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Inspection on 08/10/09 for The Rosemary Care Home

Also see our care home review for The Rosemary Care Home for more information

This inspection was carried out on 8th October 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

We found no significant examples of good practice when handling medicines.

What the care home could do better:

Records of medicines kept in the home must be clear, accurate and complete so that all medicines can be fully accounted for. Medicines must be given at the right and best time to help make sure they work properly and to respect people`s personal needs. Information about how `when required` medicines are to be used should be more detailed to help make sure they are given to people correctly. Suitable procedures for the auditing (checking) of medicines and assessment of staff competence must be put in place to help make sure staff have the necessary skills to handle medicines safely.

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: Simon Hill Date: 0 8 1 0 2 0 0 9 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: Conditions of registration: Category(ies) : Din T Vanat 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. 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. Care Homes for Older People Page 2 of 12 2 6 0 8 2 0 0 9 Brief description of the care home 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 12 What we found: We carried out this visit to make sure medicines were being handled safely because we found some shortfalls at a recent key inspection. The visit was carried out by a pharmacist inspector and it lasted approximately five hours. We checked medicines records, medicines stock and peoples care plans. Overall we found some shortfalls in the way medicines were being handled that were placing the health and wellbeing of people at unnecessary risk. When we checked the medicines records against medicines stock we found the system of stock control was not good enough to account for many medicines, notably those contained in traditional packets and liquid medicines. Medicines that were carried over to a new month were not recorded correctly and packaging was not dated upon opening so we found it difficult to check whether some medicines were being given to people correctly. Records of medicines received into the home were not always accurate and remaining stock from the previous month was not properly carried forward so current stock could not be easily checked. Medicines that were contained in the special packaging system supplied by the pharmacist were simpler to audit and our checks showed these were usually given correctly. We looked at the times medicines were given and found some medicines were not being given at the right and best time for people. Medicines that should have been given before food were given wrongly after food and some medicines that should be given last thing before going to bed were given earlier at 6pm, staff said this was because the medicines rounds had always been arranged this way. The deputy manager also said that no night staff were trained to give medicines so it was easier for day staff to try and fit all the medicines into the day time. Medicines should be given to people at the best time for them and should fit into their normally daily living routines and not be arranged for the convenience of staff. We looked at a sample of care plans and records to check if medicines were properly reflected in them. Although we found some care plans were detailed we also found some lacked important information. One person that was looking after some of their own medicines did not have a clear care plan in place. The original risk assessment had not been reviewed for over a year so there was a risk that they might not receive the right amount of support from staff to do it safely. Several people that were prescribed when required medicines did not have any information about how and under what circumstances they should be given including those used for pain, anxiety and as laxatives. We gave some advice about these issues and how to improve the paperwork because having clear written plans helps make sure people have their medicines handled safely. We checked how controlled drugs (medicines that can be misused) were handled. A secure cupboard was used for storage and a special register was used for record keeping and the entries we checked were usually witnessed, accurate and complete. We found one strong pain relief medicine was given a day late because staff had forgotten to do it, although this was normally well organised. Witnessed records and secure storage of controlled drugs help prevent mishandling and misuse. Care Homes for Older People Page 4 of 12 We looked at how medicines were audited (checked) and found no formal procedures in place so we gave some advice about how to carry these out and how to record them. We saw some certificates for medicines handling training and the owner said that further training was planned. Staff had not been formally assessed as competent but the deputy manager said this was planned and we gave some advice about how to do this. Regular audits, staff training and formal competency assessments help make sure staff have the necessary skills to handle medicines safely. What the care home does well: What they could do better: 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 5 of 12 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 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 Page 6 of 12 Care Homes for Older People 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 legislation. To ensure there are suitable arrangements to provide a safe system of moving and handling residents 4 18 13 Ensure that if or when 30/09/2009 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. 5 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. To promote the safety of residents, visitors and staff. 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 Care Homes for Older People Page 7 of 12 01/09/2009 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 safety of residents 7 28 18 Ensure all staff have a 01/09/2009 criminal record bureau disclosure before they start work at Rosemary care home To provide safeguard to residents and staff and to comply with regulations 8 29 19 (1)(a) Two written references must 31/07/2008 be obtained prior to new staff starting work at the home. 9 29 19 Management must ensure 02/09/2009 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. 10 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 Page 8 of 12 Care Homes for Older People 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 authority and record in the fire register on the day the date that these checks have been undertaken. To keep residents and staff safe. 11 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 disease, any serious injury or serious illness to a resident,any theft burglary or accident and any allegation of misconduct. To comply with regulations. Care Homes for Older People Page 9 of 12 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 9 13 Accurate records of all 12/11/2009 medicines kept in the home must be made. This will help make sure they can be fully accounted for. Suitable procedures for the 12/11/2009 auditing (checking) of medicines and assessment of staff competence must be put in place. This will help make sure medicines are safely handled by suitably skilled staff. 2 9 18 3 9 13 Medicines must be given at the right and best time for people. This is important to help make sure medicines work properly and to help make sure peoples needs are met. 12/11/2009 Care Homes for Older People Page 10 of 12 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 Information about how when required medicines are to be used should be more detailed to help make sure they are given to people correctly. Care Homes for Older People Page 11 of 12 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. 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. Care Homes for Older People Page 12 of 12 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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