Care Home: Rosecroft

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Rosecroft 39 Carter Road Drayton Norwich Norfolk NR8 6DY The quality rating for this care home is: 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Judith Last Date: 0 8 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. They reflect the things that people have said are important to them: 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 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 43 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 43 Information about the care home Name of care home: Address: Rosecroft 39 Carter Road Drayton Norwich Norfolk NR8 6DY 01603861356 01603864449 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Care Management Group Ltd (trading as CMG Homes Ltd) Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 3 Number of places (if applicable): Under 65 Over 65 3 3 0 0 learning disability physical disability Additional conditions: Date of last inspection 0 6 1 1 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 43 A bit about the care home Rosecroft is a care home providing personal care and accommodation for up to 3 younger adults with a learning disability. The service users may also have a physical disability. Care Management Group Limited, whose registered office is located in London, owns Rosecroft and four other small homes around Norwich. The home is located in a residential area on the outskirts of Drayton and close to the city of Norwich. Local amenities, shops and pubs are also close by. The home consists of an adapted bungalow. All bedrooms offer single occupation and none of them have en-suite facilities. There is ample communal space. Care Homes for Adults (18-65 years) Page 5 of 43 Limited off-road parking is available. The fees for this organisation are based on the amount of care the service users need. This is currently 729.00 to 1345.89 pounds weekly. Care Homes for Adults (18-65 years) Page 6 of 43 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: Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 43 How we did our inspection: This is what the inspector did when they were at the care home harges for the service vary according to peoples needs. The currently start at 600 pounds a week. We reviewed all the information we had about the service, including the information we asked the manager to send to us before we went. We also had written comments from three members of staff. We had two surveys completed by the people who live at the home but it was clear from the information staff helped to record, that they had not clearly understood the questions. Care Homes for Adults (18-65 years) Page 8 of 43 We visited the home and spent five hours there. One person was not able to communicate with us. The other person found it difficult to make themselves understood, so we listened and observed what was going on During our visit, the main method of inspection we used was case tracking. This means we look at records to see what they say about peoples needs. We then find out from discussion and observation what happens in the daily lives of people living at the home. This helps us to see what outcomes they experience. Care Homes for Adults (18-65 years) Page 9 of 43 We also looked round part of the home, tried to communicate with people living there spoke to staff, and listened to and watched what happened in the home while we were there so we could see how well people were being supported. We used this information and the rules we have, to see how well people were being supported in their daily lives. What the care home does well Care Homes for Adults (18-65 years) Page 10 of 43 People who are thinking about moving to the home have information gathered about all their needs and the opportunity to visit before they decide whether to move in. This helps everyone decide whether the home is suitable. People can keep their own rooms how they like them, and have their own possessions around them. The home is comfortable. Staff try hard to communicate with people. The things we saw and heard showed that the people living at the home are comfortable with staff and get on well with them. Staff were able to tell us about some of the ways people communicate, when they are not able to speak. Care Homes for Adults (18-65 years) Page 11 of 43 Staff help people to go out and to go on holiday. Staff work hard to help people to stay well and to help them see health professionals. They follow up concerns about peoples health so that if they need treatment, they can get it. The company monitors the quality of the service regularly and tells the manager what she needs to do to improve things. Care Homes for Adults (18-65 years) Page 12 of 43 What has got better from the last inspection The manager has started the training she needs to help her run the home effectively. She is going to apply to register with the Commission. One person has moved out who had some behaviour that was difficult to manage. This meant that staff had to spend a lot of time with that person. They can now spend more time with the people still living there to help them do the things they want to do. The way medicines are managed has improved and there are full and accurate records. This means that the manager is able to show people receive the right medicine at the right time and in the right dosage. Care Homes for Adults (18-65 years) Page 13 of 43 All of the reports that the company representatives complete, about the quality of the service, were up to date and available so the manager had them to refer to when she is planning what needs to happen to improve things. What the care home could do better While we were at the home, most of our concerns were about things to do with safety of people living there. Sometimes, the ways to identify and reduce risk did not clearly take into account peoples individual