Care Home: Rosedale Court

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What the care home does well The home has a friendly feel, where visiting is encouraged and people are made welcome. The accommodation provided for people is good. People are able to make themselves feel at home through having their own things about them. Communal areas are spacious and there is pleasant outdoor space for people to enjoy. The manager always ensures that people`s needs are assessed before they move into the home to help make sure that it is the right place for them. People generally seemed satisfied with the care that they receive. One person said, "All staff provide wonderful care for my relative," another that, "I have been very satisfied with the care at Rosedale Court." People were also positive about the food provided by the home feeling that it was of a good standard, plentiful and that they were offered choice. Medication at the home is managed well and people will receive good support with this aspect of their care. Staffing at the home is fairly stable so that people receive care from staff that they know and are used to. What has improved since the last inspection? A new manager has been appointed to the home who is keen to continue to improve and develop the service for the benefit of residents. The new manager is being supported in this by the appointment of a new Care Operations Director for the Company. Although it is early days there is a clear commitment to review all areas of the service with special attention given to improving dementia care. The home has changed the pharmacy provider that they use and this has improved the management of people`s medicines. Areas of the home have been redecorated with some furnishings, carpets and equipment being replaced. This process is ongoing. Steps have been taken to improve the laundry service and ensure that the overall environment is kept clean and hygienic. Other aspects of documentation and management of the service have been improved. What the care home could do better: Although people are generally happy with the service, the one thing that many people raised was that they felt there were not enough staff available to always meet people`s needs, provide flexible care, and to provide a sufficient level of activity and stimulation. We saw for ourselves that a lack of staffing or good staff deployment was an issue that impacted on the provision of good holistic care. The provider therefore needs to review the numbers or deployment of staff to see how this can be improved. We asked the provider to look at this following the last inspection of the home, but clearly this did not make a sufficient difference to people`s experience. To protect people living in the home it is important that all staff have a good understanding of safeguarding, and what to do if they feel people`s treatment is not as it should be. Up to date information needs to be available to help people understand the actions they need to take. Senior staff need to be properly trained so that know how to properly manage any incident. Key inspection report Care homes for older people Name: Address: Rosedale Court Hockley Road Rayleigh Essex SS6 8EP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Vicky Dutton     Date: 2 7 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Rosedale Court Hockley Road Rayleigh Essex SS6 8EP 01268773180 01268774025 rosedale.court@runwoodhomes.co.uk www.runwoodhomecare.com Runwood Homes Plc care home 73 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: To provide personal care to 51 service users with dementia. (DE(E)). To provide personal care with nursing to 22 older people on the first floor. (OP). Total number not to exceed 73 service users. Date of last inspection Brief description of the care home Rosedale Court is a large purpose built detached building set back from the main road. The home is approximately one mile from Rayleigh town centre. Residents are accommodated on the ground and first floor and there is lift. The home has good car parking facilities. There is a large patio area and small grassed area to the rear of the building. The home is divided into four areas; Jasmine, Primrose and Honeysuckle accommodate older people with dementia care needs, whilst Lavender accommodates older people who have nursing care needs. All bedrooms have en suite facilities and there are separate lounge, dining and bathroom areas on each floor. The home has a statement of purpose and service users guide available. Information about the home Care Homes for Older People Page 4 of 31 Over 65 51 22 0 0 Brief description of the care home and most recent inspection report are available to residents/visitors in the lobby area of the home. It was confirmed that the range of current weekly fees at the home are from £450.00 to £725.00. The charge made is individually negotiated and varies according to needs, funding arrangements and whether occupying a nursing or residential care bed. There are additional charges for chiropody, hairdressing, personal items, newspapers/magazines and some outings. Care Homes for Older People Page 5 of 31 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key site visit. At this visit we (CQC), considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. Two inspectors spent nearly nine hours at Rosedale Court. We looked around the premises to see if it was pleasant and safe for people. We viewed some care records, staff records, medication records and other documentation to see how well these aspects of care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to management and staff. We also spoke to a number of visitors during the site visit. We spent some time in one area of the home observing the experience of a group of people identified on their care plans as having dementia. This is because people with dementia are not always able to tell us about their experiences and we wanted to find out about their Care Homes for Older People Page 6 of 31 experience of care. The homes Annual Quality Assurance Assessment (AQAA) was sent in to us when we asked for it. The AQAA is a self assessment tool that providers are required by Law to complete. The AQAA tells us how management feel they are performing against the National Minimum Standards and how they can evidence this. The AQAA for Rosedale Court was satisfactorily completed by the manager and gave us the information that we asked for. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives, involved professionals and staff. We received responses from sixteen residents, five relatives, two visiting professionals and four staff. The views expressed at the site visit and in survey responses have been incorporated into this report where appropriate. We were assisted at the site visit by the manager and other members of the staff team. Feedback on findings was provided throughout the inspection. The Care Operations Director for the Company also attended for part of the inspection, and for the closing summarising of findings. The opportunity for discussion or clarification was given. We would like to thank the staff team, residents, relatives and visiting professionals for their help throughout the inspection process. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Although people are generally happy with the service, the one thing that many people raised was that they felt there were not enough staff available to always meet peoples needs, provide flexible care, and to provide a sufficient level of activity and stimulation. We saw for ourselves that a lack of staffing or good staff deployment was an issue that impacted on the provision of good holistic care. The provider therefore needs to review Care Homes for Older People Page 8 of 31 the numbers or deployment of staff to see how this can be improved. We asked the provider to look at this following the last inspection of the home, but clearly this did not make a sufficient difference to peoples experience. To protect people living in the home it is important that all staff have a good understanding of safeguarding, and what to do if they feel peoples treatment is not as it should be. Up to date information needs to be available to help people understand the actions they need to take. Senior staff need to be properly trained so that know how to properly manage any incident. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. People can feel confident that staff will work with them to ensure that the home is suitable to meet their needs. Evidence: The home had a Statement of Purpose and Service Users Guide in place. These were available in the foyer area of the home. On surveys all 16 people who completed these said that they had received enough information about the home. A relative of a newly admitted resident said that the admission process had been smooth and that they had been impressed with the home. They said, I have been very happy with everything so far. To ensure that Peoples needs can be met by staff, an assessment of their needs should be undertaken before they move in. We looked at the files of four people who had been more recently admitted to Rosedale Court. We saw that satisfactory assessments of the persons needs had been undertaken. Pre admission assessments Care Homes for Older People Page 11 of 31 Evidence: are undertaken using a set format that covers peoples physical and social needs. The AQAA said that since the previous inspection that these assessments are now completed in more detail. We also saw that for some people additional information was available from other agencies involved with their care such as the hospital or Social Services. Intermediate care is not provided at Rosedale Court, but there is provision for up to four people to use the home on an interim care basis. This is where people who have been in hospital move into the home for a short period of time to complete their recovery, wait for care packages or adaptations to their own homes, or have some rehabilitation in a non-clinical setting. People stay at the home for a few weeks before returning home, or making the decision to move permanently into residential care. The home also offers short term respite care. The manager confirmed that preadmission assessments are also undertaken for people using the home for short term care. Care Homes for Older People Page 12 of 31 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 living at Rosedale Court will receive care that seeks to recognise and meet their their individual needs and preferences. Evidence: During the day most people living at the home and relatives told us that they were happy with the care received at Rosedale Court. People were generally well groomed and appropriately dressed. On surveys twelve people living at the home said that they always received the care and support that they needed, and four that they usually did. We did receive some negative comments from relatives. They felt that there could be more attention to detail in ensuring that people are offered proper support to manage their continence, and that staff do not always ensure that people start the day with all their needs attended to such as wearing glasses and hearing aids. Overall however there were many more positive comments. People using the service said: I am very happy with everything, and, I am very satisfied with my