Care Home: Rosehill (Robins` Hill)

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What the care home does well People tell us that they `chose Rosehill because it is very homely and the staff are very caring`. On the whole, important information is obtained about people prior to agreeing to their moving to the home. Care plans are well structured around what each person wants and the team have a good understanding of this. The team of staff work well with professionals, which helps to improve peoples` health and social well being. People who live at the home say that the staff are "helpful" and the care is "good". Their relatives are very satisfied with the care and also say that their relations are "settled". They also tell us "it is the best thing that happened" for their relation. People are treated as individuals for example their faith is respected. The home has an open feel. People living there say that they have the freedom to do what they want to, when they want to. At the same time, they are confident about the way staff protect their property for them. Families and friends say that they are encouraged to visit whenever they wish to and are kept informed about any changes. There is a good choice of appetising and well-balanced meals. We saw people enjoying a hearty meal and they tell us that meals are "delicious" and "all home cooked". Rosehill is a comfortable place to live. People tell us that the home is well maintained. Building work to extend the home and improve facilities, has, people tell us had "little impact" on their life there. People living there say that they are encouraged to see it as their own home and that it is always spotlessly clean. Staff feel well supported and are encouraged to do training so that they care for people properly. What has improved since the last inspection? The medicines policy and procedure has been updated and ensures any risks to people is minimised and that staff have up to date guidance to follow. Additionally, staff have had training to up date their knowledge about handling medicines. Therefore, people`s medication is managed by staff that have received appropriate training and are competent to undertake this task. Regular updates have been provided for all staff that has ensured they know how to recognise, and are clear about the procedures to follow in the event of an allegation of abuse being made. This has protected people living in the home from potential abuse. A quality assurance survey has been done and people have been asked for feedback more regularly about how their life might be improved at the home. Their suggestions have been listened to. Financial records provide an accurate account of what transactions have taken place, to provide an accurate audit trail in the event of any query. People`s financial interests are better protected because of this. What the care home could do better: People`s assessments should provide sufficient detail to ensure that staff have a complete picture of an individual`s needs. Storage facilities for controlled medicines should be upgraded so that people`s medicines are kept secure in a way that meets the law. People`s needs should be assessed in terms of occupation, interest and capabilities using an evidence based tool such as the `Pool Activity level instrument`. This will ensure that activities are person centred and appropriate for the individual. The recruitment procedure has not been consistently followed. Pre-employment checks must be done before staff are allowed to work so that people are properly protected and cared for by suitable staff. We made an immediate legal requirement about this. A record of induction of new staff should be kept so that the service is able to demonstrate when this took place and what was covered. This will ensure that people are cared for by appropriately by new staff that have been inducted. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rosehill (Robins` Hill) Raleigh Hill Northam Bideford Devon EX39 3PA     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: Susan Taylor     Date: 1 2 0 3 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 29 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 29 Information about the care home Name of care home: Address: Rosehill (Robins` Hill) Raleigh Hill Northam Bideford Devon EX39 3PA 01237477625 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Beryl May Jago care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Rosehill provides 24-hour residential care for 10 older people some of who may have dementia. The service is run in a large detached Victorian house standing in its own grounds and is a short drive away from the centre of Bideford. Access into the home is up a number of shallow steps from the car park. There is also wheelchair access from the car via a side entrance. The majority of bedrooms are located on the first and second floors, two bedrooms are on the ground floor, all vary in size and outlook and one bedroom is shared. A chairlift operates from the ground floor providing assistance with access for those that need it. There is a small section between the first and second floor that is not covered by the stair lift, therefore residents living on the Care Homes for Older People Page 4 of 29 Over 65 10 10 0 0 Brief description of the care home second floor need to be mobile. The home has the `Investor In People award. Fees charged range from £322 to £385 per week; additional charges are made for some things such as hairdressing, chiropody, toiletries, magazines and newspapers and disposal of incontinence items. A copy of previous inspection report is available in the entrance of the home. Care Homes for Older People Page 5 of 29 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 Two stars. This means the people who use this service experience GOOD quality outcomes. This was a key inspection of Rosehill under the Inspecting for better lives arrangements. We were at the home with people for 7 hours. We looked at key standards covering: choice of home; individual needs and choices; lifestyle; personal and healthcare support; concerns, complaints and protection; environment; staffing and conduct and management of the home. We looked at records, policies and procedures in the office. A tour of the home took place. We met 9 people that live at Rosehill and observed how staff looked after them. We met 3 staff and the manager. We sent surveys to 10 people living in the home and received 6 back. We sent surveys to 3 GPs and 3 other healthcare professionals and Care Homes for Older People Page 6 of 29 received 0 back. We also sent surveys to 5 staff and received 1 back. The comments people made, the results of our survey and our observations are in the report. In March 2009, the fees ranged between 322 pounds to 385 pounds per week for personal care. Additional charges are made for chiropody, hairdressing, newspapers and toiletries and these vary. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 29 Peoples assessments should provide sufficient detail to ensure that staff have a complete picture of an individuals needs. Storage facilities for controlled medicines should be upgraded so that peoples medicines are kept secure in a way that meets the law. Peoples needs should be assessed in terms of occupation, interest and capabilities using an evidence based tool such as the Pool Activity level instrument. This will ensure that activities are person centred and appropriate for the individual. The recruitment procedure has not been consistently followed. Pre-employment checks must be done before staff are allowed to work so that people are properly protected and cared for by suitable staff. We made an immediate legal requirement about this. A record of induction of new staff should be kept so that the service is able to demonstrate when this took place and what was covered. This will ensure that people are cared for by appropriately by new staff that have been inducted. 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 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 29 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 29 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 are fully involved in the assessment process and information is gathered from a range of sources to ensure that the persons needs are met. The home does not offer intermediate care; therefore no judgement has been made about this. Evidence: We received 6 surveys from people living at the home, which verified that they had been given enough information with which to make a decision about whether or not to move into the home. A person wrote, It was the best I saw in the area. Additionally, 100 percent of people responding a in survey had a contract of residency. We looked at the assessment information for 3 people who currently receive care and support at Rosehill. The people who currently use the service are either supported by social Services or are privately funded. Additionally, information about each individual had been obtained from social services, where appropriate. Care Homes for Older People Page 11 of 29 Evidence: The manager meets with a person before they move in to the home to do an assessment. A newly admitted resident told us that the manager had gone through a questionaire and found out about them. The assessment template recorded the diverse needs that the person had, for example what significant people were important to them and detailed information about the persons physical disability. A social and economic history had also been completed. Additional information about this persons needs had been obtained from the local authority supporting the move into the home. This information provided the team with a picture of the social network a person has, hobbies and interests, and past working life. The assessment information was compiled and stored in computerised records and staff have unique IDs enabling them to access these. The records detailed the individuals personal and health care needs including any specific conditions that require specialist input, some information about likes dislikes, dietary needs and social needs. This information had been used to draw up a plan of care enabling care workers to understand what the needs and wishes of the individual are and how they should provide care and support to meet these needs. All of the people whose files we looked at had been fully involved in the assessment process. In the case of one person without mental capacity, we saw documentation on their file that demonstrated that demonstrated that they had an advocate supporting them who was the first point of contact for the team. We looked at 2 other care files for people living in the home and casetracked their needs; 1 of which was incomplete. There was no information on this file that indicated that the person had poor mobility, needed to walk with a zimmer frame or is at risk of falls. However, a handling assessment had been completed which ensured that the persons safety is maintained if staff are required to assist the individual to get into a standing position for example. The provider verified that intermediate care is currently not provided at Rosehill. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive good personal and healthcare support that is person centred and is based upon the rights of dignity, equality, fairness, autonomy and respect. Improvement of the storaged of medication will ensure that peoples medicines are kept secure and meet the law. Evidence: 6 people returned surveys, which verified that 100 percent of people living in the home are satisfied with care and support that they receive. Their responses also tell us that the staff listen and act on their wishes and are always available when they need them. Their comments included anything I need they will get for me and care is very good and ..the staff are very caring. We casetracked 3 people by speaking to them and also observing the care they were given. We read their care plans and concluded that individual personal preferences, routines and social activities were well known by staff and had been documented. This has ensure that all staff have a good understanding of how each person prefers their care and support to be delivered. Whilst talking to one of these people they said I Care Homes for Older People Page 13 of 29 Evidence: thoroughly recommend it...Im treated like a queen. The person went on to tell us that when they moved into the home they were in a terrible state but with tender care had greatly improved. We met the same persons relative who was visiting and they said Rosehill has been fantastic for Mum, I cant fault it. We looked at the care records kept on computer and in paper files. These demonstrated that the home has good professional relationships with general practitioners, nurse specialists and the consultant psychiatrist. For example, a person with dementia had been visited at the home by the consultant psychiatrist and their medication had been reviewed and changed. In addition to this there are good links with the mental health and social services teams. Letters seen on files indicate good communication and partnership working that ensures that people living in the home receive appropriate care. The home had clear policies and procedures about risk assessment and management, which had been robustly implemented. All of the care files had guidance on action to be taken to minimise identified risks with regard to tissue viability, falls, manual handling, and continence. All of the assessments had been regularly reviewed. Where a high risk of development of pressure ulcers had been highlighted, we read similiar entries in the persons care plan and saw that the individual was sitting on pressurerelieving equipment. The same person was having oxygen therapy and their care plan about this was detailed and ensured that staff follow safe procedures when handling the oxygen for this person. There was a good standard of information to ensure that care and health needs were planned for and monitored. Verbal information and feedback in respect of individuals personal and health care needs is given to staff at the start of each shift. This process was observed at the beginning of the afternoon shift. This