Inspection on 14/07/05 for The Rock

This inspection was carried out on 14th July 2005.

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

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

Other inspections for this house

The Rock 27/09/06

The Rock 02/02/06

The Rock 18/01/05

The Rock 07/09/04

The Rock 17/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Rock 1 Station Road Buckfastleigh Devon TQ11 0BU Lead Inspector Judy Hill Unannounced 14 July 2005 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 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. The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Rock Address 1 Station Road, Buckfastleigh, Devon, TQ11 0BU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01364 642706 Mr Julian Roger Smith Mrs Ruth Millicent Smith NA Care Home 14 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (14) of places The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th January 2005 Brief Description of the Service: The Rock is registered to provide accommodation and care for a maximum of fouteen people in the registration categories of Dementia - over 65 years of age and Old Age, not falling within any other category. The registered service providers are Mrs Ruth and Mr Julian Smith. There is no separately registered manager and Mrs Smith is responsible for the day to day management of the home. The Home is situated in a residential area of Buckfastleigh and is close to the village shops and amenities. The house is detatched and set in attractive gardens. There is a private carpark directly opposite the house which provides ample off street parking for the staff and visitors. The home is attractively decorated, comfortably furnished and clean. The residents private accommodation consists of six double and two single bedrooms. There is a shared lounge/dining room and separate sitting room. Adequate bathrooms and toilet facilities are provided. Meals are home cooked on the premises. Care staff are employed on a twenty-four hours basis. The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out by one inspector from 11.105am to 1.45pm on Thursday, 14th July 2005. The information contained in this report was gained in conversation with one of the registered providers, Mrs Ruth Smith, who is also responsible for the day to day management of the home, two care assistants, one resident and two visitors to the home. All of the residents were seen during this inspection, several were spoken who could not assess the quality of the care provided because of their advanced stages of dementia. The interaction between the registered provider, staff and residents was observed. Additional information was gained from a partial tour of the premises and from documentary evidence, including the Statement of Purpose and Service Users’ Guides, copies of which have been sent to the Commission, and the medication administration records. Other records which should be kept on the premises, including the residents needs assessments, risk assessments, risk management strategies and care plans and the record of food provided were requested, but were not available for inspection. What the service does well: What has improved since the last inspection? What they could do better: The owner/manager said that the resident’s need assessments’, risk assessments, care plans and reviews were not at the home. These are working documents and need to be kept at the home and be used to ensure that the resident’s individual needs are identified and met. The system used for the handling, safe administration and recording of the residents medication need to be reviewed to reduce the risk of errors being made. An occupational therapist with knowledge of the needs of people with dementia and physical disabilities needs to be commissioned to inspect the premises and facilities to The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 6 ensure that any additional aids and adaptations that would benefit the service users can be identified. The residents rights to privacy needs be safeguarded with the provision of suitable door locks, where practicable, and lockable storage facilities. A quality monitoring or quality assurance system should be introduced to demonstrate that the residents and their representatives and the staff are actively involved in the development of the service. Notification should be given to the Commission of any accidents or incidents, including the death of a resident, that are likely to have an adverse effect on the service users. All records must be kept on the premises. Records intended for use as working documents, such as risk management strategies and care plans must be kept accessible to the staff. 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 Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 No judgement can be made about the quality of the resident’s needs assessments’ as they were not available for inspection. EVIDENCE: From conversations with Mrs Smith it was evident that prospective new resident’s needs are assessed before they are offered a place at the home. However, Mrs Smith said that the Business Manager and Head Carer had taken the resident’s case files containing their needs and risk assessments out of the home to upgrade them and so they were not available for inspection. The Care Homes regulations state that these records must be kept at the home and available for inspection at all times. A requirement made in the last inspection report has been carried forward as it could not be followed up. The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 9 The residents care plans were not at the home so no evidence was available to demonstrate that their needs had been identified or that they were being met. The system used for recording and administering the resident’s medication increases the risk of errors being made which could be harmful to the residents. EVIDENCE: The resident’s care plans were requested but Mrs Smith said that the Business Manager and the Head Carer had taken them off the premises to upgrade them. These documents must be kept at the