Inspection on 14/12/06 for Rossetti Lodge Residential Home

This inspection was carried out on 14th December 2006.

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

Rossetti Lodge Residential Home 28/11/08

Rossetti Lodge Residential Home 13/12/07

Rossetti Lodge Residential Home 11/07/07

Rossetti Lodge Residential Home 02/06/06

Rossetti Lodge Residential Home 06/12/05

Rossetti Lodge Residential Home 08/06/05

Rossetti Lodge Residential Home 23/11/04

Rossetti Lodge Residential Home 21/06/04

Rossetti Lodge Residential Home 03/06/04

Rossetti Lodge Residential Home 23/02/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Rossetti Lodge Residential Home Rossetti Lodge Residential Home 3 Sea View Road Birchington Kent CT7 9LB Lead Inspector Christine Grafton Key Unannounced Inspection 09:45 14th December 2006 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.V306097.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.V306097.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 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) Ms Kiki Clementina Cole 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.V306097.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. 2nd June 2006 Date of last inspection Brief Description of the Service: Rossetti Lodge is a detached building with 15 ground floor bedrooms and 4 bedrooms on the first floor. There are 5 double bedrooms, the remainder are all singles. Bedroom sizes were previously agreed as a pre-existing home and several are smaller than the national minimum standards specify. There is a stair lift to the first floor. All bedrooms have a call bell point and some rooms have television points. There are 3 lounge areas and 2 dining areas, all interlinked. The majority of the ground floor bedrooms have a patio door leading to the enclosed rear courtyard garden, with lawn and flowerbeds. The home is within easy reach of the railway station, seafront and local shops. Care staff work a rota that includes two waking carers on duty at night. Information provided by the admin Manager on 14th December 2006 indicates that the fees range from £303.00 to £420.00 per week and additional charges are made for hairdressing, chiropody, toiletries and newspapers. Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report takes account of information obtained from various sources since the last inspection, including two visits to the home. Two inspectors carried out an unannounced visit on 14th December 2006 between 09.45 hours and 13.30 hours and an announced visit on 15th December 2006 between 10.00 hours and 12.35 hours. The visits included talking to the administrative manager, staff, residents and observing the interactions between residents and staff. The administrative manager accompanied the inspectors on a tour of the building and various records were checked. The care of five residents was case tracked. At the time of the visits there were 16 permanent residents plus one person staying temporarily for respite care. The inspection followed up on the things identified as needing improvement and the requirements made at the last inspection of 2nd June 2006. As this was the second inspection this year and relatives, care managers and doctors were consulted at the last inspection, further surveys were not sent out on this occasion. The pre-inspection questionnaire, which was sent out well in advance of this inspection, was not returned to the Commission. The administrative manager was able to provide some, but not all, of this information at the visits. The registered manager was on maternity leave and the registered provider was away at the time of both visits and therefore not available for discussion. A telephone conversation took place between the lead inspector and the registered provider on 5th January 2007 to give some feedback on the inspection findings. What the service does well: Residents have personalised their bedrooms with their own pictures, photographs and ornaments and several residents commented that they like their rooms. There is lots of useful information about the home displayed for people to read, both in the entrance hall and on the residents’ notice board in the dining room. This includes advice on how to make a complaint. Residents felt they could speak to staff if they had any worries. Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 6 The home has a stable nucleus of staff that have achieved their National Vocational Qualification (NVQ) in care and have a good understanding of residents’ needs. What has improved since the last inspection? What they could do better: Following the last inspection the provider’s action plan indicated that an interim manager position was to be advertised to cover the manager’s maternity leave, but the person appointed did not take up the position. Little progress has been made to rectify all of the things identified at the last inspection as in need of improvement. There are still a number of things that need to be done to ensure that residents’ welfare is promoted and they are provided with a safe, comfortable environment. The assessment of prospective residents’ needs should include proper risk assessments before they move into the home to make sure that their care can be properly managed when they move in. Although each resident has an individual plan of care, poor cross-referencing and monitoring of residents’ healthcare have meant that some health care needs have not been followed up as quickly as they should. This poses the risk that residents’ needs might not be met. Medication practices need some review to ensure safety. A particular weakness was identified in the way one resident’s medication was being managed