CARE HOMES FOR OLDER PEOPLE
The Rookery Care Home 130 Church Street Eastwood Nottingham NG16 3HT Lead Inspector
Sharon Rosenfeld Unannounced Inspection 27/09/05 10:15 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 The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Rookery Care Home Address 130 Church Street Eastwood Nottingham NG16 3HT 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) 01773 713176 01173 770258 Lightdawn Limited Mrs Joanne Lesley Elizabeth Craig-Humphreys Care Home 30 Category(ies) of Dementia (30), Old age, not falling within any registration, with number other category (30) of places The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The number of persons for whom residential accommodation with both board and care is provided at any one time shall not exceed THIRTY (3) The residents shall be within registration category I & MP/E One Identified resident shall be 60 years of age or older Date of last inspection 8th March 2005 Brief Description of the Service: The Rookery Care Home is an extended converted detached house. It is located on the outskirts of Eastwood town centre within a residential area. It is close to local facilities such as shops, banks and the medical centre. There are good local public transport links. The accommodated is over two floors. There are 24 single and 4 double rooms. Both stair lift and passenger lift are provided. Care is provided for older people who may or may not be diagnosed with a form of dementia. The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced statutory inspection took place over approximately seven hours. The inspector looked around some parts of the building and a number of records were inspected. Five residents, three relatives, four staff, and the Registered Manager were spoken with either on the inspection or following it. What the service does well: What has improved since the last inspection?
The quality of the care planning continues to improve and has been developed in a more person-centred approach. The three records examined used a consistent system and gave a valuable insight into resident’s needs and how they wanted their needs to be met. The care plans are being placed on the computer making it possible for them to be produced in different formats according to the needs of the residents, their representatives and staff.
The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 6 The daily living assessments include the resident’s capacity to undertake a range of activities, including possible involvement in food preparation. There is also a comprehensive self-medication assessment. One staff has been given the responsibility for the administration of the Total Quality Management monitoring and for the management of the medication ordering system. A qualified person has been appointed to implement fitness programmes with some residents. 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 Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. There are proper assessments of need prior to people moving into the home. EVIDENCE: The admission assessment format is comprehensive to ensure that information is available about the resident’s individual needs. The assessment’s value is however reduced, as after admission, the ongoing assessment forms are not always completed in full. The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8. 9. Progress has been made to ensure that needs are identified through a comprehensive care planning system. Not all needs are met in the recommended way however. The deployment of staff at specific times of the day means that some residents are left unsupervised for unacceptable periods of time and this has a potential to place people at risk. EVIDENCE: The residents personal preferences about the way they want to be treated and have their care delivered is well documented and this is good practice. Discussions with staff however indicated that these personal preferences are not consistently met. Staff pressures and other perceived work priorities are given as the reason for this. Both the day and night care staff have additional auxiliary responsibilities that the management state should come second to the delivery of care and the monitoring of residents. The staff however, said they feel they must meet all of their given responsibilities (and some cleaning tasks they undertake of their own volition) so as not to over burden the next staff arriving on shift, even though this action could at times compromise the quality of care provided.
