Care Home: Rosclare Residential Home Ltd

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What the care home does well People living there said "I`m well looked after", "it`s very nice", "beautiful", "not bad" and "I like it". "I have nothing but praise for the care home", "What I like best about Rosclare is its warm and friendly atmosphere", "More care and support is given to my relative than I ever thought possible in a care home" and "I don`t think it can improve - so good already" were comments from relatives or friends. The home is well run and the manager provides clear leadership to the staff team. Staff members receive a good level of training and clearly work well together. The service is a comfortable, homely and friendly place for people to live. The friendly atmosphere was commented on by both the people who live there and their relatives or friends. What has improved since the last inspection? A number of comments received from relatives or friends of people all centred on improvements made in the staff team. These included "I have seen a marked improvement in this area over the last year" and "the care manager and her staff are very friendly and approachable". Procedures for managing medication have been improved. The call bell system has been replaced and now works properly. All the Requirements we made at the May 2007 inspection have been addressed. What the care home could do better: The challenge for the home is to continue to make progress and build on the good work completed in recent months. The service should continue to make the care and support provided even more person centred. Developing occupation, engagement and purpose should be seen as equally important to the support given with physical care. The systems for staff supervision need development. CARE HOMES FOR OLDER PEOPLE Rosclare Residential Home Ltd 335 Ewell Road Surbiton Surrey KT6 7BZ Lead Inspector Jon Fry Key Unannounced Inspection 10:15 23 & 30th May 2008 rd X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosclare Residential Home Ltd Address 335 Ewell Road Surbiton Surrey KT6 7BZ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8390 4183 merci@sky.com Rosclare Residential Home Ltd Evelyn Elkins Care Home 19 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories 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 2. Dementia - Code DE The maximum umber of service users who can be accommodated is: 19 31st May 2007 Date of last inspection Brief Description of the Service: Rosclare provides care and accommodation for nineteen older people including up to eight people who may have dementia. The home is situated in a residential area on the borders of Surbiton and Tolworth. It is close to public transport, churches, leisure facilities and local shops. The home has nineteen single bedrooms, eleven of which have en-suite toilets. A copy of the home’s Statement of Purpose and Service User Guide can be obtained on request from the home. Current fees range between £510 and £535. Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection was carried out by one inspector who spent seven hours in the home over two separate visits. The inspector talked individually with seven people living at the home. One relative or friend of an individual were also spoken with during the inspection. A number of records were examined and discussions took place with the manager and two staff members. Completed surveys were received from seventeen people living at the service, seven relatives or friends of a person living at the home and two care professionals. The home sent us an annual quality assurance assessment (AQAA). This is a self-assessment that gave us information on how well outcomes are being met for people using the service. What the service does well: What has improved since the last inspection? Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 6 A number of comments received from relatives or friends of people all centred on improvements made in the staff team. These included “I have seen a marked improvement in this area over the last year” and “the care manager and her staff are very friendly and approachable”. Procedures for managing medication have been improved. The call bell system has been replaced and now works properly. All the Requirements we made at the May 2007 inspection have been addressed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Good information is made available to people about the home. Assessments are completed before individuals move in to make sure that their needs can be met. EVIDENCE: “The social worker found it”, “I’ve no idea – I was staying somewhere else” and “my family found it for me” were some comments from individuals about how they came to live there. 76 of people who returned surveys said they had enough information to help them decide if the home was the right place for them. The home encourages day visits and gives out an information brochure to help people make a decision about using the service. The brochure has some pictures of the home and it’s facilities. A Statement of Purpose is made Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 9 available which contains information about the service provided and this can be provided in large print if requested. We have recommended that more pictures of the staff and the local facilities be included to help make sure the information can be used by as many people as possible. The manager will visit people in their own home or in hospital to carry out an assessment to make sure that the home can meet their needs. The assessments held by the home for two people were looked at. We saw that some good information was captured in these but the format in use limits the information that can be recorded. The manager told us that they were already looking at trying out a different assessment form. Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans have been improved and now provide much more detailed individualised information. Arrangements for the handling, storage and administration of medication are good. EVIDENCE: Comments from people who live at the home included “I’m alright – I’m not on my own”, “I’m well looked after”, “very helpful” and “I’m looked after too well really”. In surveys, 47 of people said they ‘always’ got the care and support they needed. 29 said ‘usually’ and 24 replied ‘sometimes’. Relatives or friends of individuals said “they treat my relative as an individual”, “my relative has improved enormously since the move there” and “a lot more care and attention being given”. Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 11 We looked at the care plans for two people and saw that the information provided has been improved since the May 2007 inspection. Care plans include headings like ‘what information I would like people to know about me’ and ‘things I would like you to help with’. We saw that some good detail has now been included which is specific and individualised. The daily care plans in particular had some lovely detail written from the point of view of the individual – ‘I get up at 8.30 each morning’ and ‘for breakfast I like a pot of tea’. A care professional said that they thought the care plans were “clear and holistic”. Areas we saw that could be developed include further expanding life histories in the care plans or starting individual life story books for each person living there. This may be particularly important for people with dementia. We think that staff should look at daily notes they write. These were sometimes very repetitive and also included some negative or labelling language about the person. The focus needs to be on good quality information about the individual which can then be used to review and evaluate the support being given. “They call the doctor if you ask” and “If I need it, they’ll call the GP” were comments from people who live there. We saw that people are supported to access local healthcare services and good records are kept of individual appointments. One care professional said “the health is monitored and staff assist in a timely fashion”. Medication procedures have been improved. Administration records are kept well and items of medication are correctly stored. Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are given the opportunity to take part in a variety of activities. Individuals enjoy the food provided. EVIDENCE: “We have activities and the odd outing”, “I’d like to do more”, “there’s enough to do”, “I don’t want to do much – I’m quite happy” and “not a lot to do really” were the range of comments received from the people who live there. Relatives or friends of individuals said “Provides stimulation, good food and friendly support” and “it involves family and friends in activities”. A care professional told us that the person they were involved with was “encouraged to take part in choosing social activities”. We saw that the home provides regular organised activities including ball games, skittles, singalongs, afternoon walks, a film club, bingo and Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 13 reminiscence. One member of staff has responsibilities for organising the programme and they have attended some training in this area. Trips out have been arranged to the seaside, the zoo and to a tea party arranged by a local grammar school. Both staff we spoke to said that people are regularly supported to go the local park or shops nearby. The home told us in the AQAA they sent us that people are given the opportunity to take part in the life of the home such as preparing vegetables, washing up or folding linen. This is important to provide people with purpose and occupation and we have recommended that the home continues to develop these opportunities for everybody living there. Other ideas to try could include rummage boxes, ‘work activities’ and developing links with the local adult education centre. Comments about the food included “very good”, “sometimes good, sometimes average”, “quite good”, “the food’s nice”, “good grub” and “you have what you like”. 59 of people who returned surveys said they ‘always’ liked the meals at the home. 29 said ‘usually’ and 12 said ‘sometimes’. When we visited, people living there looked to enjoy the mealtime and the food being served. The meal choice was written up on a whiteboard by the dining room and the manager said that they were in the process of developing picture menus for the people living there. Another idea being tried was having people serving themselves at the table from serving bowls. A four-week revolving menu is in place. We have recommended that the menu is regularly reviewed and different ideas tried such as international meals, buffets, recipes from people who live there or recipes from the past. Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns about the care provided are listened to and acted on. The home understands the procedures for safeguarding adults and trains staff in how to do this. EVIDENCE: People who live there told us that they would speak to staff or their relatives if they were unhappy about anything. Comments included “I would speak to the manager if I have a problem” or “I would speak to one of the girls here”. In surveys, 65 of people knew how to make a complaint while 35 said ‘no’ in answer to this question. As stated previously, more use of pictures within the user guide may help make the complaints procedure more accessible to people. Records are kept of any concerns or complaints received and we saw that these are well maintained. The complaints policy and procedure is part of the guide for the people living there. We have again recommended that this procedure be displayed in a large print or picture format. Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 15 The home has a copy of the Royal Borough of Kingston Council’s Safeguarding Adults procedures. Care staff receive training around Safeguarding Adults as part of their induction to the service. Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home generally enjoy a clean and comfortable living environment. EVIDENCE: We saw that the home generally provides a pleasant and comfortable place for people to live. People we spoke to were happy with the environment. People can bring smaller items of their own furniture and personalise their rooms to their taste. We saw individuals using the well kept garden which is a nice place to spend time when the weather allows. We saw that the home is generally kept in good decorative order. We have recommended that the owners consider updating the bathrooms as part of the Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 17 ongoing programme of refurbishments. These areas could be made even more comfortable and homely for the people living there. One relative or friend of an individual said “it’s a very clean home”. This was the case on both days we visited. Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are provided with the training they need to do their jobs. In order to safeguard people who use the service appropriate checks are carried out on staff before they start working in the home. EVIDENCE: “They’re nice”, “excellent”, “fine”, “very very good” and “ok” were comments about the care staff from people who live there. 47 of people said that staff are ‘usually’ available when needed. 41 said ‘always’ and 12 said ‘sometimes’. Comments from care professionals included “friendly approachable staff” and “service user treated with respect at all times”. As stated in the summary of this report, one of the areas that relatives or friends commented on was the improvements in the staff team over the past year. We looked at the records kept for three members of staff. Recruitment checks are completed and these include a Criminal Records Bureau (CRB) check. Staff Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 19 are offered training in a number of topics and we saw that recent training had included dementia care, medication and abuse awareness. Some staff have the NVQ Level Two or Three qualification and training for other staff members is ongoing. Very good records of induction training are kept for new care staff and these are mapped to the Skills for Care Common Induction Standards. Each member of staff has their own personal development portfolio and training needs are regularly looked at by the home. Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is well run. There are good arrangements to make sure that the health and welfare of people using the service is protected. EVIDENCE: We received very positive comments about the manager from relatives or friends of people who live at the home. Comments included “due to the new care manager and staff, the care home has improved in the last year and I hope it will continue to improve” and the manager “plays a large part in the improvements that have taken place”. Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 21 A system for staff supervision is in place which means that staff can meet with their manager to discuss their work. We saw that many of the supervisions recorded were in group sessions and we have strongly recommended that each staff member is able to regularly meet with their line manager on an individual basis. Meetings are regularly held to consult with people who live at the home. At the last meeting in May 2008, individuals had been asked about menus, visits from a local Church minister, postal votes and planned trips out. An annual development plan is in place for the home. We looked at the financial records for two people. The home only keeps small amounts of cash for individuals and the records checked were correct and up to date. Health and Safety is generally well managed. Records are kept for regular checks on the fire system, call bells and water temperatures. Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 2 X 3 Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP3 Good Practice Recommendations The user guide to the home could include more pictures of staff and local places. The assessment format should be reviewed to make sure that good quality person centred information is recorded. This can then be used to inform the care plan from when the individual moves in. The service should continue to look at expanding individual life histories within the care plans. Life story books could be developed with individuals and their family or friends. These books could then be used to help communication and engagement. Staff may wish to develop their own life story books to share. The content of daily notes should be discussed to make sure that good quality and useful information is being recorded. 3. OP7 4. OP7 Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 24 The use of negative or labelling language should be reviewed within care plans and daily notes. 5. OP12 The home should continue to look at how care staff could be involved in the provision of social and emotional care. The service should develop opportunities for individuals to be involved in the daily life of the home. 6. OP15 Menus could be presented in picture format. Menus should be regularly reviewed with the people who live there. Ideas such as international meals, buffets, recipes from people who live there and recipes from the past could be tried. 7. 8. OP21 OP36 The bathrooms could be updated to be more comfortable and homely for the people who live there. Staff should have regular opportunities for 1-1 supervision with their line manager. Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rosclare Residential Home Ltd DS0000067005.V364770.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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