treatment at this home. I am treated well. Relatives said: They always take care of the residents, and their needs are placed first, My [relative] is getting wonderful care from all staff, It cares very well for the disabled without exception, They look after people well, I am Care Homes for Older People Page 13 of 31 Evidence: happy. They always put the needs of the patient first which I feel is important, and, So far I cant fault the care or staff. Our (CQCs) observations of care on the day of the site visit caused some concerns in that people often had to wait some time for care, or did not have appropriate support available to them due to staffing levels/deployment. A relative commented that, They could respond to call bells quicker which would stop my [relative] having falls as they try to get to the toilet themselves. This will be explored further under the staffing section of this report. Other issues observed suggest that staff are not always as proactive as they could be in identifying and managing peoples needs. For example one relative had left a note asking for attention to be given to their relatives eyes and ears. Issues which staff should have picked up on. We looked at a number of care files to see how well care is planned for and arranged. We wanted to see if people have a say in their care, how the home ensure that staff are made aware of peoples needs, and how they are helped to meet them in an individual way. We saw that care plans in place provided sufficient information for staff to enable them to offer individual support. Individual care plans relating to different aspects of care such as mobility, personal care, continence, interests and activities were in place and provided a good level of detail. For newer residents we saw that care plans were compiled in a timely manner and incorporated information from pre-admission assessments. Staff spoken with generally had a good understanding of individual residents needs and abilities. Records indicated that people are asked to agree to the care planning process and, where possible, were involved in regular reviews. Some areas where care plans could be improved to enhance resident care were identified. Where people have specific needs this should be a thread throughout their care plans. For example one person had a care plan in place to identify that they have significant sensory impairments, but this was not mentioned in other relevant care plans such as mobility, personal care and so on. Similarly short term care needs that impact on the persons whole care should be reflected in the relevant care plans. Records showed that people access appropriate health care to meet their needs. On surveys eleven people said that they always received the medical care that they needed and five that they usually did. Records of health professionals visits were well maintained. The AQAA said that since the previous inspection better relationships had been established with doctors and the district nursing team. One visiting professional survey said that, There is good communication between us. Another however said that what they could do better was to, Communicate with each other and to the district nursing team. Care plans incorporate assessments for nutrition and good nutritional records are maintained to monitor peoples diet. Falls risk assessments were in place to identify people at increased risk of falls. However we noticed that a number of people were using zimmer frames where the ferrules were worn through to Care Homes for Older People Page 14 of 31 Evidence: the metal. This could increase the risk of falls. As part of this inspection we looked at medication systems on Lavender and Jasmine units. Medication at the home is well managed and no errors in records or the system were identified. Relevant policies and procedures were readily available to staff. Staff spoken with confirmed that they had completed training. We saw that the system is regularly audited to ensure that correct procedures and practice are being maintained. On the day of the site visit, due to staff sickness the morning medication on the residential units took a long time and was not completed until about 10.30. This needs to be monitored to ensure that people receive their medicines in a timely manner and that any regular doses are spread evenly through the day. Observations through the day showed that staff approached residents in a calm and kind manner. Doors were kept shut when personal care was being carried out. Staff do however need to consider how they refer to residents as terms such as feeders were heard to be used. Also, on one occasion cleaning staff were noted to enter a room and commence cleaning without knocking on the door or explaining to the resident that they were about to clean the room. This does not fully support peoples privacy, dignity or demonstrate an individual approach. Care Homes for Older People Page 15 of 31 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. People will have some opportunities for occupation and stimulation. People will always be able to welcome their friends and family. Evidence: On surveys and in discussion, feedback from people living in the home and their relatives on the availability of activities was varied. Some people were satisfied with opportunities provided and others not. Positive comments were: The home arrange indoor and outdoor activities for residents, They do personal programmes for my [relative] - they took them to Tropical wings, The home organised a sherry party last year, Always organise interactive barbecue ensuring everyone is involved, and, Staff engage well with residents and their families. Less positive was, We