Inspection on 27/11/07 for Rosslyn

This inspection was carried out on 27th November 2007.

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

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

Other inspections for this house

Rosslyn 10/11/08

Rosslyn 09/01/07

Rosslyn 28/06/06

Rosslyn 13/10/05

Rosslyn 16/05/05

Rosslyn 18/10/04

Rosslyn 10/05/04

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Hawkhills

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Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Rosslyn 29 Bagdale Whitby North Yorkshire YO21 1QL Lead Inspector Karen Ritson Key Unannounced Inspection 09:30 27th November and 4 December 2007 th 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 Rosslyn DS0000007728.V355279.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. Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosslyn Address 29 Bagdale Whitby North Yorkshire YO21 1QL 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) 01947 820931 Mr Jeremy William Southgate Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th January 2007 Brief Description of the Service: Rosslyn provides long-term accommodation and personal care for a maximum of eleven older people. The home is located on a main route into Whitby and is conveniently situated for the shops and other community facilities including transport links. Rosslyn is a traditional house with modern extension built on two floors with the communal areas and two bedrooms being located on the ground floor. One bedroom has an en suite toilet facility. A stair lift gives access to the first floor for residents with limited mobility and consequently the residents placed in bedrooms on the first floor have to be reasonably ambulant. The home has its own parking facilities and there is on-road parking within close proximity. The front of the house has ramp access as well as steps. The home has a statement of purpose and service user guide, which provide information about the scope and nature of the care and facilities on offer. These, with CSCI reports, are available on request at the home. The fee charged is usually £375 per week; however, this may vary with the degree of assessed needs. Hairdressing and newspapers are not included in this fee and these are charged at cost. Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection for this service took 12 hours. This includes time spent gathering information and examining documentation before and after two unannounced site visits and in writing the report. The first site visit took place on 27/11/07 between 9:40am and 3pm, the second on 04/12/07 was between 9 and 9:40 am. Information for this inspection was gathered from the following: • • • • • • • • • • • A tour of the premises Observations of care throughout the day of the site visit. Speaking with service users. Speaking with the manager Speaking with staff. Case tracking service users on the day of the site visit. Looking at information provided by the home in a pre inspection questionnaire. Notifications sent to the commission from the home since the last inspection. Examining policies, procedures and records kept at the home. Examining information regarding the home on the file kept by CSCI. Considering comments made by relatives, health care and social services staff. All key standards were looked at during this inspection. The manager was present throughout the day of the site visit. What the service does well: This home provides a homely and welcoming place to live. It is well decorated and maintained. The people who live here say that the staff are kind and that they are well looked after. One relative wrote: I feel the staff in the home does not just care for the residents but care about them. They strive to make the home comfortable and feeling as much like the residents home as possible.’ The medication is well managed and people are treated with respect. The food is good and all comments received about meals were very positive. Staff go out of their way to make sure residents get the meals they prefer and there are always snacks and treats available. Residents said that any complaints are listened to and acted on and that they feel safe at the home. Safety is important to the manager with up to date health and safety procedures in Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 6 place. There are enough staff on duty to care for the number of people living at the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, standard 6 is not applicable. People who use the service experience adequate quality outcomes in this area. Prospective service users and their representatives have some of the information needed to choose a home which will meet their needs. They have their needs assessed but this requires more detail to ensure the correct care can be offered. This judgement has been made using a range of evidence including a visit to the service. EVIDENCE: There is evidence that people receive an assessment prior to admission. Basic areas of care needs are considered, but there is insufficient detail to give people or their representatives a clear idea whether the home can meet their needs. However, people and representatives said they were given sufficient verbal information and were reassured that the home could offer the right level Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 9 of care. Risk assessments need to be more detailed and specific to each individual. The home does not offer intermediate care. Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People who use the service experience adequate quality outcomes in this area. The health and personal care that people receive is not always based on their individual needs. The principles of respect, dignity and privacy are put into practice. This judgement has been made using a range of evidence including a visit to this service. EVIDENCE: A plan of care is available for some service users. For those who have social services involvement a care manager draws this up. For some service users the care plan is not sufficiently detailed to offer staff the degree of direction needed to offer appropriate care. In some cases the assessment and care plan are one document. More detail is required to make sure that all areas of health, personal and social care needs are met. Although daily notes show that health care professionals have been consulted for advice over how to offer care, the care plans do not include this information in enough detail. One Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 11 health care professional indicated that the home had taken some time to understand how to manage pressure area care and there had been some concerns about this which had been communicated to the home both from health and social services staff. However, the home seems now to have taken advice on board and both social services and health care workers said that care in this area has improved. The care plans are kept under regular review, but there is no evidence that people or their representatives had been involved in the process. Care plans do not adequately cover such areas as mental health and cognition, pressure areas, nutritional screening, access to dental, chiropody, or pharmaceutical care, sight or hearing tests. This means that needs may not always be met. Staff weigh service users regularly and have recently had a pressure areas awareness briefing from a trainer. People at the home said they felt their care needs were well attended to and positive comments were received from relatives. One relative wrote. ’It is a great comfort to me to know that mum is well cared for and her emotional, physical and material needs are well met.’ Medication is well kept, administered and returned according to policy and procedure. Staff have received training from Boots chemist in the safe handling of medication. Throughout the day of the site visit, staff were observed treating service users with respect and regard to dignity. One relative wrote: ’I have never heard the staff say anything detrimental or discriminatory about any resident.’ A service user said: ‘They treat us very kindly. They never come in without knocking.’ Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. People who use the service experience adequate quality outcomes in this area. They are not all enabled to make informed choices about the way they live their lives. They have a good diet they enjoy. This judgement has been made using a range of evidence including a visit to this service. EVIDENCE: Service users said they had outings with family or friends, two enjoyed watching sky television in their rooms, another person said she enjoyed crosswords. The manager said that people sometimes enjoy doing domestic tasks such as washing up, dusting or folding sheets. One person enjoys reading and the home helps arrange frequent changes of books for her. The home puts on a Christmas party where all friends and relatives are invited and the atmosphere on both days of inspection was relaxed and friendly. Staff spent time chatting with people and treating each person as an individual. One relative stated: ‘Mum was allowed to get up and go to bed when she wanted to. She could have breakfast early or late whichever suited. ‘ Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 13 However, the home offers little in the way of activities tailored to the assessed social needs of each person. Staff said that people often did not wish to join in with activities, finding them too much bother. However, some people said they would enjoy being offered more in the way of stimulation and several relatives and other visitors felt there was not sufficient effort being made to discover what each person might be interested in. The home is caring for some service users with specific needs due to their medical condition and their social and lifestyle needs were not adequately addressed in their care plans. Examination of daily notes showed that that little was being done in practice either. The home has a semi open visiting policy avoiding meal times or late visits. Visitors said the staff were always very welcoming and one visitor said the place was ‘a home from home.’ Another relative said: ’I phone the home regularly and whenever mum is awake they take the phone to her and hold it to her ear so we can have a chat. …They have contacted me when she said she wanted to talk with me.’ People said they enjoyed the meals and that they had choice. One person said: ‘The food is home cooked and always lovely.’ A visitor said: ‘(There are) good home cooked meals with plenty of treats provided…If mum wants something different for tea they .. always do their best to provide whatever she fancies.’ A midday meal was observed, and was of a high quality. Nutritional needs and meal choices are recorded, which helps with planning menus and ensuring people receive the right diet. Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. They are able to express their concerns, and have access to an effective complaints procedure, they are protected from abuse, and have their rights protected. This judgement has been made using a range of evidence including a visit to this service EVIDENCE: People said they were always listened to and if there were a complaint, they would have no hesitation in talking with a member of staff. Relatives said they would speak with staff or social services if they were dissatisfied with care, but said that the manager and staff were good at sorting out problems as they arose. Some members of staff had received abuse awareness as part of their NVQ training; other has received training from an external source. Staff said they would pass any concerns on to the manager if they suspected abuse. There had never been any referral from the home through the protection of vulnerable adults procedure. Health and social care staff said out that ignorance of correct pressure care had had a detrimental effect on the well being of one service user for a time. Staff were now better trained to deal with this and the care being given was improved. Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 15 People said they felt safe at the home and that the staff always treated them kindly. One relative said: ‘They often come in to talk and to ask if everything is okay. They go out of their way to make sure she’s never left alone for long.’ Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good quality outcomes in this area. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. This judgement has been made using a range of evidence including a visit to this service EVIDENCE: The home is well decorated and maintained. Several improvements have been made to the environment since the last inspection. For example, the home has purchased new dining furniture, there is new carpeting and some of the individual rooms have been re decorated. One relative said; ‘They asked (my relative) about the decoration of her room and it has all been done taking what she said into consideration.’ Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 17 The laundry is reached through the kitchen, which is not ideal, however, the manager was aware of the need to contain laundry and to avoid the risk of cross contamination., staff require infection control training. People said their clothes were well cared for. Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,and 30 People who use the service experience adequate quality outcomes in this area. Staff in the home are generally trained and in sufficient numbers to support the people who use the service. Staff recruitment needs attention to ensure people living at the home benefit from well recruited staff. This judgement has been made using a range of evidence including a visit to this service EVIDENCE: Staffing levels are sufficient for the needs of those who live at the home. During the day there are two members of staff on duty and at night there is one awake with one on call. All staff have received induction to ‘skills for care’ guidelines. This ensures staff have the knowledge to offer appropriate care from an accepted base of values. Most staff have received up to date foundation training, however, updates were needed for infection control. Staff are recruited according to procedure, however, the manager does not use standard interview questions. This is required so that each candidate has the same chance and opportunity to show what he or she knows of care, to allow the best candidate to be selected for the needs of those living at the home. Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People who use the service experience adequate quality outcomes in this area. The management and administration of the home is based on openness and respect, the manager however, is not registered with CSCI and does not have the necessary knowledge of regulation to be fully effective in her role. The quality assurance system is not yet effective. Service users are protected by health and safety procedures. This judgement has been made using a range of evidence including a visit to this service EVIDENCE: The manager has achieved NVQ at level 3 and plans to begin NVQ level 4. She is not yet registered with CSCI. This is now a matter for urgent action. Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 20 Staff said she was supportive and helpful, and that they could approach her at any time. Health care and social services staff agreed that Mrs Butler listened to advice and worked well with them, but that there had been concerns in the past year that the Manager had offered care to some service users outside the scope of the homes’ capacity. The manager was unfamiliar with the detail of the National Minimum Standards and Regulations despite having been in post for 18 months. This means that at present, the staff and users of the service do not have the benefit of a manager who understands the regulatory framework for care. The quality assurance system is in the planning stages, with some surveys having been completed by users of the service, but wide surveying to include relatives and others who come into contact with the home has not yet begun. Results of the surveys have not yet been compiled, and there is no annual plan devised from the results of such surveys. It is therefore not possible to say that the home plans improvements based on the views of those who come into contact with the service. The home does not handle service users personal allowances. Formal supervision of staff has yet to begin, although staff said that they consulted with the manager informally on a frequent basis. Those who live at the home are protected by the up to date fire risk assessment, environmental risk assessments and the health and safety procedures operating at the home. Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 21 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 X 3 Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 23 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 OP31 Regulation 12 Requirement The manager appointed to run the care home must be registered with the Commission. An application must be received by 11/01/08 The manager must establish and maintain a system for reviewing the quality of care provided at Rosslyn. Previous requirement of 13/10/05 not met. Previous timescale of 28/02/07 not met. Timescale for action 11/01/08 2. OP33 24 31/03/08 3 OP3 14 4 OP7 15 5 OP8 14 6 OP12 16(2)(l) 7 OP18 13 Rosslyn 8 OP30 18 Assessments must be sufficiently 28/02/08 detailed to ensure the home can offer a place based on a thorough knowledge of needs and whether these may be met. A plan of care must be 28/02/08 sufficiently detailed to provide the basis for good appropriate care. The plan must include 28/02/08 consultation with health and other care professionals where relevant. Service users must be given 31/03/08 opportunities to choose interesting and stimulating activities and enabled to follow them. The home must ensure that 04/12/07 those being cared for are not neglected or in any way placed at risk at harm. DS0000007728.V355279.R01.S.doc Version 5.2 Page 24 The manager must ensure that 31/03/08 staff have training in infection control to keep service users safe. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP30 OP29 OP36 Good Practice Recommendations Care plans should be reviewed once a month. All staff should have foundation training as planned. A standard set of interview questions for new staff should be drawn up. Staff should receive regular supervision in line with standard 36. Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rosslyn DS0000007728.V355279.R01.S.doc Version 5.2 Page 26 - 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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