Care Home: Rosecroft Care Home

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What the care home does well People are well assessed on entry to the home, having been given good information on what the home is like and what to expect. They receive good contracts of residence and they are provided with a good care plan for staff to follow. People are very well supported with health care that meets their needs and their expectations.They are protected from possible harm due to taking the wrong medication, because they have their medication handled by the staff in the home, and the staff follow robust practices and procedures. People experience good levels of privacy, have their dignity maintained, and their right to make decisions is respected. They are encouraged to maintain contact with family members and friends and enjoy visits from these people any time of the day, and they are encouraged to exercise choice and control over their lives. People enjoy good food, which matches their expectations and preferences, but also offers a satisfactory level of nutrition. They are confident their complaints will be listened to and acted upon. People are protected from abuse by robust recruitment and selection procedures and practices, as well as by the service`s policies, procedures and practice under the safeguarding adults systems. They experience a safe, clean and well-maintained environment. A sufficient number of care staff work in the home on each shift to meet the needs of people living there. Care staff are satisfactorily trained and skilled to the recommended standard. The manager runs the service in the best interests of people living there, safeguards their financial interests, and maintains their health, safety and welfare. What has improved since the last inspection? The training and development opportunities for care staff have been improved and all staff, but one, have recently undertaken safeguarding adults training. General training opportunities have also improved There is now a satisfactory number of carers working on each shift to meet the assessed needs of individuals. There has been an improvement in the recruiting of new staff to make sure no one begins working in the home until an initial security check has been carried out and the result received. The service now has an appointed manager in post for whom an application is pending. Care staff now receive full and detailed supervision from their line manager. There is now a system for completing annual appraisals on all staff. There are now systems in place to Staff have been given other opportunities to train and develop their skills in caring for people. There are now bedrail risk assessments in place for anyone using bedrails What the care home could do better: As a matter of good practice the service could make sure no prospective employee works in the home, including `shadowing` more experienced workers, until all records as set out in Regulation 19 have been received. The seeking of and receipt of an initial security check pending receipt of a full security check, ought only to be done in `very exceptional circumstances.` The service could make sure the appointed manager submits an application to register with the Commission within 28 days of receipt of this inspection report. CARE HOMES FOR OLDER PEOPLE Rosecroft Care Home Rosecroft 34 Wrawby Street Brigg North Lincolnshire DN20 8BP Lead Inspector Janet Lamb Unannounced Key Inspection 29th January 2008 09:15 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 Rosecroft Care Home DS0000045639.V358957.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. Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosecroft Care Home Address Rosecroft 34 Wrawby Street Brigg North Lincolnshire DN20 8BP 01652 652213 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) rosecroftcarehome@tiscali.co.uk Abbey Residential Homes Limited Position Vacant – Jenny Jordan is Acting Manager Care Home 28 Category(ies) of Dementia (4), Old age, not falling within any registration, with number other category (28) of places Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 6th December 2006 Brief Description of the Service: Rosecroft is a purpose built, single storey home situated in the centre of Brigg within close proximity to local amenities. There are good bus routes to Grimsby and Scunthorpe. The home has large well-maintained grounds with ample car parking for visitors. The home was originally owned by the local authority but is now leased long term to Abbey Residential Homes. The home provides accommodation and care for up to twenty-eight people over the age of sixty-five, four of whom may have needs associated with dementia. The home also has the capacity to provide day care facilities. District Nurses and community psychiatric nurses provide any element of nursing care that may be required. The staff ratio is four staff during the morning, four in the afternoon, and three staff at night. The home also has a good complement of domestic and catering staff. The manager is supernumerary and the Care Coordinator has a proportion of their hours designated to care. All bedrooms within the home are single. One bedroom has an en-suite facility. The home has four bathrooms, three of which are assisted and one shower room. There are six single toilets throughout the home close to communal areas. All are accessible to people in wheelchairs. The home has four lounges one of which is a smoking lounge and a large dining room with individual tables set out. The home also has a quiet room/meeting room which is available to service users and their visitors. Weekly fees range from £360.75 to £388.90 per week. Information on the service is made available to prospective and current people using the service via the statement of purpose, service user guide and inspection report. Copies of these documents can be obtained from the home. Rosecroft Care Home DS0000045639.V358957.