get bored, More recreation is needed, Have more activities for the elderly, and, There is not enough stimulus for people, bingo big deal, and silly bits. They need something lively to hold their interest. Rotas showed us that an activity co-ordinator is employed to work every weekday from 08:30 to 16:30. They were however off when we visited. We saw that a weekly timetable of activities was on display. However as the activity co-ordinator was not available the timetable was not being fully adhered to. A bank activity co-ordinator undertook a music session in the morning, and in the afternoon people were left to their own devices with some staff undertaking Care Homes for Older People Page 16 of 31 Evidence: nail care. We saw that care files contained a life history and care plans relating to peoples social and activity needs. Activity assessments and records are maintained by the activity co-ordinator and held in a communal folder separate from peoples individual care files. This may not provide a joined up and holistic approach to meeting peoples needs. When we looked at activities records we saw that no entries had been made since the 12th or 14th of October. When we spoke to the bank activity coordinator they were not fully aware of what records were maintained. Records and information showed us that the home do try to provide for peoples occupational needs. Sensory equipment is avaialble, a range of regular activities such as music, ball games, flower arranging and crafts take place. A trolley shop is provided so that people can buy bits and pieces. Special events, outside entertainers visiting the home, and regular opportunities for fulfilling spiritual needs occur. However it is recognised by management that, particularly to meet the needs of people living with dementia, there is a need to move towards a more robust and proactive approach based on peoples individual histories and needs, and making the most of opportunities presented in daily living activities. Some care staff may need support with this and encouragement to move away from their current task based approach. Routines of daily living at the home may not always meet peoples expectations. In the mornings people waited for breakfast until 08:30 to 09.00. People may have been up for some time but they had not been offered a hot drink. Other people had to wait for assistance to get up. One person told us, I just want to get up and wash my face. Im gagging for a cup of tea. Another person told us that they were an early riser and would love a cup of coffee. At lunch time on one unit people were encouraged to sit up to the table nearly half an hour before the meal was due to be served. One person told us that routines were not flexible and when they had asked for a cup of tea staff had not been willing to provide this other than at a normal trolley round time. These issues need to be reviewed. People living at Rosedale Court are able to welcome their visitors at any time. During the inspection people came and went and were made welcome. People said, The home knows how to look after my family, The staff are always helpful and pleasant when I visit, Make you feel welcome at all times, and, Makes you feel very welcome, friendly staff both nursing and domestic. The home has a pleasant visitors room that can be used if wished. People utilized different areas of the home and went where they wished during the day. A number of people preferred to remain in their rooms and this was supported by staff. We saw that people were able to bring in their own possessions in order to make their rooms homely. There was information available about local advocacy services so Care Homes for Older People Page 17 of 31 Evidence: that people can know where to go for independent support and advice. On surveys when we asked Do you like the meals at the home nine people said always, six people said usually, and one person said sometimes. Feedback on the day was positive with people making comments such as, That was very nice, I love rice pudding, and, The food is always pretty good. A visiting professional said, From what I can obtain, meals are nutritious and plentiful. When we looked at menus we saw that a good range and choices of food are offered. Currently people have to choose what they would like for their lunch and tea on the day before. This may not be helpful for people who have dementia. Staff said that some people are unable to choose so they choose for them. At drinks times we noticed that people were not offered a choice of hot drink or able to choose their own biscuits. These were just presented to them. On the day of our visit it was a cooked breakfast day. Residents enjoyed this but it did mean that a number of people had breakfast after nine oclock and were then given lunch at 12.30. This is quite a short gap. Feedback from one person suggested that people were not given adequate assistance with their food. We saw that generally people were being given appropriate assistance, but that they sometimes had to wait a while for this. In the meantime, on one unit their meals were sitting in front of them getting cold. We saw that one member of staff who was assisting someone with a drink and biscuits did not allow them sufficient time to chew and swallow before giving them more. Care Homes for Older People Page 18 of 31 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 are encouraged to raise any concerns, but may not be fully protected through a robust approach to safeguarding. Evidence: The home has a clear complaints procedure in place. This is on display in various locations around the home. In some cases the information needs to be updated as it referred