Inspection on 14/09/07 for Rottingdean Nursing And Care Home

This inspection was carried out on 14th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rottingdean Nursing And Care Home 20/06/06

Rottingdean Nursing And Care Home 28/02/06

Rottingdean Nursing And Care Home 07/09/05

Rottingdean Nursing And Care Home 01/03/05

Rottingdean Nursing And Care Home 26/08/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Rottingdean Nursing And Care Home 30 - 32 Newlands Road Rottingdean Brighton East Sussex BN2 7GD Lead Inspector Jennie Williams Key Unannounced Inspection 14th September 2007 09:45 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 Rottingdean Nursing And Care Home DS0000014036.V348182.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. Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rottingdean Nursing And Care Home Address 30 - 32 Newlands Road Rottingdean Brighton East Sussex BN2 7GD 01273 308073 01273 300377 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) Mr Jon Breeds Mrs Carol Breeds Mrs Melanie Jane Barber Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That service users accommodated must be aged sixty five (65) years or over on admission. That a maximum of twelve (12) places can accommodate service users in receipt of personal care only at any given time. That the maximum number of service users to be accommodated is thirty four (34). 20th June 2006 Date of last inspection Brief Description of the Service: Rottingdean Nursing and Care Home is a care home providing care for up to thirty-four (34) residents over the age of sixty-five (65). It is registered to provide nursing care to residents and a maximum of twelve places can accommodate residents in receipt of personal care only at any given time. It is located in a quiet residential area in Rottingdean. There is limited car parking available at the home, but free parking is available on the adjacent streets. Local amenities are available at the town centre, a short walk down the hill. Rooms are located over three floors. There are twenty-eight (28) rooms for single occupancy, of which eleven has en suite facilities and three (3) double rooms with no en suite facilities. There is a passenger shaft lift available at the home to assist residents to access all floors. There are suitable toilet facilities provided throughout the home to meet the needs of residents. There are five bathrooms and one shower room for residents to use. There is a dining room, a good-sized lounge room, a conservatory area and a garden at the rear of the building that is accessible to residents. Weekly fees range between £525 and £575. There are additional fees for hairdressing, chiropody and newspapers (cost of paper plus delivery charges). This information was provided to the CSCI on the 14 September 2007. A copy of the Statement of Purpose and Service Users Guide is available from the home upon request. Residents/relatives know about the service through social service referrals and word of mouth or from living in the area. Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. It should be noted that following recent CSCI consultation, it was identified that service users prefer to be called people who use services. It was confirmed that the home uses the term residents. For the purpose of this report, people who use the service will be referred to as residents. This unannounced site visit took place over seven hours on the 14 September 2007. Evidence obtained at this site visit and information that the CSCI have received since the last inspection forms this key inspection report. Five residents were spoken with and residents eating in the lounge room at lunchtime were met and advised to let the Inspector know if they wished to speak with her. Four residents chose to complete a survey. One of these were returned. The Inspector viewed a care plan with the resident and specialist care needs were looked at in another care plan. There were no shortfalls identified with the care plans at the last inspection. Ten staff were spoken with throughout the site visit including; three registered nurses, a student nurse, four care workers, a cook and the receptionist/administrator. Six staff files were viewed and training records inspected. Six staff surveys were left for staff not working on the day of the site visit to provide them with an opportunity share their views, three of these were returned. Three visitors were spoken with at the site visit. A tour of the environment was undertaken and some individual rooms were viewed, with the resident’s permission. Medication procedures were inspected. Recent results of the quality assurance surveys were viewed. The Inspector was unable to locate the complaints records on the day of the site visit and spoke with the Registered Manager at a later date regarding these processes. The procedure for dealing with residents’ personal allowances was checked. An Annual Quality Assurance Assessment (AQAA) was sent to the home prior to the site visit. This was to obtain information about the establishment to assist CSCI in the inspection process. Health and safety records were not viewed as this information has been provided in the AQAA. There were thirty-three residents residing at the home on the day of the site visit. Twenty-nine in receipt of nursing care and four in receipt of personal care only. The Registered Manager was absent from the home on the day of the site visit and the Inspector would like to thank the staff for their assistance throughout the day. Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Action has been taken to address all four requirements made at the last inspection. The Statement of Purpose has been amended to advise that intermediate care is not provided at the home and advises the reader on how to access a copy of the most recent CSCI inspection report. Staff and residents confirmed that there have been positive changes in the provision of activities provided at the home, ensuring residents are provided with sufficient stimulation to fulfil their interests and needs. Suitable action has been taken to ensure staff do not carry uncovered commode bowls from residents rooms to the sluice room, assisting in promoting good infection control practices. Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rottingdean Nursing And Care Home DS0000014036.V348182.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 Rottingdean Nursing And Care Home DS0000014036.V348182.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, 4, 5 & 6. 