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Inspection on 11/07/07 for Rossetti Lodge Residential Home

Also see our care home review for Rossetti Lodge Residential Home for more information

This inspection was carried out on 11th July 2007.

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

The location of this home, within walking distance of Minnis Bay sea front views and to the community facilities of Birchington shopping centre and other seaside towns, is likely to be attractive to potential service users. The property has retained a number of original, characterful features. The manager has the requisite qualifications and experience and has an opendoor policy, which is inclusive of residents and is appreciated by relatives and staff. Team working and flexibility have been identified as key strengths of this staff team, and interactions between individual staff and residents appeared kindly and caring.This home meets the needs of those who use the service, and it can demonstrate adequate outcomes for all users. Some outcomes are good. There are sufficient management and staffing resources in place to keep people safe. This home is generally viewed positively by those using its services. Users are consulted and are afforded choices on a day-to-day basis. The manager is aware of necessary improvements and accepts what action is required.

What has improved since the last inspection?

Since her return from maternity leave, the manager has been working hard to address the matters raised for attention at the last key inspection site visit, and some improvements were already evident, by their due date. The property is just starting to benefit by the maintenance officer`s hours being increased from part time to full time status.

CARE HOMES FOR OLDER PEOPLE Rossetti Lodge Residential Home Rossetti Lodge Residential Home 3 Sea View Road Birchington Kent CT7 9LB Lead Inspector Jenny McGookin Key Unannounced Inspection 09:40 11th & 12th July 2007 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 Rossetti Lodge Residential Home DS0000023514.V343252.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. Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rossetti Lodge Residential Home Address Rossetti Lodge Residential Home 3 Sea View Road Birchington Kent CT7 9LB 01843 841571 01843 848180 rossetti@rossetticare.co.uk www.rossetticare.co.uk Ms Kiki Clementina Cole 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) Lisa Abdullah Care Home 24 Category(ies) of Past or present alcohol dependence (1), Old registration, with number age, not falling within any other category (23) of places Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To admit one (1) Service User with past or present alcohol dependence, whose date of birth is 19/09/40. 14th December 2006 Date of last inspection Brief Description of the Service: Rossetti Lodge is a detached two-storey building in a quiet residential setting, situated on the corner of Sea View Road and St Mildred’s Avenue. It has 15 ground floor bedrooms and 4 bedrooms on the first floor. There are 5 double bedrooms, currently used for single occupancy, and the remainder are all registered as single rooms. As this home pre-existed the National Minimum standards, an exemption has applied in respect of its spatial dimensions, most notably in respect of its bedroom space. Nine are below 10 sq.metres (the standard now is 12 sq.m) and only one double room meets the standard that now applies (16 sq.m). All the bedrooms have a call bell point and a number have television points. There is a stair lift to the first floor. There are 3 lounge areas and 2 dining areas, on the ground floor, all interlinked. The lounge and all the ground floor bedrooms have their own patio door onto a rear garden, enclosed on all sides, with areas put to lawn and flowerbeds. In terms of access and community links, the home is within walking distance of a bus top and the local railway station (which includes a regular London service), seafront and Birchington town centre, with all the community facilities and transport links that implies. There is no on-site parking but there is unrestricted kerb-side parking on Sea View Road and St Mildred’s Avenue. Care staff work a rota that includes two waking carers on duty at night. The current fees for the service at the time of the visit range from £350 - £420 per week. Additional charges payable include: clothing, toilet requisites, stationery, dry cleaning, hairdressing, chiropody, physiotherapy, newspapers, special beverages / meals, medical requisites (other than by prescription), spectacles, hearing aids, batteries, incontinence products and items of a luxury or personal nature, any other treatment or care requested by or necessitated by a resident’s worsening state or health not provided by the NHS, and certain forms of entertainment and outings Information on the Home’s services and the CSCI reports for prospective Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 5 service users should be detailed in the Statement of Purpose and Service User Guide. The e-mail address for this home is: rossetti@rossetticare.co.uk Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on two site visits, one unannounced and a follow up visit, which was agreed with the manager. Both visits were used to check progress with matters raised from the last key inspection site visit (December 2006), given all the timeframes set on that visit had run their course; and to review findings on the day-to day running of the home. The inspection process took, on total, just over sixteen and a half hours, and involved meetings with five residents (including two group over lunch), two visiting relatives. And it took into account a range of feedback questionnaires issued by the CSCI, and by the manager in March 2007. The inspection process also involved meetings with staff representing the various functions of the home; the manager; the deputy manager; two senior carers; a carer; the chef; the administrator and the maintenance officer. A visiting GP