Care Home: Rosegarth

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What the care home does well We found the atmosphere in the home to be relaxed, comfortable and informal and residents spoken to said that they could choose for themselves how they would like to spend their day. We saw that residents were able to freely access all the available facilities in the home and felt comfortable coming into the office and speaking with the manager. People who had moved into Rosegarth told us they had been given enough information about the home, including an up to date service user guide, to help them make a decision about whether they wanted to live there. Enough staff were on duty at any one time to meet people`s needs and residents told us they were treated with respect and staff were `very kind`. Other comments included, "The girls (staff) know what I need and make sure I get help", "I wouldn`t want to live anywhere else" and "Everyone is very helpful". We saw that plenty of activities were available for people to join in if they wished and people told us they could spend the day `how they wanted to`. The home was clean, tidy and had no unpleasant odours. Expert by Experience findings: "I was greeted by the deputy manageress and offered refreshments. I was immediately struck by the friendly atmosphere". "Lunch was served in the dining room which is set out like a restaurant...." "Staff are very accommodating and help the residents..." "All the staff were very kind and observant, when they noticed help was needed they reacted before residents asked..." What has improved since the last inspection? A new system to support the management team in developing things such as care plans, risk assessments and policies and procedures for the running of the home had been purchased from a professional consultancy firm. Staff now had access to clear information and policies about safeguarding adults. What the care home could do better: Although people living in the home told us they were well looked after and that their personal and health care needs were usually met by most of the staff team, lack of proper detailed care plans and risk assessments being in place could lead to a risk that some people`s needs may not be fully identified and planned for. Lack of regular reviews of such plans could also put people at risk of their changing health needs not being recognised in a timely way and not being acted upon.Although we saw that staff had received some training this appeared to be inconsistent and some staff spoken to said they would benefit from some further training. Lack of providing staff with relevant on-going training means staff may not always have the required knowledge and skills to meet people`s specific needs. No quality assurance system was in place to check that policies and procedures were being followed correctly and that staff practices were safe and meeting people`s needs. This was a requirement at the last inspection and was still outstanding. We found the home to be clean and comfortable but a lot of areas were showing significant signs of wear and tear and looked `shabby`. A programme of redecoration and refurbishment should be put in place. Expert by Experience findings: "The driveway was uneven and some parts had loose gravel and could be a hazard when walking or using a stick or frame. The narrow level access for wheelchairs at the side (of the building) had two areas I consider dangerous, one led to a few steps and the other to a bumpy area. If I had made a slight mistake (in my electric wheelchair) I could have gone down the steps". Key inspection report Care homes for older people Name: Address: Rosegarth 40 Moseley Road Cheadle Stockport Cheshire SK8 4HJ     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: John Oliver     Date: 2 1 0 1 2 0 1 0 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: Rosegarth 40 Moseley Road Cheadle Stockport Cheshire SK8 4HJ 0161-4853349 01614858466 rosegarth@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Rosegarth Limited care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Service users to include up to 25 OP. Date of last inspection Brief description of the care home Rosegarth is a Victorian building situated at the end of a quiet cul-de-sac in an area between Cheadle and Cheadle Heath. The home is set in gardens, surrounded by mature trees. Rosegarth provides care and support for up to 25 service users who are older people. Single bedroom accommodation is provided for all service users on the ground and upper floors. People are able to bring small items of furniture and personal possessions with them. A call system is installed in all rooms to summon support or assistance from staff. The home has a Statement of Purpose and Service User Guide which were reported to be given to prospective people or their families when they visit the home to look Care Homes for Older People Page 4 of 31 Over 65 25 0 1 8 0 2 2 0 0 9 Brief description of the care home round. Copies of these are also in bedrooms. Fees for accomodation and care at the home range from 340 - 425 pounds per week. 