The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 10 One example of this is the pressure staff feel to get a number of more dependent residents out of bed from 5:30 am. The care staff confirmed these people dressed and taken to the lounge to help out the incoming day staff. The residents are then left unsupervised downstairs while the staff get more people dressed, until the day staff arrive on duty at 07:00 am. These examples were shared with the Registered Manager and Senior Carer who expressed concern and stated they would look into this. One relative said that the staff work effectively with people who have dementia. Not all staff have received training in this specialised area of work. Dementia care planning was not evidenced in the documents seen. There was however valuable information about individuals that would enable staff to get to know the persons likes and dislikes, reasons why they may, for example, become irritable, and the persons capacity for self care in some areas. This approach to care planning is good practice. The Registered Manager employs a qualified person to assess resident’s fitness needs and implement physical activity programmes. This is also good practice. The staff have received instruction in the delivery of these programmes however, the care plan states this should take place everyday and the reality is that it does not. Two relatives expressed concerns about the way in which some of their relatives care needs are met. One person feels their relative requires more personal care assistance and help to manage continence problems. Another person states an opinion that the ‘general care is going downhill’. The staff also stated that because of recent staff changes, the care being provided is not of the same high quality as it used to be. One resident was left for an unacceptably long period in wet clothing before staff came to assist him to get changed. The Registered Manager indicated there were some problems accessing local health services such as continence assessments. Where this is the case these should be documented and raised with the local Primary Care Trust (PCT). In the meantime, referrals should continue to be made to relevant specialists such as the Continence Advisors for assessment where needs assessment indicate this is necessary. Whenever possible residents are supported to attend local dental surgeries themselves and this is good practice. The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 11 The Commission did not fully inspect medication management (Standard 9) on this occasion. Previous inspections have found this standard to be met. However there was evidence that the home is not administering one prescribed drug to one of the residents. It was explained by staff that this drug is being withheld at the request of family members. There was no evidence that consultation with the resident has taken place, that a medical review of this person’s medication has been arranged nor that the prescribing doctor is aware that the drug is not being given. There is a comprehensive self-medicating assessment in place. The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14. Regular contact is maintained between resident’s and their families and friends. Residents generally exercise choice over their lives. EVIDENCE: The care plans evidence the high degree of consultation that takes place with residents about how they prefer to be supported at The Rookery. Throughout the day staff were heard talking with residents, asking their permission to undertake specific care tasks and offering choices about every day situations. The staff need to increase their knowledge the content of individual care plans so that care is delivered in accordance with their preferences. Relatives said that they are able to visit at any time. Some people continue to access local community resources. The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Concerns are not handled properly to provide people with confidence that they will be listened to, taken seriously and have their concerns acted upon. The Vulnerable Adults policy offers staff understanding about their role and responsibility and thus the residents are afforded protection from abuse. EVIDENCE: The home’s complaints procedure does not explain the time scales within which concerns will be investigated. Nor does it give the Commissions full contact details. Two separate but similar concerns have been raised with the Commission by relatives. These people state they have previously discussed their concerns with management but both feel that they have not been listened to and one person said the promised improvements have not been forthcoming. One person stated ‘you get the feeling you are being fobbed off’. Another person said staff didn’t take the concerns raised seriously. Both people stated that the quality of care has recently declined. The relatives have elected to raise their concerns formally with the Registered Manager or the Commission if improvements are not forthcoming. The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 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 the following standard(s): 19, 26. Some improvements to the décor have been made. There are a number of other matters that require attention to provide a safe and comfortable home for residents. EVIDENCE: The Registered Manager has plans to improve the home by building a conservatory and replacing the worn carpets. One resident said she was looking forward to the proposed changes. The following areas require attention: 1. The carpets in the ground floor communal areas are very worn and dirty in places. 2. A window extension arm in the lounge is broken this prevents it from being properly secured. 