Care Home: Rosehill Residential Home

What the care home does well People living in Rosehill and their relatives gave very positive views about the care and support provided at the home. We spoke to the daughter of one of the residents who was visiting and she confirmed that she was very happy with the care her mother received. She told us, `The staff are very kind and mum is happy here`. Admissions only take place after a full assessment of needs is completed by the manager and one of the care officers. This assessment of needs and capabilities indicates to the manager whether or not the home will be able to meet those needs in an appropriate and acceptable way. Individual care plans are started on the day of admission with information taken from the initial assessment. Care plans contained details relating to the needs of the resident and how outcomes for the residents would be met. Healthcare needs are met through good working relationships with the residents` doctors, the district nurses and other external professionals. The manager is very involved with the care and support provided and she has a clear vision of what the home hopes to achieve. The atmosphere is warm, friendly and relaxed with the environmental standards maintained to an extremely high standard. The Trust ensures all aspects of the home are consistently well maintained. There is a good system in place for the receipt, recording, administration and disposal of medication and the records we examined were well kept and up to date. There is a well trained and experienced staff team that have been recruited correctly, which ensures those living in the home are safeguarded at all times. What has improved since the last inspection? Standards remain high in this home with an annual redecoration and refurbishment programme always in place. The corridors have been decorated and new carpeting laid. One of the lounges has been refurbished. A second `state of the art assisted bath` has been installed. This ensures that the residents are able to enjoy and safe and pleasurable bathing experience. A new conservatory has been erected as part of one of the lounge/dining rooms. This has made a considerable difference to the communal space and the residents were enjoying their breakfast in this area on the day of our visit. What the care home could do better: We have not made any requirements as a result of this visit and made only one suggested recommendation and we are confident that Rosehill will continue to provide the excellent standard of care and support already in place. Key inspection report Care homes for older people Name: Address: Rosehill Residential Home Rosehill Residential Home Rosehill Carlisle Cumbria CA4 8AA     The quality rating for this care home is:   three star excellent 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: Margaret Drury     Date: 2 4 0 3 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 25 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Rosehill Residential Home Rosehill Residential Home Rosehill Carlisle Cumbria CA4 8AA 01228513660 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): admin@henrylonsdale.co.uk The Henry Lonsdale Trust Name of registered manager (if applicable) Mrs Gillian Brown Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE. The maximum number of service users who can be accommodated is: 40. Date of last inspection Brief description of the care home Rosehill Residential Home is registered to provide accommodation for up to 40 older people with varying forms of dementia. The home is owned by The Henry Lonsdale Charitable Trust with Mrs Mary Styth being the responsible individual. The registered manager is Mrs Gillian Brown. The home is situated in a residential area not far from the city of Carlisle and all its amenities. Rosehill is an older property that has been adapted, extended and renovated for its present use as a care home. Accommodation for the residents is all Care Homes for Older People Page 4 of 25 Over 65 0 40 Brief description of the care home on the ground floor, which is divided in to four units, with ten bedrooms and a lounge/dining room in each. There are small sitting areas around the home that enable residents to have private visits if they wish. All rooms are for single occupancy, with ten of them having en-suite toilet facilities. The communal toilets and bathrooms are equipped for people with a disability and there are handrails on the corridors to assist with movement around the home. There are large, well kept gardens and car parking is available at the front of the building. The fees for this service currently in line with those set by social services, with extra charges for newspapers, private chiropody and hairdressing. This home does not provide intermediate care. Care Homes for Older People Page 5 of 25 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: three star excellent 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 assessment of this service took place over several days and included a visit to the service on the 5th March and we, The Care Quality Commission (CQC) were in the home for just over 5 hours. Information about this service was gathered in a variety of ways and helped us with the assessment of this service. We received an Annual Quality Assurance Assessment (AQAA) completed by the registered manager. It is a legal requirement that this document is completed annually by every registered provider. The AQAA was extremely comprehensive and outlined the facilities and services available at Rosehill. We spoke to staff, residents and