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 3-star. This means the people who use this service experience excellent quality outcomes. The Key Inspection of Rosecroft has taken place over a period of time and involved sending an ‘annual quality assurance assessment’ (AQAA) document to the home in late September 2007 requesting information about people and their family members, and the health care professionals that attend them, as well as asking for numerical data held in the home. We received the requested information on 24th October 2007 and survey questionnaires were then issued to a selected number of people and their relatives, their care manager, their GP and any other health care professional with an interest in their care. This information obtained from surveys and information already known from having had contact with the home over the last few months, was used to suggest what it must be like living there. A site visit was made to the home on 19th January 2008 to test these suggestions, and to interview people, staff, visitors and the home manager. Some documents were viewed with permission from those people they concerned, and some records were also looked at. A total of four people, two staff, and the manager, were spoken to or interviewed during the site visit and several more people living in the home were observed. All of the information collected, in conversations, through observation and in survey questionnaires was collated to determine what it must be like living in the home. What the service does well: People are well assessed on entry to the home, having been given good information on what the home is like and what to expect. They receive good contracts of residence and they are provided with a good care plan for staff to follow. People are very well supported with health care that meets their needs and their expectations. Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 6 They are protected from possible harm due to taking the wrong medication, because they have their medication handled by the staff in the home, and the staff follow robust practices and procedures. People experience good levels of privacy, have their dignity maintained, and their right to make decisions is respected. They are encouraged to maintain contact with family members and friends and enjoy visits from these people any time of the day, and they are encouraged to exercise choice and control over their lives. People enjoy good food, which matches their expectations and preferences, but also offers a satisfactory level of nutrition. They are confident their complaints will be listened to and acted upon. People are protected from abuse by robust recruitment and selection procedures and practices, as well as by the service’s policies, procedures and practice under the safeguarding adults systems. They experience a safe, clean and well-maintained environment. A sufficient number of care staff work in the home on each shift to meet the needs of people living there. Care staff are satisfactorily trained and skilled to the recommended standard. The manager runs the service in the best interests of people living there, safeguards their financial interests, and maintains their health, safety and welfare. What has improved since the last inspection? The training and development opportunities for care staff have been improved and all staff, but one, have recently undertaken safeguarding adults training. General training opportunities have also improved There is now a satisfactory number of carers working on each shift to meet the assessed needs of individuals. There has been an improvement in the recruiting of new staff to make sure no one begins working in the home until an initial security check has been carried out and the result received. The service now has an appointed manager in post for whom an application is pending. Care staff now receive full and detailed supervision from their line manager. Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 7 There is now a system for completing annual appraisals on all staff. There are now systems in place to Staff have been given other opportunities to train and develop their skills in caring for people. There are now bedrail risk assessments in place for anyone using bedrails 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. Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 8 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 Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 9 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): 2, 3 and 6. People who use the service experience excellent quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. People’s individual and diverse needs are well assessed so they are confident needs will be met. They receive sufficient written information in the form of a statement of purpose and a service users guide so they can decide if the home is the right place for them. EVIDENCE: Discussion with several people in the home, the manager, deputy and staff and viewing of documents held in files with people’s permission reveals the systems for assessing prospective people to use the service is clear and well followed, and there is good written information available to tell people what they should expect if they choose to live there. The home has both a ‘statement of purpose’ and a ‘service user guide’ for prospective people and their relatives to view, and people are invited to visit Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 10 and/or take a short stay in the home before they decide to become a permanent resident. These documents are both up-to-date. There are also contracts of residency in place and these have been amended to meet the requirement made at the last inspection to ensure the name of the person responsible for ‘third party top ups’ is included. There is clear documentation in place that records the first telephone contact for a placement, when a person visited to look round the home, the level of the person’s dependency, their nutritional assessment and the full care and health care needs assessment of each individual’s diverse needs. The assessment of needs follows 12 areas of daily living each with a brief risk assessment, and then there are risk assessments for moving and handling, nutrition etc. All documents reflect the differing needs of people because of race, culture, religion, disability, gender, sexuality etc. and are held in people’s case files. Letters are given to say if the home will be able to meet peoples’ needs or not. People spoken to give a mixture of responses in that some remember their assessments being done and others do not. One person said, “I was in hospital first, then went to another care home before coming here. I was quite poorly and do not remember my assessment being done.” Another said, “Yes, I remember having a good talk with the social services and the manager from here, not together. They took all my details down and put them in a care plan, which the staff come round with now and again.” The systems in place for assessing and recording needs are very robust and well maintained. Standard 6 is not applicable to the home. Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 11 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 receive excellent quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. People have their health and social care needs well documented in care plans, so they are confident all their needs will be met. They have good opportunities to self-medicate or their medication needs are well managed, and they enjoy good levels of privacy and their dignity is well maintained, so their overall quality of life is good. EVIDENCE: Discussion with several people, the manager, deputy and staff and viewing of case files for three people with their permission, where possible, and viewing of medication administration record sheets, reveals people have their personal and health care needs well recorded in a care plan and have those needs well met. People are able to self-medicate if risk assessed as capable and both privacy and dignity are well managed and upheld. Care plans are devised from information collected on assessment, from relatives and people themselves. There are care plans in files that have been Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 12 produced by the placing local authority and also by the home. All documents reflect the differing needs of people because of race, culture, religion, gender, sexuality, disability, etc. Rosecroft care and health care plans reflect the 12 areas of need recorded on assessment and show people’s strengths, their specific need, the problem to be overcome and the risk involved. There are also three extra areas noted in the care plans, legal and financial needs, social and emotional needs and mental health needs. Where possible people sign all documents in agreement with their content. Relatives will sign where people are unable to fully understand. There is an evaluation sheet, which is completed monthly. There is an action plan for each area of need and a risk assessment to enable the plan to be carried out. Daily progress records are also in place showing the care and support provided, how it was done and by whom. Other records include monthly weight chart, professional visitors, weekly activities and a blank RIDDOR form in readiness. This is an accident record form required by the Health & Safety Executive, in certain circumstances. There are also written and signed declarations from people in the home stating they do/do not wish to be checked at night, have their photograph taken, have window restraints on their bedroom window and have particular pieces of furniture and equipment in their rooms. Health care needs are similarly recorded in care plans and all involvement from professionals is listed for action and recorded when met. Care and health care plans are reviewed six-monthly in the home, and annually with the council and other stakeholders, and all dates are maintained and copies of reviews are held. People and staff spoken to confirm these care plans and the practices and support given to meet needs. Medication administration systems provide protection for people. There is a secure medication cupboard for storing drugs and a locked trolley is used to administer drugs around the home. Medication administration record sheets are used effectively and only signed upon each administration. Practice observed at lunchtime shows staff select the cassette, identify the person, remove the drugs to a pot, close and lock the trolley and then take the pot and a glass of water to the person. Staff wait with the person until they have taken the drugs and then they return to the trolley to sign the record sheet. There is a medication key handover, which is recorded and shows who is accountable for the security of drugs at any given time. There is a locked controlled drugs facility, which meets the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973, and the drugs trolley is chained to the wall in a designated store when not in use. Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 13 Staff that give out medicines are trained in administering medication, and they confirm this in interview. Not all do so. Their training files also confirm training undertaken. People spoken to about the systems for administering medication are quite satisfied with them. One person said, “Staff give out my medication, whatever they give to me I take. I am happy with that.” Another said, “The girls bring medicines to us, but you can have it yourself if you are capable. I don’t do it myself, as I would not like to look after it.” Observation of people during the day and conversations with them reveal their privacy and dignity are satisfactorily upheld. They are assisted with personal care only in private and they are spoken to and treated respectfully. One person said, “I have to get help for everything, but it is done how I want it doing. I have no complaints, they (staff) are all very good and they never do anything embarrassing. It’s all done in private.” Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 14 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 evidence gathered both during and before the visit to the service. People enjoy flexible routines, good contact with relatives and friends, good opportunities to be self-determining, and satisfying food provision, so they are confident their daily lives and social activities meet their expectations. EVIDENCE: Discussion with people, staff, the manager and deputy and viewing of diary notes reveals people lead fairly fulfilling lifestyles of their choosing and according to their abilities. They enjoy a variety of activities and good nutritious meals. From discussion with people in the home and observation of the way they pass the time of day, it is clear there are wide ranging physical and cognitive abilities amongst them. Those that are still cognitively very capable tend to congregate in one particular, smaller lounge, although they still have a varying range of physical needs. They talk about daily routines and social activities being very much of their making and choosing. People rise when they wish, join in if they wish and Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 15 generally decide their own routines. Some join in with bingo on Mondays, monthly Alpha religious group on Tuesday, motivation exercises on Wednesdays, and carpet bowls on Thursdays. There are other impromptu pastimes such as going out with relatives or receiving visitors and enjoying discussions etc. Others choose to watch. One person said, “Oh there are no activities for me, I’m not able to join in, so