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 inspection was undertaken as part of a key inspection, which includes an analysis of any information received by us (the Care Quality Commission) in relation to the home prior to the site visit. The visit, which the home did not know was going to happen, took place over the course of one day on Thursday 21 January 2010. During the course of the site visit we spent time talking to residents and the manager and staff on duty to find out their views of the home. At the time of this visit, the registered manager was not on duty and we were assisted by the deputy manager. Throughout the report the term manager has been used to refer to the manager on duty on the day of our visit. Residents is also the preferred term to be used when referring to people who live at Rosegarth. Care Homes for Older People Page 6 of 31 During the course of this inspection the services of an Expert by Experience was used. Experts by Experience are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term expert by experience is used to describe people whose knowledge about social care services comes directly from using a care service. Jenifer Turnock, an Expert by Experience, joined the inspector on this site visit. Jenifer spoke to residents, toured part of the building and observed people using the service and staff interactions. Some of her comments and observations have been included in this report. Before the site visit we sent the manager of the home an Annual Quality Assurance Assessment (AQAA) document for them to complete and return to us before the visit took place. The information asked for in this document helps us to assess the service being offered by the home and to see if the manager sees the service the same way as we do. On this occasion details in the AQAA were very basic and did not tell us whether all the things we said must be done at the last inspection had been acted on. We discussed the sort of information we need with the manager so the registered manager can complete the next AQAA in much more detail. 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 living in the home told us they were well looked after and that their personal and health care needs were usually met by most of the staff team, lack of proper detailed care plans and risk assessments being in place could lead to a risk that some peoples needs may not be fully identified and planned for. Lack of regular reviews of such plans could also put people at risk of their changing health needs not being recognised in a timely way and not being acted upon. Care Homes for Older People Page 8 of 31 Although we saw that staff had received some training this appeared to be inconsistent and some staff spoken to said they would benefit from some further training. Lack of providing staff with relevant on-going training means staff may not always have the required knowledge and skills to meet peoples specific needs. No quality assurance system was in place to check that policies and procedures were being followed correctly and that staff practices were safe and meeting peoples needs. This was a requirement at the last inspection and was still outstanding. We found the home to be clean and comfortable but a lot of areas were showing significant signs of wear and tear and looked shabby. A programme of redecoration and refurbishment should be put in place. Expert by Experience findings: The driveway was uneven and some parts had loose gravel and could be a hazard when walking or using a stick or frame. The narrow level access for wheelchairs at the side (of the building) had two areas I consider dangerous, one led to a few steps and the other to a bumpy area. If I had made a slight mistake (in my electric wheelchair) I could have gone down the steps. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of moving into the home received sufficient information to help them to make a decision and an assessment of their needs was undertaken before they moved into the home. Evidence: To help people make a choice about moving into Rosegarth all potential new residents were provided with a copy of a statement of purpose and a service user guide. The manager provided us with a copy of the latest service user guide. All relevant information about the service appeared to be included although some information needed updating in parts, for example, the title Commission for Social Care Inspection (CSCI) needed updating to the Care Quality Commission (CQC). The manager told us that all potential new residents would be visited in their own homes or hospital for a full pre-admission assessment of their needs to be carried out. This assessment would usually be carried out by the registered manager of Rosegarth. Care Homes for Older People Page 11 of 31 Evidence: Since the last key inspection the registered manager had purchased a management system that provided support in developing appropriate paper records for things such as pre-admission assessments, care planning and other service related documents. We looked at the files of 3 people living at the home and found that they all contained needs assessments that had been completed by a member of the social services assessment teams. We looked for evidence of the pre-admission assessments completed by the management team of Rosegarth. There was some indication that the new documents had been used but not consistently. It was difficult to assess what information had been gathered and recorded before admission and what had been completed after admission. Not all questions had been answered nor had all documents been appropriately signed and dated by all parties involved. There was no evidence that, following any pre-admission assessment, people had been informed that Rosegarth was/was not a suitable service to meet their identified needs. It is important that people considering moving into Rosegarth feel confident that their needs have been fully assessed and recorded and are informed of the suitability of the service before any admission into the home takes place. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff provided support to people to make sure their individual personal and health care needs were met but a lack of adequate care planning presents a risk that changes to needs will not be identified and addressed. Evidence: Since the last key inspection in February 2009 the registered manager has tried to further develop the system used for care planning and risk assessing in Rosegarth. To aid her to do this she had purchased a professional management tool that offered guidance when developing paper records for things such as care planning and carrying out risk assessments. From the information provided by this guidance the manager had put in place a new care plan and risk assessment format. We looked at a number of care files in order to assess if the new care plans and risk assessments had improved the way information was shared and acted upon regarding meeting peoples current care needs. Although we found care plans to be in place these were inconsistent in their format Care Homes for Older People Page 13 of 31 Evidence: and we found the information difficult to follow. For example, pages of the care plan did not follow on from one another as intended by the new system and therefore lacked structure. On one care plan examined it stated that the resident required one carer to assistance with personal care and one carer to assist with mobility. Details of how that assistance should be offered/given was lacking and therefore the way in which support may be carried out could vary. Lack of such important information could place both the resident and member of staff at risk from inappropriate practice being carried out. There was a written record that care plans were being reviewed on a monthly basis but it was difficult to know how the care plan was being assessed due to the lack of detailed information in them. One one review sheet examined it stated Whole care plan reviewed, no changes identified, current care plan reflects needs, the same statement was recorded over a number of months. Although risk summaries had been carried out using the new system of recording, no actual risk assessments had been completed. We looked at the risk summary for one person relating to moving and handling and support needed when being assisted to the toilet. The only details in the summary was that the person required the assistance of one carer. The information did not clarify what the risk was, how the risk was to be managed and did not link to a specific care plan. Lack of detailed, consistent and meaningful care plans and risk assessments could mean that staff do not have the necessary information about the care they need to provide and how they should monitor peoples changing needs on a day to day basis. Although care plans and risk assessments needed to further improve, on speaking with staff it was clear that they had the knowledge and and skills to meet peoples needs from working with them on a day to day basis. People living in Rosegarth had access to other health care professionals such as the local General Practitioners and district nursing service. We saw that the district nurses kept their own records of the treatment they were giving to people. During out visit one district nurse called to see a number of people. The feedback she gave to the manager on duty was very positive about how staff were supporting peoples health needs to improve. Expert by Experience findings: All the staff were very kind and observant, when they noticed help was needed they Care Homes for Older People Page 14 of 31 Evidence: reacted before residents asked.. As I was leaving I asked about residents care at night, one carer had experience of night work as well as daytime, she said, Its like your own home, we pop in to the rooms to check on everyone, check all electrics are turned off and curtains are properly drawn. We hear people moving around (and) one resident wakens about the same time every night for the toilet and we check hes OK. A lady often comes down for a cup of tea and stretches her legs then returns to sleep some more. Any hospital appointments necessitates an extra member of staff who escorts the resident and stays with them throughout the visit. A hairdresser visits each week and opticians, chiropodist, physiotherapist and choice of three doctors visit as and when necessary. Medication in the home was administered via a monitored dosage system provided by a local pharmacy. We looked at a small sample of medicine records and these were found to be appropriately maintained and accurate. We carried out a spot check of medication that had a variable dose (one or two tablets) which was also to be given as and when required. It was difficult to ascertain what balance should be left as staff had not been recording whether one or two tablets had been administered. It is important that all medication in the home can be accounted for at all times to minimise the risk of errors occurring. During the visit we watched how staff treated residents, especially when helping them to the toilet/bathroom and to their bedrooms. This was done quietly whilst maintaining the individuals dignity and treating them with respect. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported to make choices and maintain control over their own daily routines and activities. Evidence: Part of the care staffs role was to make sure that various social activities took place on a regular basis. A large noticeboard in the hallway displayed various notices and posters advertising events that had or were due to take place as part of the organised activities. People spoken to told us that there was always something going on and you can join in if you want to, but nobody forces you. Information contained on a number of care files we examined demonstrated that people had taken part in a range of activities such as watching films, beauty treatments and gentle exercises classes. Mealtimes were seen as an important part of the day and people we spoke to told us that the food provided was very good. Copies of menus were available, which showed that choice was provided at each mealtime and a varied diet was available. Care Homes for Older People Page 16 of 31 Evidence: Expert by Experience findings: I looked at the long noticeboard full of information, menus, activities and photographs of the summer fair which was held outside in the lovely gardens. This event was very well supported by visitors and relatives of the residents and friends and family of the staff who all know the residents and treat them like an extended family.... Lunch was served in the dining room which is set out like a restaurant, with round tables and set for 4 people with glasses, cutlery and condiments suited to the menu. I kept a resident company as she ate her lunch of gammon, cauliflower cheese and roast potatoes. A staff member offered to cut the gammon, but this (offer) was declined. Sometime later she asked again and the resident accepted her help with it and the potatoes. The meal was substantial, hot and very nicely presented. Food is a popular topic of conversation and everyone spoke highly of the home cooking and certainly everything on the plate was freshly prepared and the thick slice of ham was very lean and cut like butter. All the staff were very kind and observant, when they noticed help was needed they reacted before residents asked. I was offered three good choices of main course and provided with a glass of whole milk (my choice). Care was taken that food was eaten and alternatives were offered as each course was served. Quantities were generous, nicely presented and very apetising. Daily activities are many and varied and rely on circumstances, seasonal variations and weather. In summer there are more outdoor activities, relaxing in the garden, planting bulbs, gardening, making hanging baskets, short trips, shopping, longer trips to country parks, stately homes, garden centres etc. Rosegarth has a vehicle and driver who is available for these trips. Variations in the winter programme includes invited performances from singers, muscians, school choirs and dancing. Care Homes for Older People Page 17 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. Policies and procedures were in place, which protected the residents in the home from abuse. Evidence: The complaints procedure was available in the Service Users Guide and Statement of Purpose. We spoke to a number of people living in the home who told us that if they had any concerns or worries they would speak to a member of staff or the manager. At the time of our visit the complaints register could not be found and we were unable to ascertain if any complaints had been recorded. Within the annual quality assurance assessment returned to us by the registered manager it was stated that no complaints had been received by the service in the last 12 months. Since the last key inspection a new policy and procedure relating to the protection of vulnerable adults had been developed and was available to all staff. Details in this policy directed staff to be aware of the procedures used by local authorities including the Department of Health guidance No Secrets and Stockports All-Agency Safeguarding Adults Policy. Copies of both these documents were available on file. Staff spoken to during this visit told us that they had received some training in the protection of vulnerable adults but this was a long time ago. On checking staff files, most indicated that safeguarding training had last been conducted in 2005. Care Homes for Older People Page 18 of 31 Evidence: Those staff spoken to were generally aware of the procedures in place but were unsure of the procedure to follow in the event of an allegation being made. Most staff stated they would expect the manager of the service to carry out at full investigation of any allegation being made before notifying the relevant safeguarding team. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Rosegarth was clean and homely but standards could improve. Evidence: As part of our visit we carried out a partial tour of the home. The lounges were found to be comfortably furnished, pleasant and had homely touches such as ornaments, plants and pictures. In one small lounge it was noticed there had been quite a large water leak to the right of the window. There was a large patch where the wall had been very damp and wall paper had lifted and was peeling away from the wall. The manager told us that this leak had been fixed but the appearance of the water stain and peeling paper indicated that the room should be considered for redecoration sooner rather than later. There was a large, pleasant conservatory area which, at the time of our visit was being used by a number of people to relax in. People spoken to said they enjoyed using this facility as it was bright with plenty of room to move about. Leading into the main conservatory area were two birdcages housing two budgerigars belonging to one of the