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. The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home. The pre admission process ensures that only residents whose needs can be met at the home are admitted. EVIDENCE: The home has a Statement of Purpose available upon request that provides brief information on the facilities and services provided at the home. A Service Users Guide is also available. The Inspector did not read the Service Users Guide. The Inspector was informed at the site visit and confirmed by the Registered Manager at a later date that she is leaving employment at the home. The registered providers will need to ensure these documents are kept up to date in regards to the management arrangements within the home. Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 10 The Registered Manager or registered nurse undertakes a pre-admission assessment on all prospective residents. Pre admissions were not viewed on this occasion, as there were no shortfalls identified at the last inspection. Relatives/representatives are involved in this process wherever possible and information is obtained from other health professionals, wherever applicable. The AQAA identifies that the home does not take emergency admissions or residents who require intermediate care. Staff spoken with confirmed that they felt all residents were appropriately placed and all their needs were being met. It was confirmed that the Registered Manager takes appropriate action if someone’s’ needs change and can no longer be met at the home. This was evident on the day of the site visit with a resident moving to another home more suited to meet their needs. Prospective residents/representatives are provided with an opportunity to visit the home prior to moving in if they wish. Of the residents that were asked, all confirmed that they or a relative had visited the home prior to being accommodated at the home. The home does not take emergency admissions. The home has developed surveys for residents to complete on admission as part of their quality monitoring process, to assist in identifying improvements that could be made on admission. Some written comments viewed on these surveys were; ‘Lovely to arrive in a fresh, clean room and all the staff being genuinely pleasant and helpful. A gentle, re-assuring welcome’ and ‘All information, room, welcoming and admission was excellent. We all felt very welcome. Thank you’. The home does not have dedicated accommodation to provide intermediate care, however respite care is available if there is a spare place. Rottingdean Nursing And Care Home DS0000014036.V348182.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 & 10. 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. Residents confirmed that their needs are being met at the home and there is guidance in the care plans for staff on how to meet these needs, albeit some actions were not being followed. Residents are generally safeguarded by the medication procedures in place. EVIDENCE: Care plans were not viewed in detail at this site visit, as there were no shortfalls noted at the last inspection. The Inspector went through a care plan with a resident, with their permission. The resident confirmed that the information contained in the care plan was fairly accurate. Residents care plans provide guidelines for staff on the assessed needs of individuals. These read as being personalised to the individual. There was evidence that care plans are being reviewed on a monthly basis. A relative spoken with confirmed that they are involved in the reviewing of their relatives Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 12 care plan. Care plans briefly viewed had a plan of care form signed by the resident’s advocate to confirm that they agree with the plan of care and the home will notify them of any changes to the plan as soon as is reasonably practicable. Registered nurses develop the care plans for all residents. Some residents confirmed that staff discuss their care with them, whilst others stated that they would not want to be involved in their care plans. It was noted that monthly reviews are undertaken, however the information on the front page of the care needs is not always updated to reflect the changes. Staff may have to read months of reviews to identify the changes. This was discussed with a registered nurse at the site visit and later with the Registered Manager. The Registered Manager confirmed that staff have been informed of ensuring the front page is updated as needs change and will reiterate this to the staff. Of the staff that were asked, all confirmed that they found the care plans user friendly and easy to understand. Two of the staff surveys received identified that they are always given up to date information about the needs of residents they support or care for. One identified they are usually provided with this information. For a resident who remains in bed due to their medical needs, the care plan identified that staff need to encourage passive and active exercises. There was no evidence that this was being done and a registered nurse confirmed that it is not done. Staff must ensure they provide the care as reflected as being an assessed need in the care plan. It was discussed with a registered nurse that the daily notes could be expanded. Writing care as per care plan does not provide information on the well being of an individual and care plans are not always accurate. There is pressure-relieving equipment at the home to promote tissue viability and specialist advice is sought when required. There was evidence of this in individual care plans. A resident observed to be wearing glasses confirmed that eye tests are arranged as necessary. It was noted that turning charts and other monitoring charts are being used effectively. (Turning charts - used for people who have limited movement and are at risk of developing pressure areas.) It was discussed with a registered nurse at the site visit that staff record when providing mouth care. There was evidence that regular mouth care had not been provided to one resident, who also confirmed that regular mouth care had not been provided. There was no evidence of mouth care equipment being present in the room. The registered nurse confirmed that mouth care is provided, however agreed that it appeared that it had not been provided on this occasion. The registered nurse confirmed that she would address this. Registered nurses are responsible for the administration of medication within the home. Medication Administration Record (MAR) charts inspected contains Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 