needs. Also, the measures in place to reduce risk in one case, were not being followed. This means peoples safety could be compromised unnecessarily. Staff were still using a bath seat that had failed its test at the beginning of August, and was labelled to say do not use. The companys own audit says it should have been replaced in April. The regional director and manager did something about that while we were there, but we were very concerned it had not happened sooner because people using the equipment could be at risk. Care Homes for Adults (18-65 years) Page 14 of 43 Staff do not have clear guidance about the use of peoples individual monies and this has led to it being used improperly to fund administrative costs and to people subsidising one another. This means that measures are not sufficiently robust to ensure people are protected from financial abuse. The manager could not show us the information we needed about staff, although we know that the company generally has good systems for checking people are suitable to work with vulnerable adults. Staff are not being supervised as often as they should be, so they can discuss their work and the manager can be sure they understand their roles and the philosophy of the home. The manager can tell you in detail what we have said must happen, and what we have suggested should happen to improve the quality of the service. Care Homes for Adults (18-65 years) Page 15 of 43 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Judith Last 33 Greycoat Street London SW1P 2QF 02079792000 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 16 of 43 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 17 of 43 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Although work is in progress, there is still a shortfall in the information that prospective service users, or their representatives, would need to make an informed choice about the services the home offers. However, people can be sure their needs will be assessed and there will be opportunities to visit so that everyone can see if the home is able to meet their needs. Evidence: The statement of purpose and service users guide are not currently available because they are being reviewed by head office following a change of company structure. We know this from other services in the group. We have not repeated the requirement because we know the work is now in progress. The manager says there is some very basic and simple information in pictures about the service, issued by head office when people enquire, but she was not able to show us this. There are systems to provide for collection of information about peoples needs, including a visit by the manager and a member of head office assessment team. The manager is aware of the importance of ensuring these are properly and fully assessed, particularly in relation to how a prospective service users needs were in relation to the Care Homes for Adults (18-65 years) Page 18 of 43 Evidence: needs of others already living at the home. There is an introductory process so people can make short visits to meet other people living at the home, the staff and have a look round the home. This means people would be able to see for themselves what it might be like to live there. Recently there have been difficulties because the needs of someone (now moved) impacted adversely on the quality of life for other people living there. The manager says a process of introduction to the home will be used to make sure that this does not happen and that the person (as well as the service) can decide if it is the right place for them. Care Homes for Adults (18-65 years) Page 19 of 43 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 . People could be more involved in making decisions about their daily lives and planning their care. Support plans need to reflect changes in need promptly, so staff are always clear about the help people require to meet their current needs. Evidence: We looked at plans for both people living at the home. We were not able to discuss this with people living at the home in any detail. One person has complex communication needs and one person communicates verbally but with considerable impediment. (Staff who know this person well can understand what they are saying.) Each person has their likes, dislikes, needs and strengths assessed and there are individual action plans developed from these. However, it is not always clear that information is up to date. For example, information about communication for one person is dated January 2006 and was set out by the persons previous placement. There is one handwritten comment added to it since the person moved to Rosecroft but this is not dated. Other support plans include written comments but with no date. However, all three staff who wrote to us, feel that they always have up to date Care Homes for Adults (18-65 years) Page 20 of 43 Evidence: information about peoples needs. Peoples goals are reviewed regularly. However, as before, they repeatedly show no change over prolonged periods. For example, one person has a long term goal to dress and undress without supervision but there has been no change in the plan indicating progress for well over four years. We recommended last time that goals be broken down into smaller steps for people but this has not happened to help identify peoples progress in practising or learning skills and working towards their potential. One persons communication is recognised as difficult. Information about the persons ability to manage emotions is dated January 2006, from their previous placement. This says the person does not appear to show any emotions but we know when X is happy. We asked a staff member on duty how they knew when the person was happy with an activity on offer, or a meal that was being presented. They gave an account that included the sounds the person made and their body