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Inspection on 02/06/06 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 2nd June 2006.

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

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

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

What the care home does well

Residents 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. The home has a stable nucleus of staff that have achieved their National Vocational Qualification (NVQ) in care level 2. Residents felt that the care staff work hard and do their best for them.

What has improved since the last inspection?

A new extractor fan has been fitted in the sun lounge area where residents are allowed to smoke. All the communal areas are open plan and interlinked. There are no doors between the lounges and dining rooms to separate them, so this is an improvement for people who do not smoke. A new call bell point has been added in the television lounge, so that residents can call for assistance if required. Unfortunately not all residents can reach it.

What the care home could do better:

There are not enough staff on duty to look after the residents properly and to keep the home clean. Residents are generally satisfied with the care they receive, but there are some times when no one is available to immediately help them. They feel that the staff are kind and caring, but there are not enough staff on duty all the time, to always help them when they need it and to keep their bedrooms clean. There is little stimulation for them except on two afternoons a week when a leisure therapist does activities with them. The poor staffing levels are having an impact on the overall standards within the home and some residents are not receiving the level of care and attention that they need. Things came to light at the visits indicating a failure to uphold the dignity of some residents, such as having to wait for staff assistance to go to the toilet. All prospective residents should have their needs properly assessed before they move into the home and this was not being done. The home needs to ensure that all of the residents` healthcare needs are met. One person`s needs were not being dealt with in a satisfactory way. Improvements are necessary in the care planning and monitoring of residents` healthcare. Some omissions in this respect were apparent that pose a risk of harm if not dealt with. Residents spoke of staff not having time to sit and talk with them, and of their worries about the lack of management. Feedback from a relative indicated that they do not receive any responses to complaints. The home was not being kept clean and hygienic and several residents commented about the dust in their bedrooms. There were dirty carpets and waste bins in bedrooms that were full and had not been emptied. There were odours in two bedrooms and an unclean toilet posed an infection risk. Care staff had to do the cleaning, as there had been no cleaner at the home for some time and not enough designated cleaning hours were being provided. The care staff were trying to fit this in between their care tasks. A new part time cleaner had just been appointed, so some improvement is now expected. Building maintenance still needs to be improved. Staff were not following safe infection control procedures and the sluice room where the commode pans are cleaned is unhygienic and not fit for purpose. Environmental health and safety checks had not been completed at regular intervals. An inappropriate moving and handling procedure was seen that placed a resident at risk of harm. Some of the staff have not been trained in moving and handling to ensure that residents are always moved safely and to reduce risk to themselves. All of these things indicate a failure on the part of the home`s management to identify deficiencies quickly and to take the necessary action to make sure that residents` best interests are met. Although there is a quality monitoringprocess in place, it is clearly ineffective in bringing about the necessary improvements. Therefore the overall management of this home is poor. Twenty-three requirements have been made and if not appropriately addressed within the timescales set, enforcement action might be necessary to drive improvements.