was also interviewed. The inspection necessarily involved an examination of records (including personnel files), and the selection of three residents’ case files, to track their care. Interactions between the staff and residents were observed throughout both site visits. Eighteen bedrooms were checked for compliance with the National Minimum Standards on this occasion, along with all the communal facilities. This effectively means that almost the entire property has been subject to inspection. What the service does well: The location of this home, within walking distance of Minnis Bay sea front views and to the community facilities of Birchington shopping centre and other seaside towns, is likely to be attractive to potential service users. The property has retained a number of original, characterful features. The manager has the requisite qualifications and experience and has an opendoor policy, which is inclusive of residents and is appreciated by relatives and staff. Team working and flexibility have been identified as key strengths of this staff team, and interactions between individual staff and residents appeared kindly and caring. Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 7 This home meets the needs of those who use the service, and it can demonstrate adequate outcomes for all users. Some outcomes are good. There are sufficient management and staffing resources in place to keep people safe. This home is generally viewed positively by those using its services. Users are consulted and are afforded choices on a day-to-day basis. The manager is aware of necessary improvements and accepts what action is required. What has improved since the last inspection? What they could do better: This care home is judged a poor service because although it has some strengths, there are serious and important weaknesses that could directly affect the welfare of the residents. The building itself has had a poor level of investment, and a detailed summary of findings has been reported back to the home’s management separately. The business management systems are not judged sufficiently effective. The proprietors have not demonstrated sufficient awareness of their responsibilities regarding Standards, Regulations and Requirements. The proprietors needed to evidence compliance with their regulatory duty to carry out documented unannounced inspection visits at least once a month. The reader is advised that breach of this regulatory duty constitutes an offence, and this matter has been raised with the proprietors before. The manager has resumed the quality assurance feedback questionnaires system in Spring 2007 but the proprietors still need to show how feedback can influence the way the service is delivered. There is a lack of understanding about care planning outcomes and the need to demonstrate an inclusive approach. The lack of investment in staff training is of particular concern, as staff practice runs the risk of becoming variable. The manager needs to provide documented evidence of formal supervision sessions to comply with the National Minimum Standard, so as to underpin expected practice standards. Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 8 Some matters are raised in respect of the Statement of Purpose, Service Users’ Guide and contract, and not just to obtain full compliance with the National Minimum Standards and current legislation. Some statements simply do not reflect practice, and are likely to mislead and disappoint prospective service users. There is insufficient evidence of financial viability. There also needs to be an annual development plan for the home, which conspicuously refers to the quality assurance system. The views of all stakeholders should be central to both processes, to properly measure the home’s success in meeting its aims, objectives and Statement of Purpose. Improvement has been judged unlikely without intervention and a very substantial investment. The reader will, moreover, note in the schedule of required action the number of deadlines already missed or partially addressed in many cases. This is judged an extremely poor use of the regulatory framework. 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. Rossetti Lodge Residential Home DS0000023514.V343252.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 Rossetti Lodge Residential Home DS0000023514.V343252.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 1, 3, 4, 5 The home cannot robustly evidence that prospective residents and their representatives have the information needed to choose a home, which will meet their needs. Residents have their needs assessed. This home does not have the facilities or expertise to offer Intermediate care. EVIDENCE: This home has a Statement of Purpose and Service User Guide, each of which describes the facilities, services and principles of care. But work will need to be done to obtain full compliance with all the elements of this standard. These matters have been reported back to the manager separately. Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 11 No other languages are currently warranted, but the proprietors report having provided large print versions in the past, and feedback from two service users and three relatives indicated they had received sufficient information to make an informed choice. Given the poor recall of many residents or their relatives it was recommended that there should be an admission checklist to evidence the issuing of these documents and whether other languages or formats (e.g. large print, tape etc) were required, so that the home’s commitment to equal opportunities can be assessed. Feedback on these site visits confirmed that the decision to apply to this home was generally made by third parties (such as care managers from funding authorities or relatives) and influenced more by its locality (i.e. close to where the resident or their friends or relatives lived), than by any public information produced by the home itself for residents or their relatives. The residents and relatives spoken to on this