3. Malodours were noted particularly in the bedrooms visited. The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 15 A new heating system has been fitted that responds to a drop in temperature by switching on and heating the room to a comfortable temperature. This needs to be more closely monitored as three residents complained that it was too chilly. Several windows had been opened in the lounge and two residents complained about this. There is a thermometer in the lounge and this should be checked periodically to ensure the level of heating meets the needs of the residents. The laundry facilities were not assessed at this inspection. The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27. The deployment and number of staff available is not always sufficient to fully meet the needs of the residents. EVIDENCE: There were three care staff on duty and an immediate requirement was made to maintain staffing levels at four during the day. Sufficient domestic staff hours are provided however the deployment of these hours is not effective to ensure acceptable standards of cleanliness are maintained at all times. The rota for the month of September showed that domestic hours were concentrated in the mornings. There was no domestic cover in the afternoons and over two weekends. During these periods, the care staff take responsibility to maintain the cleanliness of the home. One of the senior staff acknowledged this was a problem that was being addressed. The day and night care staff are also responsible for the laundry and ironing. Two relatives expressed their concerns about the quality of the laundry system, damage done to clothing through and clothing not being returned to the appropriate resident. The care staff undertake a range of domestic duties which the Registered Manager states must not take precedence over their care duties. However, the staff state they do complete these tasks in any event. The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 17 At night the residents are monitored at 10:00pm, 01:30am, 03:30am and lastly at 05:30am when some people are dressed and taken downstairs. This was said to happen to assist the day staff arriving for duty at 07:00 am. A full assessment of each person’s night time are needs is required to inform the deployment of the night staff and to satisfy the Commission that staff can respond to the residents individual needs in a timely manner. The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33. The staff need more direction and support to ensure that care is delivered in a manner that is consistent with individual care plans. Some of the resident’s representatives state their opinions and concerns are not taken seriously. EVIDENCE: While residents, visitors and staff made some positive comments about the staff team, concerns were also expressed that the quality of care provided was not as good as it once was. Changes in the staff team were highlighted as possible reasons for this. Discussions with management and staff indicated inconsistencies in the delivery of care. In addition two relatives said the management was not taking their concerns seriously. One person stated their opinion that communication between staff ‘is now poor’ and this is affecting the quality of the care provided. Another relative said the home ‘keeps me informed of mum’s condition.’
The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 19 The Registered Manager writes a newsletter that is available to residents, family, friends and staff about developments at the home. One member of staff is responsible for the administration of the Quality Monitoring at the home. The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 2 X X X X X The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 21 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 12, 15. Requirement The Registered Manager must ensure that staff deliver care in accordance with the instructions given in the care plans. The Registered Manager must obtain the staffs views about the conduct of the care home in relation to the quality of care provided. The Registered Manager must refer the resident identified at the inspection to the Continence Advisor. The Registered Manager must maintain clear written records about decisions made to withhold prescribed medication and subsequent medication reviews by the GP. The Registered Manager must record and investigate all complaints made and ensure the complainant is informed of the outcome and of the action to be taken within the timescale of 28 days. The Registered Manager must provide the Commission with a copy of the homes maintenance
DS0000008801.V252315.R01.S.doc Timescale for action 30/11/05 2 OP7 21 30/11/05 3 OP8 13 01/11/05 4 OP9 13 25/10/05 5 OP16 22 25/10/05 6 OP19 23 30/11/05 The Rookery Care Home Version 5.0 Page 22 7 8 9 OP19 OP26 OP25 23 16 13, 23 10 OP27 12, 18 11 OP27 16 12 OP27 18 13 OP33 24 plan that shows when the carpets on the ground floor will be replaced. The Registered Manager must repair or replace the broken window in the communal lounge. The Registered Manager must ensure that the home is kept free of offensive odours. The Registered Manager must monitor the temperature at the home and ensure it meets the needs of the residents. The Registered Manager must make proper provision for the care and supervision of residents at night. There must be four care staff on duty during the day dedicated to the care of residents. The Registered Manager must make appropriate arrangements for maintaining the cleanliness of the home. A full assessment of residents night time needs must be made that will inform the number and deployment of night staff. The Registered Manager must arrange a review of the quality of care provided at the home through consultation with residents and their representatives. A copy of the review must be shared with the Commission. 08/11/05 30/11/05 25/10/05 27/09/05 30/11/05 30/11/05 30/11/05 The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 23 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 3 4 5 Refer to Standard OP3 OP3 OP30 OP8 OP26 Good Practice Recommendations The Registered Manager should ensure that all of the needs assessment documentation is fully completed. The Registered Manager should implement a recognised specialist assessment tool in relation to dementia care such as the Dementia Care Mapping Tool. Staff should receive training in Dementia Care Mapping. The Registered Manager should document any further problems accessing health care services and raise these concerns with the PCT. The Registered Manager should monitor the quality of the laundering of resident’s clothes. The Rookery Care Home DS0000008801.V252315.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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