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 2nd June 2006 09:20 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.V297800.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.V297800.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.V297800.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. 17th September 2002 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 registered double bedrooms, including one that is only 12.8 sq.m. currently used as a single. 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. The home is currently staffed by a team of carers, and a cook. Care staff work a rota that currently consists of two waking carers on duty at night. Information from the registered provider in May 2006 states that the fees range from £320.00 to £420.00 per week. Rossetti Lodge Residential Home DS0000023514.V297800.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; telephone contacts; written information provided by the manager and registered provider; surveys completed by residents and relatives; views of care managers and doctors. The inspection focussed on key standards and requirements made at the last inspection. An unannounced site visit was carried out by two inspectors on 2nd June 2006 between 09.20 hours and 14.40 hours and a second visit took place on 5th June 2006 between 10.15 hours and 12.50 hours. The visits included talking to 4 staff members, 8 residents, looking round the home and checking some records. The care of 3 residents was case tracked. At the time of the visit there were 15 residents. Information in the pre-inspection questionnaire completed in May 2006 states that the current fees for the home range from £320.00 to £420.00 per week. The registered manager is on maternity leave and has not been working at the home since the 8th May 2006. What the service does well: What has improved since the last inspection? A new extractor fan has been fitted in the sun lounge area where residents are allowed to smoke. All the communal areas are open plan and interlinked. There are no doors between the lounges and dining rooms to separate them, so this is an improvement for people who do not smoke. A new call bell point has been added in the television lounge, so that residents can call for assistance if required. Unfortunately not all residents can reach it. Rossetti Lodge Residential Home DS0000023514.V297800.R01.S.doc Version 5.2 Page 6 What they could do better: There are not enough staff on duty to look after the residents properly and to keep the home clean. Residents are generally satisfied with the care they receive, but there are some times when no one is available to immediately help them. They feel that the staff are kind and caring, but there are not enough staff on duty all the time, to always help them when they need it and to keep their bedrooms clean. There is little stimulation for them except on two afternoons a week when a leisure therapist does activities with them. The poor staffing levels are having an impact on the overall standards within the home and some residents are not receiving the level of care and attention that they need. Things came to light at the visits indicating a failure to uphold the dignity of some residents, such as having to wait for staff assistance to go to the toilet. All prospective residents should have their needs properly assessed before they move into the home and this was not being done. The home needs to ensure that all of the residents’ healthcare needs are met. One person’s needs were not being dealt with in a satisfactory way. Improvements are necessary in the care planning and monitoring of residents’ healthcare. Some omissions in this respect were apparent that pose a risk of harm if not dealt with. Residents spoke of staff not having time to sit and talk with them, and of their worries about the lack of management. Feedback from a relative indicated that they do not receive any responses to complaints. The home was not being kept clean and hygienic and several residents commented about the dust in their bedrooms. There were dirty carpets and waste bins in bedrooms that were full and had not been emptied. There were odours in two bedrooms and an unclean toilet posed an infection risk. Care staff had to do the cleaning, as there had been no cleaner at the home for some time and not enough designated cleaning hours were being provided. The care staff were trying to fit this in between their care tasks. A new part time cleaner had just been appointed, so some improvement is now expected. Building maintenance still needs to be improved. Staff were not following safe infection control procedures and the sluice room where the commode pans are cleaned is unhygienic and not fit for purpose. Environmental health and safety checks had not been completed at regular intervals. An inappropriate moving and handling procedure was seen that placed a resident at risk of harm. Some of the staff have not been trained in moving and handling to ensure that residents are always moved safely and to reduce risk to themselves. All of these things indicate a failure on the part of the home’s management to identify deficiencies quickly and to take the necessary action to make sure that residents’ best interests are met. Although there is a quality monitoring Rossetti Lodge Residential Home DS0000023514.V297800.R01.S.doc Version 5.2 Page 7 process in place, it is clearly ineffective in bringing about the necessary improvements. Therefore the overall management of this home is poor. Twenty-three requirements have been made and if not appropriately addressed within the timescales set, enforcement action might be necessary to drive improvements. 