Inspection on 10/05/07 for Rossmore Nursing Home Limited

This inspection was carried out on 10th May 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

Rossmore Nursing Home Limited 27/05/09

Rossmore Nursing Home Limited 15/04/09

Rossmore Nursing Home Limited 15/04/08

Rossmore Nursing Home Limited 01/02/06

Rossmore Nursing Home Limited 08/09/05

Rossmore Nursing Home Limited 04/11/04

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Hawkhills

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

CARE HOMES FOR OLDER PEOPLE Rossmore Nursing Home Limited 68 Sunny Bank Spring Bank West Kingston upon Hull East Yorkshire HU3 1LQ Lead Inspector Kate Emmerson Key Inspection 10th May 2007 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.V339737.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. Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rossmore Nursing Home Limited Address 68 Sunny Bank Spring Bank West Kingston upon Hull East Yorkshire HU3 1LQ 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) Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registration includes twelve (12) stroke rehabilitation patients and 6 day places. 1st February 2006 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. Fees for the home range from £327.50 - £501.50 per week plus a £10 top fee. Additional charges include Hairdressing £2.50 - £16.00 and chiropody £5.00. Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 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 8 hours and included a tour of the premises, examination of staff and resident files and records relating to the service. Service users were spoken to in an informal manner. Five staff members were spoken with privately and discussions were also held with other staff on duty in the course of their work. Surveys were received from three staff members, twelve service users and sixteen relatives, carers or advocates. Some of their comments have been included in this report. Although there were a number of new requirements arising from this inspection the provider was proactive in addressing some of the issues immediately after the inspection. Written evidence was provided to the Commission setting out the actions taken following the site visit. These included actions taken to address deficiencies in training, care planning and medication systems. This information is included in the body of the report and assisted in improving the quality ratings in some areas. A detailed action plan was also provided at a meeting held with the provider and manager on the 29 June 2007. This evidenced that the provider had taken the issues raised seriously and was actively working to meet requirements. What the service does well: Meals at the home offer residents and visitors choice and variety and the food is well presented and appetising. The service users were full of praise for the kitchen staff and said ‘’they couldn’t be better, top marks’. The home is welcoming and has a relaxed atmosphere. Service users said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. The home provides detailed about the home and the service it provides. This is made available to all the service users. The home provides excellent facilities for those who have had a stroke and need short term care to enable them to regain their independence. There was a high level of satisfaction with the care provided from both service users and visitors. Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: They could improve the care plans by ensuring that the way they are going to meet service users needs are recorded. They could ensure that service users are not exposed to unacceptable risk when being assisted with mobility by improving their risk assessment processes, staff training and providing adequate moving and handling equipment. They could improve the systems for storage and administration of medication to ensure that these systems are safe. They could improve systems for monitoring service users health in relation to diet, weight and diabetes. They could improve the provision of activities especially for those with dementia. They could improve staff training by ensuring they have a plan of training for the year and by being aware of when refresher training is due. They could improve protection for service users by ensuring they always obtain two written references before employing staff and providing regular staff training in safe guarding adult’s procedures. They could improve fire safety in the home by ensuring alarms are regularly tested and staff have fire training. They need to take advice from the fire officer in relation to a locked fire door. They need to ensure that when bed rails are used that they have been risk assessed and are safe, they need to complete regular safety checks on bedrails that are in use. They need to ensure that staffing levels are consistently provided at levels sufficient to be able to provide care in a timely manner. Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 7 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. Rossmore Nursing Home Limited DS0000062082.V339737.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 Rossmore Nursing Home Limited DS0000062082.V339737.