language. This indicates that staff do understand some of the ways the person might express themselves even though it is not reflected in the support plan. Some parts of one persons plan - who can speak - do record quotes from the person about what they have said in response to discussion of the information. However, there are no pictures or symbols that could be used to help people with communication difficulties as reminders for activities, skills and goals that they are working towards or to help make choices. The manager says she has plans to develop this further. There are risk assessments for activities and these have been simplified so that they are easier to follow. We did see staff following one risk assessment when they are helping a person off the trampoline. This task is set out as needing two staff and we saw this happen so the persons safety was promoted. However, risk assessments and support plans are always consistent with advice that has been given by others. For example, one person has difficulties with mobility and needs staff support with this, particularly around kerbs and steps. Feedback from one appointment records that a health professional suggested a walking stick might be useful but there is no evidence that this has been followed up. The manager says that the person has had a fall when they were visiting family and this has affected their confidence meaning they need more support around the home than they did previously. Again, this is not shown in the support plan or risk assessment. We were told that one person will help with simple meal preparation and might be guided hand over hand by staff with chopping vegetables. There is no risk assessment available giving guidance about how staff are to minimise risk while encouraging participation. The risk assessments for one individual do not take into account epilepsy. For example this has not been taken into account in the assessment for using the trampoline, or transport. The person also goes swimming. This means that the person could be at risk Care Homes for Adults (18-65 years) Page 21 of 43 Evidence: while doing these things. Care Homes for Adults (18-65 years) Page 22 of 43 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 . People have opportunities to live a fulfilling lifestyle although activities within the home do not always present variety that reflects their interests and develops their skills. Evidence: We saw staff making efforts to engage people in activities. One person has more profound communication problems and there are limited alternative methods in use as yet to help encourage this person to make choices about their activities. However, there are lots of games available with lights, colours and noises that provide some sensory stimulation. Staff also gave us an account of how the person would indicate that they were happy with something. When offered the opportunity for a walk the person made noises consistent with the staff explanation that they may not want to do something. Their choice was respected. Care Homes for Adults (18-65 years) Page 23 of 43 Evidence: Support plans show what activities people enjoy, both inside and out of the home. For one person this recorded in house activities like painting, drawing, snack cookery, skittles, music (playing instruments). We checked daily records for this person from the 8th September to 30th. These show the person did help in making scones on one occasion, had been swimming once, to the shops once and out for a walk twice. They show that most of the time is spent relaxing in the lounge or comfy chair watching television or listening to the radio. (We did hear the person singing along to music while we were there and clearly enjoying it.) The in house activities that the other person is said to participate in, include music, stories and story tapes, skittles, floor basket, ball, velcro darts, stunt kite, walks and massage. The persons records refer predominantly to playing with sensory toys and the occasional ball game. They do not show that a variety of other leisure and recreational opportunities within the home are consistently offered and match the preferences and interests set down for the person. One staff member wrote to us that the the home could do better in offering more inhouse activities. Two staff wrote that there was a lack of drivers and that this sometimes presented difficulties in getting people out. The person we spoke to said that this has been better lately. Peoples cognitive abilities mean that it is difficult for them to participate in classes or employment. Records show that people go out and make use of local facilities, including a nearby pub. One person told us they like the pub. One person went there while we were at the home. People are supported to go on holiday. One person goes horse riding and swimming. Records show the second person had opted to join in a boat trip on the day before we went and had been on a trip to Norwich. This shows staff try to provide opportunities for people to get out and about in their community. Records show that one person helps to clear the table and is regularly recorded as taking their cup and plate to the sink. However, there is no follow up showing the person is encouraged to develop this skill further (for example by washing up) to develop skills further. There is evidence in records that people are supported with family contact and visits. While we were there one person clearly enjoyed talking to a relative on the telephone. There is reference to one persons awareness of relationships and understanding about taking someone elses views and wishes into account. One persons support plan sets out the aim to maintain weight and the need to ensure a high fat diet to help with this. An update four years later shows more weight gain needed. There was screening of the persons body mass index (BMI) in