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.V297800.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.V297800.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 poor. 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. The failure to ensure suitable pre-admission assessments are completed does not ensure that the home can meet the needs of new residents at the time of their admission. 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 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 Rossetti Lodge Residential Home DS0000023514.V297800.R01.S.doc Version 5.2 Page 10 below the standards. Copies of the statement of purpose and service users’ guide seen still did not make this clear. There was no pre-admission assessment or care management assessment for a new resident with high dependency needs and significant parts of the care plan lacked any information even though the person had been resident at the home for six weeks. The needs assessments for two residents did not contain all the information needed to provide the necessary care. Rossetti Lodge Residential Home DS0000023514.V297800.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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Shortfalls in the home’s systems for care planning and monitoring residents’ healthcare place residents at risk of their health and personal care needs not being met. Medication storage and procedures are generally satisfactory but some practices need to improve to fully ensure safety. Two situations identified showed a failure to ensure that those residents’ dignity was respected. EVIDENCE: The home’s care plan format used covers the components specified in the standards and contains some useful information, but the separation between the various different sections in the layout has created repetition and some things were not being appropriately cross-referenced. Care staff spoken to were able to describe the care needs of the residents case tracked, plus those of three other residents spoken to by the inspectors. Two residents felt that staff were providing all the care they needed. A resident said that staff had arranged for a doctor to re-asses them due to a Rossetti Lodge Residential Home DS0000023514.V297800.R01.S.doc Version 5.2 Page 12 continuous problem that had been getting worse. The resident was pleased when the doctor visited later in the day. Discussion with another resident identified that some aspects of their personal care could be improved. The resident said that the staff were good and doing their best, but it was clear from observation that some of this person’s care needs were not being met. Some skin integrity risks and nutritional risks had not been followed up in the care plan, which had a number of omissions. An inappropriate lifting procedure was observed and no moving and handling assessment had been completed. This was discussed with the deputy manager who was unaware that the method used posed a risk of injury to the resident. The deputy manager stated that although the care plan indicated a low dependency, the resident’s needs were of a high dependency. Some of this person’s healthcare needs discussed had not been recorded, although the deputy manager indicated that a doctor had visited and prescribed medication. Some other behaviour issues that had recently changed had not been reviewed or updated in the care plan. The sections of the care plan that had been completed had not been reviewed. For another resident whose needs had changed from high to medium dependency, there was contradictory information in the care plan, which did not reflect this change. Some important information had not been included in the care plan, posing the risk that if it is not passed on verbally by staff, this person’s health care needs might not be met. Because of this person’s medical condition, they were not able to communicate very well, so it is vital that such things are recorded properly as well as passed on between staff at the shift handovers. Improvements in medication storage and procedures noted at the last inspection have been maintained. Medication storage and records were satisfactory on the whole, however, there were some discrepancies, which were discussed with the deputy manager. Internal and external medications were being stored together in a separate metal locked cabinet and it was discussed to separate these. The medication trolley cannot be taken round the home to dispense the medications due to problems with the access to the room where medications are kept. Staff were observed talking to residents in a respectful manner. A resident confirmed that their privacy and dignity is respected. However a resident spoke of the call bell not working in their bedroom and of having to shout when in bed to attract staff attention when they needed help with toileting. Another resident spoke of feeling embarrassed when a male carer was on night duty and they needed personal assistance. Although it transpired from discussion with the deputy manager that there was also a female carer on duty at night, the resident had not felt confident to ask for the female carer instead. Rossetti Lodge Residential Home DS0000023514.V297800.R01.S.doc Version 5.2 Page 13 