Care Home: Rosedene

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What the care home does well We observed many staff being kind and considerate to the people who live at the home. Positive contact and a good rapport was also seen. Relatives are welcomed and the home has an open and inclusive relationship with many providing relatives with information about how their relative spends their time. Residents consent is sought. Comments from surveys states that they felt that the home did well by stating the following, "Rosedene caters for a number of people with varying needs and difficulties. Many of the clients they have are difficult with behavioral problems which the staff manage very well", "manage a diverse group of people with differing levels of need in a structured yet dignified way", "manages complex cases with enduring mental health problems," have a good understanding of clients needs," treats people as individuals and the manager has a hands on approach, being involved in clients care". Comments in staff surveys were as follow " meets the needs of the service users " " cares for a wide selection of people" Residents surveys comments included " looks after us well "most things"" its a happy place" and "good food". What has improved since the last inspection? The home continues to notify the commission of significant events in the home. The fire alarm system is now tested weekly and a record is maintained. The management of medication within the home has improved with appropriate records being maintained. Some refurbishment of the home, has taken place which have included new parker baths being installed, new flooring in the lounges as well as new blinds and chairs have been added to the conservatory. New dining room chairs and tables have made the ground floor dining room much more homely for the people who live there. The outdoor area has a new summer house. What the care home could do better: The home must continue with its refurbishment programme to ensure that the home remains homely and safe for the residents. Residents meetings record must be organised so that there is a set agenda which is reported on and where individual concerns are raised that they are recorded elsewhere. Staff meetings must take place more frequently. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rosedene 141-147 Trinity Road Wandsworth Common London SW17 7HJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Davina McLaverty     Date: 2 7 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Rosedene 141-147 Trinity Road Wandsworth Common London SW17 7HJ 02086727969 02086723005 terry@rosedene-nursing.fsbusiness.co.uk 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) : Mr T Lewis care home 67 Number of places (if applicable): Under 65 Over 65 67 0 67 dementia learning disability mental disorder, excluding learning disability or dementia Additional conditions: 67 1 67 Learning Disability The Home may provide accommodation and care for one named service user with a learning disability only. The category LD is to be removed once this service user is no longer accommodated at the Home. Date of last inspection Brief description of the care home Rosedene is a registered care home, presently registered for 67 nursing beds for service users with needs including dementia and mental health. The property is located in Wandsworth Common, close to shops, pubs, the post office, bus routes, underground and over ground rail links. The home is on a busy main road, with parking to the front. The property comprises four large three storey terraced houses that have been joined together to form one care home. There are two passenger lifts between all floors. There is a garden to the rear, to the side of which there is a building where activities Care Homes for Older People Page 4 of 28 Brief description of the care home are provided. The fees range from £750 to £1670.25 per week. Care Homes for Older People Page 5 of 28 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: two star good 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: The quality Rating for this service is 2 stars. This means that people who use this service experience good quality outcomes. The inspection of this service included an unannounced visit to the home on the 16th July 2009, by a regulation inspector and a local area manager. The homes manager and quality assurance manager were both available on the day. Documentation looked at included medication records, staff recruitment information, residents care plans and health and safety documentation. We also looked at the premises and spoke to staff, residents and some relatives. Care Homes for Older People Page 6 of 28 The manager also completed a self assessment of the home which is called an AQAA and this was used to help form some of the judgments in this report. Thirty surveys were sent to the home for staff, residents and Social and Health care professionals to complete, Four were returned from health care professionals, , four from staff and seven from residents . Comments in them all were largely positive with no areas of serious concerns being raised. