Inspection on 26/08/09 for The Rosemary Care Home

This inspection was carried out on 26th August 2009.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Rosemary Care Home 29/03/10

The Rosemary Care Home 03/02/10

The Rosemary Care Home 08/10/09

The Rosemary Care Home 26/06/08

The Rosemary Care Home 03/07/07

The Rosemary Care Home 29/01/07

The Rosemary Care Home 11/07/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: The Rosemary Care Home The Rosemary Care Home 13 Newhey Road Milnrow Rochdale Lancashire OL16 3NP     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kath Oldham     Date: 2 6 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 53 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 53 Information about the care home Name of care home: Address: The Rosemary Care Home The Rosemary Care Home 13 Newhey Road Milnrow Rochdale Lancashire OL16 3NP 01706650429 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Din T Vanat care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 27 Date of last inspection Brief description of the care home The Rosemary Care Home is a privately owned residential home, which provides care for up to 27 people. The home is in the centre of Milnrow and is close to local shops and pubs. It provides good access to the motorway network. The home is on three floors and there is a passenger lift to all levels. Twenty-one single and three double bedrooms are provided. Two of the bedrooms have the added provision of an en-suite. Two lounges and a dining area are provided on the ground floor and a combined diningroom and lounge on the first floor. A bathroom is provided on each floor and a Care Homes for Older People Page 4 of 53 Over 65 27 0 Brief description of the care home level access shower room on the ground floor. Two of the baths are fitted with fixed hoists. Toilets are located near to lounge areas and bedrooms. A well maintained garden is available to the front of the home where there is also parking. The most recent inspection report was available in the reception hall. The fees were £370 plus a top up fee of an additional £10. Additional charges were made for hairdressing, trips, newspapers, telephone, alcohol, clothing and personal toiletries. Care Homes for Older People Page 5 of 53 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This visit was unannounced, which means that the manager, staff and residents were not told that we would be visiting, and took place on 26th August 2009 commencing at 7.15am. The inspection of Rosemary care home included a look at all available information received by the Care Quality Commission (CQC) about the service since the last inspection which was on 26th June 2008. We should have just undertaken an Annual Service Review (ASR) this year instead of an inspection.This is when we do a review of good and excellent services that takes place between key inspections. Good services only have an inspection every two years and excellent services every three years. An inspection visit wasnt due as on our last visit the home was deemed a good service. We did an annual service review this year.However, information received for the annual service review told us we needed to have another look at this service.We had Care Homes for Older People Page 6 of 53 received information about the home in relation to procedures not being followed when an allegation of potential abuse had been made and we had received a complaint about staffing levels. The home has been without a registered manager for three years, since the owner purchased the home.Despite repeated requests from the Commission the previous acting manager did not submit a fully completed application form.At the time of this inspection the current acting manager who has been in post since April 2009 has not sent a fully completed application form to us. Every year the person in charge or manager is asked to provide us with written information about the quality of the service they provide.Some months before our visit we sent the owner a questionnaire,called an Annual Quality Assurance Assessment (AQAA), telling us what they thought they did well, what they need to do better and what they have improved upon. This helps us to determine if the management of the home see the service they provide the same way that we do.We considered the responses and information provided and have referred to this in the report. Whilst the AQAA gave us some information,for future it does need to contain additional information about the service provided. We are trying to improve the way we engage with people who use services,so we gain a real understanding of their views and experiences of social care services.We used an expert by experience on this inspection.Anexpert by experienceis a person who has experience of using care services.They help us to get a picture of what it is like to live in or use a social care service. The expert by experience helps us get information to make judgments about the quality of life that people that use services have when using a care service.Comments from the Expert by Experiences report are used in this report. Rosemary care home was inspected against key standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. Comment cards were sent as part of the annual service review and these comments were used to report on our findings when we did this. Some comment cards were returned after we had written that report and these comments have been used in this report. We also took with us on our visit some comment cards for distribution to staff, relatives and other professionals who visit the home.The views expressed in returned comment cards and those given directly to the inspector and expert by experience are included in this report. We got our information at the visit by observing care practices and talking with residents and their visitors,the acting manager and staff.A tour of the home was also undertaken and a sample of care, employment and health and safety records seen. The main focus of the inspection was to understand how the home was meeting the needs of residents and how well the staff were themselves supported to make sure that they had the skills, training and supervision needed to meet the needs of residents. The care service provided to three residents were looked at in detail to help form an opinion of the quality of the care provided.We call this case tracking.This is a way of Care Homes for Older People Page 7 of 53 inspecting that helps us to look at services from the point of view of the people who receive a service. We track residents care to see whether the service meets their individual needs. The term preferred by people living at Rosemary care home was residents. This term is, therefore, used throughout the report when referring to people living at the home. A brief explanation of the inspection process was provided to the acting manager at the beginning of the visit and time was spent at the end of the visit with the owners and acting manager to provide verbal feedback of our findings. We have received one complaint with regard to staffing levels. This was passed to the owner to investigate using the homes complaints procedure. We had also been informed by Rochdale local authority of a safeguarding referral. The local authority and the police are looking into these matters.The fact that the owner had not reported this allegation in line with the local authorities policies and procedures gives us some concerns about how the owner sees safeguarding matters.This was ongoing with the local authority at the time of the inspection. References to we or us in this report represents the Care Quality Commission(CQC). Care Homes for Older People Page 8 of 53 What the care home does well: What has improved since the last inspection? What they could do better: We gave feedback to the owner and acting manager on conclusion of our visit. We asked that certain things were completed before the owners left the home on the evening of our visit. This was to safeguard residents and staff. This was in relation to fire safety as checks had not been made recently.We spoke with the owner on the telephone the day after our visit and asked that confirmation of the actions taken in relation to fire safety was confirmed to us in writing.This information has not been Care Homes for Older People Page 9 of 53 received at the time of writing this report. To promote the safety of residents, visitors and staff,the stored items at the top of the stair and on the landings which is a route to be taken to reach the fire exit must be removed and staff given instruction that the stair care and stairwell must not be used as a storage area due to fire regulations. To comply with regulations and to keep residents and staff safe,provide all staff with fire drill training on their next duty at the home ensuring that all staff know what to do in the event of such an emergency. To ensure that fire equipment works,undertake the checks to the means of escape, automatic door closures, fire extinguishers and emergency lighting systems at the regularity prescribed by the fire authority and record in the fire register on the day the date that these checks have been undertaken. We made other requirements which are detailed at the end of this report.These were in relation to make sure the home has the facilities, knowledge and staff have the right training to care and support residents properly and to ensure residents receive the correct care and support. Residents must only be admitted to the home on the basis of a full written assessment undertaken by people trained to do so. To ensure residents receive the care and support they need at a time and frequency that is needed.The registered person must after consultation with the resident or their representative prepare a written care plan on how the residents needs in respect of their health and welfare are to be met. To ensure there are suitable arrangements to provide a safe system of moving and handling residents.The registered person must ensure that hoists are available to support staff to mobilise residents safely and that these are serviced by a recognised and qualified person at intervals required by health and