13 photos of residents and demonstrated that medication is being signed for at the time of administration. There are records kept of incoming and outgoing medication. A registered nurse confirmed that the disposal of unused medications comply with current regulations. It was confirmed that there are policies and procedures in place for all aspects of dealing with medication, the content of these were not read. There is evidence that there are accurate records kept of controlled drugs in use at the home. Medications are stored securely in the home. Residents are provided with an opportunity to self medicate, based on a risk assessment. There was no one self-medicating on the day of the site visit. There were prescribed creams on MAR charts not being signed for and no clear information if these were still in use or not or where they were required to be applied. Where medication is signed for as one or two tablets, some staff were not recording how many were given. Where a tablet may have been dropped etc and an additional one taken out of the blister pack, there were no records identifying why an extra tablet had to be used. These shortfalls were addressed with the Registered Manager following the site visit, who confirmed she will address these issues. No requirement or recommendation has been made in relation to this. Staff were observed to have a good professional rapport with residents and were heard to be calling them by their preferred term of address. All residents spoken with confirmed that they felt their privacy and dignity are respected. Staff were observed to knock on residents’ room door prior to entering. Residents are able to have private phones installed in their room if they wish. When visiting a resident in their room, the Inspector overheard a staff member questioning their colleague, who was assisting an individual, about a need of another resident. It was discussed with the Registered Manager that staff be made aware of discussing other residents in front of residents who they may be providing personal care to. Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ lifestyle within the home is their own choice and residents are provided with sufficient stimulation to fulfil their interests and needs. Residents are offered a choice in meals to ensure preferences and nutritional value is catered for, however action is needed to ensure that hot food is eaten at a suitable temperature. EVIDENCE: All residents spoken with confirmed that their lifestyle within the home is their choice and they are able to choose their own routines of daily living. A new activities person has been employed at the home and works four days a week for three hours in the afternoon. Once a week there is a fitness/exercise class. The Inspector was informed that various entertainment visits the home every four to six weeks and an outing is arranged approximately every six weeks in a mini bus. It was confirmed that the outings are rotated amongst the residents. Most staff felt there have been positive changes in the provision Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 15 of activities. Residents spoken with confirmed that there are sufficient activities provided at the home, should they choose to be involved. Some prefer, by choice, to remain in their rooms. The activities person also visits residents who remain in their rooms by choice or due to their medical needs. There was evidence of this on the day of the site visit. A visitor confirmed that they felt there were sufficient activities provided. Staff must give consideration to the use of televisions and radios in use for those residents who remain in bed or in their rooms, due to the level of their needs. One resident who was being nursed in bed had a television on quite loud in their room. On speaking with the resident, they confirmed that they did not like the television on and staff never ask them if they wish for it to be on. No requirement or recommendation has been made in relation to this, however management must ensure this is addressed. Visitors are welcomed and encouraged to visit the home. All relative/visitors spoken with confirmed that there were no time restrictions for visitors and were always made to feel welcome. Of the residents that were asked, all confirmed that they could receive visitors in private. Comments about the food provided at the home ranged from ‘fairly nice’ to ‘very good’. Residents are provided with a choice in meals and a registered nurse will visit residents in the morning to find out what the residents wish to eat. There was evidence of this procedure on the day of the site visit. The Inspector observed the lunchtime meal being served to residents and was concerned to note that some meals were left by residents’ beds for half an hour before the staff were free to assist them. Some meals had covers on them and some did not. On feeling the temperature of the plates, the hot meals did not feel very warm by the time staff were free to assist the residents to eat. This was addressed with staff on the day of the site visit. One resident confirmed that their meal was ‘luke warm and it could be hotter’. This had been identified in the last quality assurance surveys and identified in the AQAA as an area they plan to improve in the next 12 months. It was also observed that there was not a lot of communication between the staff and residents when being assisted to eat their meals in their own rooms. The Inspector was unable to contact a registered provider on the day of the site visit, however spoke with them the following day to advise that this must be addressed immediately. It is unsuitable for residents to have to eat meals that are not hot. On speaking with staff, most confirmed that the observation of the Inspector is generally a daily occurrence at lunchtime. No residents were observed to eat in the dining room, with most either in the lounge room or in their own rooms. Residents are able to chose where they wish to eat. Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 16 A cook was spoken with who confirmed that they have sufficient equipment to undertake their duties and that there are no financial restrictions with purchasing food. It was confirmed that Environmental Health visit the home and no concerns have been raised. There are water coolers located throughout the home of which residents are able to use whenever they wish. Rottingdean Nursing And Care Home DS0000014036.V348182.