September 2008 which shows a little under BMI for size but within healthy guidelines. No action is considered necessary by the health professional carrying out the screening although there is a recorded direction to monitor. The information in the care plan about the persons need for weight gain and a high fat diet conflicts with that in the health action plan which shows no special diet and records that the person needs a healthy Care Homes for Adults (18-65 years) Page 24 of 43 Evidence: balanced intake with not too big a portion to balance my weight. Guidance is therefore unclear and contradictory about what staff are to do to assist the person with maintaining or increasing their weight, and what the target weight would be to keep them healthy although at present there are no concerns from the health professional consulted. One person was able to tell us that they like the food. For lunch they had baked potato and cheese. We needed staff assistance to understand this. Daily records show how well people have eaten or whether they needed encouragement. Care Homes for Adults (18-65 years) Page 25 of 43 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are supported to maintain their personal and health care, as they need and prefer. Medicines are handled in a way that helps to make sure people get the right medicines at the right time, to help keep them well. Evidence: Records show peoples personal care needs are attended to and reflect their preferences (for example one person prefers a wet shave). There are male staff employed at the home which means, subject to the duty roster, people can have some choice about who assists them with their personal care. They have the aids they need to help with this (for continence and bathing). One person is recorded as having a physiotherapy programme in place to help with mobility. Daily records do not show that this is consistently delivered however. Each person has a health book setting out their needs, any screening or tests they might have had, medical history and medication. These have been completed and show input from specialists as needed. This includes routine tests showing that peoples health is monitored so problems can be identified and addressed promptly, to help keep them well. Care Homes for Adults (18-65 years) Page 26 of 43 Evidence: Epilepsy is monitored with seizures recorded. There is consultation with medical practitioners about managing this and any other health conditions that present concerns. We looked at medication records for people. These were clear and complete. We checked medicine that was not in the monitored dosage systems and found that the balance remaining corresponded to the amount that was given. During our visit we saw a staff member preparing medicines for administration. The staff member checked labels against the administration record, made sure the right medicines were dispensed into a pot for one person at a time, and signed the record of administration after they had been given. This shows that the practice of administration provides for checks to make sure people get the right medicines at the right time. The staff member we spoke to confirmed they had accredited training in the administration of medicines. Before this was delivered, the person was assessed in house, following a period of observation and practical supervision. This helps to ensure staff are competent to follow the companys procedures and administer medication safely. The medicine cupboard does not allow for storage of controlled drugs but the company is in discussion about replacing medicine cabinets in the small homes so that they meet legal requirements and do not result in delay of treatment for anyone who might be prescribed such medication. Care Homes for Adults (18-65 years) Page 27 of 43 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. 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 . Although there are measures in place to address concerns a resident or their representative might raise, people are not wholly protected from abuse. Evidence: There is a clear complaints procedure. People living at the home would need help to understand who they would complain to given their cognitive abilities. However, the procedure is available in symbol form to help simplify it for people. There is a record of complaints received and the actions that have been taken to address them. All three staff who wrote to us say they know what to do if someone (or their representative) expresses concerns about the service. This shows that concerns raised on behalf of people living at the home would be listened to. The training matrix shows that all staff have training in recognising and responding to abuse. We asked one staff member what might give rise to concern and what they would look for that might indicate problems in this area. The staff member gave us a comprehensive account that took into account communication difficulties and reflected on how someones behaviour might change if something untoward had happened to them. They also told us about checks and records that would be made on body charts to record any bruising, and who they would report to. This shows staff would be alert to any physical or sexual abuse. However, we did have concerns about the way peoples individual finances are managed. An audit by the organisations quality assurance officer in April looked at Care Homes for Adults (18-65 years) Page 28 of 43 Evidence: finances. This recorded questionably high costs of staff meals that were met by service users when they were taken out. It also showed the high cost of a taxi fare for one person (45 pounds to the Norfolk Showground). There are acknowledged problems in that the service does not have a budget for day care which means that people living at the home do cover the cost of staff admissions for example, to events that they wish