safety legislation. To support and promote residents safety and protection.Ensure that if or when allegations of potential abuse are made that these are actioned immediately by management and that the local authority adult protection procedures are followed. Provide all staff with training in adult protection so they are able to recognise signs of abuse and be aware of what to do if abuse is alleged. To provide safeguards to residents and staff and to comply with regulations,ensure all staff have a criminal record bureau disclosure before they start work at Rosemary care home. To safeguard residents and offer some degree of protection. Management must ensure that the recruitment and selection procedures are robust and are followed and two written references,are obtained before staff commence work at Rosemary Care Home. To maintain and promote the safety of residents.The manager must make sure that there are sufficient number of staff on duty and on the premises. Care Homes for Older People Page 10 of 53 To promote the respect of residents,the laundry service needs to be reviewed and changed to provide a reliable service.The current number of hours allocated to laundry services and the procedures for doing residents laundry needs to be reviewed with additional hours allocated so that residents laundry is washed in a timely manner and there clothes are returned to them. The owner and or manager must refer to the regulations and make themselves familiar with them and in relation to regulation 37 notify CQC without delay which is followed up in writing of any death, any outbreak of any infectious disease, any serious injury or serious illness to a resident,any theft burglary or accident and any allegation of misconduct. There are also recommendations which need to be addressed by the home. Make sure that residents care plans are up to date and are recorded as having been reviewed monthly or more frequently if the need is identified. The detail in the care plan should inform staff of the care needs of residents and how and when the care needs are identified. Provide all staff who have responsibility to administer medication with training before staff are given this responsibility. Introduce a system to evaluate staff practice when administering medication to ensure staff are confirmed as continuing to be competent to administer medication. Ensure this evaluation is recorded as having taken place. Ensure that staff follow the procedures when giving out medication which includes the signature of staff on the medication administration records or a recognised symbol indicating that the residents do not want there medication which must be completed on administration. This will confirm residents have taken there medication or decided they didnt want it and that the medication administration records are maintained accurately. To safeguard residents make sure that when entering handwritten details on the medication administration records that these are signed by the staff member making the entry and also signed by a second staff member to verify the medication has been correctly copied from the prescription. The medication records must clearly have written on them the regularity that the medication has been prescribed by the doctor. When residents are prescribed creams or lotions these must be recorded when they are administered by staff to ensure that the creams or lotions are applied at the right frequency. Obtain a copy of the Royal Pharmaceutical Guidelines and read and review the homes medication policy.Make the Royal Pharmaceutical Guidelines available to all staff who have the responsibility of administering medication. To promote best practice ensure all controlled drugs medication is double signed within the medication administration records. Care Homes for Older People Page 11 of 53 Liaise with residents and their relatives or friends to find out what activities they would like to take part in and provide these routinely.Ensure that activities undertaken are recorded to demonstrate what is available. The home must produce an improvement plan to the Care Quality Commission which details how they will comply with the requirements and the action they will take and the timescales. The home has had a new manager in post since April 2009 but the Care Quality Commission (CQC) have not received an application for this person to be registered with them.An application must be received. Staff need to receive updated and new training which should,if transferred into practice benefit the residents at Rosemary care home and provide additional safeguards. The training should include induction training to skills for care specification,NVQ,infection control, food hygiene,moving and handling,medication training, health and safety and protection of vulnerable adults. Residents would also benefit if staff were to learn more about dementia and care of residents who have dementia.The provision of updates and training to staff should go some way to further develop practice and routines. All staff do need to attend the training to make sure that the theory is put into practice. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 12 of 53 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 13 of 53 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admissions process does not ensure that residents care needs are properly assessed and residents cannot be sure they will receive the right level of care and support. Evidence: The detail in the AQAA signed by the acting manager which was completed in April 2009 informed us we have a good standard of care and needs are excellent. The home gets recommended by the service users and their family. At the moment we have a waiting list for admission. We were also told thatservice users needs are assessed prior to admission to the home and that service users may visit the home before deciding the course of action to take. We looked at a selection of care files for residents. The assessment procedures we evidenced did not support the information provided to us before our visit. In particular for the most recent admission there was no assessment completed by the home. Care Homes for Older People Page 14 of 53 Evidence: There was some brief handwritten notes dated before the resident was admitted but not a complete assessment which should be in place to make sure the home has the skills and abilities to look after someone properly. The omission of this information could lead to the resident not getting the care and support they need. The acting manager told us they hadnt a lot of information about this resident and were waiting for nurses to let them have some more information. The resident was admitted to Rosemary Care Home in July 2009. We didnt look at the statement of purpose or service user guide on the visit. These are documents which should be provided to residents to let them know about the services provided and the rules of the home. We asked the acting manager to email this information to us. At the time of writing this report these documents hadnt been received. A relative told us, X has settled in well and quickly, to my great surprise as (X is 90 plus) and loved there own home. X is happy and feels safe. Rosemary Care home is clean and the residents look cared for. Care Homes for Older People Page 15 of 53 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning was insufficient to demonstrate that residents health and personal care needs were being met.Medication arrangements did not fully promote the wellbeing of residents. Evidence: The information in the AQAA told us, we involve relatives in most aspects of residents care. Residents are all treated individually according to their own needs.The expert by experience told us, It was great to hear a member of staff check with residents to ensure they were wearing their hearing aid. We asked to look at a selection of care files for residents. For one resident who had been staying at the home for a little over a month there was no care plan in place. The care plan should describe the residents care needs and support and identify any risks and how these are managed. The omission of this detail may result in residents not getting the care and support they need when they need it. The acting manager said that they were waiting for some more information on this resident from nursing staff. Care Homes for Older People Page 16 of 53 Evidence: We looked at some other care plans which were dated in 2008 and didnt include a review so it wasnt clear if residents were receiving the care and support that was identified at that time. Care plans must be reviewed monthly to make sure that if there have been any changes to the care and support these are recorded. Staff should then know these needs then residents should get the care they need. The acting manager did say that they were currently rewriting care plans as the way they were written previously didnt include any space for a review to record if residents care needs have changed. A relative said, I appreciate the hard work involved in the care of the elderly, and I am satisfied that X is in the right place for her needs at the present. I would however appreciate any possible improvement as care of ones loved ones is paramount.A further relative told us, I have found the service at Rosemary what I expect in every way and I visit three times a week to see X. The lack of care plans could mean that staff are providing care how they think it should be provided and not all staff may know certain things about residents or how they like things doing or how often so the care may not be consistent, may not be the right care for that resident or at the right time. A relative in response to the question what does the home do well,told us, care for my X is excellent. A staff comment card told us, The care given is very good,everything is done to ensure the clients needs are met. The staff go out of their way to cater for the clients. Interactions between residents and staff were observed to be relaxed and appropriate,whilst being respectful and maintaining individuals dignity. For residents who were supported with personal care this was provided in a discreet and sensitive way. We observed