people living in Rosegarth. Although everyone was happy enough to have these birds in the lounge areas it would be good if risk assessments were carried out to ensure people who may have problems with chest complaints are made aware of any risks, for example, from feathers and dust. Care Homes for Older People Page 20 of 31 Evidence: We looked at a number of bedrooms which were found to be adequately furnished and decorated. Most rooms had been personalised to varying degrees, reflecting the character of the person whose room it was. A number of clocks showed the wrong time which could be disorientating for people, especially if they already have some confusion. Staff need to be aware that such things are important when trying to orientate people who suffer with varying states of confusion. In a number of bedrooms furniture and carpets were beginning to show distinct signs of wear and tear and a programme of refurbishment and redecoration for Rosegarth should be developed and put in place. All these areas were discussed with the manager. In one toilet it was noticed that the wooden toilet seat was split at the front. To safeguard people using this toilet, the seat must be replaced. Liquid soap and paper towels were found to be in place in most toilet and bathroom areas helping to reduce the potential risk of cross infection. On checking the laundry area we found the sink that should be used for staff to wash their hands dirty and stained. No liquid soap and no paper towels were available for staff use increasing the potential risk for cross infections to occur, especially after handling soiled linen. It is important that wherever possible, potential risks to the health of both staff and service users are minimised at all times by the use of good practice procedures. Expert by Experience findings: After lunch I took the lift up to the ground floor and entered the first lounge. I spoke to two ladies who were smartly dressed, one lady had chosen Rosegarth to stay close to her husband who became resident before her. Rosegarth was her first choice and she hoped to share a bedroom but they each have a single room close to each other on the upper floor. Each room contains a bed, wash basin and commode and pieces of furniture, a mirror and other possessions from home. One bed had a structure attached to the residents own bed which she holds on to as she gets in and out of bed (support aid). Bathrooms and separate toilets are on four levels and key workers arrange a rota for baths and showers (according to residents choice and preferences). Bathrooms have hoists, walk in showers and all machinery (hoists) is maintained. The driveway was uneven and some parts had loose gravel and could be a hazard when walking or using a stick or frame. The narrow level access for wheelchairs at the Care Homes for Older People Page 21 of 31 Evidence: side (of the building) had two areas I consider dangerous, one led to a few steps and the other to a bumpy area. If I had made a slight mistake (manouvering my electric wheelchair) I could have gone down the steps. 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 were supported by a team of staff who know them well but a limited range of staff training means staff may not always have the knowledge and skills to fully meet peoples needs. Evidence: We looked at the staffing rotas for the home and these indicated that enough staff appeared to be on duty at any one time to meet the needs of the people using the service and people living in Rosegarth and staff on duty at the time of our visit told us that there were always or usually enough staff available to meet peoples needs. The manager told us that no new staff had been employed in the home since the last key inspection in February 2009 and therefore we did not look at any staffing personnel files on this occasion. We looked at a number of staff training records to see what training had been recorded during the past 12 months and found that most staff had completed moving and handling training. District Nurses had also provided staff with some training on supporting people with epilepsy. Other training was difficult to assess as records were inconsistent in their contents. Staff spoken to told us that they did get some training but not a lot. A number of Care Homes for Older People Page 23 of 31 Evidence: staff said that they felt more training should be provided. Records indicated that most staff last completed Safegarding Adults training in 2005. It is important that all staff receives the necessary training to regularly update their knowledge and skills to enable them to meet their job roles safely and effectively. We discussed induction procedures for staff with the manager. She told us that a recently purchased management system would be used to support the management team when taking new staff through an induction into their job role. The management team should ensure that the new management system for carrying out inductions is in line with the Skills for Care Common Induction Standards. Within the returned annual quality assurance assessment (AQAA) we were told that 98 of the care staff team had successfully obtained a National Vocational Qualification (NVQ) at level 2. It would be good if a training matrix was developed to show all training each member of the staff team had completed or was due to complete in any 12 month on-going period. Expert by Experience findings: Staff are very accommodating and help the residents play the games (social activities). All the staff were very comfortable