Random 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 zero star poor service 26/08/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Lucy Burgess Date: 2 9 0 3 2 0 1 0 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): Name of registered manager (if applicable) Din T Vanat Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 27 Number of places (if applicable): Under 65 Over 65 27 old age, not falling within any other category Conditions of registration: 0 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.
Care Homes for Older People Page 2 of 13 0 8 1 0 2 0 0 9 Brief description of the care home The home is in the centre of Milnrow and is close to local shops and pubs. It provides good access to the motorway network. Accommodation is provided 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 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 3 of 13 What we found:
This was a Random Inspection carried out by an inspector and pharmacy inspector. The purpose of the visit was to look at what improvements had been made following our Key Inspection on the 3 February 2010. The home had previously been inspected in August 2009 to follow up on concerns that had been raised with us. Following this visit the quality rating for the home was reviewed and changed to 0 stars, providing poor outcomes for people living at the home. A number of requirements were made ensuring the safety and protection of people living at the home. Due to concerns in relation to medication practice we also made a referral to our pharmacy inspector requesting they visit the home to audit the medication system. A random inspection was undertaken by our pharmacy inspector in October 2009. At that time we found several areas that required improvement to ensure the system in place was safe and kept people for harm. We then carried out a Key Inspection at the beginning of February 2010. Whilst some of the previous requirements had been addressed the lack of progress in other areas gave us cause for concern. Our pharmacist again visited the home and found that no improvements had been made. The quality rating was again reviewed after our visit and remained unchanged, 0 stars, providing poor outcomes for people. Following this visit we conducted a management review to discuss the outcome of the inspection and consider what further action we need to take. This included up to date accounts being requested from the Owners so that we could look at the viability of the home. We also sent a Warning Letter stipulating further areas of compliance that must be addressed. Prior to this visit we received some information about the management and conduct of the service. We were also advised that the acting manager had been dismissed following our February inspection. It was concerning to note that a further manager has again ceased employment at the home. This means there have been 3 different managers over the last year and does not provide clear leadership or continuity to both staff and people living at the home. Nor does it demonstrate that a thorough and effective recruitment process has been undertaken and that effective working relationships have been established between the Registered Provider and the manager ensuring the safety and protection of those living at the home. The Registered Provider has been advised that failure to have a manager in place could reflect on their fitness, which may result in further action being taken. We have also received concerns from people about the management of residents personal monies. Due to this we have made referrals to the Local Authority in line with their Safeguarding procedures. Other individuals had also contacted the Local Authority directly with their concerns. These are currently being investigated. To complete this inspection an inspector and pharmacy inspector carried out a site visit to follow up on those requirements made during our Key Inspection in February 2010 and detailed within our Warning Letter, dated 8 March 2010. Prior to the visit we received an improvement plan from the Registered Provider outlining what action they were to take to address the
Care Homes for Older People Page 4 of 13 requirements made at the Key Inspection. Information provided was minimal and lacked detail. This was discussed with the Registered Provider during our visit and additional information was requested. During the visit time was spent with the Registered Provider and Deputy Manager discussing the requirements made. We also spent time looking at records, the environment, staffing rotas, training and development, discussing meal arrangements and areas of health and safety. A full audit was also carried out in relation to medication. We were advised that recruitment had taken place with regards to a new manager for the service. An applicant has been offered the position pending satisfactory references and criminal record check. We were told that the home is presently being managed by the Deputy Manager and Registered Provider. We found that the Deputy Manager had been working hard to address some of the requirements made during our last visit particularly in relation to medication, staff training and development and staff supervision. As part of the visit a pharmacist inspector checked how medicines were being handled because we found some serious shortfalls on our last two visits. We checked medicines records, medicines stock and looked at a sample of care plans. Overall we found good improvements in the handling of medicines that meant they were now being given and recorded in a much safer way. Records of medicines received into the home, given to people and disposed of were usually signed and up to date. A new running stock balance system had been introduced and this had helped staff organise and give medicines in a much safer way. The deputy manager now carried out regular recorded checks weekly and monthly to make sure care staff were giving and recording medicines correctly. These checks were efficiently carried out and when any mistakes were found action was taken immediately to help prevent them happening again. All care staff that handled medicines had their competency formally assessed by the deputy manager and appropriate action had been taken against staff that failed to follow the policies and procedures of the home. Medicines records were now being completed more accurately and we saw a general improvement in the handling of medicines stock. We saw an example of good practice when staff were not waking people to give them their medicines but were returning later in the morning when the person was ready to take them. We saw new paperwork to support the use of when required medicines such as painkillers and laxatives and gave some further advice about how these could be developed so there is a clear plan in place. Our detailed checks of the current stocks and records showed medicines were usually being given to people correctly. Medicines that needed to be given before food were now usually given at the right time because a pre mealtime medicines round had been properly organised. Giving medicines at the right time helps make sure they work properly. We looked at how external medicines such as creams were applied and recorded. The records were now being used correctly because care staff were signing them straight after applying the creams. The deputy manager was regularly checking the records and creams to make sure care staff were following the correct procedures. This is a good improvement from our last visit that helps make sure these medicines are used properly.