I watch.” One person receiving day care expressed a wish to do some of the things that take place on the days they do not attend. Another said, “We can have visitors any time. They can stay for tea if they wish. I go out with my family at the weekend. The home’s bus broke down just before Christmas and when we do go out in it we need lots of wheelchair pushers, so trips out have to be planned and staff has to be brought in especially.” People in the largest lounge in the home also have varying abilities and understanding. They still indulge in pastimes though, one person reads books a lot, one completes word search puzzles, another makes models from matchsticks, and others read newspapers, listen to the radio or CDs and watch television. There is a pet bird and an organ is available for playing, which two people do. Some people like to join in with setting tables for lunch or folding washing. There is contact with the local community when school children visit for concerts, when people take a walk or ride to the local shops or pub, and when people visit church or chapel. Visitors are frequent to the home and there is no restriction on when they may call. Much of this was evidenced in people’s case files and diary notes and from conversation with them. Discussion with people reveals some of them handle their own finances, others have family that do, and a small number have finances handled by the home management staff. Where money is held in safekeeping by the home, there are record sheets held for each person showing accounting details. Only one check on finances was made as only one from three people giving permission to look at records has money in safekeeping. This was accurately maintained. One person spoken to, said, “My money is kept in the bank and I have to be taken there to get out what I want. I pay my accommodation with a cheque.” There is a change noted in this person’s care plan in respect of finances, stating the changes in arrangements and the need to now take the person to the bank when they request it. Everything spoken about and seen in the file corresponds. Meal provision is well organised, carefully planned and smoothly carried out. The cook consults people about menu choices and they are asked about suggestions in meetings. The cook asks each person what his/her preferred Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 16 choice is for the following day’s meals and records this. If they change their mind or decide they do not like the choice an alternative is offered and prepared. Food is prepared in a well-organised and clean kitchen and this is then loaded onto hot-locks for dishing up at table. Domestic staff collect the hot-locks and take them to the dining rooms where each person is again asked what they want on his/her plate. Staff use appropriate blue cloves and aprons, and hats when dishing up food. On the day of the site visit people had a choice of chicken Kiev or sausages, mashed potato, cabbage and gravy, and lemon ‘roly-poly’ and custard for dessert. There is also fruit and yoghurts available each day. People sit at tables of four and generally the mealtime is a social occasion. Those that require assistance are offered it discreetly. One person was observed in an uncomfortable position for eating and suggestions were discussed with the staff and manager. People spoken to about meals had mixed views. One said, “Sometimes I would like something different, but the cook cannot do separate meals. I have no complaints.” Another said, “We get very good food majority of the time. It’s well cooked. The other day we had chicken chasseur, dumplings, peas and carrots, and mashed potato and turnip. It was lovely.” A third person said, “The food is variable, I eat most things. I usually eat what I like, but we don’t always get an alternative if we don’t like it. Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 17 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 who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. People make use of complaint processes and systems and have all issues dealt with appropriately, so they are confident their concerns are dealt with effectively and efficiently. They also experience good promotion and protection of their welfare and so feel confident the systems in place to protect them are robust. EVIDENCE: Discussion held with people in the home, the manager, deputy and staff and viewing of records and case files reveals there is a healthy attitude towards dealing with issues, complaints and allegations, and people feel confident they can speak out any time. There are complaint and protection policies and procedures in place, staff have undertaken safeguarding adults’ training in the last 12 months and generally people’s grumbles and complaints are dealt with at the point of there being an initial problem. People spoken to say they know how to complain and who to go to if they feel unhappy about anything. One said, “If I wanted to make a complaint I would have to see Jenny, the manager. I’ve never made any.” Others said they would talk to any of the staff on duty and all expressed confidence in being able to come forward about anything. Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 18 There is a monthly complaint log held in a complaint file and there are corresponding complaint sheets showing what people are unhappy about. There is only one complaint logged and recorded in the last 12 months, about staff not having training in dealing with someone with diabetes. The record shows the detail of the complaint, the action taken by the manager and the outcome of the complaint. The outcome was deemed satisfactory by the complainant. Staff have, since the complaint, been given information on caring for people with diabetes, and the subject of the complaint has had their care plan reviewed and rewritten to suit. There is a safeguarding adults’ policy and procedure in place, staff have now completed safeguarding adults’ training, and there is a record of any allegation or referral made to the social services safeguarding adults’ team. According to information in the AQAA and from discussion with the manager there has been one referral to the team and to the protection of vulnerable adults list held by the Home Office, but it did not require investigation and was dropped. Staff in interview are very aware of their responsibilities towards safeguarding individuals, for passing on information and for whistle blowing, and they champion people’s rights and responsibilities well in respect of representations. Two staff confirm in interview the training they have done in these areas, one is very new to the post and has yet to do the safeguarding adults training with this employer. It has been done with a domiciliary care agency worked for prior to their present employment though. Files seen with permission show evidence of training. Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 19 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 and 26. People who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. People have a well-maintained, safe, clean and comfortable environment in which to live, so they are confident they live in a good home. EVIDENCE: Discussion with people, staff, the manager and deputy and observation of the communal areas of the home reveal the house is suitable for its stated purpose of providing care and accommodation to older people. It is clean, safe and comfortable. The home meets the requirements of the local fire service and environmental health departments. The last visits made by these departments were Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 20 17/04/07 for fire safety and 27/09/07 for food hygiene. According to the manager all recommended actions have been taken. Rosecroft is a purpose built care home that is all on one level. There is no upper floor. There is a car park to the side for several cars and large gardens to the rear and smaller ones to the front. Two or three of the bedrooms have been extended slightly to provide extra floor space in the form of a bay window and external door to the garden. This is intended for many of the other rooms that will accommodate it. Bedrooms are personalised and very comfortable. The largest lounge in the home is possibly to have a conservatory built off that will provide views to the connecting corridor between the two parts of the building. More sitting space will be provided. Meanwhile the house is well maintained, has fixed mobility aids in bathrooms and toilets and also in individual’s rooms where necessary. There are sufficient bathrooms and toilets to meet the needs of people in the home, in line with the amended environmental standards. The home is clean and there is an infection control policy in place. Staff have undertaken infection control training, evidence of which is in their files. The laundry is very well organised, clean and efficient. It meets the Water Supply (Water Fittings) Regulations 1999. Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 21 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 who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. People are cared for by well-recruited, well-trained, confident and skilled staff in satisfactory numbers to meet their needs, so they enjoy a good service of care. EVIDENCE: Discussion with two care staff, the manager and deputy, and viewing of staff files with their permission reveals there are improvements in the staffing standards. Residential Staffing Forum figures when calculated shows the home is sufficiently staffed in terms of staffing hours provided per week. Forum figures require 501.88 hours for 1 high, 7 medium and 19 low dependency people, and the general environment/layout of the home causing some difficulty in providing care. The home provides 580 hours each week, and therefore standard 27 is being met. Discussion with staff and the manager and information taken from the inspection questionnaire reveals there are now 14 from 18 care workers with or soon to have the required NVQ level 2 qualification, giving 78 with or Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 22 soon to have the award. Standard 28 is being met. Staff confirm their commitment to training in interview and files show evidence of courses done. There is a recruitment and selection policy and procedure for management to follow and discussion with staff and viewing of files reveal these to be satisfactorily followed. Requirements under regulation 19, schedule 2 are being met. Staff files contain details of their application for the job, security check, employment contract, job description and so on. Of the two files viewed one has security checks that were completed in 2004 and therefore it is recommended that checks that are more than three years old be redone and updated. It is a Criminal Records Bureau recommendation that checks be completed every three years. The other file did not have the full security check through yet and the carer was working on a POVA First check only, and had only been in post one month. This person was being fully supervised and was instructed not to work in isolation with anyone. Security check guidance allows for this in exceptional circumstances, but never-the-less this is not good practice and the home is recommended to only have staff working in the home that have received confirmation of a CRB check. This becomes a good practice recommendation in the report. The files viewed had all other documents in place. All new staff now undertake induction training in line with Skills For Care and do mandatory training in fire safety, moving and handling, food hygiene, emergency first aid, safeguarding adults and medication administration etc., as well as other courses in such as dementia, continence, nutrition and so on. Certificates of completion and attendance are evident in files. Staff confirm this in their interviews. There are some staff working in the home that originate from other countries, but discussion with them reveals they do not have any particular diverse needs that their employer is not meeting. The deputy manager and two senior staff have completed an equality and diversity course and all staff are encouraged to adhere to the principles of equality and diversity in their roles when dealing with each other and when caring for people living in the home. Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 23 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, 33, 35, 36 and 38. People who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. People live in a home that is well run and in their best interests, where good systems are in place to determine the quality of the service. Their financial interests are safeguarded and their health, safety and welfare are well promoted and protected, so they are confident they will be safe and well cared for. EVIDENCE: Discussion with the manager, deputy and staff, and viewing of documentation, safety records and certificates reveals, people and staff benefit from a safe and well-run home. Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 24 The manager has one unit to complete on the NVQ level 4 Registered Manager’s Award. She has several years experience in a supervisory role and 18 months experience as a manager. She constantly strives to improve her own knowledge and understanding of the care business for the benefit of improved services to people. The deputy has completed the Registered Manager’s Award. Together the two people in these roles complement one another, work very much as a team, sharing responsibilities and delegating others to senior staff etc. They present as being very organised and are disciplined in their maintaining of records and documentation. Both people know exactly where information is stored and ensure it is maintained in an up-to-date and very orderly fashion. They also have good knowledge, understanding and control of the staffing teams as well as good understanding of the needs of people living in the home or using it for day services. There have been no changes to the systems for quality assuring the service provided in the home since the last inspection. These were not fully assessed on this inspection, but the manager explains the home usually carries out people, relative and staff surveys to obtain information on how well the service is doing, and produces an analysis of the information obtained. The home carries out an annual service review, but has not yet actually reviewed the quality assuring systems in use. Should this take place, then under regulation 24, a report is required, a copy of which should be sent to the CSCI. The home has been reviewed by North Lincolnshire Council and was awarded the council’s Gold Standard in their quality development scheme. People have control of their own finances, where possible, and if unable then their relatives do so. Some have a small amount of money held in safekeeping for which the home maintains a record of money in and out, with signatures and running balance. Only one check on finances was made as only one from three people giving permission to look at records has money in safekeeping. This was accurately maintained. Staff confirm in interview they now have regular supervision in line with requirements of standard 36, and their file details evidenced this. The manager explains that the appraisal system is currently being carried out annually but she is considering changing this to six-monthly. The manager and staff maintain a safe environment for people and staff by ensuring all equipment is regularly serviced and certificated if necessary, by following all relevant legislation in respect of health and safety responsibilities, and by maintaining appropriate records of safety checks, etc. Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 25 Areas sampled to determine whether or not standard 38 is met are, fire safety, hoist maintenance, water temperature and legionella testing, and safety in the use of cleaning substances. There is a general fire safety file, which contains information for action in the event of fire and the procedure to follow. There are weekly equipment checks carried out and recorded on a sheet showing how all of the different points are tested on different occasions. There is also a log of each fire equipment test, and a further record of each test showing greater detail. There is an evacuation procedure and evidence of staff evacuation training in the form of question and answer sheets on evacuation in an emergency. Fearl Walker Ltd. last carried out extinguisher maintenance checks in September 2007 and completed an annual systems check in October 2007. There is a fire risk assessment document that is reviewed annually and recorded as such on a review log. The risk assessment identifies all of the hazards in the home. There is also a copy of the ‘Fire Safety Employer’s Guide.’ The last Humberside Fire & Rescue Service visit was on 17/04/07 and general advice was given. There are certificates in place to show Arjo Mecanaids last maintained the mobile lifting hoist and fixed bath hoist on 19/09/07. Rosecroft does not have an upper floor and therefore there is no passenger lift. There is evidence that Acumen Solutions last carried out a legionella test on the hot water storage system on 16/03/07. The home also maintains temperature and records checks on all hot water outlets. There was a requirement made at the last inspection in relation to use of bed safety rails. The manager confirms there is now information available on using bed rails and risk assessments are carried out before any are used, but that at the moment there are no people in the home using them. Information is obtained from the Medical Devices Agency via e-mail contact. Other requirements made in this section at the last inspection have also been met, except the one in relation to the manager submitting an application to become the registered manager. The manager has been in post for over a year and therefore an application to become the registered manager is required by the end of April 2008. All materials used in the home for cleaning etc. are kept locked safely away, have appropriate safety instructions and dilutions and are used in conjunction with the necessary safety guidelines under Control of Substances Hazardous to Health Regulations 1988. No products were observed to be unattended. Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 26 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 X 4 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 4 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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. 1 Standard OP31 Regulation 8 Requirement The registered person must make sure the appointed manager submits an application to register with the Commission so people are confident they live in a home in which someone fit to be in charge manages. (This requirement, in a changed form, is still outstanding from the last inspection – previous timescale of 31/03/07.) Timescale for action 30/04/08 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 Refer to Standard OP29 Good Practice Recommendations The registered person should ensure that no prospective employee works in the home, this includes ‘shadowing’ more experienced workers until all records as set out in Regulation 19 have been received. This includes receipt of a POVA 1st check pending receipt of a CRB check. This is so people are protected and cared for by safe staff. Rosecroft Care Home DS0000045639.V358957.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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