visitors on the day and also received a number of completed survey questionnaires that also gave us information about the care and support received. During our visit to the service we looked at care plans, the admissions procedure, staff Care Homes for Older People Page 6 of 25 personnel files and other records required by legislation. We also toured the building looking at the environmental standards within the home. Care Homes for Older People Page 7 of 25 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 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 8 of 25 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 9 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good system to introduce people to the home, with information provided and a needs assessment completed. This ensures all who are admitted know their needs can be met in an appropriate way. Evidence: This service has a relevant and up to date admissions procedure in place that ensures those admitted to the home can have their care and support needs fully met. All those wishing to move in to Rosehill are fully assessed before an offer of accommodation is made. The assessment is usually completed by the registered manager and one of the care officers. All aspects of daily living are included in the assessment, which is then used as a base for the plan of care prepared for all residents. We were able to check the care files for three of the residents living in the home and details of our findings are recorded in this report. People wishing to use this service and their family members are invited and Care Homes for Older People Page 10 of 25 Evidence: encouraged to visit the home to look at the accommodation, meet the staff and those already living in Rosehill. This helps to ensure that, if they do decide to move in, the transition will be as smooth and relaxed as possible. All residents have a written contract and terms of residency advising them of their rights and the facilities on offer. The fees charged are in line with those agreed by social services with extra charges for hairdressing newspapers and private chirpody. Rosehill has a statement of purpose containing information about the home and the Henry Lonsdale Trust. This has recently been brought up to date to give details of changes in the staffing and information about the recently appointed registered manager. Care Homes for Older People Page 11 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All social and healthcare needs are met through an appropriate care planning system Evidence: Each resident has an individual plan of care that is based on the initial assessment of needs and capabilities. The care plans outlined the individual needs and what the staff were expected to do to ensure the outcomes met the needs and expectations of the residents. The information covered such areas as, mobility, dietary needs and preferences, healthcare needs, communication and social and religious preferences. There is appropriate equipment in the home to ensure residents are assisted with mobility and bathing. There is nutritional screening through the use of a universal screening tool. This, together with the record of all meals taken ensures all those living in Rosehill are well nourished. We looked at the care records for three of those living in the home and found them to be up to date and relevant. Healthcare needs are monitored through good working relationships with the visiting doctors and district nurses. Specialist medical attention is provided by occupational therapists and physiotherapists when necessary. Optical, chiropody and dental treatment are also Care Homes for Older People Page 12 of 25 Evidence: available. We looked at the records for the receipt, storage, administration and disposal of medicines. These were well kept and showed that those living in the home received their medication at the right time and as the doctor prescribed it. Medication is received monthly from the chemist in a monitored dosage system. High risk medication is recorded and stored safely and correctly. The manager conducts regular audits and frequently administers the medication. This ensures that a stock of medication is not allowed to build up. Observations during our visit evidenced that the staff interacted very well with the residents. They were polite, considerate and gentle when giving care, always mindful of preserving dignity and privacy. Care Homes for Older People Page 13 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and meals are well manged and provide variations for people living in this home. Evidence: As the home does not employ a designated activities worker the staff undertake to organise some activities every afternoon between 2 and 3.30pm. The manager and staff did, however, tell us that it was extremely difficult to persuade residents to join in as very often they refused. There is an activities room with equipment in it for residents to use. One visitor told us that her mother liked jigsaws but has not done any for some time. We mentioned this to the manager who said she would talk to the staff about this. Visiting entertainers are very popular especially a gentleman who plays but doesnt sing. This means that the residents can, and do, enjoy a dance. Singers from the local church visit about every 3 weeks to sing and take a short service that is enjoyed by many of the residents. There are special events organised by residents families with the proceeds going to the amenity fund. The manager is hoping to organise some outings when the weather improves. The home has