chatting to the residents, some did not know who I was and approached me very naturally as though I was a potential resident having a look around or a visitor. Care Homes for Older People Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures and systems in the home need to be better managed to improve weak areas in service delivery. Evidence: On the day of our visit the registered manager was not on duty and the deputy manager was managing the service in their absence. We know that the registered manager has a number of years experience in working in the residential sector and has completed the NVQ Level 4 in Care Management and the Registered Managers Award (RMA). We were told by people living and working in the home that residents meetings were held on a regular basis where issues such a meals, menu planning and activities including trips out were discussed. One person spoken to told us, Elaine (the manager) and the rest of the staff listen to what you have to say and they make sure we are well looked after. Another person told us, The managers and girls (staff) are very caring and you couldnt wish for any better. Care Homes for Older People Page 25 of 31 Evidence: When asked about the management of the home staff told us, We are fully supported by the manager, she is a very good and fair manager. The manager is approachable and you get supervision. (We have) very good and thorough management who are on the ball. No formal quality assurance system was in place to ensure that the staff and management working practices were in line with current guidance, regulation and legislation although a Quality and Quality Assurance Policy and Procedure had been developed since the last key inspection. Efforts had been made to improve key areas of the service such as record keeping and care planning but the manager needs to make sure that a system of audit is developed that will inform the management team of how staff are performing, the quality of service delivery and what other key people think about the service. We did not have access to records in respect of peoples money but the manager told us that receipts were kept of all transactions made. We randomly selected a number of servicing records that showed us that health and safety checks had been carried out in the building and equipment had been regularly serviced and maintained. Expert by Experience findings: The residents gave a vote of thanks to the staff at the residents meeting on January 7th 2010 for the wonderful Christmas. Minutes from the meeting were available. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 33 24(1) To find out how people feel 30/06/2008 about the quality of the service they receive and to ensure that the staff and management working practices are in line with current guidance, regulation and legislation, a quality assurance system must be developed and implemented. Care Homes for Older People Page 27 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 7 15 Peoples individual care plans and risk assessments must fully reflect peoples identified needs and contain sufficient details that clearly sets out the support and interventions needed to meet those needs. To ensure staff have appropriate information to enable peoples identified needs to be met at all times. 21/04/2010 2 19 13 The split toilet seat shown to the manager must be replaced. To minimise the risk to residents from injury occurring whilst using that toilet. 03/03/2010 3 33 24 An effective quality assurance and quality monitoring system, based on seeking the view of people living in the home must be put in place. 30/06/2010 Care Homes for Older People Page 28 of 31 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 To measure success in meeting the aims and objectives of the service provided by Rosegarth. 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 1 A review of the statement of purpose and service user guide should be undertaken to ensure all information is correct. All information gathered and assessed prior to a persons admission should be clearly and consistently recorded and be signed and dated by all parties involved. Following assessment, people should be informed, in writing, that Rosegarth was/was not a suitable service to meet their identified needs. Where medication has a variable dose, a record should be kept of how much medication has actually been administered at any one time. Refresher training in the protection of vulnerable adults should be arranged for all staff to ensure they have a good understanding of the procedure to follow in the event of any allegation of abuse being made. Risk assessments should be carried out to make sure that the two budgerigars in the lounge area do not affect the health of any resident. The small lounge where the water leak has stained the walls and damaged the wallpaper should be re-decorated. Liquid soap and paper towels should be available to staff at all times in the laundry area. A training matrix should be put in place to clearly demonstrate what training each member of the staff team has completed or will complete over any 12 month period. 2 3 3 9 4 18 5 19 6 7 8 19 26 30 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 9 30 Consideration should be given to reviewing the training needs of all staff working in Rosegarth to ensure people receive the right training and have the necessary skills and knowledge to meet the needs of the people living in Rosegarth. 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. 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