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 the needs of some residents. Limited recreational opportunities are provided for residents. The food served is of satisfactory quality and on the whole meets residents’ individual tastes. EVIDENCE: A leisure therapist does activities with residents on Monday and Wednesday afternoons. Residents were seen occupying themselves by reading, watching television or chatting. Several residents said that they were used to this and seemed content with their lifestyles. A resident spoke about a group of singers that had recently visited and said that the entertainment had been enjoyable. Several residents spoken to 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, for example a staff member spoke about a resident who chooses to sit in the quiet lounge after dinner every day to read their library books. Residents spoke of visits by their families and friends, saying that staff always welcome them. Rossetti Lodge Residential Home DS0000023514.V297800.R01.S.doc Version 5.2 Page 14 Outings are arranged in the home’s minibus shared with the other two homes under the same ownership. The trips are shared with the other homes. A resident spoke of wanting to go out, but of not having the opportunity any more, as they now needed a staff member to accompany them and there were not enough staff. Residents spoken to commented that the food is usually quite nice, although one said that it was not as good as it used to be. Comments in residents’ surveys indicate that they usually like the food, but that there is repetition over each two-week period. Alternatives for the lunchtime meal mainly consist of cold options such as salads or omelettes. Rossetti Lodge Residential Home DS0000023514.V297800.R01.S.doc Version 5.2 Page 15 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 poor. This judgement has been made using available evidence including a visit to this service. The home is not meeting its stated objective to ensure that residents are enabled to raise their concerns and to make sure that all complaints are responded to. The failure to ensure that new staff know the home’s procedures for safeguarding adults and the lack of staff training on abuse places residents at risk of residents not being adequately protected. EVIDENCE: The majority of the residents spoken to said they had no complaints, they would speak to staff if they had a complaint and that staff listen to them and are supportive. However, three residents spoke of staff being very busy and not having enough time to sit and talk with them, except when dealing with their personal care. Residents spoke of their worries because the manager is absent and “we haven’t got a full team now”. A relative’s comment in one of the surveys indicated that they do not receive any responses to entries made in the home’s complaints book. Therefore, although the home’s complaints procedure is prominently displayed and the documentation provided by the management states that complaints are welcomed as an opportunity to provide better services and that residents should find it easy to raise their concerns, the outcome for residents is that this is not being achieved. The home has a policy and written procedures on abuse, ‘whistle blowing’ and restraint, which are kept in the staff room. The deputy manager knew that any suspicions of abuse should be reported to care management and to the commission. According to the staff-training matrix on display in the office, ten Rossetti Lodge Residential Home DS0000023514.V297800.R01.S.doc Version 5.2 Page 16 staff have not done any adult protection training. A new staff member’s induction record indicated that the adult protection and prevention of abuse polices had not been covered. Rossetti Lodge Residential Home DS0000023514.V297800.R01.S.doc Version 5.2 Page 17 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, 20, 21, 22, 23, 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 environment of the home does not always meet residents’ needs. Measures to maintain hygiene and prevent the spread of infection in the home are unsatisfactory and place residents and staff at risk of harm. EVIDENCE: A new extractor fan has been fitted in the sun lounge where residents smoke. A call bell push has been fitted in the TV lounge, but a resident stated they would not be able to reach it to summon assistance, as it was across the room and they had mobility problems. The tour of the building identified that the home was not being kept clean, with dusty furniture, dirty carpets and waste bins in bedrooms that were full and had not been emptied. There were strong odours in two bedrooms. The administrative manager stated that the home’s cleaner had been on long term sick leave and had just left. Two service user surveys contained comments that there are not enough cleaners and that bedrooms are particularly dusty. Rossetti Lodge Residential Home DS0000023514.V297800.R01.S.doc Version 5.2 Page 18 A resident spoke of their bedroom needing to be cleaned and having to ask for this to be done, as it had not been cleaned properly for a long time. The home was extremely hot at the first site visit – it was a hot day and a number of residents were complaining of the heat. Staff said the night staff had turned the heating up and it was difficult to adjust, as one side of the building gets hotter. The deputy manager turned the heating thermostat down during the morning but the heat had built up by then. Three residents