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provided detailed, up to date, information about the service and made this freely available to service users and their relatives enabling them to make an informed choice about the home. All service users had had their needs assessed prior to admission to the home enabling residents to be confident that their needs can be met by the service. Intermediate care facilities and service were excellent, with individuals receiving the care and support needed to maximise their independence and return home. EVIDENCE: Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 10 Detailed and up to date information regarding the service was provided in written format in the statement of purpose and service users guide. These documents were displayed in the entrance hall and lounge areas. Service users and their relatives confirmed that they had had received all the information required to make an informed choice about the home. Each resident had their own individual file and all six of those looked at had a detailed needs assessment completed within them. The information from the assessment process was used to formulate the individuals care plan. Those residents at the home who received nursing care had undergone an assessment by a Registered Nurse from the Health Authority, to determine the level of nursing input required by each individual. The home had specialist facilities for the stroke unit within an adjacent property and residents from the unit have access to a rehabilitation kitchen; dining room, lounge and therapy room. There were also purpose-built facilities where residents were encouraged to practice their self-caring skills, ready for their discharge home. Specific care staff were allocated to this unit and physiotherapists and occupational therapists provided the specialist care to service users within this unit. They provided all the documentation in relation to care planning for this unit and recorded their input and instructions for the staff within these care plans. Rossmore Nursing Home Limited DS0000062082.V339737.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although service users and visitors were satisfied with the care provided the care plans did not include action plans to identify how some of the service users identified personal and health care needs would be met. Not all the service users identified needs were adequately risk assessed and there were some deficiencies in monitoring of the service users health. There were deficiencies in the administration records and storage of medication, which may put service users and visitors to the home at risk. The provider was proactive in quickly addressing some of the issues raised relating to the care plans and medication following the site visit. EVIDENCE: Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 12 Individual care plans were in place for all residents and detailed the health and personal care needs identified for each person. The plans are well laid out but tended to focus on nursing needs. All the care plans seen had been evaluated on a monthly basis. There were some deficiencies in care planning, monitoring of health and identifying and recording risk as follows. Although recorded at assessment there was little in the way of care planning to evidence how individual wishes and likes/dislikes or the social and emotional aspects of care would be met. Where a service user had a particular problem relating to their dementia, which could put their health and safety at risk, this had not been identified in the care plan and a risk assessment had not been completed. Risk assessments regarding nutrition had been completed but did not always inform the care plan. Nutritional status was not adequately monitored, as service users were not weighed routinely. Staff reported and management agreed that the scales provided were unsuitable for the majority of service users accommodated and the layout of the building. The staff reported a low incidence of pressure sores at the time of the inspection and was able to describe the care and equipment provided to those at risk. Although tissue viability risk assessments were completed, there was little evidence of care planning for the prevention of pressure sores and little evidence that staff provided regular pressure relief on a planned basis. Staff were unable to advise the inspector when service users at risk due to their reduced mobility had last been assisted to relieve pressure. Where service users required assistance with moving and handling this was not always identified in care plans and a risk assessment had not always been completed. There was little consistency in the completion of risk assessments for bedsides and where these had been completed they were very basic and did not adequately identify all the hazards or actions required to minimise risks. Where service users required their blood sugars to be monitored as part of the management of their diabetic condition this had not always been completed regularly or in line with their care requirements. For example where it was indicated that a service user should have their blood sugars monitored twice per week records showed that this had been completed only four times in April this could put the service users health at risk. There was little evidence that care plans had been seen and agreed by service users or their representative. Service users were not sure if they had seen their care plan. Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 13 Following the site visit the manager provided information as top how she would address issues relating to care plans and try to improve consistency of the documentation. Service users and relatives spoken to were very happy with the care provided at the home and said ‘it couldn’t be better’. There was some evidence that the reduced staffing levels were impacting on the provision of personal care with some service users still in night attire until lunchtime. Information in the care plans indicates that service users have access to GP’s, opticians and hospital services. Physiotherapy and occupational therapy are available to the stroke-unit residents on a weekly basis and other residents in the home can access these services through a GP referral. Although the manager stated that it is the homes policy for individuals to selfmedicate if they want to and after a risk assessment has been completed and agreed she could not provide any evidence of risk assessment in this area. Service users spoken with prefer to have staff