to attend themselves. The manager says the regional director is trying to resolve this. The quality audit officer told the manager following the audit, that she needed to put a protocol in place about appropriate spending and service users personal monies. The manager says she has addressed issues but has not written it down. This means staff do not have clear guidance about this to help safeguard people from financial abuse. When we checked financial records we found that one person had paid the whole cost of a taxi fare to an activity that both people living at the home had participated in (in excess of forty pounds). The manager says that the other person would pay next time. However, effectively this means one persons money being used to subsidise another. Additionally, the record for the same person showed that they had paid over ten pounds for photocopying, envelopes and stamps. The person neither reads nor writes. Care Homes for Adults (18-65 years) Page 29 of 43 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 . People live in a homely and comfortable environment, but where improvements are needed to the way it is maintained. Although the home is clean, risks from the potential for infection to spread may have increased. Evidence: There are checks on fire safety at the home, and the training matrix shows that staff have training in fire safety. Records also show that new staff participate in fire drills promptly when they start work. This helps promote peoples safety should a fire break out. There is ramped access to the front door to aid people who find it difficult to manage steps. One person needs an aid to use the bath. This means that adaptations are provided to help people access the facilities in their home. Peoples rooms are personalised and reflect their interests with pictures and ornaments for example. When we last visited we did not make a requirement about the exterior of the home. This is because we were told that there were plans to address concerns about the poor condition of paintwork and woodwork to doors and windows. Care Homes for Adults (18-65 years) Page 30 of 43 Evidence: However, the providers own quality audit visit from January this year shows doors and windows as needing repair and that this was to be done within four months. A subsequent visit in March shows that the exterior doors and windows are in poor repair and need attention and this was to be achieved by June 2008. A third visit in April requires the front door to be replaced or repaired as agreed with maintenance but within four months. It also refers to the window frames. This work remains outstanding showing that the organisations own timescales for ensuring the building is well maintained for people who live there, have not been met. We asked staff about how they helped reduce the risk of infection. The staff member told us about protective clothing that is available. We were told about the bagging and disposal of continence pads. Records did show that bedlinen and bedclothes had needed changing as the result of faecal incontinence. This has arisen since a change in the client group and had not been noted at previous visits. We asked about this and were told red alginate bags are in use for soiled linen although the washing machine has no sluice cycle. Additionally, soiled linen needs to be taken into the kitchen for washing. The staff member told us that a higher temperature is used for soiled linen. The information the manager sent to us shows that she considers she still has work to do on measures to control infection. The tumble dryer is broken. The manager says the order was submitted three weeks ago and is currently awaiting head office approval. The handle for the fridge door is also broken. The manager says that a replacement fridge was ordered but the model approved was not available. There are monitoring, checks and training in place to help ensure that food preparation and storage is safe. There were no unpleasant smells. Care Homes for Adults (18-65 years) Page 31 of 43 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 . We did not have access to full information to support that staff are wholly skilled and competent to support people. Evidence: We did not have access to full documentation to show how the service was achieving outcomes in this area. This is because the manager said she did not have access as she did not have the key to get in the filing cabinet. The manager sent us information that showed two of the staff have national vocational qualifications and another is working towards this. We were unable to see separate recorded evidence to verify this. The staff member we spoke to told us about training and says they had induction training to explain to them what the job was about and what they needed to do. The three staff who wrote to us say that they have training that keeps them up to date and helps them to meet peoples needs. However, one goes on to say that they would welcome more training. The training matrix shows that there is a range of short courses on offer including basic first aid, food safety, health and safety. However, the providers own quality audit in January shows that new staff were to attend courses in First Aid, Food Care Homes for Adults (18-65 years) Page 32 of 43 Evidence: Hygiene, Fire training and Health and Safety within three months. These two staff have not yet attended First Aid training to help promote peoples safety almost 9 months after the audit. However, the matrix shows the other courses required are complete and a staff member confirmed this. The manager says first aid training has now been arranged and this will contribute to maintaining safety in the home. The providers own quality audit visit recorded in January that there was a lot of information missing for one person employed at the home. Omissions included checks on their suitability