Inspection on 15/04/08 for Rossmore Nursing Home Limited

This inspection was carried out on 15th April 2008.

CSCI found this care home to be providing an Adequate service.

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 10/05/07

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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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 Beverly Hill Key Unannounced Inspection 16th April 2008 09:20 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rossmore Nursing Home Limited DS0000062082.V361513.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.V361513.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.V361513.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. 10th May 2007 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) for needs associated with physical disabilities or dementia. 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. The main unit has accommodation provided over two floors within single or shared rooms; one of the shared rooms has en-suite facilities. Access to the upper floor is available through the use of stairs or the passenger lift. The main unit has four assisted bathrooms and two shower rooms and the stroke unit has two shower rooms. Communal areas consist of a large lounge with doors into a dining room, which in turn leads into a small quiet room. Although four shared bedrooms for the stroke unit are located at one end of the main unit the communal areas for the unit is a separate building. These consist of a lounge, rehabilitation kitchen with a table and chairs at one end, a therapies room and several offices on the second floor for health professionals. There is a small garden leading off from the quiet room on the main unit and a courtyard accessible for the stroke unit. Fees for the home range from £348.50 - £560 per week plus a £10 top fee, which is determined on an individual basis. Additional charges include hairdressing, toiletries, newspapers, chiropody and a small contribution for transport costs on outings. Information regarding the services the home provides can be located in the service user guide and statement of purpose, both available from the managers’ office. Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 10th May 2007. It includes information gathered during a site visit to the home, which took place over one day. Throughout the day we spoke to several service users and three relatives to gain a picture of what life was like at Rossmore. We also had discussions with the manager and two nursing staff members. Information was also obtained from surveys received from service users, relatives, staff members and visiting professionals. Comments from the surveys and discussions have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them. Since the last visit there has been two formal complaints raised with the Commission for Social Care Inspection. One of these was managed by the home and resolved and the other was forwarded to the safeguarding team for investigation. The manager of the home has made four referrals to the local authority for investigation under the safeguarding of adults procedure. These have been fully investigated leading to two staff members being dismissed and their names forwarded to the protection of vulnerable adults register. No further action is required. We would like to thank the service users, staff and management for their hospitality during the visit and also thank the people who completed surveys and had discussions with us on the day. Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? A lot of the requirements issued at the last inspection had been met. The team have worked very hard to improve the care plans used in the home and a new system has been implemented. The manager and nursing staff had re-written the care plans for all service users except those admitted for intermediate care services. They were just getting used to the new way of writing care plans and although more detailed, there were still some improvements needed. See below in the section on what the home can do better. During the writing of the report the management team advised that further staff training in care planning had been arranged with the providers of the new system. The home has obtained sitting scales so they can monitor peoples’ weight and they way the home stores medication and incontinence aids has improved. New hoists have been purchased to make sure the home has sufficient moving and handling equipment. Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 7 Carpets have been replaced in the lounge, dining room and some bedrooms. The fire door at the top of the stairs has been attended to and staff members always make sure that the linen room is now kept locked. The boiler has been relocated and fire alarm checks are completed on a more regular basis. The manager and provider have put in place a new staffing structure. Staff members are much happier with this and it has improved sickness levels. How training staff members receive is now more organised and refresher courses are planned. What they could do better: Care plans must contain all the information gathered during the assessment stage so staff members have clear guidance in how to meet peoples’ needs. Also the risk assessments and care plans must be updated when the persons’ needs change otherwise care could be missed. One person needs to have a specific plan in place to manage behaviour that could be challenging to themselves and staff. One person was given medication they were not prescribed for. Although this was done in good faith staff members must ensure service users receive only the medication ordered for them by their doctor. Also when staff hand write instructions onto the medication administration record they must get another person to check it and sign it and the full manufacturers instructions must be written. This will help prevent mistakes from being made. The home could make sure that people with dementia are provided with more stimulation. The activities in the home were limited for them and this could affect their wellbeing. The home could provide privacy locks to bedroom doors when people vacate the rooms. This will ensure they are standard rather than on request as is the case at present. They could improve protection for service users by ensuring they always obtain two written references before employing staff. This was mentioned at the last site visit. The way the home consults with service users and other visitors to the home could improve. We couldn’t see that they had completed any questionnaires last year and so far only a few have been completed this year. It’s important that people are consulted about the running of the home so improvements can be highlighted. Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 8 Some adjustments are required to the way the home manages peoples’ finances to make sure they are not paying any third party top up and that they do not go into deficit with their account. The home could improve the frequency with which staff members receive supervision. The manager needs to make sure that people that require bedrails have the right ones for their bed and the risk assessment takes note of health and safety guidance. 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.V361513.R01.S.doc Version 5.2 Page 9 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.V361513.R01.S.doc Version 5.2 Page 10 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, 5 and 6 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. All service users had had their needs assessed prior to admission to the home enabling people 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: We examined five individual care files during the visit. The registered manager or other qualified nurse completed the homes pre-admission assessments and these were comprehensive covering a range of health, personal and social care needs. There was also evidence the home consistently obtained assessments completed by the local authority. The information from the assessment process was used to formulate the individuals care plan. Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 11 Those residents at the home who receive nursing care have undergone an assessment by a registered nurse from the Health Authority, to determine the level of nursing input required by each individual. The manager confirmed that it was possible for prospective service users and their families to spend time at the home talking to people who live there, meeting the staff, enjoying a meal or spending the day there. The home also had the capacity to admit people for respite care and short breaks. 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. People were encouraged to practice their self-caring skills, ready for their discharge home. Service users spoken with were very happy with the rehabilitation service, ‘we take small steps – the emphasis is on getting home’ and ‘they make certain we do as much as we can’. Specific care staff were allocated to this unit during the day and physiotherapists and occupational therapists provided the specialist care to service users. Care staff from the main unit provided support during the night. The manager confirmed that health professionals 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. When one of the care files was examined the care plans appeared to be those written whilst the person was still in hospital and prior to admission to the stroke unit. There were assessments and treatment plans, completed since admission to the stroke unit, in relation to feeding and swallowing, physiotherapy and occupational therapy, a wheelchair assessment, and evaluation of the persons’ ability to dress. The service user had also had home visits by an occupational therapist to assess their progress in their own environment. Care staff spoken with explained the service was, ‘therapy led with small goals to start off with and then long term goals’. One health professional stated in a survey, ‘very rehab focussed’ and ‘enables them to live their lives as independently as they want to’. There did not appear to be a care plan covering all areas of need per se, but more a range of assessments that gave some instructions to care staff. The health professionals would be used to working in this way but the care staff did not appear to have a cohesive care plan to guide them through all the tasks they needed to carry out. This was mentioned to the manager to check out and address with health colleagues. Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 12 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. 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, gaps in care planning, and assessing and updating risk meant that not all service users assessed needs were planned for. This could mean that staff may not have full information and care may be missed. The home did not manage the stock control and administration of one persons’ medication and there were deficiencies in hand written records. This meant that a service user was administered medication not prescribed for him. EVIDENCE: Five care files were examined during the visit. Files were organised into sections and easy to read. Each service user had a brief history and the key worker had completed a précis of their daily routines for quick reference. Some key worker notes had not been kept up to date. Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 13 The care files contained information from assessments and risk assessments, which staff members used to formulate plans of care. A new care plan system had been introduced since the last inspection and it was clear that staff had worked very hard to re-write the care plans for all service users, other than those people admitted for intermediate care. The new system could account for some of the shortfalls in care planning. During the writing of the report the management team advised that further staff training in care planning had been arranged with the providers of the new system. All five of the care plans required some attention to ensure they were clear about service users needs and how they were to be met. For example one care plan lacked clear plans regarding the persons memory impairment, how they were to be stimulated and how to manage/promote their continence. The second had no plans to manage their communication, again how to provide stimulation and how to prevent pressure damage despite a high risk being identified. The third plan did not address assessed need in areas of memory impairment, nutrition, social stimulation and mobility. The assessment stated the person required encouragement to eat, which was confirmed by staff and observed by us during lunch but was not included in the plan. The forth care plan omitted areas of mobility and nutrition despite the service user requiring a diabetic diet. The fifth care plan was of a service user in the stroke unit. See the previous section relating to intermediate care provision. One of the care files examined identified specific behavioural issues but did not have a clear management plan to ensure a consistent approach for staff to manage the persons’ needs. Risk assessments were seen to cover skin integrity, nutrition, moving and handling, falls, the need for bed rails and constipation. Again some needs identified in the risk assessment had not been followed through to the care plans. For example one service user had a high risk of developing pressure sores but no preventative plan. Two other people had risk assessed needs associated with mobility, one that had increased recently, but no plans were in place. Another person had a risk associated with constipation but it was not addressed in any health or nutritional care plan. Daily recording of the care provided to people was quite basic but there were various charts to compensate. However there were gaps in some bowel management charts and personal hygiene records so some people did not have a full record of all the care provided. Generally care plans and risk assessments were evaluated on a monthly basis and some were updated as needs changed. However as mentioned this was not consistent in all the care plans examined. Evaluations need to take into account information detailed in other parts of the care file, for example daily recording. There was evidence that people had access to a range of health care professionals to assist in the meeting of their health needs. Staff documented Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 14 when the person had input from a professional visitor. There was evidence that not all professional advice was followed through to the care planning stage although care staff and others spoken with were clear about some changes in need. For example a dietician visited a service user and left clear instructions regarding their diet. This had even filtered through to catering staff but there was no record on the care plan. In another example a service user wore compression stockings but this was not in their care plan and a health professional was concerned these had been missed on occasions as a leg ulcer had occurred. A third person required their legs to be elevated and to wear heel pads but again this was not in the care plan and the person often declined to have this care. One health professional did state in a survey that on visiting their patient they felt their mobility and pressure area care needs had increased and they suggested a more accessible bedroom and the use of a hoist for moving and handling. They stated the home responded positively to the request, however the senior staff needs to be more proactive in responding to changing needs. Sitting scales have been purchased to enable staff to monitor the weight of service users unable to weight bear. The funding authorities carry out yearly reviews of the care provided in the home and minutes of these meetings showed that service users and their relatives had input into this process, where possible. One relative stated, ‘we get invited to meetings about his care with staff’ and another person confirmed they had seen the care plan and that they, ‘had chance to go through it with mum and staff’. Discussion with some service users showed that staff respected their wishes and promoted their privacy and dignity. 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. Observation showed good staff interaction with service users. They were polite and friendly, and sensitive to peoples’ needs. Relatives in discussions felt that service users needs were generally met and some comments were, ‘they close doors and respect his privacy and dignity’, ‘I’m very happy with the care’, ‘he’s had his cataracts done since he’s been in the home and they organise the dentist and opticians’ and ‘personal care is good, hair, nails and teeth – she has a bath weekly and they do her hair’. People were complementary of the staff saying that they were kind and helpful. 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. Medication including controlled drugs was stored appropriately and changes had been Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 15 implemented since the last inspection. All medication was held in the downstairs nurses office for the main unit and in the care staff office in the stroke unit. Generally recording was good, however when nurses transcribed medication details onto the medication administration record they did not always put the full manufacturers instructions and there were not always two signatures as required. One service user was prescribed a laxative, however the home did not have this in stock so gave him one dose of another type of laxative. People must only be administered medication they are prescribed for. Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 16 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 quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although there continues to be a high level of satisfaction in the care and meals provided, there were limited activities available in the main part of the home especially for people with dementia. This could mean that people could be bored, lack stimulation and be isolated in their bedrooms, which could lead to deterioration in their cognitive abilities. Visitors were made to feel welcome to the home and communication was good between the home and interested parties. EVIDENCE: There did not appear to be any change in the activities provided since the last visit to the home. The four records examined in the main unit indicated that two people had participated in bingo three times in January and twice in February. The other two people had no record of any activities during that time. In February two of the people enjoyed entertainment from a singer brought into the home. Other records examined showed that as well as bingo Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 17 some people had participated in dominoes, cards and social skills – although it did not state what these were. The lounge had televisions, DVD’s and CD players and there was evidence of jigsaws, books, magazines and games. There was evidence of varied daily activities in the stroke unit but there were no specific activities for people with dementia in the main unit. Service users and relatives spoken with and surveys received from them had a mixed response to the provision of activities. Some people stated they preferred to stay in their bedroom and although offered did not or could not join in due to choice or their particular condition. One person stated, ‘I like to be quiet and keep my own company’ and another said, ‘I stay in my room and watch TV – I do go out in the summer’. In surveys, when asked if there were activities to participate in two people stated, ‘always’, one person, ‘usually’ and a forth, ‘sometimes’. Relatives spoken with stated their loved ones stayed in their bedrooms, preferring to be on their own, ‘he is happier sat upstairs on his own’ and ‘she tends to stay in her room, she’s a big reader and the family bring in books and magazines – there are occasional entertainers’. Although there were no specific arrangements in the home for meeting service users religious needs there were no issues raised by the service users or relatives in this area. Records showed that the key worker system of documenting specific one to one time had not been maintained. Relatives confirmed they were able to visit regularly and spoke well of the staff and the care received by their family member. All three spoken with stated the home had a friendly and welcoming atmosphere. One person stated in a survey, ‘its greatest asset is the family feel in the home’. Relatives reported good communication and support from the home particularly with the manager and the provider. They knew their names and stated they could always go to them to sort out any issues. The menus were varied and provided an alternative to the main options. We observed that the meal on the day was presented well and suitable for the service users needs. People spoken with confirmed there were alternatives and this was observed in practice as staff tried to accommodate a service users preference. Some comments about the meals were, ‘very happy with the food – she often praises the chef’, ‘lovely, very good variety’, ‘the food is very nice’, ‘brilliant food’ and ‘good choice of menu’. One person did comment in a survey that hot lunchtime food was carried uncovered through the home to the stroke unit. This needs to be checked out and addressed. The catering staff were knowledgeable of service users likes and dislikes and these were recorded. Special diets were catered for. The chef advised that staff checked with people what they preferred from the menu and forwarded the information to the kitchen. Catering staff documented when service users Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 18 didn’t eat their meal and let the nurses know. This exchange of information worked well and enabled staff to monitor food intake. Although there was a 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. The service users who required assistance to eat meals received individual attention from the staff and aids were available for those who required them. Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 19 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. This judgement has been made using available evidence including a visit to this service. Service users live in an environment where they feel able to complain and are protected from abuse by staff training and adherence to policies and procedures. EVIDENCE: The home had a complaints policy and procedure that was found within the statement of purpose and service user guide. It was also on display in the hallway. Service users spoken with showed a clear understanding about how to make their views and opinions heard and said, ‘I would see the staff if I was unhappy’. Three relatives spoken with confirmed they all knew how to complain, ‘you can go to anyone, I’m not worried about anything’, ‘I asked for a shelf to be put up and they did this straight away’, ‘I would see Veronica or David’ (the manager and proprietor) and ‘when they first moved in there were teething problems but they were soon sorted out’. All five surveys received from people indicated they knew how to complain and all stated they knew who to go to if they were unhappy. Staff in surveys also demonstrated they knew what to do, and how to record it if someone complained to them. Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 20 Since the last inspection the Commission had received two complaints, one of which was dealt with appropriately by the home and the second was referred to the local authority safeguarding of adults team for investigation. A concern raised about staffing levels has been resolved with a reorganisation of the staffing structure. The information provided to the Commission showed that the home had policies and procedures to cover safeguarding of adults from abuse, whistle blowing, aggression, physical intervention and restraint and management of service users’ money and financial affairs. There was evidence that staff were provided with information and training on safeguarding adults on induction to the home. Documentation showed that staff had received training in how to safeguard vulnerable people from abuse and the manager was delivering refresher training to staff on the day of the visit. The manager had completed safeguarding training with the local authority and was aware of their referral responsibilities. This was confirmed in practice as since the last inspection the manager of the home had made four referrals to the local authority for investigation under the safeguarding of adults procedure. These have been fully investigated leading to two staff members being dismissed and their names forwarded to the protection of vulnerable adults register. No further action is required. Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 21 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, 20, 24 and 26 People who use the service experience good quality 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, safe and clean environment and they were able to personalise their own bedrooms. EVIDENCE: The home continues to be warm, homely, clean and odour free. One person spoken with stated, ‘its always clean and fresh from top to bottom’. Five surveys from service users stated it was clean and fresh, ‘always’ or ‘usually’ and a comment in a relatives surveys was, ‘Rossmore has always presented an exceptionally, friendly and clean atmosphere’. One relative in a survey did comment that the home could have better furniture but this appeared to be related to a specific individual issue that was resolved but not fully to their satisfaction. Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 22 The stroke unit was well equipped to enable up to eight service users to regain their skills and independence. People receiving a service there had access to a rehabilitation kitchen with dining area, a lounge, therapies room and two shower rooms all housed in a separate building adjacent to the main home. Service users slept in the main home in four shared bedrooms. Each of the bedrooms had curtain dividers to offer a degree of privacy although none of the rooms had privacy locks installed to the doors. The main home had a mixture of single and shared bedrooms, one of which had en-suite facilities. Communal areas consisted of a large lounge, a dining room leading to a quiet sitting room, which in turn led onto a patio area. The manager confirmed that the dining room was not frequently used, as service users tended to have their meals whilst sitting in their chairs in the lounge or in their own bedrooms. This was observed in practice and the dining room had become an area to store wheelchairs and other items. Because of this it would not be possible for service users to use the room safely. Since the last visit the home had acquired two new specialist baths so the main home has four bathrooms and two shower rooms. There were ample toilets throughout the home. The garden areas, although small, were attractive, well maintained and secure. Service users spoken with and surveys returned indicated people were pleased with their individual bedrooms 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 they preferred, however some people liked sharing a room. The rooms were generally well decorated and the home provided lockable storage space for resident’s monies and other valuables in the bedrooms. None of the bedroom doors had privacy locks, however the provider confirmed people were asked on admission if they would like one installed. It was recommended privacy locks be fitted as standard to each bedroom door when rooms became vacant. The requirements issued at the last inspection regarding the environment had been met. The home had replaced the carpets in the lounge, dining room and some bedrooms. Linen cupboards were now kept locked, a fire door had been attended to, continence aids were stored safely and the boiler had been moved to an alternative and safer location. There were some corridors and doorways that suffered from scuffing from wheelchairs but this was an ongoing issue for maintenance personnel. The home had a separate laundry with commercial washing and drying machines, clothes press and ironing facilities. The home employed specific personnel for the laundry. Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 23 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 good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Improvements in staff deployment and training meant that generally, a competent staff team supported service users. A gap in the recruitment process for one non-caring staff member meant that the home did not have full information for them prior to employment. EVIDENCE: The home had a good mix of qualified nurses and experienced care assistants who work as a team in delivering care to people. Information from the staffing rota indicates that the home aims to maintain two nurses and eight 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. There is also an extra carer employed between 5.15pm and 9.15pm to assist people to retire. 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 staffing rota had recently been changed to enable staff to work longer days but to have more time off. The proprietor confirmed this had worked Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 24 really well. All staff members were happy and the system had improved sickness levels. Service users and relatives spoken with were happy about the care they or their loved ones received. Some comments were, ‘they are kind, caring and fantastic’, ‘the staff are lovely, they look after us well’, ‘it’s an excellent home, they are looked after well’, ‘the staff have got to know him quite well’, ‘I trust them’, ‘they are kind, caring and polite – you only have to mention something and its done’, ‘mum likes it, they’re friendly carers’. 