home at all times, used by the staff to inform service delivery and kept available for inspection. The storage of medication and the medication administration records were inspected. The resident’s medication is kept in a locked metal cupboard in a small lockable office. A separate medication fridge is provided but was empty at the time of the inspection. The medication is supplied in pharmacy packets and bottles but is being ‘potted on’ by the Head Carer. The medication administration records which are signed by the staff as the medication is administered to the residents are handwritten and include only the name of the resident, the name of the medication, the dosage and an approximate time of The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 10 administration or if the medication is to be given on a PRN basis only. There are no facilities for storing controlled medication separately. No un-prescribed medication was seen. No recent records of medications returned to the Pharmacist or disposed of were seen. The last entry in the returns book was dated 15th April 2005. Prescribed rectal diazepam and Hydroxocobalamin injections were seen in the medication cupboard, which should only be administered by the District Nurses. As the systems used for recording and administering the resident’s medicine does not conform to the standard practices found in care homes, arrangements have been made for the Commissions Pharmacy Inspector to carry out a more detailed Inspection. The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 14 & 15 Visitors are made welcome and some of the resident’s benefit from regular contact with their families and by participating in community activities. The residents enjoy well-cooked and nutritious meals. EVIDENCE: The Statement of Purpose/Service Users’ Guide states that resident’s are given help to maintain links with their families and friends. Two visitors were met during the inspection and both had come to the home to visit their husbands. One was engaged in conversation and she said that she was always made to feel welcome at the home and always offered a drink and cake or biscuits. This hospitality was seen being provided to the second visitor. The visitor who was spoken with at length said that she had recently been unwell and unable to visit the home and that on a number of occasions the staff at the home had brought her husband to visit her, which had benefited them both. During conversations with Mrs Smith it was evident that the residents are given the opportunity to participate in activities in the village and that the home has maintained links with and is part of the close-knit community. The resident’s needs assessments, care plans and reviews were not available for inspection and so it was not possible to assess the extent to which the residents are able to exercise autonomy and control over their lives. The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 12 Meals are cooked on the premises. Dinner was seen being served during the inspection and consisted of beef stew, peas and carrots and roast potatoes. A choice lemon tart with cream or rhubarb tart with custard was offered for desert. The meal looked very well prepared and was enjoyed by the residents. One of the residents and his visitor said that the meals were always very good and that individual likes and dislikes were catered for. Mrs Smith said the records of food provided were not on the premises. A requirement made in previous inspections has been carried forward as it could not be followed up. The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The owner/manager has a good understanding of what constitutes verbal and physical abuse and provides training to ensure that the residents are protected from verbal abuse. EVIDENCE: A summary of the Complaint’s Procedure is included in the Statement of Purpose and attached to the Service Users’ Guides. A copy is also displayed on a notice board in the home. Records of complaints were requested but Mrs Smith said that she did not know if such a record was kept as only one complaint had been made, ten years ago. The Conversations with the registered provider and a Care Assistant identified that some of the staff have attended training courses on abuse and that arrangements are being made for further training to be provided. In addition to this the registered person said that she had given the staff a lecture on the verbal abuse and the importance of using the correct tone of voice when talking with the residents. The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22, 24 & 26 The home is attractively decorated, comfortably furnished and clean and provides a pleasant environment for the residents although access to the grounds could be improved. EVIDENCE: The home is located in a residential area close to the village shops and amenities. From a physical inspection of the premises it was observed that the house and gardens are well maintained. Mrs Smith said that the resident’s access to the grounds was limited for safety reasons but more could be done to make an area of gardens to the side of the house safe and accessible. Some specialist equipment is provided to help the residents to maintain their independence and to help the staff in providing assistance for the residents. However, an assessment of the premises and facilities has not been carried out by suitably qualified professional persons, including a qualified occupational therapist. The communal rooms and the bedrooms seen were attractively decorated, comfortably furnished and clean. None of the resident’s bedrooms has been The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 15 fitted with a lock and lockable facilities are not provided to enable the residents to store money and other valuables safely. The laundry facilities are accessible through an outside door and so soiled laundry is not carried through areas when food is stored or prepared. The laundry room was seen to be clean and well organised. The modern washing machines are capable of reaching temperatures that are sufficient to minimise the risk of