to work with vulnerable people. The manager says this is because the person had transferred from another service and their records had not come with them when they transferred before Christmas. We know that recruitment checks in the organisation are generally complete but we were not able to access information to confirm this is always the case at Rosecroft and that statutory records are maintained. The information is needed before people start work at the home to ensure that they are properly checked and confirmed as suitable to work with vulnerable adults. We were not able to access supervision records that would support the dates entered on the schedule had in fact been carried out. Not all the dates on the schedule had been signed off by people receiving supervision to show it had taken place, or by the manager and team leader to show they had given it. One person who started work before Christmas had one supervision recorded on the schedule and signed off. There was another date for March but this was not signed off as having happened. This would represent (if completed) two supervisions in 10 months. A second new member of staff, starting in December, had dates on the schedule for January and May. The schedule does not show that the team leader has had supervision from the manager, since May. This means that there is a lack of evidence to show staff are properly supported by their manager and their work and understanding of their role is monitored. However, staff who wrote to us do say they meet with their manager to discuss their work. Care Homes for Adults (18-65 years) Page 33 of 43 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 manager has not acted consistently and promptly to address identified risks to peoples safety and welfare. Evidence: The manager is applying for registration and has started work towards her Registered Managers Award so she acquires the underpinning knowledge to support her in her role and to run the home effectively. We have not therefore repeated the requirement we made last time. She participates in periodic training offered by the company. The organisation carries out regular audits of service quality. There are visits monthly by another manager in the group, and quarterly visits by the regional director or another of the quality monitoring team. However, one of the monthly visits was carried out by the manager of the home. Regulations say this must be carried out by someone who does not have day to day responsibility for the service. This situation has now been rectified so that there is more independence in the way service quality is monitored and peoples views are taken into account. Other audits show a range of checks are carried out. However, as identified elsewhere Care Homes for Adults (18-65 years) Page 34 of 43 Evidence: in this report, some of the requirements made by the companys own auditors are considerably overdue showing that some of the improvements identified as necessary in peoples best interests have not been made. The manager says surveys of stakeholders are now taking place. These are coordinated by the office and not directly from the home. She says she will be informed of results when these are collated and can take action to address any issues arising. This will help improve the quality of the service taking into account the view of others connected with it. The manager carries out regular checks of safety in the home. However, the routine check on safety in the bathroom does not cover a visual check on the safety of aids in use or monitoring that servicing is up to date. This means that the safety of people who need these aids could be compromised. The providers quality audit in January 2008 shows concerns about the condition of the bath seat, and said it should be replaced within four months. A subsequent visit in April also identifies concerns saying it is badly stained and needs replacing. This action had not been taken although it was in the interests of the person who needs the equipment. We checked the maintenance report and saw a sticker on the equipment from the maintenance engineer. The report dated 1st August 2008, says that the equipment failed because of some faults and repairs needed. The sticker on the equipment says that it has failed - do not use. The manager said when we visited, that the equipment remained in use. As the equipment failed its test in August and had been in use despite the instruction not to use it, there were immediate risks to the health and safety. Because of these concerns we spoke to the regional director who has told us about actions taken to address them. The bath seat is heavy and has to be lifted into and out of the bath. The manager was not able to show us a manual handling assessment showing how staff were to do this safely and without risking injury to their backs. The assessment of risk for the person using the bath seat, in relation to their safety when bathing, does not incorporate the safety of the equipment itself, the competence of staff to set it in the bath properly and safely, or any reminders to the person using it in relation to the risk of trapped fingers or heels for example. This means the persons safety could be at risk. One risk assessment for the safety of an individual in the event of fire, says that there is to be one member of staff on each shift who is trained in first aid in order to reduce risk to an acceptable level for the person. When we visited, neither member of staff on duty had this training and it had not been arranged within the time specified at one of the providers quality audits. (This should have been completed within three months of the audit in January.) This means that the service is not following its own guidance about actions needed to minimise risks for the person. Care Homes for Adults (18-65 years) Page 35 of 43 Evidence: The Landlords gas safety certificate is overdue for renewal. It was last done on 19th September 2007. This is needed every year to make sure that the system remains safe and does not present a risk to people living and working in the home. Care Homes for Adults (18-65 years) Page 36 of 43 Are there any outstanding requirements from the last inspection? Yes  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 Care Homes for Adults (18-65 years) Page 37 of 43 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 Description Timescale for action 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 Description Timescale for action 1 9 13 Risk assessments for activities must take into account the needs of each individual, any changes and advice from other professionals that would contribute to reducing risk and increasing confidence. 