resulting in a potential risk to their health. Information received from the home on 5th January 2007 indicates that appropriate professional healthcare advice had been sought. Residents should be given opportunities for stimulation through the provision of a range of activities within the home to suit their needs and preferences. There are still a number of outstanding maintenance and refurbishment things to be completed to improve the environment for residents, including external maintenance, the replacement of old, worn bedroom furniture, poor quality bed linen and curtains and poor lighting in some rooms. The numbers of staff on duty are still not sufficient to adequately meet the needs of people being cared for in this home. This was identified at the last inspection as an area for improvement and there has been no change except that the cleaning post has been appropriately covered. Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 7 Residents could be placed at risk by being cared for by some staff that have not been properly trained in safe moving and handling techniques. Due to the lack of adequate management cover, there has been no quality of care monitoring, or proper premises checks, to identify deficiencies quickly and take any necessary action to protect and maintain residents’ welfare, safety and comfort. The manager returned to work at the home on 3rd January 2007. The provider confirmed that she would be given sufficient management time (supernumerary to the care staff) to address the things identified in this report. The provider indicated that the manager would be working three days a week in addition to the care hours provided, so this should help to bring about some of the necessary improvements. The provider needs to make sure that the resources are available for this. 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. Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 8 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.V306097.R01.S.doc Version 5.2 Page 9 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 the following standard(s): 1, 3 & 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service users’ guide, although well written, still do not contain all the information about certain aspects of the building for people to be able to make a fully informed decision about moving into the home. Whilst the home’s assessment process identifies prospective residents’ needs, it does not make sure that all potential risks can be properly managed when they move into the home. The home does not provide intensive rehabilitation, or admit people for intermediate care, so standard 6 is judged as not applicable. EVIDENCE: The home’s statement of purpose and service users’ guide are displayed on notice boards in the entrance hall and in the dining room. There is also lots of other information on display and readily available for residents and visitors to Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 10 read. This includes the complaints procedure and copies of the home’s previous inspection reports. As a pre-existing home there are a number of bedrooms that do not meet the minimum size specified in the national minimum standards and certain other physical aspects of the building that fall below the standards. At previous inspections this had not been made clear in the written information provided to residents. Copies of the service users’ guide and statement of purpose provided at this inspection still contain some inaccurate information, for example, both refer to there being 20 bedrooms in the home, but the schedule of accommodation indicates that there are 19 bedrooms and the service users’ guide only provides a brief statement that room sizes are available on request. The care of one new resident was case tracked. There was a copy of the care management assessment in the care plan file and an assessment had been recorded following admission. The documentation contained some useful information and gave some indication of needs, including a risk assessment element, but there were some significant omissions regarding the management of a healthcare need that is necessary for all staff to know to provide the required care. Discussion with the resident and two staff members indicated that the staff know what to do and the resident felt confident in the care being provided. However, certain risks were discussed with the deputy manager that had not been recorded. If this information is missed because it has not been verbally transferred between shifts, without the written information, there is a risk that this person’s care needs might not be met. Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 11 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 the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst the care planning system provides staff with some useful information to meet residents’ needs, the monitoring and reviewing processes need improvement so that residents can be assured that all their health care needs will be fully met. Whilst medication storage and procedures are generally satisfactory, immediate improvements are necessary in staff practices to ensure a resident’s healthcare needs are met and to maintain safety when administering medications. Personal care is generally offered in a way to protect residents’ dignity and privacy. EVIDENCE: The home’s care plan format used covers the components specified in the standards and contains some useful information. Care plans seen as part of the case tracking identified the residents’ needs and gave instructions for the Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 12 care to be delivered. However, there continues to be some repetition