infection. The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 EVIDENCE: None of the above standards were inspected on this occasion. The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 & 37 The resident’s benefit from a home which is run and managed by an owner/manager who has a good understanding of their care needs. This needs to be reflected in the record keeping and all documentation. EVIDENCE: One of the registered providers, Mrs Ruth Smith, is also responsible for the day-to-day management of the home. She is a qualified nurse (SRN) and holds an In-Service Award. She has considerable experience of working in the care sector but will need to complete a Registered Manager’s Award to meet this standard. It was observed that Mrs Smith had a good working relationship with the staff on duty and that both she and the staff interacted well with the residents and visitors. Mrs Smith said that she had introduced a quality monitoring/quality assurance system but that it was not at the home and was not, therefore, available for The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 18 inspection. In light of this the requirement made in the last report could not be followed up and has been carried forward. At the start of this inspection Mrs Smith asked if the inspection could be postponed because her business manager and head carer had taken most of the homes records out of the house to upgrade them and very few records were available either for use by the management and staff as working documents, which is the purpose of most of the records, or for inspection. All of the records listed in Schedules 2, 3 and 4 of the Care Homes Regulations must be kept at all times available in the home for inspection by any person authorised by the Commission to enter and inspect the home. The deaths of resident, accidents and incidents that affect the well being of the residents are not being reported to the Commission. The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 1 15 2 COMPLAINTS AND PROTECTION 2 x x 2 x 2 x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x 1 x x x 1 x The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 20 Yes Are there any outstanding requirements from the last inspection? 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 3 Regulation 13, 15 & 17 Requirement The registered persons must ensure that risk management strategies are carried out, recorded and used by the staff to reduce identified risks. The registered person must provide evidence that the service users and/or their representatives have been actively involved in the assessment, care planning and review processes. Previous timescales 27/10/04 and 25/4/05 not met. The residents needs assessments must be kept in the care home and available for inspection at all times. 2. 7 13, 15 & 17 The registered person must provide evidence that the service users and/or their representatives have been actively involved in the assessment, care planning and review processes. The registered person must develop the individual service users risk assessments by including risk management strategies in the 14/8/05 Timescale for action 14/8/05 The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 21 service users care plans and by ensuring that the staff use the care plans as working documents. Previous timescale 25/4/05 not met. The residents care plans must be kept in the care home and available for inspection at all times. The registered person must ensure that unnecessary risks to the health and safety of residents is reduced by using procedures for the recording, handling, safe administration and disposal of medicines that comply with guidence from the Royal Pharaceutical Society. Previous timescale 25/2/05 not met. The registered persons must ensure service users plans, which identify the individual residents support needs and abilities, are used by the staff as working documents. Previous timescales 25/4/05 not met. Care plans must be kept at the home at all times. The registered persons must ensure that athe records of food provided include individual alternatives to the set meals. Previous timescales 27/10/04 and 25/2/05 not met. The record of food provided must be kept on the premises at all times. The registered persons must 14/10/05 D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 22 3. 9 13 14/8/05 4. 14 13 14/8/05 5. 15 17 14/8/05 6. The Rock 19 23 7. 24 12, 13 & 23 ensure that an area of garden is suitable and safe for use by the residents.ckable storage facilities must be provided for each of the residents. Lockable storage facilities must be provided for each of the residents. Previous timescale 13/4/05 not met. The registered persons must introduce a quality assurance/quality monitoring system. Previous timescales 13/4/05 not met. The registered persons must notify the Commission of any accidents and incidents that affect the well being of the residents. The registered persons must ensure that all records listed in Schedules 2, 3 & 4 of the Care Homes Regulations are kept at the home and available for inspection. Previous timescales 13/10/04 & 25/4/05 not met. 14/10/05 8. 33 24 14/10/05 9. 37 17 & 37 14/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 22 Good Practice Recommendations To meet this standard the registered persons should arrange for the premises and facilities to be inspected by an occupational therapist with specialist knowledge of the needs of people with dementia. To meet this standard the registered persons should arrange for locks to be fitted on the residents bedroom D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 23 2. The Rock 24 3. 31 doors, unless it can be demonstrated through individual risk assessments that it would not be safe to do so. To meet this standard the registered owner/manager should complete a Registered Managers Award (NVQ at Level 4 in Management). The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Rock D54-D07 S3840 The Rock V224679 120705 Stage 4.doc Version 1.40 Page 25 - 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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