at meal times that residents were sat in wheelchairs at the table as opposed to sitting in dining chairs. This may be their choice. Residents should be provided with an opportunity to sit in dining chairs when they have their meals. The expert by experience told us, A resident spent the morning in their wheelchair and not in an ordinary chair. This could have been through choice,but as they had had a stroke,I would imagine that they would be more likely to be prone to body sores. Care Homes for Older People Page 17 of 53 Evidence: The care file for one resident contained accident reports detailing eight falls in the previous six months. A risk assessment hadnt been put in place to reflect this so it wasnt clear what the home were doing to keep the resident safe or minimise the risk of falls. The acting manager told us that a referral had been made for a falls assessment for this resident but there was nothing in the care file that confirmed this. For this person there was reference to a fall that we couldnt find an accident report for. There was an entry to say that they had seen a doctor eight days after having a fall and was assessed for back pain. The record also said that the resident had a history of back pain and medication was prescribed. There was nothing written which identified that the fall experienced by the resident could have been a contributing factor to the pain they were experiencing. For the same resident we saw papers that detailed an accident in June 2009 which resulted in the resident going to hospital. There wasnt an accident report for this and the Care Quality Commission had not been notified as they must be.An event affecting the health and wellbeing of residents should be notified to the Commission in line with regulations, things like people going to hospital after having a fall or a residents death are some examples of the things we must be told about. Daily reports were completed for the residents that we looked at.They were written with enough detail and in a way which was respectful of the residents needs and abilities. To support staff to ensure that residents health and welfare is being promoted staff should weigh residents monthly unless there is a reason for them to be weighed more frequently than this. We looked at the weights for the residents whose care files we saw. For one resident the records identified a weight loss. However there was nothing written in the care plan that this was being kept an eye on or if it had been referred to the residents doctor. There was a fluid and food intake chart for the resident but this hadnt been completed everyday or the resident wasnt eating or drinking regularly. When we gave feedback at the end of our visit to the acting manager and owners,the acting manager said that they had new scales and the weights previous to the last two entries were not accurate. This is again not good enough. In effect what the acting manager was saying is that the weights from January 2009 up to June 2009 could not be relied upon.Weights are taken to support residents health and the weighing scales should be fit for purpose and if found not to be functional should be replaced in a timely manner. As otherwise staff have no way of knowing if residents weights are stable. We identified that two residents needed a hoist to transfer them safely in addition a Care Homes for Older People Page 18 of 53 Evidence: person that comes to the home for day care on specific days also has mobility problems which need staff to transfer them by using a hoist. We were told that the hoist was not being used as it hadnt been serviced and to make sure it was safe the acting manager had arranged for the service engineer to come to the home to service it before staff used it. This means that staff are transferring these residents without the correct equipment and are putting themselves and the residents at risk of possible harm. The acting manager said that the service contract for the hoist had been terminated and that the engineer was scheduled to visit the home on the day of our visit. We were also told that on that visit the service contract had been set up and the engineer would return to the home the following day to service the hoists. Residents and staff are being put at risk due to the fact that the hoists are not being used as they have not been serviced at the regularity of health and safety guidelines. One of these hoists had a note on to say it was last serviced in January 2008. Maintenance services should be completed six monthly to check they are fit for purpose and safe in line with health and safety regulations. We were told that one resident was due to have a bath and had been told throughout the morning that the staff were busy and they would come back later, this went on for the whole of the morning. We looked at the medication administration records which were started on 7th August 2009. The records contained handwritten entries in the records. These are handwritten when for example the residents doctor has prescribed medication after the records have been printed by the pharmacist, or if the the medication has been missed of the printed sheets by the pharmacist. To make sure that the information is copied correctly from the prescription best practice is that staff sign the record and a second member of staff also sign to verify the accuracy. This needs to be arranged by the acting manager. For one resident medication was handwritten and also printed. On two occasions the medication was recorded as being administered twice as opposed to once a day. The handwritten medication records didnt indicate how often the medication was prescribed. Staff should sign when they have administered medication to residents. If a resident doesnt want some or all of their medication there are symbols which should be used by staff as indicated on the medication administration records. The symbol is defined so you would know the reason for non administration. On occasions a symbol was used which was not defined so it was not clear why the resident didnt have their medication. On another occasion a symbol was used which was contradicted by the Care Homes for Older People Page 19 of 53 Evidence: fact that the resident had other medication when it was suggested by the use of the symbol that they were not available to take this medication. We asked to see the previous medication administration for one person that comes to the home to visit. We were told that there had been some mix up with this persons medication and it was unclear what the arrangements were for medication administration for this person. When someone is visiting and staying at the home for the day it should be made clear before they start coming to the home if medication is needed during their stay who is giving it to them, when and who arranges delivery to the home. This detail should be recorded to safeguard the person and keep them well. Some residents are prescribed creams by their doctor and the prescription says how often they are to be applied. There were no records for some of the residents who need the support of staff to say they had these creams administered. We were told by the acting manager that they dont have a separate cream chart. These if they are used are usually in residents bedrooms so it is easier for staff to fill them in when they apply the cream. In the absence of these the medication administration records should be used. This can then be used to confirm that the cream or lotion has been applied as per the doctors instruction. If a resident is not getting better then without these records it cannot be confirmed how often the cream is being applied. The acting manager needs to remedy this omission and ensure that accurate records are kept of medication administration. One resident was prescribed eye drops,one drop to be administered daily. On seven occasions the administration of these eye drops was recorded as having been given twice which is not as prescribed by the residents doctor. We asked the manager to provide us with a list of all staff and the training they had obtained. There was only one senior member of staff who was recorded as having received medication training. Staff who have the responsibility of administering medication must receive medication training to make sure they know what to do. Also the acting manager should on occasions assess staffs competency when administering medication to make sure they are following the correct procedures to keep residents safe and well.This is not currently arranged at Rosemary care home. When the doctor prescribes a variation to residents medication,for example,one or two tablets or spoonfuls the number of tablets or spoonfuls was clearly written on the medication administration records. This ensures that an accurate record is made of medicines administered to residents. There were photographs accompanying the medication records to confirm and aid in identification. This provides an additional Care Homes for Older People Page 20 of 53 Evidence: check so staff can double check that they are giving medication to the right person. The controlled drugs medication must be double signed in the medication administration records in addition to the controlled drugs book. This is due to the medication being a controlled drug and the safeguards that need to be in place to protect residents and staff.This needs to be arranged by the acting manager. Care Homes for Older People Page 21 of 53 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with activities and a variety of home cooked food which they enjoy. Evidence: We were told in the AQAA that we have just employed a new cook in the hope food will improve further.The acting manager said, we could arrange more social activities but struggle at times to arrange them. When we arrived at the home at 7:15 am five residents were sat at the dining room tables on the ground floor. They told the inspector that they hadnt had a drink on rising. This was provided more or less right away after this by the cook who had arrived early for her shift. We were told that night care staff should prepare a drink to residents on rising but this hadnt been undertaken on our visit. One resident