between the various sections of the care plans and staff are still not cross-referencing information from the daily records and doctors visits sections when they write the care plan review notes. Therefore care plans are not always being properly updated as needs change and there is a risk that some important things can be missed. Not all daily record entries were signed and a communication book contained some personal details about residents. Weight records in a resident’s care plan indicated a significant weight loss over a two-month period that had not been followed up. The moving and handling assessment had not been updated as needs had changed when a wheelchair became necessary. Although a risk of falls had been identified in one section of the care plan, it had not been appropriately followed up and this person’s dependency assessment was recorded as a low dependency when the case tracking indicated that their needs were at least medium dependency. All of this was discussed with the deputy manager, who said that in the manager’s absence, there had not been enough time to audit these things as she only works part-time. The deputy manager and a carer spoken to had a good knowledge of the care needs of the residents case tracked. Two residents commented that the staff understand their needs and assist them as required. The medication administration records (MAR) were checked and on the whole were well recorded. A discrepancy was identified in relation to one resident, where a whole day’s and an evening’s tablets had been signed as given on the MAR sheet, but were still in the box, which had no name on it. When this was discussed with the deputy manager, she could not account for it. Therefore practices need reviewing to make sure that a full audit trail in relation to medications can be evidenced. A risk assessment had not been completed for the self-administration of insulin and staff gave conflicting information about the morning and evening insulin doses that were not recorded in the care plan or the MAR sheet. A staff member described some recent changes in the insulin dosage that had not been recorded. The staff member explained that the doctor had instructed the doses could be increased if blood sugar levels were high and decreased if low, but there was no guidance for staff on how high or low, or how to recognise the indications for this. The deputy manager was asked to write a risk assessment and send a copy to the commission by 18th December 2006, which was received, but was not detailed enough. In a subsequent telephone conversation, the deputy manager was asked to expand it and submit another copy. Following the feedback conversation with the provider on 5th January 2007, the deputy manager sent confirmation of action taken later the same day indicating arrangements have been made for a specialist diabetic nurse to give a talk to staff and the resident about this. It Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 13 was also confirmed that the doctor had been consulted about the resident’s weight loss, which was being followed up. Staff were observed talking to residents in a respectful manner. One resident confirmed that staff respect their privacy and dignity. However, another resident said that a staff member of the opposite sex had entered their bedroom on one occasion while they were undressed. Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The routines of daily living in this home suit residents’ needs. There are not enough recreational opportunities currently available within the home for residents to take part in stimulating and motivating activities. The food served, on the whole, meets residents’ individual tastes. EVIDENCE: Two residents said that they are content with their lifestyles at this home. Residents were seen occupying themselves by reading, watching television or chatting. A resident described their daily routines, which were clearly flexible. Some residents had chosen to stay in their bedrooms, whilst others prefer to sit in the lounges. Staff knew residents’ preferences. Residents spoke of visits by their families and friends. A leisure therapist used to work at the home on two afternoons a week, but has left since the last inspection. A resident said they missed these two activities sessions and commented that residents mainly occupy themselves now. The administrative manager said that a new activities person is currently Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 15 being recruited to fill this gap. Some carol singers were due to visit on the afternoon of the first visit and at the second visit, a resident said how much they had enjoyed this. Residents spoken to commented that the food is quite nice. The four-week menu plan indicates that alternatives for the lunchtime meal mainly consist of cold options such as salads or omelettes. One day’s menu for week one indicates two cold options of cold meat or cold ham. Previous recommendations have been made to review the menus to provide more variety and positive choices for residents. Menus provided still do not indicate changes to this effect. Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a satisfactory complaints procedure. However, processes need to be developed and consistently applied, including records of outcomes, to ensure transparency. The lack of staff training on abuse poses a potential risk of residents not being adequately protected. EVIDENCE: Residents spoken to at this inspection said they had no complaints; that they would speak to staff if they had a complaint and that staff listen to them and are supportive. Since the last inspection, the commission received a letter of concern from a relative of a resident who had a respite stay at Rossetti Lodge. This was forwarded to the registered provider and a response was received from the administrative manager indicating that the concerns had been looked into. The home keeps a complaints book in the dining room, which contained an entry of this concern when it was initially made to the home by the relative. The entry indicated that the deputy manager had tried to follow it up via a telephone call to the complainant, but the person was not available and no further action was taken at the time. This was discussed with the deputy manager and the administrative manager and they were advised that each Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 17 complaint should be recorded separately to comply with confidentiality and that the outcome should have been recorded. The home has a policy and written procedures on abuse, ‘whistle blowing’ and restraint, which are kept in the staff room. At the last inspection it was identified that the majority of care staff had not been trained in adult protection procedures and how to prevent abuse. The administrative manager said that no action had been taken to rectify this and the staff-training matrix indicates that eight of the current care staff still have not done any adult protection training. Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 18 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 the following standard(s): 19, 21, 22, 24, 25 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of attention to the external maintenance and poor condition of some of the furnishings, fixtures and fittings means that residents live in an inadequate and potentially unsafe environment. EVIDENCE: The tour of the building identified that the home was being kept clean and odour free, but there were still a number of maintenance and refurbishment things that need attention, many of which have been pointed out at previous inspections. For example, poor quality furniture in some bedrooms, over bed or bedside lights absent, or not working, poor lighting in some bedrooms, a rotten window that had still not been repaired in one bedroom, although this had been pointed out at inspections in 2005 and 2006. The administrative manager said she had obtained an estimate for a replacement window for this room in October 2005, but nothing had been done. Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 19 Externally, the flat roof over the sun lounge still has the blue plastic sheet over it with green moss type growth all over the roof, as seen at the 2nd June 2006 inspection. The administrative manager said the leak had been repaired and an estimate for the whole roof repair had been obtained, but it would entail doing the fire escape as well, so she was not sure whether it would be done. On 5th January 2007, registered provider stated that the roof repair had been completed in September 2006. Two residents said they liked their bedrooms and were satisfied with the facilities provided in the home. One resident spoken to had brought their own furniture in with them and was pleased with their room. The majority of bedrooms have been personalised with residents’ own pictures, photographs and ornaments. Some bedrooms had poor quality bed linen and the curtains in one bedroom were very worn and thin with tears in them and holes at the bottom. The administrative manager said that the resident’s key worker was going to buy some new ones with money provided by their relative. This room had been attractively personalised with a new bedspread, cushions and ‘throw’ over the chair, all of which had been provided by the relative. On 5th January 2007 it was confirmed that the curtains were replaced “just before Christmas”. A maintenance man works one day a week at the home and carries out weekly safety checks. He was seen repairing a bedroom door so that it would selfclose properly. There are four toilets on the ground floor. The two situated by the lounge areas are both in bathrooms, so if the baths are in use residents have to walk down the bedroom corridor to access the other two toilets. There are no ensuite facilities. A review of toilet facilities was requested at the last inspection, but the registered provider feels this is sufficient and would only be reviewed ‘as needs change’. Three new commodes had been purchased since the last inspection, but two more were seen that need replacing as one was taped and one had a torn plastic seat and back, posing an infection risk. Call bells can only be reached at the point of source and there is no facility to attach pull cords in bedrooms. This has previously been pointed out as in need of upgrading. A resident confirmed that when they had used the call bell at night, staff had responded in a timely way. Some infection control risks were identified: the bath thermometer was attached by a short piece of string to the ring that holds the chain for the plug. Therefore, when the bath is full of water the thermometer is left soaking in the bath water. The deputy manager could not account for this practice that poses a risk of infection. The macerator fitted in the garage is still out of action, so Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 20 soiled incontinence pads are disposed of via an external waste contractor. A Category E green waste bin was seen outside the sluice. A flip-top bin with yellow plastic bag is used in the parker bathroom for soiled pads, which are then transferred to the external waste bin. It was again discussed that foot operated bins should be used to prevent the spread of infection. The sluice room is still unhygienic with worn wooden surfaces that pose an infection risk. Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff have a good understanding of residents’ needs, however, the numbers of staff on duty are not sufficient to ensure that residents’ changing needs can be properly met. Recruitment procedures are adequate, but induction practices do not ensure that residents are kept safe and fully protected. EVIDENCE: Rotas provided at this inspection indicated no improvement in the numbers of care staff on duty to meet residents’ needs, with two carers on duty throughout the day. The manager is currently on maternity leave. A part-time cleaner works five mornings a week and there is one cook who covers up until 15.45 hours on five days, plus one morning. When the cook and administrative manager go off duty in the afternoon, there is only two care staff left and one has to go into the kitchen to prepare the evening meal, leaving only one carer to provide assistance to the residents. A carer said that if a resident needs two staff to take them to the toilet during this time, the carer in the kitchen has to leave the meal preparation to go and help the resident. They then have to make sure that they change their protective clothing and wash their hands properly to prevent infection. Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 22 In the absence of the manager, the deputy manager has been trying to do the monitoring of care and medication audits that the manager would normally have done. However, as she only works four, half-day care shifts, plus one half-day shift where she is the third person on duty to do her management tasks, this has clearly been insufficient as demonstrated in the previous sections on Choice of Home (regarding risk assessments) Health and Personal Care, Complaints and Protection, where things have not been properly followed up. The staff-training matrix provided at this inspection, indicates that four staff have their National Vocational Qualification (NVQ) in care level 3. The year dates have been added to the matrix that indicates that the only training courses completed during 2006, was two staff members’ fire training, one person’s moving and handling training and one person’s NVQ level 2 in care. At the time of the two site visits, there were no new staff since the last inspection, but the administrative manager spoke of the appointment of one new carer who worked one weekend and did not return. This person’s record was seen, indicating that appropriate pre-employment checks had been completed. However, this person was employed as a night carer and the administrative manager confirmed that they had not worked any day shifts before starting night duty and there was no induction training paperwork. The administrative manager said that there may have been some paperwork, but could not confirm if any induction training had been completed prior to them starting night duty. Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management arrangements at this home are inadequate. This is having an impact on the quality of care provided to residents and could compromise their safety. EVIDENCE: The manager’s maternity leave absence has not been covered with an equivalent full time post. The action plan submitted following the last inspection, indicated that an interim manager position was to be advertised to cover this. The provider stated in a telephone conversation on 5th January 2007, that a person had been appointed, but did not take up the position. The deputy manager has taken on some of the manager’s duties, but is part-time and mainly works on shift as the second carer. The administrative manager is Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 24 based at Rossetti Lodge and does the administration work for all three homes in the Rossetti Care group and does not have care experience. The administration manager said that there had not been any monthly Regulation 26 visits to check on the conduct of the home. Discussions with staff at the two site visits indicated that the home is stretched in the absence of a manager and with no one to do the quality of care monitoring, or to carry out quality assurance checks, this has impacted upon the outcomes for residents, as identified throughout this report. Health and safety issues are still not being managed effectively. Environmental risks assessments had been recorded in 2004, but were not very detailed. Some had been updated since then, but not within the last six months and some were not dated. Therefore they all require reviewing and updating. The administrative manager said that the home’s electrical certificate (dated 30th May 2001) should have been renewed in May 2006, but had not been done. The last inspection identified the need for staff moving and handling training, which has not been completed and the administrative manager said that no arrangements had been made to address this. The fire safety logbook indicated that regular monitoring checks had been carried out. Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 25 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 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 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 2 1 X 2 2 X 1 2 1 STAFFING Standard No Score 27 1 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X X X 2 1 Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 26 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 statement of purpose and service users’ guide must contain clear and accurate information about the physical environment, indicating where it falls short of the minimum standards. (Previous requirement 24/11/04, 06/12/05, 02/06/06). 