administer their medication. The home had three medication points for the home, each with their own paperwork. Two were for the ground and first floor of the nursing home and one was for the stroke unit. The registered nurses managed all parts of the medication processes in the home. There were records maintained for the receipt, administration and disposal of medication in the home including controlled drugs. With the exception of the controlled drug book, there were a number of errors in the medication administration records, which included missing signatures where medication had been administered or staff signing for medication that had not been given. A monitored dosage system was in place and medication in one case had been given from the wrong place. The above practices could lead to medication errors being made and are not acceptable to the Commission. Medication storage on the first floor was not adequately controlled and extremely warm with records showing temperatures reaching 36°C and fridge temperatures showing temperatures of up to 13°C. Although a fan had been provided there was little evidence of any other action taken to control temperatures to within acceptable limits. Storage of medication at these temperatures may adversely affect the medication. Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 14 The home was following new guidelines for the disposal of medications but not all the medications that had been disposed of were held securely and could be accessible and a potential hazard to service users or visitors to the home. The manager and provider was advised to review all medication systems in the home as soon as possible to ensure safe handling and storage of medication. The manager provided written evidence of the actions taken to improve systems of medication administration and storage in the home following the site visit. Actions included meeting with all staff to discuss deficiencies for the inspection and weekly audits of the medication system and records by the manager. The service users and relatives spoken with at the inspection were pleased with the way that care was given in the home; they were complementary of the staff saying that they were kind and helpful. Observation showed good staff interaction with service users and they were polite and pleasant and sensitive to service users needs. The home ensured service users privacy was protected during care provision through the use of signage on doors and by knocking prior to entering bedrooms, toilets or bathing facilities. Service users preferred term of address was recorded in care plans and was used by the staff. Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. There was a high level of satisfaction in the care provided. Although there were excellent activities available in the stroke unit there were limited activities available in the main area of the home. These did not meet specific needs of some the service users accommodated which could lead to feeling of isolation, lack of stimulation and a deterioration in service users cognition. Visitors were made to feel welcome to the home and communication was good between the home and interested parties. The meals provided in the home were of a high standard and suitable for the service users accommodated. EVIDENCE: There were no arranged activities on the day of the inspection and the manager stated that the activities coordinator was off work at the time. There Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 16 was no evidence of an activities plan although the manager and service users stated that they had bingo regularly and sometimes had entertainment such as singers. The manager stated that there were a number of informal activities available in the home such as Television, music, jigsaws and games. Although there was evidence of varied daily activities in the stroke unit the manager stated that there were no specific activities for those with dementia. Although there were no specific arrangements in the home for meeting service users religious needs there were no issues raised by the service users in this area and the manger stated that extra staff would be provided to enable service users to go to church if no other means were available to them. One relative stated that staff should go to see the service users who are in their rooms more frequently than just at meal times. Records showed that the key worker system had not been maintained. A weekly programme is provided in service users rooms, which details the menu and forthcoming events. The service users said that their families and friends are able to visit regularly and they enjoy trips out with them when the weather is fine. The relatives generally spoke well of the staff and the care received by their family member. The records showed high levels of visitor activity and the home provided a friendly and welcoming atmosphere. The visitors reported good communication and support from the home particularly with the manager and the provider. All the service users spoke very highly of the meals provided and the menus were varied and provided an alternative to the main options. The kitchen staff were knowledgeable of service users likes and dislikes and these were recorded. The meals seen were well presented and suitable for the service users needs. Although there was dining room available for use, the majority of the service users remained in their rooms or took meals at their individual tables in the lounge areas. The service users who required assistance to take meals received individual attention from the staff and aids were available for those who required them. Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 17 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 adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system with evidence that any complaints acted upon appropriately. Service users were generally aware of the complaints procedure and who to speak to if they were unhappy. The home had procedures in place to safe guard adults but staff had not received updates in training. However the provider had been proactive in arranging training following the site visit. EVIDENCE: The home has a clear and simple complaints procedure that is made available to service users and visitors in the statement of purpose and service users guide and is displayed in the hallway. The complaints records show that there have been four complaints made to the home since the last inspection. These had been investigated and detailed records were held. The majority of service users and relatives stated that they would know how to make a complaint or who to speak to if the were unhappy with the service. Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 18 The information provided to the Commission showed that the home had policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of resident’s money and financial affairs. There was evidence that staff were provided with information and training on safeguarding adults on induction to the home. Staff files showed that staff had not received refresher training since December 2005. The manager stated that this was provided on induction and then again only if there were any issues. She was advised that staff should receive refresher training in this area at least annually and was requested to bring this up to date as soon as possible. The manager provided written evidence that safeguarding adult’s updates had been provided to nine staff and that further sessions were booked. There had been four allegations of abuse made since the last inspection, two of which were referred and investigated buy the safeguarding adults team. One in relation to the care of a service user following a fall was founded. The home had improved its procedures in relation to this incident and good practise was observed at the time of the inspection. Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 19 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, 25 and 26 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users were provided with a comfortable and clean environment and they were able to personalise their own rooms. There were some potential hazards in the home, which may put service users health and safety at risk. EVIDENCE: The home was warm and homely, reasonably well-maintained and clean and odour free. Outside the garden areas although small are attractive well maintained and secure. Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 20 The stroke unit was well equipped to enable service users to regain their skills and independence. Service users spoken to during a tour of the home were very pleased with their individual rooms and they had brought in a number of personal possessions to make them feel more homely. There was evidence from service users that they could have single rooms if wished, however some preferred sharing a room as it was nice to have company. All shared rooms had screens in place to offer individuals privacy during care giving. The rooms were well decorated and the home provided lockable storage space for resident’s monies and other valuables in the bedrooms. Some of the bedrooms looked a little untidy with the storage of continence aids and various other items on top of wardrobes and one was so overloaded as to be a hazard. The smoke room carpet and one bedroom carpet was marked with multiple cigarette burns from the previous service users occupancy. A fire exit on the first floor had no signage to direct service users and visitors and another fire door had been locked to prevent a service user wandering on to the stairs. The linen cupboard on the top of the stairs had not been locked and could present a fire hazard. New boiler had been fitted to the first floor landing but pipe work had been left exposed which put the service users at risk of accidental scalds should they fall against them. Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home does maintain staffing levels consistently and although there is a high level of service user satisfaction with the care this impacts on the provision of personal care. Not all the checks were completed before staff commenced employment in the home and this may put service users at risk. Staff received induction into the home and initial training. However there was a lack of planning for refresher training and refresher training in mandatory areas had not been provided to all staff. There was poor practise in moving and handling, which could have put service users at risk of injury. The provider was proactive in arranging training for staff in mandatory areas following the site visit. 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 aims to maintain two nurses and nine Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 22 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. Separate staffing was arranged for the stroke unit. The manager is supernumerary to these hours and the home employs additional ancillary staff for domestic, kitchen and laundry duties. The rotas showed that on the day of the inspection there were only six care staff on duty on the morning shift. The manager was also covering the nurse’s role on the stroke unit and was working a night shift the following evening. The manager and staff confirmed that there were some staffing issues and some shifts had been short. The manager stated she was actively recruiting staff and two staff were waiting to start on receipt of all the employment checks. The low staffing levels had impacted on the care that morning and personal care was still being provided until 12.15pm. Although generally service users expressed high levels of satisfaction with the care provided, service users and relatives had noticed the staffing issues. One service user commented that ‘ I do