said they liked their bedrooms and were satisfied with the facilities provided in the home, but one resident pointed out holes in their bedroom curtains. The majority of bedrooms have been personalised with residents’ own pictures, photographs and ornaments. However many of these were very dusty. One resident spoke of the call bell being broken in their bedroom and of having to shout at night for attention. This had still not been fixed at the second site visit. Call bells can only be reached at the point of source and there is no facility to attach pull cords in bedrooms. A resident spoke of there not being enough toilets in the home. The four toilets on the ground floor are either in bathrooms or shower rooms, so when the main bathroom, near the dining room is in use, residents have to walk across the dining room, a lounge and a quiet lounge to the use the only other toilet near the communal areas. Alternatively, they would have to walk even further to use one of the other two toilets on the ground floor, which entails walking down a long bedroom corridor. There are no ensuite facilities. The toilet frame in the parker bathroom was seen to be stained with faeces at the time of the first visit and this had not been removed at the time of the second visit, three days later. Observations on the tour of the building identified that there were still a significant number of maintenance and refurbishment things that need attention, many of which have been pointed out at previous inspections. These include: two unhygienic commodes; a bedspread with holes in the underside; a thin mattress; a divan base that was worn and frayed exposing the wood; a laundry light not working; a number of bedroom doors that did not completely close without being pulled shut; rust on the fire escape stairs; the sun lounge roof had a temporary repair but still needed attention. Infection control procedures are still poor. The sluice room is unhygienic and the procedure for cleaning commode pans is unsafe. Staff were using a toilet brush for this that was not being kept clean. The wash hand basin plughole was full of dry debris and the deputy manager confirmed this was not being used. Staff were using the washbasin in the kitchen for hand washing and were not following the written procedure. A new macerator had been fitted in the garage where the laundry is housed, but it was out of action and needed attention. Rossetti Lodge Residential Home DS0000023514.V297800.R01.S.doc Version 5.2 Page 19 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. Staffing levels are unsatisfactory and do not meet the needs of all of the residents. There is a nucleus of trained staff who work hard to support residents with their daily living needs, but staff rotas are not well thought out and do not ensure that the changing needs of residents can be properly met. Recruitment procedures are adequate EVIDENCE: Comments in the service users surveys indicated that there were not enough staff on duty, but that the staff at the home are very good. This was followed up in discussions with several residents during the visit, who made similar comments. Rotas seen indicated only two carers on duty throughout the day, including the deputy manager. The manager is currently on maternity leave and her hours have not been covered, except to move an administrative manager to Rossetti Lodge for four days a week. The home had been without a cleaner for some time and care staff have to cover the cooking on the cook’s day off. There were only two carers, plus the administrative manager on duty at the first visit, until 10.30 am when a third carer arrived. The pre-inspection questionnaire indicated twelve residents with low dependencies and three residents with medium dependencies. However, the case tracking indicated that this was inaccurate, as there had been two Rossetti Lodge Residential Home DS0000023514.V297800.R01.S.doc Version 5.2 Page 20 residents that were high dependency, although one of these was subsequently assessed as medium dependency. The deputy manager stated that there was one high dependency, five medium dependency and nine low dependency residents. This included four wheelchair users, at least two of whom needed two staff to assist them to move into and out of their wheelchairs. One care plan indicated in the moving and handling assessment that the person needed “2 to 3 staff to assist” with transfers at one stage. The day care hours provided were clearly insufficient and included all of the deputy manager’s hours, although she was expected to complete a number of the care management tasks that would normally have been completed by the manager. When calculating the number of care hours required, account should be taken of the spread of the building, non-care tasks that the staff have to undertake, such as leaving the building to do the laundry and access the sluice to clean commode pans, plus the time needed to complete essential cleaning tasks when there was no designated cleaner. A new cleaner had recently been appointed, but had only worked one shift at the time of the first visit. A situation was observed that demonstrated there were not enough staff on duty. It occurred before 10.30 hours during the first visit when there were only two care staff on duty. An immobile resident was kept waiting to go to the toilet because they needed two carers to transfer and one carer was busy doing a care task in another part of the building. A volunteer had