was still sat at the dining table an hour and a half later and had subsequently fallen asleep the resident was sat in a wheelchair at the table and staff had difficulty waking her. The two residents sat in the combined dining room lounge upstairs had also not had a Care Homes for Older People Page 22 of 53 Evidence: drink on getting up. We didnt know how long the residents had been up but all needed some level of support with personal care.One resident said,dont know when we will get a drink The cook has devised a four week menu which records a choice for the lunch and tea time meal. We had a meal with residents which was freshly prepared, hot and residents said they enjoyed it. The meal choice was liver and onions or braising steak with potatoes and vegetables followed by home made egg custard. Residents were seen being asked in the morning by the cook what they wanted for there meals during the day. There is currently no menu displayed for residents to look at to be reminded of the meals. A menu on the table would be good so residents could see what the meals were for the day or could act as a reminder to what they were having for their meals. A record is maintained of lunch and tea time meals chosen by residents so you are able to see what residents have had to eat each day for these meals. This record needs to be extended to include what residents have eaten for their breakfast and supper so if needed this record can be used to assess whether individual residents diet is as it is should be and they are getting the right nutrients. This record could benefit the staff at the home if a residents weight is changing.Staff will be able to use the record to double check exactly what residents are eating and use this to share with other professionals when discussing a residents care. A relative told us, X had lost weight prior to entering Rosemary and efforts are being made to tempt X to eat more and X is improving a little which I appreciate greatly. Residents do not currently have a choice of a hot breakfast option. One resident said cant remember ever having a cooked breakfast whilst staying at the home. Another resident said they used to like to eat tomatoes on toast for breakfast at home. We couldnt confirm the arrangements for supper.The acting manager told us that she thought that residents had toast or sandwiches from tea for their supper.A snack meal should be offered to residents at supper time and the interval between this and breakfast should not be more than 12 hours. One resident said, Ann is a good cook she makes all her own soups and uses fresh ingredients there is no packet or processed food when Ann is working.Residents told us that if they,dont like or fancy what was on the menu the cook would make them something else. Care Homes for Older People Page 23 of 53 Evidence: Residents were provided with fresh fruit. The cook said that each afternoon staff take out sliced fruit with the tea trolley. On our visit it was apples, oranges and bananas. Residents do not currently have the option to drink fresh fruit juice each day. One resident told us that they used to drink cranberry juice at home, all we get is diluted cordial drink, the ones children drink.The expert by experience told us, It was also pleasant to see fresh mid morning cool drinks being brought to the lounge and poured individually on choice. The expert by experience told us,The cook is a very energetic lady,who made her own pastry and cakes and used fresh vegetables in her menus.I actually saw the delivery of the veg.I was very surprised that she also had to do all the washing up.There are 24 residents.To provide food for all the mealtimes and do all the washing up plus keeping the kitchen clean is impossible to maintain without assistance. There are two cooks over a seven day period who work between the hours of 7:30am and 4:30pm and between them cover the cooking duties everyday.The cooks do not have the support of an assistant or a kitchen domestic. This needs to be reviewed by the owner to make sure that the cooks are supported to do there job well and also maintain food hygiene standards and all the records that need to be in place.A member of staff when asked what could the home do better said, employ a kitchen assistant. Everyone should have nutritional screening as part of their needs assessment when moving into a care home and the outcome should form part of their care plan.Screening should be repeated periodically and whenever a residents needs change. When we looked at residents care plans there was a form completed for some residnets when they moved into the home but as there was no recorded reviews of the residents care needs that we looked at we couldnt be certain that the nutritional screening had been reviewed. We reported earlier that for one resident staff had recorded that they were losing weight and we saw a part completed record for this person which was to detail food and fluid intake although not completed fully. The acting manager did say that the weighing scales used up to the purchase of new weighing scales about two months ago were not reliable. The Malnutrition Universal Screening Tool(MUST)is a validated,evidence based tool designed to identify individuals who are malnourished or at risk of malnutrition(under Care Homes for Older People Page 24 of 53 Evidence: nutrition and obesity).It is a user friendly 5 step flow chart that is simple and quick to use for care staff across all care settings and is accompanied by a care plan.One member of staff was recorded as having had training in this.We didnt see that this type of assessment was used for anyone at the home. We were told that care staff help with the preparation or serving of meals in the evening for example when the cook has finished for the day. We looked at the training record which the acting manager supplied to us on our visit. The record did not include that staff had taken part in food hygiene training. To ensure staff have the knowledge and skills when preparing and or serving food they need to understand the procedures for food safety and attend training in this to make sure they know what they are doing. Both cooks had undertaken food hygiene training but this was recorded as having been studied in 1991 and 2005. These need to be updated to ensure continued compliance with changes in practice and legislation. A resident told us that their visitors were made to feel welcome and are able to visit at anytime. There is a notice in the hallway asking visitors to try not to call at mealtimes so that residents are not rushing or declining their meals as they have visitors. An activities coordinator comes to the home about three times each week to provide activities and stimulation to residents. We looked at the records that detail the activities that residents take part in.These include exercise, quizzes, hand massages, singing and music. Residents told us that they would like to go out occasionally but this wasnt currently arranged.A relative told us, residents are bored not enough stimulation. No outside space for them to enjoy the fresh air although a summer house is being erected presently, but with residents needing supervision to get to it(garden is part of car parking space)I wonder how often its possible to use it bearing in mind staffing levels. Back garden needs sorting to enable access to outside space. The expert by experience in there report to us said, There was an agenda for activities, which included a sing along, poetry, and a quiz. However,these only took place over a period of three days when, the person contracted to do the work,arrived.Everyones religious requests were catered for.One resident received one to one from the people of there church who called to pick them up in order that they could attend the service of their choice.Another resident was visited by their priest who held mass for them.One resident said they would love to be able to walk across the room with help from a carer.They felt that they were losing their independence too quickly,through not having the opportunity to take short walks within the home.There are limited trips for residents to enjoy the outside world. The expert concluded on this by saying, residents were cared for well by staff,but appeared bored with limited Care Homes for Older People Page 25 of 53 Evidence: activities to encourage movement and independence. One resident told us staff are always so busy Care Homes for Older People Page 26 of 53 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures for dealing with complaints were in place,however there was no evidence to show that concerns and complaints are listened to or acted upon.Adult protection procedures were not followed to safeguard residents. Evidence: The acting manager told us, we hold an open door policy, relatives, clients and staff know they can talk openly and confidentially about any concern they have. All complaints are dealt with and immediately acknowledged, outcomes are also reported to the complainant.We were told in comment card,confidentiality is broken when anything is passed onto the manager. We made a recommendation on our inspection in June 2008, that a record of the complaint, the investigation and the outcome be kept to keep an audit trail on how compliants are dealt with.This hasnt been done One resident said they usually know who to speak to if they were not happy and one resident said they knew how to make a complaint.A further resident said they didnt know how to make a complaint. Two relatives said that they knew how to make a complaint about the care provided by the home if they need to and said the home had responded appropriately if they or there cared for resident have raised any concerns. One relative told us they were not Care Homes for Older People Page 27 of 53 Evidence: sure how to make a complaint and staff usually respond appropriately to them if they have made comments or raised concerns. On our visit we were told about complaints relating to the laundry service provided at Rosemary care home and the loss of residents clothes. This detail was not recorded. So it couldnt be seen what the management had done to address these complaints.This is insufficient. The complaints and