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 & 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. Residents feel comfortable to complain, reassuring them that they are being listened to and that action will be taken, if necessary. Staff receive training in Safeguarding Adults to ensure residents are safeguarded. EVIDENCE: There is a complaints procedure available at the home, of which a copy is provided at the entrance of the home. Residents spoken with confirmed that they knew who to speak to and would feel comfortable to raise any concerns. The Inspector was unable to locate the complaints folder on the day of the site visit. The AQAA identifies that there have been five complaints and three Safeguarding Adults alerts made in the last 12 months. These were discussed with the Registered Manager following the site visit. Staff surveys received identified that they know what to do if a resident/relative or advocate has concerns about the home. Three of the complaints were dealt with through Safeguarding Adults procedures. Other complaints were regarding conflict between two staff members and a complaint regarding the service provided by the hairdresser. The Registered Manager confirmed that they were both upheld. The Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 18 Registered Manager confirmed that records are kept of complaints and that copies of any correspondence are kept and action is taken wherever identified. The home has a complaint, suggestion and comment box by the entrance to the home, which enables anyone within the home to express concerns/ideas anonymously. Of the three Safeguarding Adults alerts, one was not upheld and the other two were inconclusive. One of these alerts was made by the CSCI following receipt of information. The Registered Manager had investigated this incident internally. Social services raised concerns with the Registered Manager that correct Safeguarding Adults protocols were not followed in this instance and made various recommendations to the home. Of the staff that were asked, all confirmed that they have received Safeguarding Adults training and registered nurses who may be in charge of shifts are familiar with procedures to take in the event of an allegation of abuse being made. The AQAA identified that there was no policy or procedure in place for dealing with bullying. This was discussed with the Registered Manager following the site visit who confirmed that she will ensure that one is developed so clear guidance is in place for staff and residents. The AQAA identifies that the plans for improvement in the next 12 months are to have more staff undertake Safeguarding Adults, advocacy and Mental Capacity Act training. Rottingdean Nursing And Care Home DS0000014036.V348182.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 & 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. Residents live in a clean and homely environment and are provided with comfortable indoor and outdoor communal facilities. EVIDENCE: The home is well maintained and residents live in a homely environment. Rooms viewed were seen to be personalised to reflect the individuals’ choice and character. Residents spoken to were happy with their individual rooms. There is a conservatory area that residents are able to use. Some areas within the home offer sea views. The AQAA identifies that new carpet has been placed in the lounge, dining room and some individual rooms in the last 12 months. Some rooms have also had new furniture placed in them. Rooms are redecorated as they become Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 20 vacant. The AQAA identifies that there are plans in the next 12 months to employ a full time maintenance person to work at the home and not between the two homes currently owned by the same people. There is a call bell system in place and grab rails and equipment located throughout the home and in communal facilities to assist individuals with mobility. Rooms are located over three floors of which all are serviced by a passenger shaft. It was observed that taps have regulators installed. The home was of comfortable temperature on the day of the site visit. Some visitors spoken with informed the Inspector that on warm days the lounge/conservatory area can become very warm and staff do not always remember to turn on the fans that are provided. They often do this themselves when visiting the home. The home was clean on the day of the inspection and no offensive odours were noted. The AQAA identifies that 13 staff have received training on the prevention of infection and management of infection control. Rottingdean Nursing And Care Home DS0000014036.V348182.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 & 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. Residents’ needs are being met with the skill mix of staff on duty and are generally safeguarded by the recruitment procedures in place. EVIDENCE: Residents spoken with were complimentary about the staff working at home. There were mixed feelings from residents, staff and visitors regarding the number of staff on duty. Some felt there were enough and some felt that at times they were short staffed. The general opinion was that staffing numbers are restrictive at peak times, particularly in the mornings. Some staff and residents felt that there was not enough time for staff to stop and spend one to one time talking with residents. A written comment from a resident survey was ‘ Just wish the carers had more time to spend with me’. The Registered Manager confirmed at the last inspection that they were looking at employing an additional carer in the morning during peak time. This did not come to fruition. Observing the lunchtime meal being served demonstrated there were insufficient numbers of staff on duty or the procedures for meal times were not suitable. Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 22 A registered nurse confirmed that there are generally seven staff working in the mornings, five staff in the afternoons and three staff working a waking night. There is always a registered nurse on duty. Management must give consideration to ensure there are suitable numbers of staff on duty to meet the needs of the residents, particularly at peak time. No requirement has been made in relation to staffing levels, however management needs to assess if there are sufficient numbers of staff on duty or if the routines within the home require changing eg. Meal times. The AQAA identifies that the plans for improvement in the next 12 months is to increase on a permanent basis the number of care staff in the morning. The AQAA identifies that there are 21 permanent care staff on duty, of which 11 has achieved their National Vocation Qualification (NVQ) level 2 or above and an additional two staff are working towards these qualifications. Six staff files were viewed that demonstrated there are generally overall good recruitment procedures followed, however improvements could be made. Three of the files did not show a full employment history and some had no explanations why people left employment or reasons for gaps in employment. There was one worker who commenced employment prior to a Protection of Vulnerable Adults (POVA) First check or Criminal Record Bureau (CRB) check being in place. Where information is provided to the Registered Manager from the CRB and where an individual has not declared this on their application form, evidence should be in place to identify that this has been addressed with the individual and that it will not impact on the safeguarding of residents. The Registered Manager confirmed that this had been addressed. It was confirmed that all staff work supervised until a full CRB check is returned. There was no information available for one staff member. It was confirmed that this person had been employed through an agency. Information regarding workers employed by the home must be available for inspection. Management need to ensure that they satisfy themselves that the people working within the care home have the necessary skills and recruitment checks in place. No requirement has been made in respect of recruitment as the Registered Manager confirmed that she will address these issues. Staff confirmed that they receive training relevant to their roles and are kept up to date with mandatory training. Registered nurses confirmed that they receive training to their roles. One staff member felt that more training could be offered. Records and certificates kept on staff training identify that some recent training included: Skin care and pressure areas, Constipation, Strokes and Catheters etc. There was evidence that new staff undertake the Common Induction Standards as set by Skills for Care. All staff surveys received identified that they receive training that is relevant to their roles and are kept up to date with new ways of working. Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 23 Rottingdean Nursing And Care Home DS0000014036.V348182.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 & 38. 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. Staff and residents benefit from a well managed home and the quality assurance system in place ensures the home is run in the best interest of residents. The health, safety and welfare of residents and staff are promoted and protected so far as is reasonably practicable. EVIDENCE: The Registered Manager is registered with the CSCI. She has been working at the home since June 2005. She is a registered nurse with current registration with the Nursing and Midwifery Council (NMC) and has completed the Registered Manager Award (RMA). Most staff spoken with were complimentary about the Registered Manager and find her supportive and approachable. Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 25 There is a sign at reception advising visitors who is in charge of the home each day so that they know who to speak to if there are any issues to discuss. The Inspector was informed on the day of the site visit that the manager will be leaving employment at this home. The registered providers have appointed a registered nurse to manage the service until a new manager is recruited. This person was spoken with who confirmed that she has the relevant experience to manage a care home. There is a quality assurance and quality monitoring system in place. This is undertaken on an annual basis. The home has implemented a questionnaire regarding the pre- admission process and arrival of any new resident to the home. Residents meetings are offered twice a year and staff meetings are regularly held where discussions take place on any improvements that could be made to the running of the home and any care issues. A summary of the analysis of the surveys for 2006 was provided to the Inspector. This identifies areas to management on what they do well and what could be improved within the home. There is evidence in the analysis that action is taken to address any areas that could be improved. It is recommended that dates be placed on the surveys for easy identification of when these were completed. The financial viability of the home was not assessed on this occasion. There is suitable insurance in place. The home has been owned by the same providers for a period of time and has given no cause for concern regarding financial viability to date. Records inspected demonstrated that there are suitable procedures in place for the safe handling of residents’ monies. Receipts are kept of all financial transactions. Residents are aware that if they require their own personal allowance, this is available during the hours that the receptionist works. Some residents are encouraged and supported to maintain their own personal allowance. All monies are kept securely at the home. There were information pamphlets for relatives in reception providing forms and advice on obtaining Enduring Power of Attorney if this was required. Health and safety records were not viewed. Staff confirmed that they have received fire training and that regular fire drills are undertaken. There was evidence of this kept in the fire safety manual. The receptionist/administrator confirmed that the home had a fire safety inspection a month prior to this site visit and that there were no shortfalls identified. The report was not read. The AQAA identifies that equipment in use has been tested or serviced as recommended by the manufacturer or other regulatory body and that all relevant policies and procedures are in place. Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 26 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 3 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 4 X X 3 Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 That care needs identified in individual care plans are addressed to ensure that all needs of service users are being met. That action is taken to ensure that service users are assisted to eat their meals whilst they remain hot. Timescale for action 15/10/07 2. OP15 16(2)(i) 16/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rottingdean Nursing And Care Home DS0000014036.V348182.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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