extensive grounds that are used a lot during the summer months. Families and friends are encouraged to visit the home Care Homes for Older People Page 14 of 25 Evidence: and are always made welcome and offered refreshments. Staff from Tuille House museum visit the home every 3 months to conduct reminisence sessions. A choice of meals is offered each day from a 4-weekly menu and there are further choices available. As many of those living in the home have various forms of dementia a visual choice of meals is offered. The cook shows each of the residents a plate containing a sample of the main meal and dessert so an immediate choice can be made. The meal is then served at the table. We looked at the menus and found them to be nutritious and appealing. We inspected the kitchen area and found it to be clean and well organised. Supplies are delivered at least twice weekly from a local supplier. Residents can take their meals in their own room if they wish and special diets are catered for. Vegetarian meals are prepared for 1 resident and other are given softer diets after consultation with the speech therapy and nutrition department at the hospital. Care Homes for Older People Page 15 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good safeguarding procedures help to ensure people remain safe in this home. The complaints procedure is clear and accessible meaning that people using this service know any concerns will be listened to and acted upon. Evidence: There are suitable policies and procedures in place for dealing with complaints and concerns. There is a complaints book in the home but there have been none to record. Comments on returned surveys and those made during our visit indicated that neither residents nor their families had any complaints to raise. All knew to speak to the manager or a care officer if they had a problem to discuss. There is a copy of the procedure in every information pack and a copy on the wall in the foyer for anyone coming in to the home to read. We at CQC have not received any complaints directly nor have we received any via social services. There are clear policies and procedures in place for safeguarding vulnerable adults and training in this subject is prepared and delivered on a regular basis by the training officer. Staff records show that all staff have enhanced Criminal Records Bureau (CRB) and Safeguarding of Vulnerable Adults (SOVA) checks completed prior to their starting work at Rosehill. This ensures that only suitable people are employed to care for those living in the home. These measures mean that all those using this service are kept safe from harm and danger. Care Homes for Older People Page 16 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Rosehill Home provides a safe and comfortable home that is extremely well maintained, decorated and furnished to a high standard. Evidence: Rosehill Home is a listed building that has been extended and adapted for it present use as a residential care home. All the accommodation is at ground floor level and the building is set in extensive grounds that are easily accessible to those living in the home. It is owned by The Henry Lonsdale Trust with a board of trustees responsible for the upkeep, maintenance and operation of the home. The front exterior of the building has retained its original features and has a very impressive appearance. There are 40 single bedrooms, some of which have en-suite toilet facilities. We toured the building to inspect the environmental standards and were very impressed with what we saw. All the residents rooms are well decorated and furnished, having matching curtains and bed linen. They are a personalised with items brought from residents own homes. Many of the rooms overlook the inner courtyard, whilst others overlook the gardens with views towards the city of Carlisle. The home is split into 4 wings each having 10 bedrooms, lounge and dining facilities. There are toilet and bathing facilities on each wing all within easy access of residents accommodation. The internal decoration is of an extremely high standard with reCare Homes for Older People Page 17 of 25 Evidence: decoration taking place at regular intervals. One of the lounges has recently been refurbished and new carpeting has been laid to the corridors. There are bathing facilities to suit residents that may have mobility problems and toilets have aids to assist. A second, new state of the art bath has recently been purchased and installed. A member of the care staff told us that the residents really enjoyed using it. All the bathrooms are well equipped and tiled and ensure that the whole experience of taking a bath is pleasurable and safe. There are sufficient communal spaces for the residents to enjoy and long corridors that give walking space to those who wish to walk about the home. Since the last inspection a new conservatory has been erected off one of the lounges. This has made a considerable difference to the space in that lounge and we observed the residents finishing their breakfast in it during our visit. They all told us how beautiful they thought it was. The kitchen area is well planned with plenty of space for preparation and storage of food. The laundry is situated a long way from the kitchen area, which is useful in ensuring there is no cross contamination from soiled linen. The home has policies and procedures in place covering infection control and staff have all completed training in this subject. The home employs domestic and laundry staff that ensures its cleanliness and it was extremely clean and sweet smelling