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 28 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 28 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 28 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 who use the service are appropriately assessed prior to moving to the service. Evidence: The manager or a senior staff member visit people who are interested in moving to the home in hospital or their own home to ensure that the home can meet their assessed needs.The home has a comprehensive assessment format which covers all activities of daily living, such as eating and drinking, personal care, mental state and where people need assistance with their mobility. The assessment takes into account information received from relevant health professionals and care managers. Wherever possible prospective residents and their representatives are invited to the home to have a look around, meet staff and other residents and to see if they like the home before they make a decision to move there. Once a placement has been agreed people will have their needs reassessed after few weeks of living there. Care Homes for Older People Page 11 of 28 Evidence: The homes Statement of Purpose and Service User Guide details what people can expect living at Rosedene and all residents and their representatives have access to copies of both documents. Care Homes for Older People Page 12 of 28 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. Care plans and risk assessments are in place and there is a system to ensure that they are regularly reviewed There is evidence of multi- disciplinary working with other health care professionals involved with the resident. Medication was found to be appropriately managed with good systems in place. Evidence: Care plans for five residents were looked at and were being regularly maintained and reviewed monthly. Care plans continue to be led from the individuals initial assessment and were comprehensive and easy to follow. Care plans contained clear, personal information on the residents next of kin,their GP and their medication. A daily living profile was also seen, as well as background information regarding the persons earlier life, which provides a pen picture of the resident which is helpful to staff. Assessment information gathered , covered appropriate areas relating to daily living ie Care Homes for Older People Page 13 of 28 Evidence: communication, breathing and mobility. Mental health assessments was seen to be in place for residents who suffer with a mental disorder. Where interests were identified evidence was seen as to how the home supported the resident to pursue these. We saw evidence of multidisciplinary input in the care plans looked at. This included chiropody, dentists, GP and Psychiatric Community Nurses. In discussion with the managers they stated that they felt that they had good working relationships with other professionals. Surveys received from social and health care professionals confirmed this with the following comments being made. Care at Rosedene has led to an improvement in both the mental state and general well being of a patient, the staff have coped well with persistent psychotic symptoms and lack of insight and managed to establish rapport with the patient. Also the staff have been very effective in working in collaboration with our team, and the staff have a good understanding of clients needs and treat people as individuals. Risk assessments were seen to be in place and like the care plans were regularly updated. Risk assessments covered areas such as risk of falls, disability, environment, injury to self and others , health relating to specific conditions as well as use of bed rails. Where relatives are involved and residents aware not able to agree to certain risks e.g. use of bed rails relatives had signed on the relatives behalf. Medication was looked at and found to be appropriately managed with residents receiving their prescribed medication. Medication administration Record sheets were completed . At the time of the inspection no controlled drugs were being administered. Staff who administer medication receive appropriate training. Care Homes for Older People Page 14 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to receive nutritious meals in pleasant surroundings. People are encouraged to maintain contact with family and friends A varied program of activities remains in place. Evidence: The home employs an activities co-ordinator who has responsibility for organising activities in the home. An activities room is available in the garden area, which contains a good mix of equipment to assist in this task. In her absence staff will carry out one to one activities with residents as well as some group activities. During the inspection various activities were seen to be taking place. Residents and relatives spoken with during the inspection said that they were happy with the level of activities provided. Trips outside of the home are organised and we were informed that a trip to Southend had been arranged which relatives were also invited to go on if they wished. One relative spoken to told the inspector how much she was looking forward to the day out. Care Homes for Older People Page 15 of 28 Evidence: Residents meetings do take place but in discussion with managers we advised that the format of these meetings must change and that these meetings must have a more general focus e.g. looking at how residents collectively want things to occur in the home.eg meals, activities, as the record seen noted individual concerns which did not have a clear outcome. Managers were advised that where individual raised individual issues that they be noted and addressed during their key working sessions. Residents seen appeared content and were being treated with respect and dignity. One relative said the staff are marvelous and treat everyone as an individual and people were able to do what they wanted. The same relative said they could still support their relative in the home if they wished e.g. support them to have a bath , use the toilet assist at meal times if they wanted. This relative felt that this was very important to them and spoke highly of the relaxed nature of