comments,the investigation and the outcome for the complainant need to be recorded.This will demonstrate that management take seriously the comments they receive from residents, their friends, visitors or staff. We were informed that a copy of Rochdales All Agency Safeguarding Adults Policy and Procedure was available.Having a copy of this should mean staff are aware of the procedures so that they can respond quickly and efficiently,to any suspicions or allegations of abuse as required by the local safeguarding adults policy. We have been made aware of one allegation of abuse before our inspection which was not reported by the owner to the local authority as it should be,at the time it was alleged,which does not protect residents. On our inspection we found further evidence that another allegation had been made and management had again not followed procedures. Failure to follow the set procedures does not protect residents and does not demonstrate that the management of the home has enough knowledge and experience to protect residents properly.Management and staff must be familiar with the policy so that they are clear about what they should do when an allegation is made. Five staff have now attended safeguarding adults training in the definitions of abuse and how to identify abuse. The remaining staff team must attend this training. The training should ensure staff are able to recognise potential abuse and be aware of what to do if abuse is alleged. The acting manager said that she was to attend this training with the local authority along with another senior member of staff on 8th September 2009. The acting manager needs to obtain some information about the Mental Capacity Act Deprivation of Liberty Safeguards and look into scheduling some training about this so she could arrange for herself and staff to attend. Care Homes for Older People Page 28 of 53 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Rosemary care home provide residents with a comfortable and clean environment in which to live. Evidence: A visitors book is placed in the hall and visitors to Rosemary care home are encouraged to sign in and out.This is to ensure that in an emergency situation,everyone in the building is accounted for. There are a variety of lounge areas to sit in on the ground floor with comfortable seating. A separate dining room is situated on this floor floor where the majority of residents had there meals.This provides residents with an opportunity to move around the home to have their meals. A combined dining and lounge area is available on the first floor, this room also has a television and residents were seen deciding what they wanted to watch.Residents said the home was clean and comfortable and they had everything that they need. The detail completed in the AQAA told us, we have a very clean environment, decor and furnishings are fresh and clean and in good repair. All repairs are carried out, gardens are maintained and kept safe. Care Homes for Older People Page 29 of 53 Evidence: A number of rooms are looking tired and would benefit from redecoration.There were no odours within the home.The house was fresh and clean. Bedrooms were personalised with items brought from residents homes.Some had a television and residents chose to spend time in the privacy of their rooms when they wished. On the day of our visit it was raining, the tiled steps leading to the front door were slippy which could result in someone falling.The owner said the tiling was supposed to be non slip.The acting manager said they could perhaps buy some rubber matting to place on the steps. A passenger lift is available to support residents getting upstairs to their bedroom. A number of bedroom doors didnt close properly into the door rebate. These doors are fire doors and should close sufficiently into the door frame to act as a barrier in the event of fire. Some bedroom doors had automatic closures on them and others had been removed. To ensure that the doors are sufficient for their purpose,checks need to be made to make sure the doors close and adjusted if and when this is needed to make sure they work properly. Some of the bedroom doors had locks fitted to them others didnt. Having a lock on the bedroom door promotes residents privacy and respect of their personal space. Door locks should be fitted to all bedroom doors. We were told that there isnt a master key system for bedroom doors but individual keys to these doors. This,in an emergency situation could delay access to a residents bedroom. The owner needs over time to replace these door locks with a type and design which has a master key system so there wont be any delays opening residents bedroom doors by looking for the correct key to fit the door. When we looked in the bathrooms and in some of the wash hand basins in residents bedrooms we noticed that they didnt all have a plug in the wash hand basin. This means that residents wouldnt be able to wash in the sink as it was intended. This needs to be remedied by the owner so that residents independence and respect is promoted and they are able to have a wash on their own when they want. We reported on our last visit that two of the bedroom doors on the ground floor were fitted with star locks which posed a risk of entrapment. We were told by the acting manager that these had been removed. We were also told that a risk assessment had been carried out for electrical appliances Care Homes for Older People Page 30 of 53 Evidence: in a resident bedrooms to make sure the resident health and safety was promoted.We reported last time we visited that the bath panel was broken in the bathroom on the first floor and needed replacement. The acting manager told us the panel still needed replacing. There are some large windows in the house and those which we tried had restrictors in place to safeguard residents.A window in one of the bathrooms has been overlooked and didnt have a restrictor fitted which needs to be. A couple of handles on the windows were broken so need to be repaired or replaced. We received comments from residents,visitors and staff with regard to the temperature of the water in bedrooms and bathrooms. In that it wasnt warm enough. We were told that the temperature is regulated to keep residents safe. When we tried a couple of the hot water taps in these rooms they were only running tepid after the water was running for a long period of time. The hot water temperatures do need to be regulated but also do need to be warm enough to promote residents comfort when having a bath,shower or wash. The expert by experience wrote,The decor was pleasant,light and provided a comfortable background.One lounge was dominated by a huge television screen, and I ate some humble pie,when a resident suggested that I should go away,and I then realised that she thought I was a new resident and I was interfering with her watching the Jeremy Kyle show.I definitely blended in.Continuing the expert by experience said, The home is on a busy road,providing constant changes of views for the residents, some of whom enjoy keeping watch.The garden is small. However,a newly built wooden gazebo and bridge has been erected, to make it more interesting. All communal areas,bedrooms and toilets were fitted with a call system.This enables residents to call for staff assistance or support. In one of the bathrooms the call system above the bath was very short so wouldnt be able to be reached by residents when they were using the bath. There was a call bell system next to the toilet in this room however the placement of the very short cord over the bath may detract residents from this fact. A relative told us that they visit there cared for relative three times a week and, I also visit there room which is spotless and comfortable etc We asked relatives what they thought the service could do better,one relative responded, I was going to say a conservatory or sun lounge outside for summer time Care Homes for Older People Page 31 of 53 Evidence: where residents can sit and rest. I have just left Rosemary and they are just starting to build a conservatory in the gardens of the grounds. A summer house has been erected in the garden. At the top of the stairs and on the landing areas on the staircase there were items stored there which could compromise the safety of residents and staff.These stored items need to be removed and staff given instruction that the staircases shouldnt be used as a storage area due to fire regulations. Care Homes for Older People Page 32 of 53 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment,selection and training procedures are not robust and compromise the safety of residents and staff. Evidence: The acting manager told us in the AQAA, we ensure a good skill mix of staff using older and younger male and female staff. All staff have been checked by CRB, POVA ,references receive induction and put onto any relevant training.We did not evidence this on the inspection. The expert in their report wrote, The staff were most pleasant and helpful, nothing was too much trouble. On the whole, the staff were good within the homes limitations. A relative told us,the staff always find time to talk to you. The owner employs a laundry assistant between the hours of 10:00am and 2:00pm for five days a week. At other times care staff and occasionally night staff carry out laundry duties. This takes care staff away from their caring duties. The current number of hours allocated to laundry services and the procedures for doing residents laundry needs to be reviewed with additional hours allocated so that residents laundry is washed in a timely manner and there clothes are returned to them. We were told by residents,staff and visitors that residents clothing often goes missing. Care Homes for Older People Page 33 of 53 Evidence: We looked in the laundry and some clothing was marked with the residents name or their initials. Other clothes were not marked with residents name. This may be one of the reasons why clothing goes missing. The acting manager told us that she had received complaints about the laundry service at the home. This laundry service is not always working effectively. To promote the respect of residents,the laundry service