to the previous manager and CSCI rather than CQC. The AQAA told us that 48 complaints had been made in the previous 12 months. Over the last year three people have raised concerns directly with us, or copied us into their raising concerns with the organisation. When we looked at complaints records we saw that the clear recording of investigations, actions taken and outcomes was variable. This needs to be improved so that people can have confidence in the homes complaints process. On surveys most people said that they knew how to raise concerns and make a complaint. The AQAA said that, An open door policy encourages friends and relatives of residents to speak to managers about any concerns that they have. One relative spoken with felt that the homes response to a complaint had not been proactive. In the last 12 months two previous managers had raised three safeguarding alerts in relation to different situations in the home. This showed an understanding and proactive approach to ensuring peoples safe care and in working with Social Services. The management of the home has now changed again and at this visit there were some concerns about this aspect of peoples safe care. Care Homes for Older People Page 19 of 31 Evidence: One person told us, I do worry about how the service users are spoken to and treated when the family is not there as one of the carers was rude to myself and my [relatives] partner and we were only asking for a cup of tea for [the resident]. Training records showed us that most staff at the home had received in house training in safeguarding so that they should know what to look for, and how to respond to any concerns. Two members of staff had not received training. The training syllabus showed us that safeguarding training covered different types of abuse, but did not cover reporting procedures or information about local safeguarding teams. When we spoke to staff about safeguarding they understood what safeguarding was, but did not understand what procedures to follow in the event of an incident occurring. For example one senior member of staff said that, I would investigate to see if the person had been abused then I would raise the alarm and discipline the member of staff. Another senior member of staff said that they would inform the manager who would then inform us (CQC) to come and investigate. The AQAA said Reported incidents are documented and investigated. These responses are not in line with established procedures to protect vulnerable adults. The situation is compounded by the fact that the Companys Policies and Procedures in relation to adult protection available in the home dated from 2005, these again did not reflect current practice expectations. Local safeguarding guidelines which would provide staff with comprehensive information and contact details were not available. The manager undertook to address these issues, but poor understanding of safeguarding protocols is a concern. During our time in the home we noticed that a resident who had dementia had bruising on their upper arm. Staff could not explain this. When we looked at their records, the bruising was not noted on their body chart. There was only one passing reference to the bruising in their daily notes. No actions had been taken to find out what had happened or make any appropriate referral. This potentially leaves the person at risk. Following the site visit the manager confirmed that additional staff training in safeguarding had been arranged to ensure that all staff are trained, and that staff are up to date in their knowledge and practice. Care Homes for Older People Page 20 of 31 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, 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. 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 live in a pleasant and comfortable home. Evidence: Rosedale Court provides a comfortable environment for residents. The home is purpose built and only a few years old. The home is situated on the outskirts of Rayleigh, and is on a bus route. The AQAA told us that in the last twelve months a number of improvements have been made to the premises. Lounges and some bedrooms have been redecorated, some furnishings and fittings have been replaced and new garden furniture has been provided. A maintenance person is employed and their hours have been increased to meet the needs of the home. For operational purposes the home is divided into four units. Jasmine and Primrose on the ground floor and Honeysuckle and Lavender (The nursing unit) on the first floor. All bedrooms are for single occupancy and include an en-suite toilet and sink. Rooms viewed during the inspection appeared clean and well presented. People spoken with were happy with their accommodation. The home has a range of communal areas and pleasant outdoor space for people to enjoy. Care Homes for Older People Page 21 of 31 Evidence: The home has good bathing facilities to meet the various needs of residents. Most bathroom areas had been very nicely and individually decorated to provide a homely environment. During our time at the home we noticed that some wheelchairs were in a poor condition and had not been kept clean and hygienic. The manager showed us that they are implementing a cleaning schedule for equipment which should mean that all chairs are cleaned each week. On surveys fourteen people said that the home was always fresh and clean and two that it usually was. People said, The home is always clean, It is kept nice and clean, The environment is always clean and tidy, and, The home is very clean and satisfactory. When we visited there were some areas of the home where odour control needed to be improved. The manager