the home. The main dining room is located on the ground floor although residents can have their meals in smaller dining areas in the lounge areas on the various floor or in their rooms if they wish. The main dining room was relaxed in appearance and the new furniture makes it more homely in that the smaller round tables allows for friendship groups to sit together and have their meal. The staff members said that the new table arrangement encourages more conversation. Residents are offered a choice of meals and all dishes are prepared from fresh. The AQAA states that over the next twelve months the home intends to work on the following areas continue to develop our food service in line with all government guidelines, to develop a supper trolley trolley along the same lines as the breakfast and offer clients a more visual aid to making their own choices and to develop a picture board menu system. People spoken with and information from surveys confirmed that they are were happy with the current meal choices. Care Homes for Older People Page 16 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A complaints procedure is in place which residents and their advocates are made aware of at admission. Staff receive training in Safeguarding of Vulnerable adults as well as whistle blowing. Evidence: The service has a complaints procedure that details the process for investigating complaints received about the service. However, the complaints log could not be located at inspection. The AQAA states that there has been no formal complaints made since the last key inspection. Responses in surveys and from discussion with residents and relatives received confirmed that people knew how to make a complaint should they wish. The staff training records demonstrate that staff have received training in safeguarding adults and whistle blowing. Internal and external training is sourced in this area. Since the last inspection there has been three safeguarding referrals which Social Services investigated under their safeguarding policies. The managers stated that as a result of safeguarding referrals the home has re-examined their own policies and now regularly discuss safeguarding during individual supervision as well as at team meetings. The service has a copy of the most up-to date safeguarding guidelines from Care Homes for Older People Page 17 of 28 Evidence: Wandsworth local authority who are the main commissioners of places at this home. The home also continues to regularly notify the Commission of incidences under Regulation 37 of the Care Homes Regulations. Care Homes for Older People Page 18 of 28 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. Positive improvements have been made to the environment to make the service more homely and safe for the people who live there. Evidence: Since the last Key Inspection refurbishment in various areas, both inside and outside the home, has improved the environment for residents and staff. New Parker baths have been installed, new flooring and dining areas on the first and second floor as well as new dining room tables on the ground floor. Where bedrooms are shared appropriate screening is now available to provide more privacy to residents and which looks more homely. The front of the home is well maintained and hanging baskets added a beautiful feature. Car parking is available at the front of the house. The backgarden area had a new summer house and garden shed in it, table and chairs were outside and several of the residents were enjoying the warm weather, sitting out in the garden. Inspectors were informed that due to the shed being moved the grass area where the old shed was due to be re-laid in the autumn. A program of on-going redecoration at the service is in place which will include new furniture and furnishing as well as decoration of several rooms. New screens had been Care Homes for Older People Page 19 of 28 Evidence: purchased for some of the double rooms which enhance the room. New carpets had been laid in the corridors, however consideration must be given to providing carpets in bedrooms where residents request or would like it. Some new beds had been purchased for some residents . Managers stated that this is on going., in the home. The AQAA states over the next twelve months that the home is wanting to develop a sensory garden for the benefit of all clients. They are also planing to purchase different styles of beds according to peoples assessed needs as well as updating the bedding with brighter and more modern range of coverings. Bathroom areas seen all had paper towels and soap in them and were clean. The home was observed to be clean at the time of our visit. Care Homes for Older People Page 20 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practices continue to ensure that residents are not placed at risk by ensuring that all the required checks are carried out before new staff commence work in the home. Internal and external training is provided to ensure that staff has the necessary skills to support residents living at the home. Evidence: Staff were observed to treat people who live here with respect when they spoke to them . Both the Manager and Quality Assurance Manager were very knowledgeable about the residents and their needs. Equally individuals spoken to were complimentary about the staff and their treatment at the home. Staffing levels were satisfactory during the inspection with staff being redeployed to areas of greater need during the day. The service holds recruitment information on all staff employed at the service. The records of the three newest members of staff was looked at. These were seen to contain relevant information such