07/11/2008 This is so activities people do are, so far as practicable, free from avoidable risk. It is unnecessary risks to peoples health and safety are avoided. 2 23 13 Personal monies belonging to 31/10/2008 people living at the home must not be used to cover administrative costs such as stationery. This is to protect people from financial exploitation or abuse. Care Homes for Adults (18-65 years) Page 38 of 43 3 23 13 There must be clear 31/10/2008 protocols about the usage of peoples personal allowances and arrangements for funding outings. This is to ensure people are protected from financial exploitation or abuse. The law says there must be arrangements to prevent people being harmed or abused, or placed at risk of harm or abuse. 4 23 13 Personal monies belonging to 31/10/2008 people living at the home, must not be used to subsidise expenses incurred by other residents during shared activities. This is to ensure that people are protected from financial exploitation or abuse. 5 24 23 Exterior woodwork to windows and doors must be made good or replaced. This is so the home is well maintained for people living there. 04/02/2009 The law says that the home must be kept in a good state of repair. 6 34 19 Full records about staff 07/11/2008 working at the home must be available for inspection. Care Homes for Adults (18-65 years) Page 39 of 43 This is so the manager can show that all staff are checked properly before they start work. It is so the manager has evidence that all the records set out in regulations have been obtained. 7 36 18 Staff must be supervised with the agenda and frequency set out in minimum standards. 28/11/2008 This is so staff are supported to work within the philosophy and aims of the home. It is also so their work with individuals can be discussed and monitored and any performance issues addressed. The law says that people working at the home must be appropriately supervised. 8 42 13 The risks associated with use 22/10/2008 of bathing aids must be assessed and guidance provided for staff about how to minimise these. This is so the safety and welfare of service users is promoted. It is also so staff know how to avoid unnecessary risks to peoples safety. 9 42 13 There must be arrangements 22/10/2008 to service and test gas appliances in the home. Page 40 of 43 Care Homes for Adults (18-65 years) This is to make sure that people are not exposed to unnecessary or avoidable risks to their safety. 10 42 13 The managers and 07/11/2008 providers own interventions specified as needed to reduce risks to an acceptable level, must be followed. This is so people are not exposed to unnecessary or avoidable risk. 11 42 23 Equipment identified as needing replacement or repair must be attended to promptly 07/11/2008 This is so peoples safety and welfare is promoted. It is also so equipment in use is properly maintained. 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 6 Goals should be broken down into smaller steps to be concentrated on in stages. This would mean that the progress of people towards goals would be more easily identified and their achievements recognised. Alternative methods of communication should be explored to make information more accessible to people and to show how they are involved in planning their care or making decisions. Where someone requires particular support to maintain their weight, the support plan and health plan should be 2 6 3 17 Care Homes for Adults (18-65 years) Page 41 of 43 consistent. This is so staff can be clear exactly what is expected of them in supporting the person properly. 4 19 Appointments for screening and the outcomes of these, should be added to health plans. This is so the health plans contain a full range of information about all aspects of peoples health needs and anything that might be needed in an emergency. Where a physiotherapy programme has been introduced by another professional, records should show that staff deliver the programme as the physiotherapist considers necessary to treat the persons condition. Advice should be taken from Environmental Health Officers about how to minimise the risk of infection spreading, taking into account the changed needs of people living at the home and the potential impact of existing laundry arrangements on food hygiene. This is to reduce the risk of spread of infection for people living and working in the home. Safety checks around the premises should take into account the safety of any aids and adaptations used by individuals. This is to help promote peoples safety. The risks to staff associated with manual handling of heavy equipment should be assessed and minimised so far as is possible, in the interests of their health and safety at work. 5 19 6 30 7 42 8 42 Care Homes for Adults (18-65 years) Page 42 of 43 Helpline: 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 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 © (2008) Commission for Social Care Inspection (CSCI). 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. 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