said that a carpet renewing programme had now been agreed. It was also stated that a programme to ensure that all rooms were deep cleaned was in progress. During our visit we saw that rooms were being cleaned in this manner. When we spoke to domestic staff they told us that they had received appropriate training and that they had adequate supplies of protective clothing. We saw that the home has a spacious laundry area that was kept clean and tidy. The AQAA said that improvements have been made to the laundry system and that the home now received fewer complaints about the laundry service. Care Homes for Older People Page 22 of 31 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. People are supported by caring and competent staff, but there may not always be enough staff to meet their individual needs. Evidence: On surveys people said that staff were always or usually available when they needed them. Feedback on staff was generally positive and comments made were, They are very caring staff, Friendly helpful staff, The staff are always cheerful and helpful. However the one common theme on surveys and in discussion was that more staff were needed. Comments such as, More staff are needed. They need to provide more helpers, It would be a better home if there were more staff, and, Needs more staff at all times were common. A visiting professional said, Carers are generally helpful. However staffing levels must be a problem as we have frequently requested that during the DN team visits - one carer accompanies the nurse to ensure accurate feedback..... Observations during the day supported these comments. Lounge areas were often unattended for considerable periods of time, people had to wait for support or did not get the assistance that they needed. On one occasion only the care team manager was available in the office of one unit. No other staff could be found. The home is divided into four units all of which accommodate people with a range of needs including dementia. Different staffing levels are provided on different units. For the residential units of 14 or 18 beds there are two care staff supported by a care team manager during the day. On the nursing unit there is a registered general Care Homes for Older People Page 23 of 31 Evidence: nurse on duty at all times supported by four care staff in the mornings, three in the afternoon/evening and one at night. The AQAA, completed at the end of September told us that 40 people living at the home required two or more staff to help with their care. When we looked at records assessing peoples levels of dependency we saw that for September and October no one was assessed as being high dependency. The assessment tool in use may not therefore be accurately reflecting peoples needs. Also the assessments for August indicated that two people had high dependency needs, however staffing levels had remained the same. Therefore the assessment tool may not function effectively in ensuring that staffing is flexible and adequate to meet peoples assessed needs. Overall comments and findings indicate that the home need to review the numbers/deployment of staff to make sure that people are properly supported. A positive thing about the staffing at Rosedale Court is that from information given the staff turnover appears to be low, with only two full time and one part time member of staff having left in the last year. The home do use agency staff but not excessively. This will help to provide people with consistency of care from people that they know. Ancillary staff such as domestic, catering, maintenance and administrative staff are provided to support care in the home. The managers hours are supernumerary. Staff spoken with were friendly and positive about their role. Some comments made were, The home runs well when we have enough staff, I enjoy working here, All staff and management run the home to their best. A lovely home to work in, and, Good staff relations. Carers tend to work well together even though we are short staffed. Current Standards say that at least 50 of care staff working in a home hold a National Vocational Qualification (NVQ) in care. This will enhance staffs knowledge and skills in working with people. At Rosedale Court out of a total of 52 permanent or bank staff eight have an NVQ and a further eight care staff are working towards this. The home therefore has some way to go before achieving the recommended 50 . To see how well people are protected by the homes recruitment procedures we looked at the files of three recently recruited staff. These showed that although all the required checks such as references, proof of identification, POVA first and Criminal Records Bureau (CRB) are carried out, some attention to detail is needed. For example one person had significant gaps in their employment history that had not been explored. References provided did not include one from their most recent employer. For another person their fitness to work had not been fully explored. These issues are now causing difficulties for the home that could have been avoided. On surveys staff said that their induction had mostly covered everything they needed. Although we could not see some completed induction records as they were Care Homes for Older People Page 24 of 31 Evidence: held by the staff working through them, one file showed us that an initial two week induction programme had been completed. The manager confirmed that an induction based on the Common Induction Standards was completed by all staff. Induction packs were seen. One member of staff had not completed an induction programme as they had transferred from another home in the group. The manager was advised that an