occasion were reasonably satisfied with the choice of home made. The admission process is in the first instance led by assessments carried out by care managers, which the manager uses to inform her own. These are now more usefully underpinned by key risk & dependency assessments. In direct response to requirements made at the last inspection in December, amendments were made to the format of the home’s own assessment. Prospective residents or representatives are encouraged to visit the home, and each resident is offered a trial stay of four weeks before their admission is confirmed by contract. But the residents spoken to on this occasion could not recall having done so. See section on “Environment” for a description of equipment and adaptations, and section on “Health and Personal Care” for a description of services provided. This home does not have the facilities or expertise to offer Intermediate care. All copies of its Statement of Purpose and Service User Guide require amendment to reflect this. Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 7, 8, 9, 10 The health and personal care, which a resident receives, is based on an assessment of their individual needs. The principles of respect, dignity and privacy are generally put into practice. EVIDENCE: The format of the care planning documents used by this home is designed to address a wide range of personal and health care needs, and in each case the care plans were usefully underpinned by dependency assessments, risk assessments, daily reports and routine checks. Each care plan is clearly designed to identify a given aspect of the resident’s care and the action required by care staff. However, a number of the instructions in the plans of action would have universal application, and would not single out one resident’s needs from another’s. Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 13 Each set of care plans is usefully prefaced by “Life Histories” covering key points of each resident’s childhood, adolescence, working or family life and later years; all of which should provide good source material some for holistic care planning. But, disappointingly, the social care needs of the residents are not followed through with the same level of attention as their personal and health care needs. Staff would benefit from an investment in training in holistic, person-centred care planning. There was evidence of care needs and assessments being reviewed in-house monthly, but the care plans seen often showed little change. Less clear, moreover, was compliance with the National Minimum Standard in respect of formal reviews, involving all the likely stakeholders, to reflect changing needs, except those led by funding authorities. When asked, none of the residents spoken to on this occasion, showed any recognition of the formal care planning process, though they each recalled being asked questions about their care needs either at the outset and/or on a day-to-day basis thereon. Relatives were more aware but, when asked, said they were not routinely invited to be involved, even in the in-house reviews. There is a need to better evidence the active participation of interested parties, most notably the residents. There was scant record of attempts to actively pursue the residents’ emotional needs or interests and to establish any unmet needs. These elements will all require attention, to ensure a more holistic approach. Observed interactions were, however, judged appropriately familiar and respectful. The home has properly secured medication storage arrangements, and an examination of current medication administration records (MAR) indicated general compliance with required standards for record keeping. There were no apparent gaps of anomalies. The home has its own policy and procedure for medication, as well as a copy of the British National Formulary. The manager was advised to extract key information from the BNF as front sheet information in MAR files for ready reference. The manager was also advised to have a copy of the Royal Pharmaceutical Society Guidance on the administration and storage of medication to hand for reference, to ensure practice complies with best practice standards. The manager said that periodic inspections of the home’s medication arrangements had recently been arranged with suppliers but reports were not available. This is recommended. There was some evidence of recent staff training in medication, but updates on things like updates on diabetes management have been identified as a further training need. Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 14 All the residents are attended by one of six GPs in one local surgery, so residents have some element of choice. Records show the home has access to a range of healthcare professionals. This home has four potential double rooms (though these are all currently being used as a singles). All the other bedrooms in this home are registered for single occupancy, which means personal care and treatments could generally be given in privacy. However, there have been circumstances where GPs have had to meet with their patients in communal areas, where (despite staff’s best efforts) privacy cannot be guaranteed. This is judged poor practice and requires better provision hereon. The visiting GP said that the home contacts the surgery appropriately (sometimes not early enough), and carries out GP instructions. The GP practice carries out medication reviews on a regular basis, either annually at the practice or in conjunction with the home when seeing patients. The aim is to have residents on as minimal a combination of medication as possible. Anyone on 4 or more medication is being reviewed. The GP said that staff seem to be au fait with whatever medication patients are on said she liked the way staff dealt with her patients. “They seem switched on and do seem caring”. Periodic assessments of the premises by an OT or specialist in mobility are strongly recommended, so that the home can maintain its capacity to meet the needs of the residents. See also section on “Environment” for details of equipment and adaptations. Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 12, 13, 14, 15 There are some activities and residents are supported to keep in contact with family and friends. Residents receive a reasonably healthy, varied diet according to their assessed requirement and choice. EVIDENCE: The residents were not able to give any examples of any particular interests and hobbies being promoted by the home. But conversations indicated that one or two had accomplished talents such as painting and gardening before coming into residential care, which could usefully be pursued. Unfortunately, there is currently no dedicated activities co-ordinator to ensure information on the range of community resources and events is kept up to date; to actively motivate individuals; or to ensure records are maintained on individuals’ activities. This has been raised for attention in feedback from residents, relatives and staff and is strongly recommended. Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 16 There is an Activities Timetable on display around the home, but it is applied flexibly. Examples include interactive pursuits such as Bingo, board games, puzzles and quizzes; jokes and poem sessions; sing-song sessions, cards and puzzles; and story telling. There are more active pursuits like Keep Fit sessions, arts and crafts, playing with a ball. Some residents like to read magazines, books or papers. Although there is said to be something happening every day, staffing levels would severely restrict the scope for meeting any diversity of activities or for one-to-one attention. Once a month there is a communion service on site. Most of the residents at this home are Church of England. One or two residents go out of their own accord. Others are reliant on staff or relatives to take them out, and the home has occasional access to a minibus belonging to the group of homes, though this is subject to staffing levels being available. The level of motivation among residents is said to be variable. Reliance is also placed on relatives to provide some quality one-to-one care in the home. Residents can choose when to go to bed or get up, and what to do during the day, but tend in practice to have their own fairly set routines. They were observed being supported to make some choices and decisions during the day of this inspection. The and one and home has open visiting arrangements and this was confirmed by relatives staff during this site visits. There are two telephone lines to the home – is for business use. The other has a cordless handset for communal use – no charge is made for its use. Records confirmed that dietary needs and preferences are properly identified in the first instance, as part of the care planning process, and there was anecdotal information on the extent to which individual preferences were being catered for thereon. One or two residents have diabetic diets and one has the components of each meal pureed, so they can continue to enjoy the experience of different tastes, colours and textures, notwithstanding any swallowing difficulties. Food is bought in weekly from local supermarkets (the store cupboard showed this was often from the supermarkets’ own “basics” range) and a farm shop; and meals are prepared from scratch on site by the home’s cook, who is a qualified chef. Menus were initially compiled by one of the proprietors, with limited scope for day-to-day variations, though the menus were under review at the time of these visits. A choice is routinely available. However, there has been no input from a dietician and there has been no periodic top up training. Both are strongly recommended. Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 17 The residents were joined for lunch on both site visits and the selected lunchtime meal options were judged well prepared and presented. The meals tend to be traditional English fare, and the residents appeared to enjoy them. The pace of the meal was unhurried. Staff were observed attending residents in a respectful way. Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 16, 17, 18 These standards were partially assessed on this occasion There is a process for resolving complaints but the home needs to better evidence its application. The home needs to better evidence that residents are protected from abuse and have their legal rights protected. EVIDENCE: The Rossetti Homes Group has a complaints procedure, which is on display in the home, and there is a complaints box and complaints slips in the lobby. The Statement of Purpose and Service User Guide simply direct the reader to the version on display. The proprietors report that a complaints leaflet was set out to family members and a guide to making complaints is also available as a download from the Rossetti web site. The manager is said to be very approachable. But no complaints are being formally registered. This is not judged a realistic reflection of communal living. The manager will need to look for opportunities to demonstrate that residents and their relatives or representatives know how to complain, and are actively supported to do so e.g. via independent advocacy services. Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 19 In discussions with the inspector, staff confirmed their commitment to challenge and report any instances of adult abuse, though they each went on to say that this had not been warranted in this home. However, there has been no training in safeguarding procedures, other than that provided by NVQ. This matter has been raised by the Commission with the proprietors before, and found to be still outstanding. Nor does the home have access to a copy of the Kent & Medway Protocol, to ensure a timely and co-ordinated approach, should an instance arise. Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home requires reconfiguring, to encourage choice and independence, but it is reasonably comfortable and safe. Residents’ best interests are not being promoted, for want of adequate investment in the property. EVIDENCE: All areas of the home inspected were found to be comfortable and (with some exceptions attributable to continence management) reasonably clean, given a poor level of investment by the proprietors. There were homely touches throughout. The furniture tends to be domestic in style but often very basic in quality, worn and in need of refurbishment. Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 21 On both site visits, the home was judged maintained at generally comfortable temperatures throughout, though lighting levels in some areas seemed poor and clearly needed to be assessed for their suitability for this resident group. All bedrooms, bathroom, WC and communal areas have call bells, though the system is not fully accessible, can be switched off centrally rather than at the point of activation (which is preferred practice) and was not, in one instance responded to in good time when tested. It will require attention, and updating or replacing altogether. The garden at the back provides a pleasant enough area to walk or sit in. There is some garden furniture and there are some focal points. But it is overlooked from three sides by the home and there are no discrete areas for privacy within it. This is recommended. Though each ground floor bedroom has its own patio door onto the garden, residents are said to find the steep gradient or step this entails in each case off-putting. This should be addressed e.g. with a more level surface to encourage use. Decking was suggested by one member of staff. The home has a “No Smoking” policy in respect of its communal areas and (with one exception, which has been risk assessed) residents’ bedrooms. Smokers would need to smoke outside and may be subject to supervision. There is a limited range of equipment and adaptation available in this home. Residents have access to their own wheelchairs, Zimmer frames and other mobility equipment. However, overall periodic audits by specialists such as Occupational Therapists, are strongly recommended, to ensure the home maintains its capacity to meet the needs of its residents. Residents have a choice of communal areas. This home has three lounge areas, and two dining areas, all of which are interlinked. And, as reported above, furnishings tend to be domestic in character throughout. In one or two cases, residents did not look comfortable at the dining tables – having to reach up or, (in the case on one resident in a wheelchair) over to their plates. Provision should be reviewed for its suitability in each case. One set of tables was lines up against a wall, obliging residents to face the wall rather than each other. This was not judged conducive to their interaction or socialising, though the proprietors have said this was in accordance with the residents’ wishes. There are two communal TVs but neither has a Loop system for use with hearing aids. See section on Daily Life and Social Activities for details on telephones and contact with families and friends. Five bedrooms are potentially double rooms, though all are currently being used as single rooms. All the other residents have access to the privacy of single bedrooms. Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 22 Eighteen bedrooms were selected for assessment against the National Minimum Standards on this occasion. A large number of them did not have all the elements prescribed. This matter has been raised by the Commission before and found to be outstanding. The reader is advised that the National Minimum Standard lists what could be expected as standard provision - the home will need to ensure that non-provision is justified in each case by properly documented consultation or risk assessment. The manager should look for opportunities to replace obvious institutional commodes with more discreet models, to accord the residents with more dignity. This home has WC and bathroom facilities on both floors and shower facilities on the ground floor i.e. reasonably accessible to all the bedrooms and communal areas. However, some facilities (e.g. the shower cubicles) are not in use at all – the proprietors report that this is the residents’ choice; and the use of some bathrooms prevents access to WC facilities. One WC will require the installation of a wash hand basin, so that users are not dependent on bathroom facilities. There is one adapted bath, which is said to be popular and another bath has a swing-out bath seat. Unfortunately only one bath has a shower attachment. This arrangements needs analysis so that better provision can be made. Continence management is of concern. Some bedrooms and pieces of furniture gave off mild but unpleasant odours. Commodes need to be emptied and handed through an internal WC window into a poorly designed and equipped sluice room, because the only other alternative would be to carry them through the kitchen area. The laundry is in an out building, which means staff are having to carry laundry through all weather conditions. The out building also houses the workshop facilities of the maintenance man. One partition wall separates the two functions. The laundry surfaces (walls, floor and shelves) are not impermeable or easily cleaned, as required. This matter has been raised by the Commission before, and found to be still outstanding. Most maintenance checks seen were up to date but the absence of a current gas safety certificate and electrical installation certificate was of concern, as this is judged likely to compromise the safety of the residents. Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 23 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 poor This judgement has been made using available evidence including a visit to this service. 