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 one non-caring staff member only had one reference and there were some unexplained gaps on one of the application forms. This was mentioned to the manager to check out. The home verified nurse’s registration with the Nursing and Midwifery Council to ensure they were able to practice and had details of registration renewal dates. Induction of new staff members consisted of orientation to the home, shadowing other staff for several shifts and completion of skills for care workbooks. These were signed off by the manager and usually took the staff member twelve weeks to complete. The manager had a training plan and obviously worked hard at collating information for it from supervisions, appraisals and refresher indicators. There had been some improvement in training since the last inspection and out of thirty-six care staff, fifteen had completed first aid and basic food hygiene and thirty-three had completed moving and handling with refresher courses booked where required. The annual fire training was arranged for April and May and most staff had attended safeguarding adults training with the remainder due on the day of the visit. All nine nurses had completed first aid and moving and handling and four had completed basic food hygiene. Courses in health and safety and infection control had been booked. Some nursing staff had received training in wound care, blood sugar monitoring, male catheterisation, Parkinson’s disease, diabetes, advanced phlebotomy and how to support people with alternative feeding regimes. Care and nursing staff had received awareness training on food texture modification for those service users who had swallowing difficulties and care staff in the stroke unit had completed a three-day stroke foundation course. The home was committed in supporting staff to gain a qualification in care. Records showed that nineteen care staff had completed a national vocational qualification in care at level 2 and 3 with one further staff member registered to start the course. Combined with nine qualified nursing staff this brings the percentage of trained staff to over 50 , which is a good achievement. Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 25 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, 36 and 38 People who use the service experience adequate quality 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 and service users felt they received a good standard of care. However there were gaps in quality monitoring, staff supervision, the management of finances and some risk management. This meant that service users welfare and safety could be compromised. EVIDENCE: The manager had completed her Registered Managers Award and discussion with her indicated that she had a wealth of experience in nursing care. Information provided by the manager showed that she regularly updated her skills and knowledge through attending relevant study sessions. She was very Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 26 organised and clearly enjoyed her role. The provider visits the home daily and generally oversees the running of the home. The home uses a specific quality-monitoring tool, the ISO 9000 quality standards. The provider was unable to locate any questionnaires and action plans produced in 2007 although service user/relative surveys had been sent out in March this year with five returns. These have not been analysed yet. The home needs to check the surveys and include other stakeholders in the consultation process about the service provided, for example, visiting health professionals and care management. Action plans need to be produced to address any shortfalls. The provider confirmed they had monthly management meetings and general audits to check the environment and health and safety. Service user/relatives meetings were held and the home produced a newsletter to keep people informed. The last assessment by the local authority as part of its quality development scheme was 2-3 years ago when the home was awarded both parts of the scheme for care planning and quality monitoring. The home had produced on time, an annual quality assurance assessment requested by the Commission. Records relating to the management of service users finances were examined. The records indicated that one person had a third party top up deducted from their personal allowance/savings, which was managed by the home. The provider had received the wrong advice about the legalities of this, as the service user cannot pay the third party top up in this specific instance. This system must cease and the provider is to arrange a meeting with the local authority to clarify. Administration staff maintained financial records in an accounts book. Receipts were provided for money deposited into the homes, ‘inpatient, non-profit account’. It was noted that some people had gone into deficit, which in effect means that other people in the home subsidised those deficit accounts without their consent. In total twenty-seven people had deficit accounts ranging from 25p to £33.15p. This needs to be managed much more effectively. Also two people were noted to have monies in the account of in excess of £1000 and £2000 but due to the nature of the account were not gathering any interest on it. This needs to be checked out to see if alternative arrangements are possible. Although there was some evidence that staff received supervision these were not at an adequate frequency to meet the standard of at least six times per year. The discussions were briefly recorded. Maintenance certificates were in place and up to date for the utilities and equipment within the building. Fire alarm checks and drills were carried out with more frequency since the last inspection visit. Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 27 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, which showed a similar amount each month. Since the last inspection the home had purchased two new hoists, which assisted staff in meeting the moving and handling needs of service users. All service users that had moving and handling needs had a risk assessment in place, however these were not all kept up to date as needs changed. All staff had received moving and handling training, and courses in health and safety and infection control had been booked. During the visit it was noted that several service users had bed rails in place to prevent them from rolling out of bed. Some were for divan beds and some were integrated with a hospital type bed. There was an inconsistent match between some of the beds, specialist mattresses and bed rails, leaving an insufficient height between the top of the mattress and the top of the bed rail. Not all rails had protectors. The home had completed basic risk assessments but these did not comply with health and safety guidance. An immediate requirement notice was issued for the home to address the shortfalls. Information from the provider within days of the notice was that they had purchased three new beds with integrated rails and completed thorough risk assessments in line with the medicines and healthcare products regulations authority. Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 28 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 3 4 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 3 3 3 X X X 2 X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 2 X 2 Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 29 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 30/06/08 2 OP7 15 3 OP8 13 and 14 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 (previous timescale of 15/06/07 not met). 30/06/08 The registered person must ensure that changes in need are reflected in care plans and when monthly evaluations occur information recorded in other parts of the care file is included in the evaluation, for example advice and instructions from health professionals involved in the service users care. This will ensure that care is not missed and staff have full and up to date instructions. The registered person must 30/06/08 ensure that risk assessments are updated as needs change and information progressed from them into the care plans. DS0000062082.V361513.R01.S.doc Version 5.2 Rossmore Nursing Home Limited Page 30 4 OP8 13, 14 and 15 5 OP9 13 6 OP9 13 7 OP12 16((2)(n) The registered person must ensure that a specific service user has a clear management plan in place to manage behaviour that could be challenging to themselves and staff. This will enable staff to have a consistent approach to managing their care. The registered person must ensure that nurses only administer medication to services users that is prescribed for them by their GP. This will ensure service users health, safety and wellbeing are protected. The registered person must ensure that when transcribing medication onto the medication administration record the full manufacturers instructions are written and two signatures are recorded. This will ensure a checking system is in place and service users receive the medication as instructed by their GP. The registered person must ensure that activities in the home reflect all the service users needs and interests including those with dementia (previous timescale of 01/07/07 not met). Social needs assessments must take into account previous hobbies and interests and current abilities to enable staff to tailor activities to meet specific needs. The registered person must ensure that two written references are obtained prior to staff being employed to ensure the protection of service users (previous timescale of DS0000062082.V361513.R01.S.doc 31/05/08 16/04/08 31/05/08 30/06/08 8 OP29 19 31/05/08 Rossmore Nursing Home Limited Version 5.2 Page 31 9 OP33 24 10 OP35 20 11 OP36 18 12 OP38 13(4) 10/05/07 not met). The registered person must ensure that the quality monitoring process is completed with thorough consultation of service users views and action plans to address shortfalls. This will ensure that service users and their relatives are fully consulted about the running of the home and any problems corrected quickly. The registered person must clarify with the local authority the legality of deducting third party top ups from service users personal allowance managed by the home and seek to address any unauthorised claim. This will ensure that service users only pay what they should for their residential fees. The registered person must ensure that care staff receive a minimum of six supervision sessions per year. All care staff to have at least one session by timescale for action date. The registered person must ensure that service users requiring bedrails have a thorough risk assessment in line with health and safety guidelines and that there is the correct match between service users, bedrails and mattresses. All bed rails to have protectors in place. Immediate Requirement notice issued to ensure this is completed quickly and service users are not at risk of entrapment or rolling over the top of the bedrails when specialist mattresses are used. 31/08/08 09/05/08 31/07/08 21/04/08 Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP12 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 manager should produce an, ‘at a glance’ system of checking if service users have participated or not in activities. This will enable staff to check out with them the reasons why they haven’t participated and tailor the programme accordingly. The provider should consider installing privacy locks to bedroom doors as standard when bedrooms become vacant. The manager should enlarge the scope of consultation about the quality of the services provided by including visiting health professionals and care management in the distribution of questionnaires. A month-by-month quality assurance plan would help to structure the quality monitoring system of audits and questionnaires. The provider should investigate alternative financial measures to ensure service users have the capacity to accrue interest on the money held for them by the home. The manager should ensure a more comprehensive record of the staff supervision discussion is maintained. 3 4 OP24 OP33 5 6 OP35 OP36 Rossmore Nursing Home Limited DS0000062082.V361513.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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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