needs to be reviewed and changed to provide a more reliable service. We were told that the home is to purchase new washing machines. The current machines do have a sanitiser programme on them but the acting manager said the new ones should be more effective. The expert by experience made comments about the laundry service in their report, The laundry system appears as poor as it can get. Most unhygienic. Much clothing goes missing. There does not appear to be an adequate system in place. One residents clothes are washed by their relative, as she has had new replacement clothing disappear. I.e. three pairs of trousers and two expensive nighties. Recruitment and selection procedures should be in place to safeguard residents and offer a degree of protection to them.It is essential that the regulations be followed to promote this.We asked to look at all the staff files for people who had been appointed since we last visited Rosemary Care Home in June 2008. We were given six staff files to look at. Staff are routinely starting work without criminal record bureau disclosures having been received back.Staff should not start work until the POVA first check is back and should only work under supervision until a full criminal record bureau check is returned.Staff can start work in exceptional circumstances on receipt of the POVA first but only shadowing a member of staff. The manager must obtain a current Criminal Record Bureau certificate for all staff before they commence working at the home.This must be done before a new person starts work so that the manager can be sure they are suitable to work at the home. Failure to follow these regulations means that the manager does not know enough about someone in order to make a proper decision about whether they are suitable to work at the home.The practice of employing someone without the proper checks taking place first means that the manager does not fully safeguard residents from unsuitable people working at the home and reflects on the management of the home. Care Homes for Older People Page 34 of 53 Evidence: Newly appointed staff have not undertaken induction training to Skills for Care Specification which would assist staff in their understanding of residents and how to support them.The omission of this training compromises the care and support provided to residents.Induction training is vital to the success of staff recruitment and retention.The management should only confirm employment when they are satisfied that competence and progress has been shown to be satisfactory against these standards. For one staff file we looked at there was information provided in the criminal record bureau check which should warrant some discussion with the member of staff. Management at Rosemary Care home had not undertaken this essential discussion satisfying themselves about staff they are employing to ensure they are the right people for the job.This omission compromises the safety and wellbeing of residents. Management has a poor recruitment procedure with shortfalls in recording and processes being evident. Residents are not involved in the recruitment of staff. Staff are appointed and starting work without references or other important documentation being received.We made a requirement in June 2008 when we last visited thattwo written references must be obtained prior to new staff starting work at the home. This has not been complied with and is repeated at this inspection. To offer some degree of protection to residents this requirement must be addressed. Staff training had not been undertaken as is required.Some staff were not recorded as having undertaken updates to their moving and handling, fire drills and practice training,health and safety, infection control,or first aid for example.This compromises the safety of residents and staff.Staff must be provided with training to ensure they have the skills and knowledge to support residents.This must to be arranged to safeguard residents and staff. There was no comprehensive training plan and much of the training is out of date. There were no reliable records of staff training that had been undertaken. The acting manager told us that they had increased the number of care staff on duty during the day to support residents and ensure they have there needs met at a time to suit them. We were told that there are occasions when there are only three staff on duty which isnt enough. The acting manager said that they are working on four on a shift and for nine shifts the week of our visit this has been maintained. We did receive a complaint in March 2009 with regard to the number of staff on duty Care Homes for Older People Page 35 of 53 Evidence: which was passed to the owners to investigate. We were told in a letter signed by the acting manager at that time, Our aim is to have four members of staff plus managers.This will alleviate any further problems that any staff may have,however all staff mostly work to their contracted hours and only covering extra shifts when desperately needed,If the shifts cannot be covered we employ agencies.We are continually improving our care home staff levels and environment, to give our residents a better level of care. The level of staffing could severely restrict the ability of the home to deliver person centered support, or provide stimulation and activity that residents request. We did write earlier in this report that one resident did say they would like to have a walk around the home with the support of staff and residents commented that they didnt always have enough to do in the day and that staff are always busy. When we looked at the duty roster we saw that staff are sometimes working 14 hour shifts. Staff confirmed this on our visit. One member of staff said, staff working too many hours-14hours sometimes 2-3 times a week.We also saw on the duty roster that when staff are working these hours they are on occasions without days off in between. It is managements responsibility to make sure that staff are able to do there job well at all times during there shift. We were also told that staff go off the premises to have there un paid breaks.This means that at these times the number of staff looking after residents is reduced. One member of staff said, senior staff leaving the building to have breaks no senior in the building. The health safety and welfare of residents is the responsibility of management and they must ensure that staff are available to meet the needs of residents throughout the day and night. There was not a central training record but we did ask the acting manager on the visits to provide us with a list of all the staff and the training and the dates this was completed. The information provided to us identified 15 care staff working at Rosemary Care Home. Three staff were recorded as having achieved NVQ 3 qualifications.Two of these staff had previously obtained there NVQ 2 as well and a further three staff had been successful in obtaining NVQ 2. This means that 6 staff out of the total staff group have training to NVQ specifications. The national minimum standards indicate that there should be a minimum ratio of fifty per cent trained members of care staff (NVQ2 or equivalent) excluding the manager. This ratio is not currently achieved. A member of staff told us that they,would like to do NVQ 2 and have been promised since March 2009 and each month since but not done. Care Homes for Older People Page 36 of 53 Evidence: The management should put a high level of importance on training and staff should be supported through training to ensure they have the skills, knowledge and direction to do there job well.There should be enough qualified and competent and experienced staff to meet the health and welfare of residents. Care Homes for Older People Page 37 of 53 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home does not operate the service in the best interests of residents and their welfare is not promoted and protected. Evidence: The information provided to us in the AQAA completed in April 2009 said, we have obtained a new manager who is currently registering with CQC. And the home is also run by two owners and back by two further owners who are GPs. The (acting) manager holds a mental health work degree equivalent to Level 5 NVQ plus advance medication etc and is experienced. The owner is an RGN and is qualified to run the home. Any further training will be completed if necessary. Managers employed in care homes should be registered with the Care Quality Commission (CQC) This means that they have attended a fit person interview with the registration team at CQC and has satisfied them that the person has the skills, competence, knowledge, experience and qualifications to be registered. Care Homes for Older People Page 38 of 53 Evidence: Rosemary Care home do not have a registered manager. An acting manager is in post who we were told started in April 2009. The previous acting manager who was at the home from November 2006 to 6th March 2009 was again not registered. We were told on the inspection that an application had been put forward by the acting manager to CQC for consideration for registration as manager at Rosemary Care home. The acting manager told us that the application was returned due to some papers or missing information. We looked at how the manager was recruited.One of the references to support the recruitment procedure was not from a referee which was quoted on the job application form. A second reference confirmed the dates the acting manager had worked for a previous employer.We couldnt see any supporting information in the staff file that confirmed that the applicant had been in a senior management post. The acting manager said that she had an interview with the owner and his wife.There was no record of this taking place, or the questions asked by the owners to satisfy themselves that the applicant was the right person for this essential job. There was no evidence of the acting manager having received any induction training or of any meetings with the owners to discuss the role of management or any developmental supervision. It is the owners responsibility to ensure that when recruiting staff to whatever position in the care home the