Care Homes for Older People Page 5 of 13 We checked how controlled drugs (medicines that can be misused) were handled. The cupboard used for storage was suitable and we saw complete and accurate records. Secure storage and accurate records help prevent the misuse and mishandling of controlled drugs. Information in relation to staff training and development showed that arrangements had been made for members of the team to attend training provided by the Local Authority. Course had been booked and confirmed between April 2010 and September 2010 and included mandatory health and safety courses, dementia care and deprivation of liberty safeguards. Further sessions had also been arranged in relation to continence care. These are to be provided by the homes supplier. Staff rotas were also examined. Due to concerns raised with us, we requested that the Registered Provider send us copies of the rotas at the end of each week. We looked at staffing arrangements for the 6 weeks prior to our visit. Records showed that in addition to the Deputy Manager there were generally 3 carers on duty throughout the day and 2 wake in night staff. However on some days we found that there were shortfalls. We also found that copies of rotas provided to us did not reflect the same information as original documents seen at the home. The Registered Provider must ensure that sufficient staff are provided at all times ensuring people are kept safe. They must also ensure that records accurately reflect the arrangements in place. Further discussion was held with the deputy manager in relation to changes within the team. Since our visit in February the handyman who was due to commence employment was not started. One of the carers had also recently terminated their employment. The deputy manager explained that further recruitment was taking place and 3 staff, 1 bank and 2 permanent workers had been appointed. We were advised that all relevant checks were being sought prior to them commencing at the home. We also asked what checks were undertaken with regards to agency staff who have been working at the home. The homes recruitment procedure details that confirmation is sought from the agency ensuring relevant checks have been carried out prior to their staff working at the home. The Registered Provider stated that this had been done verbally, however there was no evidence to support this. This must be done to ensure people are kept safe. Records were also seen in relation to staff supervision. The deputy manager had commenced bi monthly sessions with all of the care staff and records completed. At present ancillary staff are not being supervised. This was discussed with the deputy manager and arrangements are to be made to address this. Meal arrangements were also looked at. We spoke with the cook about food deliveries, stocks and choice of meals provided. The cook told us that there were no issues with regards to the supply of food items. Fresh meat, milk and vegetables were provided each day with weekly shopping undertaken for all other items. The cook also explained that petty cash was now held by the two cooks so that they could purchase any items when needed. We asked the cook about meals options provided throughout the day. Fresh vegetables are provided as well as homemade soup, cakes and pastries. There is a choice of two
Care Homes for Older People Page 6 of 13 meals for both lunch and dinner. The lunchtime meal was observed and 3 residents were spoken with. Sufficient portions were offered and the meal looked appetizing. Residents expressed we enjoy the meals, we get plenty, they give me too much Im putting weight on and the cakes are beautiful. We again looked at the environment to see what improvements had been made. The Registered Provider had been asked to send us a redecoration and refurbishment plan detailing how they intend to improve the standard of accommodation. This was not provided. A brief statement had been added to the improvement plan however this too lacked any detail about the homes plans. We found that there had been no improvements made since our last visit. The Registered provider was again informed that he must provided us with a detailed refurbishment and redecoration plan, which we will review during future visits to the home. Other areas in relation to quality assurance and policy development still need to be expanded upon. Information provided by the Registered Provider, on the improvement plan, stated that questionnaires had previously been distributed and new policies in relation to Mental Capacity and Deprivation of Liberty Safeguards had been implemented. However we found that the Registered Provider had not introduced new policies mistaking these for the Adult Protection Policy already in place. Nor does the Provider appear to understand systems of reviewing the quality of service provided. The Provider is asked to refer to the Standards and Regulations when developing this area. What the care home does well: What they could do better:
The Registered Provider was advised of our on going concerns in this area and the need for this to be completed as soon as possible along with their application to register with us. The Registered Provider was asked to formally write to us detailing the current management arrangements in place, delegated responsibilities and timescale for commencement of the new manager. This will be followed up. The completion of planned training as well future training plans will be monitored as part of our inspection process ensuring staff have the knowledge, skills and competences needed to carry out their duties safely. Accurate rotas are maintained and evidence that there are sufficient staff on duty throughout the day. The use of tipex should also cease. Were changes are made these should be crossed out and amended. The Registered Provider must continue to provide these to CQC on a weekly basis so that we can monitor staffing levels at the home. Care Homes for Older People Page 7 of 13 Written confirmation of all relevant recruitment checks should be sought by the home prior to agency staff taking up shifts ensuring they are suitable to work at the home so that residents are kept safe. Care plans and information about the use of when required medicines should be further developed to help make sure they are used correctly. A detailed redecoration and refurbishment plan must be developed covering all areas within the home. Information should also include timescales for completion. Particular attention must be given to room 11 without further delay. This room is in a poor condition. Suitable arrangements must be made in relation to the damp and poor floor covering. Progress in this area will be monitored during our future visits. Systems need to be developed to monitor and review the quality of service provided ensuring the home is conducted in the best interests of those living at the home. Policy and procedure in relation to Mental Capacity and Deprivation of Liberty Safeguards need to be implemented along with relevant training ensuring practice within the home is safe and peoples rights are protected. 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 set out on page 2. Care Homes for Older People Page 8 of 13 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 18 13 Policies and procedures and documentation in relation to Mental Capacity and Deprivation of Liberty Safeguards need to be implemented ensuring, where necessary, all appropraite action is taken to protect people living in the home. 30/04/2010 2 19 23 The providers need to 30/04/2010 provide a redecoration and refurbishment plan showing how they are to improve the standard of accommodation so that people are able to live in a home which is comfortable and well maintained. 3 26 13 Suitable waste bins need to be provided to ensure safe practice and minimize the risk of any cross infection. 30/03/2010 4 31 9 The registered person must ensure that an application is made by the manager to register with us, so that the home is provided 30/04/2010 Care Homes for Older People Page 9 of 13 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action with clear, consistent management. 5 33 24 Systems must be developed with regards to monitoring and developing the service so that people feel confident that they will receive a good quality service. 30/05/2010 Care Homes for Older People Page 10 of 13 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 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 27 18 The Provider must ensure 30/04/2010 that sufficient staff are provided throughout the day and this is clearly reflected on the rotas. This is to ensure that the needs of people living at the home can be safely met. 2 30 18 The completion of planned 30/05/2010 training as well future training plans will be monitored as part of our inspection process ensuring staff have the knowledge, skills and competences needed to carry out their duties safely. 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 9 Care plans and information about the use of when required medicines should be further developed to help make sure they are used correctly.
Page 11 of 13 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 2 27 The Registered Provider must continue to provide weekly rotas to us so that we can monitor staffing levels at the home. Written confirmation of all relevant recruitment checks should be sought by the home prior to agency staff taking up shifts ensuring they are suitable to work at the home so that residents are kept safe. 3 29 Care Homes for Older People Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 13 of 13 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