27, 28, 29, 30 Investment in staff training and staffing levels is not sufficient, to properly fulfil the aims of the home and meet the changing needs of residents. EVIDENCE: The following staffing arrangements are reported to generally apply: • • • • • The manager and administrator work Mondays to Fridays (8am-4pm) From 8am till 8pm – two carers including one senior From 2-6pm an extra carer to cover tea duties and provide extra support From 8pm till 8am there are two waking night staff, with the manager or deputy on call (evenings, weekends) There is also said to be a visiting volunteer. There is a chef most days of the week. The carers do the cooking on the other days. There are also part time domestic staff to do the cleaning and care staff share the laundry duties. The proprietors also run an agency, which the home is required to rely on for relief staff, but in practice existing staff are more usually working extra hours to cover gaps. Staffing numbers and deployment complied with this on the day of these site visits, accepting the manager was covering the tea time shift herself (while the Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 24 member of staff was on annual leave). These staffing arrangements are reported to be in excess of the standard provided by an application of the Residential Forum’s formula. However, they are not judged appropriate to the assessed needs of the service users, given the size, and layout of the home. It is difficult to see just how individual residents could be properly stimulated or supported with the maintenance or development of living skills, or even with freedom of movement around the site. This matter has been raised for attention by the Commission before. In discussions staff confirmed a systematic recruitment process, which was subject in each case to satisfactory references, identification checks and CRB checks. Records confirmed a generally systematic approach. The residents at this home are all white British and there are six males and ten females. The staff group currently comprises no males (other than the maintenance man and chef i.e. not responsible for any direct care) and ten females, and shows slightly more cultural diversity (Irish and African) but is predominantly White British. Although something like 80 of staff are reported to have NVQ2 or NVQ3 accreditation (the manager is an NVQ Assessor), an examination of an overall spreadsheet of training opportunities and attendant certificates indicated a very poor level of investment thereon. Feedback confirms that this manager has an open, accessible management style and that she is supportive to staff. However, see section on “Management and Administration” in respect of staff supervision records. All of this is judged likely to combine to produce variability of practice standards if not ultimately compromise the safety and well being of residents. This must be addressed as a priority, as evidence that residents are being properly protected. There was no evidence of training in care planning and little evidence of the principles of holistic care planning being properly translated into practice. Diabetes training was also identified as a further training need Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 25 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 poor This judgement has been made using available evidence including a visit to this service. 31, 32, 33, 34, 35, 36, 37, 38 The manager is suitably qualified and competent and her management and administration of the home is based on openness and respect. There is a Quality Assurance system in place, which places the views of residents and their relatives at the centre. Residents’ financial transactions are properly accounted for, but there is no evidence of business planning, or audited accounts in operation. The proprietors have not demonstrated sufficient awareness of their responsibilities regarding Standards, Regulations and Requirements, which means residents’ best interests are not being properly safeguarded or promoted. Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 26 EVIDENCE: Mrs Abdullah has been the registered manager for this home since 2003 and has worked in the care sector for several years. She has NVQ Level 4 accreditation as well as the Registered Managers’ Award and is an NVQ Assessor. Under her management control (resumed after her return from maternity leave) there has been better evidence of formal documented meetings with staff, residents and relatives, to comply with the elements of this standard. Team working and flexibility appear to be key strengths in this staff group and observed interactions appeared appropriately familiar and kindly. The most recent consultation event was in June 2007, which was directed at relatives and other representatives. Although it only obtained ten responses, this exercise indicated satisfaction with the quality of care given by staff at this home. However, this exercise also indicated there needed to be improvements to the environment and stimulation available to the residents. The home needs to embrace its complaints procedure as another useful quality assurance tool and as a means to evidence its ability to resolve dissatisfaction effectively. There was no sustained evidence on site of the proprietors’ regulatory duty to carry out their own inspection visits at least monthly. The reader is advised that breach of this duty is an offence and must be addressed as a priority. This matter has been raised by the Commission before. The arrangements for managing individual residents’ financial records were inspected, and judged properly accounted for. There was no business plan available for inspection. Nor were there statements to confirm audited accounts. There needs to be an annual development plan for the home which conspicuously refers to the home’s quality assurance system. The views of all stakeholders should be central to both processes, to properly measure the home’s success in meeting its aims, objectives and statement of purpose. It is accepted that a start has been made with this. Notwithstanding findings in respect of the management ethos in this home (see above), there wasn’t good evidence of formal documented staff supervision meetings, to comply with all the elements of this standard. With two exceptions (gas and electricity safety certificates) all the property maintenance records seen were up to date and adequately maintained. There were some risk assessments in place but their scope was not extensive (i.e. in respect of each individual, their activities and their environments), and there Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 27 needed to be better evidence of their regular review, to ensure the health and safety of residents and residents are being properly safeguarded. Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 28 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 2 X 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 1 1 2 2 1 2 1 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 1 1 3 1 2 1 Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 6 Requirement The home’s Statement of Purpose and Service User Guide will require attention to obtain full compliance with all the elements of this standard (Previous requirement 24/11/04, 06/12/05, 02/06/06, 14/12/06). 2 OP7 15 A plan of care, generated from a comprehensive assessment, is drawn up with each resident and provides the basis for the care to be delivered. Care plans to contain all appropriate information and to be updated when changes occur. (Previous requirement 24/11/04, 08/06/05, 06/12/05, 02/06/06, 14/12/06). 3 OP18 13(4)(6) Staff must be trained on safeguarding adults. And the manager should ensure there is a copy of the Kent & Medway Protocol, to ensure a timely and co-ordinated Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 30 Timescale for action 30/11/07 30/11/07 30/11/07 approach. 4 OP19 23 The premises must be kept in a good state of repair externally and internally. An action plan must be submitted showing a building audit and programme for delivering a safe, wellmaintained environment with planned timescales. To include any previous requirements still outstanding from 24/11/04, 08/06/05, 06/12/05 & 02/06/06, 14/12/06 plus those identified at this inspection. 5 OP21 23(2)(j) There must be sufficient numbers of toilets, baths and showers provided to meet residents’ needs. Facilities to be reviewed and action plan to be submitted. Action plan to be submitted (Previous requirement 02/06/06, 14/12/06) The call bell system in the home must be suitable to meet residents’ needs. Action plan to be submitted for the upgrade of the call bell system. (Previous requirement 24/11/04, 08/06/05, 06/12/05 & 02/06/06, 14/12/06). 7 OP24 16(2)(c) Suitable furnishings, fixtures and fittings must be provided in bedrooms. Bedroom audit to be carried out Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 31 30/11/07 30/11/07 6 OP22 16, 23 30/11/07 30/11/07 and action plan submitted showing timescales for replacement/renewal of worn furnishings. (Previous requirement 14/12/05) Action plan to be submitted 8 OP25 23 That suitable lighting is provided in all parts of the care home, which are used by residents. (To include bedside or over bed lighting). (Previous requirement 14/12/06) 9 OP26 13(3) 16(2) Action plan to be submitted Suitable procedures must be followed to prevent infection, toxic conditions and the spread of infection at the care home. Sluice room must be fit for purpose. (Previous requirement 08/06/05 & 02/06/06, 14/12/06). 10 OP27 18 Action plan to be submitted 30/11/07 At all times there must be suitably qualified, competent and experienced staff working at the home in such numbers as are appropriate for the health and welfare of the residents. Evidence to be submitted. (Previous requirement 24/11/04, 08/06/05, 06/12/05, 02/06/06, 14/12/06). 11 OP30 18 Staff must be provided with training appropriate to the work they are to perform. 30/11/07 30/11/07 30/11/07 Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 32 (Previous requirement 14/12/06) This is to be interpreted as a rolling programme of mandatory training (e.g. moving and handling, 1st Aid, Food Hygiene, fire safety, medication etc) as well as specialist training to meet residents’ assessed needs (e.g. diabetes, mobility). To ensure that the home is run in the best interests of the residents. The registered providers, or an employee not directly concerned with the conduct of the home, must visit the home once a month and write a report on the conduct of the home. The reports must be kept available for inspection on site and if requested. (Previous requirement 14/12/06) 13 OP38 13 The registered person must take appropriate action to promote and protect the health, safety and welfare of residents and staff. The home must be properly assessed for environmental risks and action taken to address any risks identified. Action plan to be submitted. (Previous requirement 06/12/05 & 02/06/06, 14/12/06) – partially met 14 OP38 23 Evidence of up to date electrical certificate for the home to be submitted. (Previous requirement 02/06/06, Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 33 12 OP33 12, 26 31/07/07 30/11/07 30/11/07 14/12/06) 15 OP38 23 Evidence of up to date gas safety 30/11/07 certificate for the home to be submitted. 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 OP1 Good Practice Recommendations The home could usefully include in its admission procedure a checklist to certify the issue of a Statement of Purpose, Service User Guide; and whether other languages or formats were warranted. There should be periodic assessments of the premises by an OT, so that the home can maintain its capacity to meet the needs of the residents. There should be input from a dietician or dementia specialist in the home’s catering arrangements and periodic top up training. Each lounge should have a loop system for use with hearing aids, subject to specialist advice on this matter That an appropriate sluicing facility for the cleaning of commode pans is provided. 2 3 4 5 OP4 OP15 OP4 OP26 Rossetti Lodge Residential Home DS0000023514.V343252.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 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 Rossetti Lodge Residential Home DS0000023514.V343252.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. 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