety and a first-aid box was now sighted in the kitchen. It was evident that the Commission had again not been notified of incidents as required by Regulation 37. Records seen indicated that many staff had not had fire training or participated in fire drills at the frequency recommended by the Fire Safety Officer. There was not a record of one staff member having undertaken an induction programme and another staff member’s induction record indicated they had not been shown the emergency procedures, accident/incident books or fire drill and procedures. Consequently, residents were potentially at risk in an emergency. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 18 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 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 3 2 3 3 3 1 2 STAFFING Standard No Score 27 x 28 x 29 x 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 2 x x 2 1 2 Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 19 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 7 Regulation 14(2)(b), 15(2), 17 Schedule 3, Schedule 4 Requirement “The registered person shall maintain records as specified in Schedules 3 and 4. The registered person shall keep the service user’s plan under review” in that service users’ individual plans and records must be kept and be up to date in that they must be consistent and specific in detail of information. There had been progress in this, however it remained a requirement from previous inspection reports The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible elimated in that risk assessments must be more comprehensive “The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users” in that all parts of the Home must have an adequate and efficient hot water supply. This was a reqirement in the previous inspection report and Timescale for action Action plan to be received by CSCI by 15/06/05 2. 7 13(4) Action plan to be received by CSCI by 15/06/05 To be completed by 31/08/05 or sooner 3. 21 25 12(1)(a) 23(1)(a) 23(2)(j) Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 20 4. 26 12(1) 13(3)(4) 16(2)(j) 5. 30 18 6. 38 37 failure to comply within the given timescale may result in enforcement action. “The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home”, in that an appropriate clinical waste bin in good repair must be provided. This was a requirement in the previous inspection report and failure to comply within the given timescale may result in enforcement action. “The registered person shall having regard to the size of the care home, the statement of purpose and the number and needs of the service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they perform including structured induction training This was a requirement in previous inspection reports. “The registered person shall give notice to the Commission without delay of the occurrence of – (a) the death of any service user, including the circumstance of his death; (b) the outbreak in the care home of any infectious disease which in the opinion of any registered practitioner attending persons in the care home is sufficiently serious to be so notified; (c) any serious injury to a service user (d) serious illness of a service user at a care home at which nursing is not provided To be completed by 30/06/05 Action plan to be received by CSCI by 15/06/05 With immediate effect from 18/05/05 Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 21 7. 38 13(4) 8. 38 23(4)(e) (e) any event in the care home which adversely affects the well-being or safety of any service user (f) any theft, burglary or accident in the care home (g) any allegation of misconduct by the registered person or any person who works at the care home. (2) any notification made in accordance with this regulation which is given orally shall be confirmed in writing.” This was a requirement in previous inspection reports. Failure to comply may result in enforcement action The registered person shall make suitable arrangements for the training of staff in first aid. This was a requirement in the previous inspection report. “The registered person shall ensure, by means of fire drills and practices at suitable intervals, that the persons working at the care home and, so far as practicable, service users, are aware of the procedure to be followed in case of fire, including the procedure for saving life” in that fire training must be provided at regular intervals. This refers to all staff, including night staff. Action plan to be received by CSCI by 15/06/05 Action plan to be received by CSCI by 15/06/05 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 7 Good Practice Recommendations It is strongly recommemded a more comprehensive and informative care planning system be used for residents H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 22 Rosset Holt Home 2. 3. 4. 11 25 33 receiving respite care It is recommended staff receive training in care for the dying and bereavement It is strongly recommended that the Home proceed with the planned installation of a new water heating system. This was a recommendation in the last inspection report. It is recommended residents’ meetings be held more regularly This remained a recommendation from the last inspection report Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection The Oast, Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 Rosset Holt Home H56-H06 S23998 Rosset Holt Home V219981 Stage 4.doc Version 1.30 Page 24 - 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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