to be asked to go and find the other carer. The second carer eventually came and the two staff then assisted the resident to the toilet. The pre-inspection questionnaire indicates a total of eleven care staff, eight of whom have completed their National Vocational Qualification (NVQ) in care level 2 or above. A new staff member’s induction record had been mostly completed, but there were gaps regarding adult protection and some health and safety issues. The staff training matrix displayed in the office did not have details of the dates courses had been completed but indicated that a number of staff had not completed their first aid, medication, adult protection, basic food hygiene and moving and handling training. Three staff files were audited and seen to contain most of the relevant paperwork in relation to the requirements of legislation. There was no photograph or evidence of identity in one file seen. The files still lack interview records to show that gaps in employment histories have been checked. Rossetti Lodge Residential Home DS0000023514.V297800.R01.S.doc Version 5.2 Page 21 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, 35, 36, 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 a detrimental impact upon all aspects of the home and does not ensure the health, safety and welfare of residents. EVIDENCE: Several residents commented that they do not have a manager at the home any more and of not having a “full team now”. They said they have to go to the carers now, who are very nice, but always so busy. The arrangements to cover in the manager’s absence do not include any additional management hours to cover the manager’s full time post whilst she is on maternity leave. The deputy manager has taken on some of the manager’s duties, but does not have sufficient time to do the care management tasks, as well as working on shift as the second carer. The Rossetti Lodge Residential Home DS0000023514.V297800.R01.S.doc Version 5.2 Page 22 administrative manager, although now based at Rossetti Lodge, does the administration work for all three homes in the Rossetti Care group and therefore does not provide any additional management time. She does not have the care experience to deputise for the manager. The registered provider has regular contact with the home, via telephone and e-mail and is available in an emergency, but she has not spent any more time at the home to help cover for the manager. Regulation 26 visits are carried out by managers from the other two homes. One of the managers from the other two homes visit once a week to provide some support, but this takes them away from their homes. Some action had been taken to meet the requirements of the last inspection, but the 23 requirements of this inspection indicate poor management. There was no evidence of any formal staff supervision since March 2006 and this is now an added responsibility for the deputy manager, who stated that she usually works thirty hours a week. Health and safety issues are still not being managed effectively. Environmental risks assessments had not been reviewed since April 2005 and no one was doing regular health and safety checks of the building. The administrative manager said that portable electrical appliance tests had been completed in February 2006 by the group’s maintenance person who had since left. There was no documentation for this. The home’s electrical certificate is dated 30th May 2001 and states that the home should be re-inspected in five years, which therefore needs updating. The fire safety logbook indicated that regular monitoring checks had been carried out, but there was no record of the last fire drill that was indicated in the pre-inspection questionnaire. The records were unclear and the administrative manager was unable to clarify them. The last fire risk assessment was completed on 22nd February 2004 and had not been updated. The fire call point test for the previous week had not been done as the maintenance person had been repairing the staff toilet that had been out of action at the first site visit and had still not been completed at the time of the second site visit. An unsafe moving and handling procedure was witnessed. The staff-training matrix indicated that six staff had not completed their moving and handling training, five staff had not completed their first aid training and seven staff had not done their basic food hygiene training. Rossetti Lodge Residential Home DS0000023514.V297800.R01.S.doc Version 5.2 Page 23 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 1 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 2 1 2 2 2 1 1 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X 3 2 2 1 Rossetti Lodge Residential Home DS0000023514.V297800.R01.S.doc Version 5.2 Page 24 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 made 24/11/04 & 06/12/05). Up to date copies of both documents to be submitted. Pre-admission assessments must be completed and documented to enable care staff to meet the persons needs upon admission. Assessments must include a risk assessment, be kept under review and having regard to any change of circumstances be revised as necessary. Care plans must be accurately completed. Monthly reviews must be carried out and recorded. Care plans must be updated when changes occur. (Previous requirement 24/11/04, 08/06/05 & 06/12/05). Timescale for action 31/08/06 2 OP3 14 31/07/06 3. OP7 15 31/08/06 4. OP8 12, 13, 14 Residents health care needs DS0000023514.V297800.R01.S.doc 31/07/06 Version 5.2 Page 25 Rossetti Lodge Residential Home & 15 must be fully met. The registered persons must ensure that needs identified in the various assessment tools are followed up. 