2 OP3 14 Pre-admission assessments must be sufficiently detailed to ensure that the person’s needs can be met at the home. Assessments must include risk assessments that cover all potential risks and include management strategies. Assessments to be kept under review and having regard to any change of circumstances be revised as necessary. (Previous requirement 02/06/06). 3 OP7 15 A plan of care, generated from a comprehensive assessment, is DS0000023514.V306097.R01.S.doc Timescale for action 31/03/07 31/01/07 31/01/07 Page 27 Rossetti Lodge Residential Home Version 5.2 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). 4 OP8 12, 13, 14 To promote and make proper & 15 provision for the health and welfare of service users. Needs identified in the various assessments and any new needs identified in the daily records must be followed up and recorded in the care plans. (Previous requirement 08/06/05, 06/12/05 & 02/06/06). 5 OP9 13(2) The registered persons must ensure that staff adhere to the correct procedures for the receipt, recording, storage, handling, administering and disposal of medicines received into the care home. (Previous requirement 06/12/05 & 02/06/06). 6 OP12 16 The registered person must ensure that residents are provided with a range of opportunities to participate in activities. An activities programme that reflects the interests and needs of all residents must be provided and implemented. (Previous requirement Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 28 31/01/07 31/12/06 31/01/07 02/06/06). 7 OP16 22 That the home’s complaints procedure is reviewed and action taken to ensure that processes are consistently applied and the stated outcome is achieved. (Previous requirement 02/06/06). 8 OP18 13 The registered person must make arrangements for staff to be trained in the prevention of abuse. (Previous requirement 02/06/06). 9 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, plus those identified at this inspection. 10 OP21 23 That there are sufficient numbers of lavatories and baths provided to meet residents’ needs. To review the home’s toilet and bathing facilities and take any necessary action to ensure that the facilities provided meet residents’ needs. (Previous requirement Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 29 31/01/07 28/02/07 28/02/07 28/02/07 02/06/06). 11 OP22 16, 23 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). 12 OP24 16 To provide in rooms occupied by residents adequate furniture, bedding and other furnishings, including curtains and any equipment suitable to the needs of residents. That suitable lighting is provided in all parts of the care home which are used by residents. (To include bedside or over bed lighting). 14 OP26 13(3) 16(2) Suitable procedures must be followed to prevent infection, toxic conditions and the spread of infection at the care home. Unhygienic commodes to be replaced. Adequate foot operated pedal bins to be provided. Sluice room must be fit for purpose. (Previous requirement 08/06/05 & 02/06/06). 15 OP27 18 At all times there must be 31/01/07 suitably qualified, competent and experienced staff working at the DS0000023514.V306097.R01.S.doc Version 5.2 Page 30 28/02/07 28/02/07 13 OP25 23 31/01/07 28/02/07 Rossetti Lodge Residential Home 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). 16 OP29 19 Staff files must contain all of the information specified in the regulations, to include evidence of completion of CRB/POVA checks, full employment checks and interview records. (Previous requirement 24/11/04, 06/12/05 & 02/06/06 ongoing). 17 OP30 18 Staff must be provided with training appropriate to the work they are to perform, including structured induction. During a new workers induction an appropriately qualified experienced staff member must be appointed to supervise the new worker. 18 OP32 12 The care home must be conducted to promote and make proper provision for the health and welfare of residents. The person managing the home must be qualified, competent and experienced to run the home and have sufficient management time. 19 OP33 24, 26 The registered person shall establish a system for reviewing at appropriate intervals and improving the quality of care provided at the care home and supply the commission with a DS0000023514.V306097.R01.S.doc 28/02/07 31/12/06 31/01/07 31/01/07 Rossetti Lodge Residential Home Version 5.2 Page 31 copy of the report. (Previous requirement 02/06/06) 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 report must be kept available for inspection if requested. 20 OP37 17 Personal information about the care provided to residents must be recorded appropriately in their individual files. (Previous requirement 02/06/06). 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) 22 OP38 13 The registered person must ensure that sufficient staff are trained in moving and handling, first aid and basic food hygiene. Evidence to be submitted. (Previous requirement 02/06/06) 23 OP38 23 Evidence of up to date electrical certificate for the home to be submitted. 28/02/07 28/02/07 31/01/07 21 OP38 13 28/02/07 Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 32 (Previous requirement 02/06/06) 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 Refer to Standard OP10 OP15 Good Practice Recommendations That all staff are instructed on how to respect residents’ privacy. That menus are reviewed to ensure they are sufficiently varied and provide positive choices for residents. (Carried forward from 06/12/05 & 02/06/06). Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Office 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 Rossetti Lodge Residential Home DS0000023514.V306097.R01.S.doc Version 5.2 Page 34 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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