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Inspection on 01/02/06 for Rossmore Nursing Home Limited

Also see our care home review for Rossmore Nursing Home Limited for more information

This inspection was carried out on 1st February 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

The home offers residents the opportunity to make choices and decisions around their daily lives. Two residents spoken to said `we try hard to be as independent as possible, and it is so nice to be able to make decisions about the care being given and have the staff respect these`. Resident`s comments indicate they hold the staff in high regard, one individual said that `the staff were friendly, helpful and always supportive`. Two residents said that they `enjoy living at the home and that it has a very welcoming and pleasant atmosphere`. Meals at the home offer residents and visitors choice and variety and the food is well presented and appetising. Two residents were full of praise for the kitchen staff and said `that the meals are first class and of a high standard every day.` The home is welcoming and has a relaxed atmosphere. Residents said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home.

What has improved since the last inspection?

The provider is fitting door locks to the bedroom doors where residents have asked him to do so. This helps them maintain their privacy and keeps their personal possessions safe when they are not in their room.

What the care home could do better:

The quality of the care plans must be consistent so all residents receive ongoing care that reflects their needs and wishes. Medication recording needs to be improved to ensure all signatures are in place for medications received and given out by the staff, so that there is no mishandling of medication and the residents health is looked after.

CARE HOMES FOR OLDER PEOPLE Rossmore Nursing Home Limited 68 Sunny Bank Spring Bank West Kingston upon Hull East Yorkshire HU3 1CQ Lead Inspector Eileen Engelmann Unannounced Inspection 1st February 2006 09:30 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 Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 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. Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Rossmore Nursing Home Limited Address 68 Sunny Bank Spring Bank West Kingston upon Hull East Yorkshire HU3 1CQ 01482 343504 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) dnd@rossmorecare.co.uk Rossmore Nursing Home Limited Mrs Veronica Eugenie Slee Care Home 56 Category(ies) of Dementia - over 65 years of age (56), Old age, registration, with number not falling within any other category (56), of places Physical disability (8), Physical disability over 65 years of age (56), Terminally ill over 65 years of age (56) Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registration includes twelve (12) stroke rehabilitation patients and 6 day places. 6th September 2005 Date of last inspection Brief Description of the Service: Rossmore Nursing and Residential Home is a two-storey building, which has been converted from a number of terraced houses for its present use. It is situated about a mile and a half from the centre of Hull in a quiet residential area of west Hull overlooking the playing fields of Hymers College. There is a range of shops and pubs within a few minutes walk. There are bus stops close to the home and the main train station is within walking distance. Car parking is available on the street outside the home. The home provides nursing and residential care to people over the age of 65 years (male and female) within the categories of Dementia, Physical Disability and Terminal Illness. The home also has a contract with Eastern Hull and West Hull Primary Care Trust to provide stroke rehabilitation services to eight people and the home provides specialist facilities for this group of service users. Accommodation is provided on two floors within single or double rooms; two of the shared rooms have en-suite facilities. Access to the upper floor is available through the use of stairs or the passenger lift. Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out with the provider, the manager and residents of Rossmore Nursing and Residential Home. The inspection took 2.5 hours and included a tour of the premises, examination of staff and resident files and records relating to the service. Five of the residents were spoken to in an informal manner; their comments have been included in this report. There has been one additional visit to the home since the last inspection; this was to discuss a Protection of Vulnerable Adults (POVA) referral made by the home to the Social Service team dealing with POVA incidents. The POVA team, and the home (after appropriate consultation), investigated this incident and one member of staff was subsequently dismissed and referred to the POVA register. What the service does well: What has improved since the last inspection? The provider is fitting door locks to the bedroom doors where residents have asked him to do so. This helps them maintain their privacy and keeps their personal possessions safe when they are not in their room. Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 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 Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. All residents undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. EVIDENCE: The home continues to meet this key standard. Two personal files for new residents to the home were looked at and the information within them included an assessment of need from the funding authorities and a pre-admission assessment completed by the home. Those residents at the home who receive nursing care have undergone an assessment by a NHS registered nurse from the Health Authority, to determine the level of nursing input required by each individual. Each resident has an up to date care plan in place, which has been developed from the information within the assessments of need. Discussion with the two residents found that they have a good understanding of their care needs and their comments indicated that staff have helped them to settle into the home and they are satisfied with the service being offered to them. Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9. The systems for care planning and medication must be improved as they contain practices that could potentially place the residents’ health and safety at risk. EVIDENCE: Discussion with the manager indicated that the home is currently reviewing the care plan format and introducing a number of changes to the documentation used within the plans. Individual care plans are in place for all residents and detail the health and personal care needs identified for each person. Since the last inspection there have been some improvements to include more of the social/emotional aspects of care into the plans. There remain some inconsistencies to the quality of the care plans, two of those examined were for relatively new residents and staff had not always reviewed the care in these on a monthly basis, one plan did not have a photograph of the resident in it even though the individual had been in the home for three months. The need for risk assessments had been identified in one plan for bed rails and use of a hoist, but there was no evidence of these being carried out. The manager assured the inspector that she would look at Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 10 the plans with the staff during supervision and ensure that they were all brought up to date. Checks of the medication system showed that the home has changed its pharmacy provider since the last inspection and is now using Lloyds to supply them with medication and associated products. The home has taken on board the recent changes to legislation, around the way that Nursing Homes must dispose of unwanted medication. They have made arrangements to safely dispose of medication through a licensed waste disposal company and have received the necessary paperwork and equipment from this company. Since the last inspection the home has introduced a positive identification system for the residents, where their photograph is put onto the medication chart to aid staff in identifying the correct individual, before medication is given. Examination of the medication records showed up a number of areas that need to improve. These include ∗There were a number of missing signatures from the staff who had given out medication to residents, but not recorded this fact. ∗Staff are not signing medication received from the pharmacy into the system. ∗Transcribed (handwritten onto the sheet) medication did not have the quantities received written down or two signatures from the staff to indicate that they had both checked the information recorded initially was correct. The above practices could lead to medication errors being made and are not acceptable to the Commission. The inspector recommended that an audit of the medication system should be carried out weekly to ensure the records are kept up to date and staff are using the system correctly. Checks of the controlled drugs and register showed that these are correct and accurately recorded. Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 and 15. The home promotes the residents’ right to exercise choice and control over their lives and offers information and contact details so they or their families can contact external agents, who will act in their interests. Residents are provided with choice and diversity in the meals provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in meals. EVIDENCE: Five residents spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. The manager said she is aware of the advocacy groups in the community that residents can access, and the contact information is on display within the home and contained in the Service User Guide. All the residents said that the home encouraged them to bring in small items of furniture and personal possessions to decorate their bedrooms. Discussion with the residents showed that they were aware of their care plans and were able to input to them and access them through their key workers. Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 12 Discussion with the two cooks on duty indicated they both have extensive knowledge and understanding of the residents’ individual needs and personal likes/dislikes. The attention to detail regarding the presentation of the midday meal was extremely good, both for the special diets and regular meals. The home has a dining room and residents are also able to enjoy their meals in the lounges or in their own rooms, as wished. Meals coming from the kitchen are catering for diabetics, soft/pureed diets and individual choices. Each plate was presented in an attractive and pleasing manner, and the residents confirmed that this was the ‘norm’ and not just because of the inspector being present. Residents are very happy with the food at the home, one commented that ‘there is always a good choice and plenty of it’. Information within the care plans indicated the home carries out nutritional assessments on residents and ensures diabetic and dietician access and input is made available, where needed. Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 13 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 and 18. The home has a satisfactory complaints system with evidence that residents’ views are listened to and acted upon. Staff and residents are confident about reporting any concerns and the manager acts quickly on any issues raised. EVIDENCE: The home has a clear and simple complaints procedure that residents, relatives and staff are aware of and are confident of using if needed. The complaints records show that there have been three minor complaints made to the home since the last inspection. These have been investigated and resolved by the manager. Residents spoken to said they would talk to the manager if they had any problems and that ‘she regularly comes round to see us, and talks to us about any niggles we may have’. ‘She tries to solve them immediately and will get back to us if she needs to take time to sort them out’. There has been one Protection of Vulnerable Adults (POVA) referral made by the home to the Social Services team dealing with these issues. The POVA team made the initial investigations and then the home conducted its own internal investigation into the allegations. One member of staff was eventually dismissed from the home and the provider, to the POVA register, referred their name. One outcome of the investigation above was the need to ensure that staff view the POVA and whistle blowing process as a positive one and to ensure that all Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 14 staff understood their responsibilities around protecting the residents from abuse. The provider issued all staff with a formal letter outlining their responsibilities in protecting the residents from harm and reporting any suspicions of abuse within the home and these issues are to be discussed at future staff meetings and during supervision sessions. Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 15 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): 24. Residents are provided with a safe, comfortable and clean environment. They are able to personalise their own rooms, and the provision of door locks, where applicable, means that their personal belongings can be kept secure. EVIDENCE: Both key standards were met at the last inspection. Five residents spoken to were very pleased with their individual rooms and said that they had ‘brought in a number of personal possessions to make them feel more homely’. They said that they could have single rooms if wished, however some preferred sharing a room as it was nice to have company. All shared rooms have screens in place to offer individuals privacy during care giving. The rooms are decorated to a high standard and the home provides lockable storage space for resident’s monies and other valuables in the bedrooms. The provision of bedroom door locks and keys for individual rooms is an ongoing issue from previous inspections, a number have been fitted throughout the home but not all have this facility. The provider told the Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 16 inspector that door locks would be fitted if requested by a resident or relative, and consent forms have been completed by all residents and are kept in their personal files. Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 17 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. Staffing numbers are sufficient to meet the needs of the residents and carry out activities. EVIDENCE: The home has a good mix of qualified nurses and experienced care assistants who work as a team in delivering care to the residents. Information from the staffing rota indicates that the home strives to maintain two nurses and nine care assistants for the morning shift, two nurses and six care assistants for the afternoon shift and one nurse and four care assistants for the night shift. The manager is supernumerary to these hours and the home employs additional ancillary staff for domestic, kitchen and laundry duties. Feedback from the residents was positive about the staff and the support they offer to people living at the home. They said that they appreciated that sometimes they had to wait a short time for assistance during peak activity times such as morning and evening, but the staff were always pleasant and friendly. Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 18 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): 35. Robust accounting and financial systems are in place to protect and safeguard the interests of the residents. EVIDENCE: The home has hand written accounts for the residents’ personal finances/allowances; these are maintained by the administrator for the home and are updated daily. Residents use a variety of methods to receive their financial payments from the benefit agencies, all residents are billed by the home for their fees; none are directly paid to the home. Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 19 Inspection of the home’s financial procedures indicated that the home encourages the residents to manage their own financial affairs for as long as possible. Where this is no longer wished or feasible then a relative or representative takes on the responsibility. Residents’ monies when they build up are transferred to a non-interest account held by the home. Information about this and other monetary options for residents is to be found within the service user guide. Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 20 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 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X 3 X X STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X X Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 21 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 OP7 Regulation 15 Requirement Timescale for action 01/05/06 2 OP9 13 The care plan must be evaluated at least once a month and updated to reflect changing needs. Risk assessments must be put into place where a perceived risk to the individual has been recognised (given timescale of 05/12/05 was not met). 01/05/06 Medicines in the custody of the home must be handled in accordance to the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society, the requirements of the Misuse of Drugs Act 1971 and Nursing staff must abide by the NMC Standards for the administration of medication (given timescale of 05/12/05 was not met). Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 22 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 The manager should carry out an audit of the medication system on a weekly basis to ensure the records are kept up to date and staff are using the system correctly. Rossmore Nursing Home Limited DS0000062082.V263987.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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. 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