get well looked after although I notice when it is short staffed’. Another service user commented that the care was ‘usually good’ but ‘could be quicker’ when you need them. A relative stated that ‘we notice that there seems to be a constant change in the care staff and some seem quite young’. Another relative commented that the home could improve by service users’ getting washed and changed and rooms cleaned before 11am’. The home has a recruitment policy and procedure and four of the most recently recruited staff files were checked. Although the majority of checks were in place two did not have two written references and where references were in place due to the format of the reference request referees were not invited to sign or date the reference it could not therefore be adequately evidenced as to whether the references were received prior to employment or who had completed the reference. The home had verified nurse’s registration with the Nursing and Midwifery Council to ensure they are able to practice. There was an induction course that meets care standards specification for new members of staff although there was little recorded evidence of this new staff confirmed the induction process. The induction process included working for seven days as an extra member of staff. The home was committed in supporting staff to gain a qualification in care. Records showed that ten staff had completed NVQ level 2, two had completed NVQ level 3 and sixteen staff had commenced level 2. The manager was unable to evidence that all staff had received mandatory annual refresher training in moving and handling, safeguarding adults and fire safety and was advised that this must be completed as soon as possible. Poor practise was seen in the home during the inspection in regard to moving and Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 23 handling and the manager and the provider were informed of this. Some staff had received training in wound care, blood sugar monitoring, first aid and health and safety. The manger did not have an overview of the training requirements of all the staff in the home and there was no formal training plan, which would ensure that mandatory training was kept up to date. The manager was advised to develop this. The manger provided written evidence of the training to be provided following the site visit this included safe guarding adults and fire training. Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 24 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 outcomes in this area. This judgement has been made using available evidence including a visit to this service. There was an experienced manager in place in the home. The service users felt they received a good standard of care. There were processes in place to safeguard service users money. There were some deficiencies in the management of health and safety in the home that could put service users at risk. However the provider was proactive in addressing issues raised at the site visit. EVIDENCE: Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 25 The manager had completed her Registered Managers Award and discussion with her indicated that she has a wealth of experience in nursing care and regularly up dates her skills and knowledge through attending relevant study sessions. The manager stated that the home monitors the quality of the care in the home using the ISO 9000 quality standards. Records relating to this system were not examined at this inspection. There were high levels of satisfaction expressed in surveys and discussion with service users. Records relating to the management of service users finances were examined. These were clearly maintained and receipts relating to expenditure on behalf of service users were held. Although there was some evidence that staff received supervision and appraisals these were not at an adequate frequency to meet the standard of at least six times per year. Two staff had received three sessions in 2006/7 and one had received three sessions in 2006 and two sessions in 2007. There were clear records maintained where staff had been involved in disciplinary procedures. Maintenance certificates were in place and up to date for the utilities and equipment within the building. Accident records were completed appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. The manager completed audits of the accidents in the home, these showed an increase in accidents over the past three months. The manager was advised to closely monitor this trend. There were some deficiencies in the management of health and safety in the home that could put service users at risk. Not all service users had a risk assessment or care plan completed where service users had reduced mobility and required assistance to transfer and mobilise. Although there were a number of hoists in the home staff reported that there was insufficient equipment such as moving and handling belts to assist in moving and handling and inappropriate moving and handling techniques were observed in one case. The manager was unable to evidence that all staff had received moving and handling training in the last year. Staff confirmed that if they had requested more equipment it would have been made available to them. The manager provided written evidence following the site visit that moving and handling belts had been purchased. Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 26 There was inconsistent use of risk assessments for those who required bed rails to keep them safe in bed. There was inconsistent use of bumpers for the bedrails to prevent entrapment and there was no evidence of regular safety checks of this equipment. The manager provided written evidence following the site visit that bed rails had been safety checked and that this would be done weekly and that bed bumpers had been provided for all bed rails in use in the home. The fire records showed that the fire alarm had only been tested eight times since January 2007 rather than weekly. The system for recording fire alarm testing was not clear and the provider said he would implement a new format to improve this. Although there had been fire training provided in 2007 not all the staff had attended this training. One fire door on the first floor lacked signage and one fire door on the stairs was locked to prevent a service users wandering. The provider was advised to take advice form the fire officer with regard to these issues. A linen cupboard door was unlocked. The manager provided written evidence of the planned fire training following the site visit. Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 27 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 3 X 3 X X 4 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X 2 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 1 Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 28 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 13(4) Requirement The registered person must ensure that risk assessments are put into place where a perceived risk to the individual has been recognised so that all risks to service users can be minimised as far as possible. (Timescale of 05/12/05 and 01/05/06 was not met). The registered person must ensure that care plans are developed which show how all the service users identified needs will be met including emotional and social, nutrition, tissue viability and mobility so that service users and staff are aware of how needs will be met. The registered person must ensure that equipment to weigh service users accommodated in the home is provided, so that service users health and nutritional status can be monitored. The registered person must ensure that service users diabetic condition is monitored as prescribed to minimise the DS0000062082.V339737.R01.S.doc Timescale for action 15/06/07 2 OP7 15 15/06/07 3 OP8 12(1)(a) 23(2)(n) 01/07/07 4 OP8 12(1)(a) 10/05/07 Rossmore Nursing Home Limited Version 5.2 Page 29 5 OP9 13(2) 6 OP9 13(2) 7 OP12 16((2)(n) 8 OP18 13(6) 9 OP19 23((2)(l) 10 OP19 23(2) risks associated with Diabetes. The registered person must review and improve all the processes relating to the storage, administration and disposal of medication to ensure that medication is stored at the correct temperature, is stored securely at all times, that medication administration records are accurately completed and medication is administered correctly from the administration system. A report of the review and actions taken must be provided to the Commission. The registered person must ensure that medicines in the custody of the home are 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 (Timescale of 05/12/05 and 01/05/06 was not met). The registered person must ensure that activities in the home reflect all the service users needs and interests including those with dementia. The registered person must ensure that staff have received annual up dates in safeguarding adults policies and procedures and signs and symptoms of abuse. The registered person must ensure that adequate storage is provided for continence aids and ensure that items are not stored on top of wardrobes to minimise risks in service users bedrooms. The registered person must DS0000062082.V339737.R01.S.doc 15/06/07 15/06/07 01/07/07 15/06/07 01/06/07 01/08/07 Page 30 Rossmore Nursing Home Limited Version 5.2 11 OP19 23(4) 12 OP19 23(4) 13 OP26 13(4) 14 OP27 18(1) 15 OP29 19 16 OP30 18(1) 13(5) 23(4) 17 OP30 18(1) replace the carpets marked with cigarette burns in the service users bedroom and lounge. The registered person must provide evidence that advice and has been sought in relation to the locked fire door at the top of the stairs and all fire exits must have appropriate signage to escape routes to ensure service users safety in the event of a fire. The registered person must ensure the linen cupboard is kept locked at all times to minimise the risk of fire. The registered person must ensure that pipe work to the boiler on the landing is covered to minimise the risks of accidental scalds. The registered person must ensure that staffing levels are maintained consistently to ensure service users needs are met in a timely manner. The registered person must ensure that two written references are obtained prior to staff being employed to ensure the protection of service users. The registered person must ensure that staff have received mandatory training updates in moving and handling and fire where this has not been completed in the last year to ensure service users health and safety. Evidence that this training has been completed must be provided to the Commission. The registered person must develop a training plan to show how the staff training needs will be met over the next twelve months and provide a copy of this to the Commission. DS0000062082.V339737.R01.S.doc 15/06/07 10/05/07 15/06/07 10/05/07 10/05/07 15/06/07 01/06/07 Rossmore Nursing Home Limited Version 5.2 Page 31 18 OP38 13(5) 19 OP38 13(4) 20 OP38 23(4) The registered person must review the provision of the moving and handling equipment in the home and ensure that there is adequate equipment provided to enable staff to support service users safely. The registered person must ensure safe systems for the use of bedrails including risk assessment and safety checks. The registered person must ensure that the fire alarm system is tested weekly and records are maintained to protect the service users in the event of a fire. 01/06/07 15/06/07 10/05/07 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. The registered person should develop an overview of the staff training to assist in planning of staff training. 2 OP30 Rossmore Nursing Home Limited DS0000062082.V339737.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. 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