on the day of our visit. Care Homes for Older People Page 18 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in this home are supported by well trained, effective staff who have been correctly recruited. This means peoples needs are met and they are safe from possible harm or poor practice. Evidence: Staffing levels on the day of our visit were satisfactory for the number and dependency levels of those presently living in the home. We looked at the staff rotas, which indicated that staff were taking holidays but all shifts had been covered. There are normally as many as 8 carers on duty during the day plus the manager and a care officer. There are 2 waking night staff and the manager confirmed that, at the present time, this is sufficient. She would however ask for extra member of staff in the short term to cover in an emergency. The majority of staff are qualified to NVQ level 2 or above with the care officers having gained their level 4. One has just completed the leadership and management qualification. The home also employs domestic, laundry, maintenance and catering staff. The numbers and skill mix of the staff team ensure those living in Rosehill are cared for, supported and kept safe at all times. There is a robust recruitment and selection policy that is dealt with by the administrative staff. Staff files were examined, which confirmed that the home follows good practice guidelines with regards to staff selection. No new member of staff starts work until all the necessary legal checks are completed. Application forms are Care Homes for Older People Page 19 of 25 Evidence: completed, references checked and a formal interview is organised. There is a good staff induction programme and all new staff are subject to a 6 month probation period during which formal appraisals take place. All these processes ensure only suitable people are offered employment at this home. Staff files were clear and up to date with all documentation in place. There is a training officer employed to organise staff training for Rosehill and the other home operated by the Trust. She is responsible for accessing and delivering all of the staff training. Subjects covered include, moving and handling, dementia care, emergency first aid, food hygiene, infection control and the NVQ awards. We were able to look at the training records during our visit. We did suggest that staff would benefit from training and awareness of aggression and challenging behaviour and the manager said she would discuss this with the training officer. We were able to speak to some residents during our visit and they all praised the staff. Comments included, the girls are lovely, I like all the staff and I am well cared for. Comments on the returned surveys were equally complementary and included, The home looks after me well and There is nothing the home could do better. Care Homes for Older People Page 20 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Effective management and quality monitoring help safeguard people using this service and procedures are in place to safeguard their interests and promote the health and safety of those living and working in Rosehill. Evidence: The service has a well experienced and qualified manager, Gillian Brown who has recently become registered with The Care Quality Commission. She has completed the Registered Manager Award and maintains her professional development through relevant training within the home. She works closely with the staff and trust managers to ensure the home is run in the best interests of those living there. On the day of our visit the atmosphere was warm and friendly and, although she has only been in post for a little over 12 months she knows all the residents well and understands their needs. Comments from the residents included. I see her often and I can speak to her when I want to. Staff also agreed that she was approachable and supportive and she very much operated an open door policy. Care Homes for Older People Page 21 of 25 Evidence: Staff supervision is completed every 2 months by the delegated officers and all staff have annual appraisals completed. The records evidenced that the supervision was appropriate and up to date. Annual quality audits are completed by means of survey questionnaires sent to residents, families and health and social care professionals. The results of the audits can be used to look at current practices and to ensure this service provides a consistently high level of care and support. There is a procedure in place for handling residents finances although only small amounts of cash are held on behalf of some of those living in the home. Records are held with all transactions checked and signed by 2 people. Records and servicing contracts confirmed that the home arranges for all equipment to be serviced under annual service level agreements. An external consulted has prepared an in-depth fire risk assessment with the same organisation responsible for the maintenance of the fire equipment. All risk assessments are in place and all these measures ensure all those living and working at Rosehill are protected and their health and safety protected. Care Homes for Older People Page 22 of 25 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 23 of 25 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 30 It is recommended that consideration be given to providing staff training in agression and challenging behaviour. Care Homes for Older People Page 24 of 25 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. 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