person have the skills, knowledge, qualifications and experience for the position they have been appointed to. There was no evidence that any supplementary checks had been made. The information seen in relation to the acting manager did not detail any management qualifications. A relative told us, communication its difficult to get answers sometimes particularly with staff change overs.We were told in a comment card, Confidentiality is broken when anything is passed onto the manager.A staff comment card told us, staff go out of there way to cater for the clients.This also applies to the owners. They are dedicated to the clients and their families. This shows in the hours they put in and the vast improvements they have made. We looked at the records and information the home keeps in relation to fire safety.Staff were not recorded as having taken part in fire drill training or practice.Staff not knowing what to do in an emergency situation could compromise residents and their own health and safety.To show that staff have received fire drills Care Homes for Older People Page 39 of 53 Evidence: and practice and they know what to do in an emergency situation,a record must be kept,with staff signing next to their printed name,when they have taken part in fire drill training and practice. Examination of the fire records identified that they had not all been recorded as having been completed at the regularity prescribed by the fire authority. The owners told us that they didnt undertake checks to the emergency lighting, means of escape, or fire fighting equipment.These checks must be undertaken regularly to ensure that equipment works so if it is needed in an emergency Rosemary Care home can be assured that the emergency lighting and means of escape are operational. Staff do not currently meet individually with their line manager on a regular formal basis to discuss their career development, the philosophy of the home and their training needs. This would assist staff in their development and identify any training needs.There is inconsistent supervision of staff with infrequent individual sessions and few staff meetings.We were told of occasions when the acting manager tells staff to undertake a task and the owners direct staff differently. Small amounts of money are managed by the care home on behalf of residents.There were small amounts of money held on behalf of some residents to pay for hairdressing and chiropody and such like. For two of the residents records examined, the acting manager had signed to say that she had given the resident some money. The manager had signed these entries,one of which was indicated on a different day and month to the one the acting manager told us she gave the resident this money. Residents whenever possible should sign when they receive monies from their accounts which would confirm their receipt. The way the monies are managed at the moment the acting manager has no confirmation that this money has been given to residents.The balances we checked between the records and the monies were accurate. The entries in these records were in the main for hairdressing or chiropody. There were no receipts in place to confirm these purchases. The acting manager told us that the hairdresser has a record book.To ensure that residents money can be accounted for receipts need to be obtained for all purchases made for all services and products. One entry in the record identified that some monies for one resident had been borrowed from another residents monies. This practice is not acceptable.The acting manager said that the owner has the money for this resident as this is paid by the local authority so there was no actual money to pay for the hairdressing the resident had received. There was no entries in this residents record since 28th April 2009. Care Homes for Older People Page 40 of 53 Evidence: Records accounting for residents monies should be maintained and accurately reflect the monies being paid in,any monies paid out and a balance. A relative told us that they received a receipt from the home for chiropody services as opposed to a receipt from a chiropodist and queried whether there cared for resident was in fact receiving a chiropody service. Under certain circumstances the home must tell us about residents as identified in the regulations. These are things like deaths or if a resident has an accident and goes to hospital.These are some of the things that the acting manager should tell us about routinely. We have not received notifications of the five deaths in the last 12 months that were quoted in the AQAA signed by the acting manager. We had received one notification of a death and an injury to one resident. The acting manager must report to us the things that affect the health and wellbeing of residents in a timely manner. A quality assurance and quality monitoring system has we were told in the past been in place. This is to obtain the views of residents and their relatives. There have been no recent questionnaires sent to residents or relatives, or other people who may wish to comment on the service provided at the home. This would provide Rosemary care home with information about peoples views about the home. To support staff to mobilise residents safely, individual residents are assessed to need the use of a hoist for these transfers. We saw on our visit that two residnets needed this type of support. The hoist is not currently in use.We were told the hoists hadnt been serviced. So to make sure residents were kept safe and staff were not using equipment that did not have a current service history they had been withdrawn from use. Staff were seen mobilising residents inappropriately putting themselves and residents at risk.The acting manager told us that the service engineer was coming to the home on the day of our visit which she confirmed as had taken place and that the engineers now there was a service agreement in place were coming to service the hoists the day after. To comply with health and safety legislation hoists should be serviced every six months and these service agreements should be updated and kept in check to make sure that such equipment is also checked at the right regularity. Care Homes for Older People Page 41 of 53 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 19 (1)(a) Two written references must 31/07/2008 be obtained prior to new staff starting work at the home. 2 31 9 (1) The manager must make an application for registration with the CQC. 31/07/2008 Care Homes for Older People Page 42 of 53 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 19 23 The stored items at the top of the stair and on the landings which is a route to be taken to reach the fire exit must be removed and staff given instruction that the stairwell must not be used as a storage area due to fire regulations. 01/09/2009 To promote the safety of residents, visitors and staff. 2 38 23 Provide all staff with fire drill 01/09/2009 training on their next duty at the home ensuring that all staff know what to do in the event of such an emergency. To ensure that fire equipment works undertake the checks to the means of escape, automatic door closures, fire extinguishers and emergency lighting systems at the regularity prescribed by the fire authority and record in the fire register on the day the date that these checks have been undertaken. To keep residents and staff safe. Care Homes for Older People Page 43 of 53 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Residents must only be 27/09/2009 admitted to the home on the basis of a full written assessment undertaken by people trained to do so. To make sure the home has the facilities, knowledge and staff have the right training to care and support residents properly and to ensure residents receive the correct care and support. 2 7 15 The registered person must 27/09/2009 after consultation with the resident or their representative prepare a written care plan on how the residents needs in respect of their health and welfare are to be met. To ensure residents receive the care and support they need at a time and frequency that is needed. 3 8 13 The registered person must 28/08/2009 ensure that hoists are available to support staff to mobilise residents safely and that these are serviced by a recognised and qualified person at intervals required by health and safety legislation. Care Homes for Older People Page 44 of 53 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure there are suitable arrangements to provide a safe system of moving and handling residents 4 9 13 The registered person must 27/09/2009 make sure that all staff who have the responsibility of administering medication are trained in medication practices and routines before undertaking this task. To keep residents and staff safe 5 18 13 Ensure that if or when allegations of potential abuse are made that these are actioned immediately by management and that the local authority adult protection procedures are followed. Provide all staff with training in adult protection so they are able to recognise signs of abuse and be aware of what to do if abuse is alleged. To support and promote residents safety and protection. 30/09/2009 Care Homes for Older People Page 45 of 53 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 6 27 18 The manager must make 02/10/2009 sure that there are sufficient number of staff on duty and on the premises. To maintain and promote the safety of residents 7 28 18 Ensure all staff have a criminal record bureau disclosure before they start work at Rosemary care home To provide safeguard to residents and staff and to comply with regulations 01/09/2009 8 29 19 Management must ensure that the recruitment and selection procedures are robust and are followed and two written references,are obtained before staff commence work at Rosemary Care Home. To safeguard residents and offer some degree of protection. 02/09/2009 9 38 37 The owner and or manager 02/10/2009 must refer to the regulations and make themselves familiar with them and in relation to regulation 37 notify CQC without delay which is followed up in writing of any death, any outbreak of any infectious Care Homes for Older People Page 46 of 53 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action disease, any serious injury or serious illness to a resident,any theft burglary or accident and any allegation of misconduct. To comply with regulations. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Make sure that residents care plans are up to date and are recorded as having been reviewed monthly or more frequently if the need is identified. The detail in the care plan should inform staff of the care needs of residnets and how and when he care needs are identified. Introduce a system to evaluate staff practice when administering medication to ensure staff are confirmed as continuing to be competent. Ensure this evaluation is recorded as having taken place. Ensure that staff follow the procedures when giving out medication which includes the signature of staff on the medication administration records or a recognised symbol indicating that the residents do not want there medication which must be completed on administration. This will confirm residents have taken there medication or decided they didnt want it and that the medication administration records are maintained accurately. To safeguard residents make sure that when entering handwritten details on the medication administration records that these are signed by the staff member making the entry and also signed by a second staff member to verify the medication has been correctly copied from the prescription. The medication records must clearly have written on them the regularity that the medication has been prescribed by 2 9 Care Homes for Older People Page 47 of 53 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations the doctor. When residents are prescribed creams or lotions these must be recorded when they are administered by staff to ensure that the creams or lotions are applied at the right frequency. Obtain a copy of the Royal Pharmaceutical Guidelines and read and review the homes medication policy.Make the Royal Pharmaceutical Guidelines available to all staff who have the responsibility of administering medication. To promote best practice ensure all controlled drugs medication is double signed within the medication administration records. The registered person must arrange for the medication records to be double signed by staff when administrering controlled drugs. 3 12 Liaise with residents and their relatives or friends to find out what activities they would like to take part in and provide these routinely.Ensure that activities undertaken are recorded to demonstrate what is available. Provide residents with opportunities to take part in activities and that these include what residents want to do either as a group or individual to the residents. Make sure that the activities include opportunities for residents to go out. 4 15 Provide residents with hot and cold drinks at all times which are offered regularly which should include providing residents routinely with a drink on rising. The owner needs to review the hours allocated to meal preparation, cooking and serving and provide support to the cooking staff to ensure they are able to do there jobs well and maintain the cleanliness and records needed to ensure correct standards in the kitchen. To further promote residents enjoyment of meals and provide them with a choice provide residents with the option of a cooked breakfast. Further develop the recording of food served to residents to Care Homes for Older People Page 48 of 53 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations include the breakfast and supper time meal they have eaten. A menu on the table would be good so residents could check what the meals were for the day or could act as a reminder to what they were having for their meal. Everyone should have nutritional screening as part of their needs assessment when moving into a care home and the outcome should form part of their care plan.Screening should be repeated periodically and whenever a residents needs change. To ensure staff have the knowledge and skills when preparing and or serving food they need to understand the procedures for food safety and attend food hygiene training or updates to make sure they know what they are doing and keep residents healthy and safe. 5 16 The management should arrange to have a complaints book or record in place which records all comments and complaints made by residents, their relatives or friends and staff, the investigation and the outcome of the complaint. To ensure that staff are aware and residents are protected the acting manager needs to obtain some information about the Mental Capacity Act Deprivation of Liberty Safeguards and look into scheduling some training about this so she could arrange for herself and staff to attend. Provide all staff with the opportunity to read the Rochdales All Agency Safeguarding Adults Policy and Procedure and ask that they sign that they have read and understood the content of the policies to ensure their familiarity with the procedures. To minimise the risk of falls or injury when entering the house from the front door, the owner needs to remedy the slippery steps in wet weather. Regular checks need to be arranged of bedroom doors,as part of the monthly checks to the means of escape to ensure that bedroom doors close sufficiently into their rebate and act as a barrier in the event of fire.The doors should be adjusted or repaired if deficiencies are identified. All bedroom doors should have a lock fitted so residents Care Homes for Older People Page 49 of 53 6 18 7 18 8 19 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations have a choice to lock there doors.The door locks should be a type and design which gives residents privacy and can be easily opened by the resident from the inside and can be over ridden from the outside in an emergency situation with a master key. The fitting of plugs to sinks in bathrooms and bedrooms needs to be remedied by the owner so that residents independence and respect is promoted and they are able to have a wash on their own when they want. Based on the assessment and vulnerability of and risk to residents, restrictors need to be fitted on all windows which have wide openings. A couple of handles on the windows were broken so need to be repaired or replaced. To prevent the risk of scalding preset valves of a type unaffected by changes in water pressure should be fitted and which have fail safe devices fitted locally to provide water close to 43 degrees centigrade. Regular checks need to be made of the water temperatures to ensure they remain within accepted and safe temperatures. 9 27 To promote the respect of residents,the laundry service needs to be reviewed and changed to provide a reliable service.The current number of hours allocated to laundry services and the procedures for doing residents laundry needs to be reviewed with additional hours allocated so that residents laundry is washed in a timely manner and there clothes are returned to them. Ensure that the needs of residents and their health and welfare are not been adversely affected by staff working for long periods.The manager should ensure that staff are not working for too long periods of hours during the day and that they are not working long hours throughout the week without time off. To safeguard residents and staff.Review all staff files to make sure they have all the information in them they should have when following a robust recruitment and selection procedure and ensure they have two written Page 50 of 53 10 28 11 29 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations verifiable references and that if they havent a criminal record bureau disclosure that these are all chased up and obtained for every member of staff employed at Rosemary Care Home.If on receipt of this information something is identified then this needs to be followed up using the homes procedures. 12 30 Ensure that a minimum of fifty per cent of staff have NVQ qualifications.Arrange for staff to attend NVQ trainiung at a minimum of NVQ 2 to ensure they are competent, qualified and have the skills knowledge and understanding to do there jobs well. Provide all staff with training or updates to their training in infection control, food hygiene,moving and handling, health and safetyand first aid. 13 30 Ensure that staff receive induction training to Skills for Care specifications within their first six weeks of employment to ensure they have the skills and knowledge to care for residents. Undertake training needs analysis for all staff and provide training to staff,which supports them to undertake their role and support residents needs. Provide CQC with an action plan of all planned training for staff and the planned dates they are to attend the training. 14 33 A quality assurance and quality monitoring system needs to be put in place,which includes obtaining views of residents and their relatives,professional visitors and health care staff and other stakeholders in an attempt to gain their views about Rosemary care home. To ensure that residents money can be accounted for,receipts need to be obtained for all payments and purchases made. The recording of residents monies needs to be improved upon to ensure that entries are made on the correct days and residents when they are given monies from their account when possible sign to say they have received the money. 16 36 Provide all staff with one to one supervision with their line manager at a minimum of six times a year to assist staff in Page 51 of 53 15 35 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations their development and identify any training needs. 17 38 Make sure that service contracts are in place for such equipmment as hoists and such like to ensure that this equipment is available for use when assessed as the way to mobilise residents Which in turn should keep residents and staff safe. To show that staff have received fire drills and practice and they know what to do in an emergency situation a record should be kept with staff signing next to their printed name when they have taken part in fire drill training and practice. 18 38 Care Homes for Older People Page 52 of 53 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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