as proof of identification, Criminal Bureau Checks, two references and a record of the interview of staff, which demonstrates that appropriate checks are carried out prior to starting work at the service. A system is Care Homes for Older People Page 21 of 28 Evidence: also in place for ensuring that nurses pin numbers are current. All support staff are trained to NVQ level 2 and are encouraged to undertake NVQ level 3 when they have worked at the home for two years. In discussion with staff they confirmed that they had received the required mandatory training applicable to their role. They also stated that staff meeting and supervision provided a forum for further discussion. Training of staff is being given priority due to the changing client group in the home ie mental health and a training record is maintained. The managers said that the home currently receives referrals for people with complex mental health needs and that they are ensuring that the home can support these people. All staff receive training on mental health and there is good links with the Community Psychiatric Nurses. Training is also provided by Wandsworth Social Services and includes areas such as dementia care, dealing with challenging behavior and mental health. The AQAA states that the home plans to continue to develop our training and staff development programs. Care Homes for Older People Page 22 of 28 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. There is a quality assurance programme at the home which takes into account the views of the people who live there and their advocates. Appropriate systems are in place regarding health and safety checks to ensure that people are not placed at risk.. Evidence: The Registered Manager has a number of years experience in nursing and has the relevant qualification for her role. During the inspection the Manager and Quality Assurance Manager demonstrated good knowledge of the people who use the service and how the home endeavors to meet their assessed needs. The service supports people to manage their personal allowance if they are not able to do so themselves and their is no family member able to do soon their behalf. The money held is used for toiletries, clothes, hairdressing, cigarettes and trips out. Records and receipts are maintained of all transactions. The proprietor is responsible Care Homes for Older People Page 23 of 28 Evidence: for the payment of fees. The care staff at Rosedene consists of trained mental health and general nurses and care workers. The AQAA states that a number of care workers have obtained at least the National Vocational Qualification (NVQ) Level 2 in care and several their NVQ level 3. In discussion with the Manager and Quality Assurance Manager they stated that the organization provides a variety of training to staff. All staff complete core training in Moving and Handling, First Aid, Health and Safety Fire awareness , Mental Health Awareness and dementia care. They stated that they also attend training delivered by Wandsworth Social Services who are the main placing authority in the home. Training has included dealing with challenging behaviour, and the Mental Capacity Act, Inspectors were informed that the home is currently working with an organization to deliver training specifically around the types of challenging behaviour residents who live at Rosedene display. Evidence of staff supervision was seen, the home were on target to ensure that all staff receive the minimum of six sessions are year. The proforma record seen should date the actual date supervision was given. Computer record detailed the content of the supervision session of which the supervisee are given a copy of. Annual appraisals were also seen to be taking place. Team meeting records were also seen. The frequency of these meetings should be increased . Currently they are held quarterly. If all staff cannot attend then minutes should be made available and staff requested to sign to ensure that they have been read. Residents meeting were seen to be taking place monthly but as already detailed the format of these meetings must be reviewed to ensure that individual querys are addressed at another forum e.g. key working sessions and that residents meetings are used for more general issues linked to the development of the home by the residents. The service maintains records to demonstrate that appropriate health and safety checks are carried out. A sample of these records were looked at and found to be in order. There is routine weekly testing of the fire alarm system and fire drills are carried out monthly. The gas safety certificate for the home was seen as was the portable appliance tests carried out. Appropriate food safety checks are carried out on the temperature of the food being served and of the food storage temperatures. A quality assurance system is in place which takes into account the views of residents and their advocates. Care Homes for Older People Page 24 of 28 Care Homes for Older People Page 25 of 28 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 26 of 28 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 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 32 Staff meetings should take place more frequent to ensure that all staff are kept up to date with any changes in practices and to provide a forum where staff can collectively and individually raise issues. Residents meetings minutes format should be better organised, with a set agenda which encourages residents to raise issues in which they can contribute to the development of their home. 2 32 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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