induction should still have been completed to orientate them to a new home, routines practices and so on. Staff surveys and staff spoken with indicated that there were good opportunities for training. A training matrix showed that not all staff have completed training in dementia care for which the home is registered. From discussion with staff the dementia care training undertaken only lasted a few hours so may not have provided them with the skills they need day to day in the workplace. This was demonstrated by a member of staff being unsure of how to react to a resident who had set ideas about what they wanted to do, and the general lack of proactive working with people who had dementia. The organisation has recently appointed a new Care and Operations Director who, along with the manager is very keen to develop good dementia care within the home. There are plans for improved dementia training. The AQAA said that all staff receive six supervisions each year, and an annual appraisal. On five staff surveys the response to asking if they received enough support in their role was variable. This may reflect recent changes in management in the home. Records showed that where supervision had taken place it may need to be more robust. For example one person had expressed difficulty in coping with some aspects of the job, but no plan had emerged to help them cope with this, or offer addittional training. Care Homes for Older People Page 25 of 31 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 live in a well managed home where their views are sought and listened to. Evidence: The long established manager at Rosedale Court left to work elsewhere in the organisation last year. The current manager was then acting manager at the home with an operations manager in overall charge of the home. They are now fully managing the home with continued support from the organisation. The manager is experienced in care and is currently undertaking further qualifications in management and dementia care to increase their knowledge and skills. They intend to apply for registration in due course. On surveys people said, The home is well organised, and, The home is very efficient and well organised. At the site visit people made positive comments about the manager and felt that they were doing well. In discussion with the manager and Care Operations Director it was clear that there is a strong commitment to rectify issues raised at this inspection and make many improvements at Rosedale Court. Care Homes for Older People Page 26 of 31 Evidence: The organisation has strategies in pace to monitor the quality of the service. A detailed annual audit is undertaken. This last took place at Rosedale Court in December 2008. The audit produces a report and an agenda for action that is then monitored. This shows that the provider is committed to improving standards. The audit included the use of questionnaires to seek peoples views. However we were told that these are not proactively sent out to people but just left in the foyer for people to complete if they wished. A suggestions box is available for people to make use of. Individual reviews and regular residents and relatives meetings also provide opportunities for people to express their views. Standards are monitored through a senior person in the organisation undertaking a regular monthly visit as is required by Regulation. The home also undertakes internal audits for areas such as medication to monitor practice and compliance. The manager completed the AQAA this year. It was satisfactorily completed, recognised achievements, and also recognised where further improvements are needed. People can feel confident that if they or their families ask the home to help them look after their personal monies, this will be done in a way that safeguards their interests. Monies checked were correct, with receipts in place for all transactions. We saw that the system was regularly audited. The AQAA identified that many of the homes policies and procedures had not been reviewed for some time. Staff may not therefore be aware of up to date practice and procedures. It was confirmed that this matter is in hand and that new policies and procedures are about to be issued. No major health and safety issues were noted on the day of the site visit. However potential hazards such as unattended hot trolleys need to be monitored. A training matrix viewed indicated that there are a number of gaps where not all staff have undertaken moving and handling or health and safety training. Also although all staff assist with food serving and assistance, only a low percentage have undertaken training in food hygiene. The training matrix also did not identify training in infection control. This could compromise safe practice. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 Requirement Timescale for action 1 18 13 Staff must receive appropriate training and support to ensure that they have a complete understanding of safeguarding and reporting procedures. So that people are protected and cared for safely through a robust understanding of protecting vulnerable adults. 01/12/2009 2 27 18 Staffing levels or the deployment of staff at the home must be reviewed. to ensure that people are supported by adequate numbers of staff to meet their individual needs and preferences. 14/12/2009 Care Homes for Older People Page 29 of 31 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 28 So that people are cared for by a skilled and well trained workforce, at least 50 of care staff should undertake NVQ training at level two or above. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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