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). The registered person must 30/06/06 ensure that staff adhere to the correct procedure for administering medications. Medications must be administered at appropriate times in accordance with the BNF guidance. (Previous requirement 06/12/05). The registered person must ensure that the care home is conducted in a manner that respects residents’ privacy and dignity. 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. That the home’s complaints procedure is reviewed and action taken to ensure that the stated outcome is achieved. The registered person must make arrangements for staff to be trained in the prevention of abuse. An action plan must be submitted showing a building audit and programme for delivering a safe, wellDS0000023514.V297800.R01.S.doc 5. OP9 13(2) 6. OP10 12 30/06/06 7. OP12 16 31/08/06 8. OP16 22 31/08/06 9. OP18 13 30/09/06 10. OP19 23 31/08/06 Rossetti Lodge Residential Home Version 5.2 Page 26 maintained environment with planned timescales. To cover previous outstanding requirements from 24/11/04 and 08/06/05 & 06/12/05 plus those identified at this inspection. 11. OP21 23 The registered person must ensure that there are sufficient numbers of lavatories and baths provided to meet residents’ needs. A review of the current toilet and bathing facilities must be undertaken and action taken to ensure that the facilities provided meet residents’ needs. Action plan to be submitted. 12. OP22 16, 23 The registered person must take action to ensure that the call bell system in the home is suitable to meet residents’ needs. Residents must be able to summon assistance when needed. (Previous requirement 24/11/04, 08/06/05 & 06/12/05). The registered person must take any necessary action to ensure the heating is suitable to meet the needs of residents in all parts of the care home used by residents and at all times. Action plan to be submitted. The registered person must ensure safe infection control procedures are followed. Adequate foot operated pedal bins to be provided. Action must be taken to ensure that staff follow a safe procedure when dealing with the cleaning of commode pans and that the sluice room is fit for purpose. DS0000023514.V297800.R01.S.doc 31/08/06 06/06/06 13. OP25 23 31/08/06 14. OP26 13(3) 16(2) 12/06/06 Rossetti Lodge Residential Home Version 5.2 Page 27 (Previous infection control requirement 08/06/05 partially met and carried forward). 15. OP26 16(2) The home must be kept clean, hygienic and free from offensive odours. (Previous requirement 06/12/05 not met). 12/06/06 16. OP27 18 The registered person must 12/06/06 provide sufficient numbers of suitably qualified, competent and experienced staff on duty to meet residents’ needs. Staffing numbers must be appropriate for the health and welfare of all residents, including sufficient ancillary staff. Evidence to be submitted. (Previous requirement 08/06/05, 24/11/04 & 06/12/05 not met). The registered persons must ensure that staff files contain all of the information specified in the regulations, to include evidence of identity, checks of gaps in employment history and interview records. (Previous requirement 24/11/04 & 06/12/05). 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 copy of the report. The registered person must ensure that all the required records are kept up to date. Personal information about the care provided to residents must be recorded appropriately in their individual files. (Previous 31/08/06 17. OP29 19 18. OP33 24 31/08/06 19. OP37 17 31/08/06 Rossetti Lodge Residential Home DS0000023514.V297800.R01.S.doc Version 5.2 Page 28 requirement 06/12/05 still not satisfactorily met and carried forward). 20. OP38 13(4), 23 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 carried forward) The registered person must take any necessary action to ensure that residents are moved safely. To include the provision of any necessary equipment. The registered person must ensure that sufficient staff are trained in moving and handling, first aid and basic food hygiene. Evidence to be submitted. Evidence of portable electrical appliance tests to be submitted. Evidence of current electrical certificate for the home to be submitted. 31/08/06 21. OP38 13 06/06/06 22. OP38 13 31/08/06 23. OP38 23 30/09/06 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. Refer to Standard OP9 Good Practice Recommendations That a Controlled Drugs Register is purchased and put into use. (Carried forward from 06/12/05). DS0000023514.V297800.R01.S.doc Version 5.2 Page 29 Rossetti Lodge Residential Home 2. 3. OP15 OP23 That menus are reviewed to ensure they are sufficiently varied and provided positive choices for residents. (Carried forward from 06/12/05). That a review of the individual bedroom space requirements is undertaken for each resident to ensure that bedrooms have sufficient space to suit their needs. Account to be taken of use of mobility aids and wheelchairs. (Carried forward from 06/12/05) Rossetti Lodge Residential Home DS0000023514.V297800.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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.V297800.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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