handover also gave staff time to ask questions and give their view about how an individual was doing. The home uses a monitored dosage system. Senior staff are responsible for stock taking. Records of ordered drugs were seen and tallied with those being stored. All medication was kept in a secure place. Whilst none of the people were prescribed controlled medication at the time we inspected, we discussed the storage facilities with the provider and highlighted that it would not meet the current legislation. Our guidance states: The secure storage of controlled drugs is specified in the Misuse of Drugs (Safe Custody) Regulations 1973. In the 2007 Amendment the term nursing home has been replaced by care home. The main impact is that every care home must store controlled drugs in a CD cupboard, including care homes registered for personal care. Care Homes for Older People Page 14 of 29 Evidence: We recommended that the provider liases with the pharmacy with which they have a contract and discuss how they might obtain appropriate storage facilities. The requirements for controlled drug storage are: Metal cupboard of specified gauge, specified double locking mechanism, Fixed to a solid wall or a wall that has a steel plate mounted behind it, fixed with either rawl or rag bolts. Suppliers of CD cabinets can confirm that a cupboard meets the legal requirements. We recommend that care homes request formal confirmation when purchasing a CD cabinet. The medication system was easy to audit and we tracked medication given to 3 people. Records accurately reflected medication having been given as prescribed by the GP. We observed medicines being given out and best practice was followed that ensures people are given the right tablets at the right time. We observed that staff always knocked on doors before entering peoples rooms. People told us that care was always done in the privacy of their room and that staff treated them with respect and kindness. One person said they all treat us as individuals. Care Homes for Older People Page 15 of 29 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 are consulted and listened to regarding the choice of daily activity, but this process could be improved further for people with dementia or communication difficulties. Evidence: In surveys 100 percent of people told us that there are always activities which they can participate in if they wish to. Their comments included entertainment comes in sometimes and there is a range of activities to suit all. The manager verified that an activity of choice is arranged three to four times a week, which tends to be a group activity. These activities include ball games,movement to music,quizes,some board games,watching films and listening to all kinds of music. People we met consistently told us that this was the case. 3 care plans that we looked at provided some information about each persons life history and their social interests. They also contained information about a persons preferred daily routine, such as what time they get up and what time they go to bed. We spoke to each individual to find out how much choice they had about their life at the home. A person who was frail and in their room was watching television and told us that they had always enjoyed watching television and reading and preferred not to mix with the group. Additionally, they said that it was their wish to only have a certain visitors and that this was respected. This Care Homes for Older People Page 16 of 29 Evidence: information was detailed in the persons care plan and therefore demonstrated that their wishes were known and followed. Another person said that they like going out shopping and did so sometimes. They also told us that they really liked to be taken out on trips to places like Westward Ho and tend to do this with their family. Information sent to us verified that outings such as shopping and trips to local areas of interest are provided for individuals that wish to go. The manager told us that this will ensure that people have 1 to 1 time available for such outings, which will give people more choice about how they spend their time. We spent time in the communal areas of the home to help us make a judgment about peoples sense of well being. A radio was on in one of the lounges and we observed a person with cognitive impairment tapping their foot in time to the music. Additionally, we observed that staff spent time with the person encouraging them to talk about their life. This meant that this person was engaged in a positive way and did not become socially isolated. Information sent by the provider verified that wherever possible staff try to ensure that people with cognitive impairment join in with activities. The home have not yet explored options available which might help these people to further engage with their surroundings. We discussed specific tools that might be useful to gain in depth information about individual capability and interest such as the Pool Activity level instrument with the manager. This would also ensure that activities are person centred and pitched at the right level for people. We met a relative who said that Rosehill was always welcoming and that they were encouraged to visit whether they liked to. Information sent by the manager verified that birthdays and special events are celebrated according to individual preferences. The comments made in this document also demonstrated that diversity is embraced and respected. In terms of faith, 9 people are christian and 1 person is a Jehovahs Witness. Support had been provided to enable people to join their congregation of choice. People we met verified that their needs with regard to worship had been discussed with them when they moved into the home. We observed the experiences of 3 people at lunch. Staff assisted people to eat by sitting with each person,attending to them and by supporting them at a pace that suited each person in an unrushed manner. Food was served plated to people. Alternatives had been made available but nearly everyone chose the main meal on offer. We heard other people make positive comments about the lunch such as excellent and delicious. The record of meals provided demonstrated that meals are varied. Care Homes for Older People Page 17 of 29 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. Improvements have ensured that people are protected from potential abuse and are listened to. Evidence: Information that the provider sent to the Commission verified that no complaints had been received in the previous 12 months. Similarly, the Commission has not received any complaints about the service. 100 percent of people responding in a survey verified that staff listened to them. Additionally, people knew who to complain to and how to make a complaint. Comments in surveys included: I am very content and happy. [This is] my second home and staff are very caring We read the complaint procedure in the service users guide, which contains information for people. We saw a copy of the Alerters guide. The home also had a whistleblowing policy, which all of the staff we spoke to understood. Kind and caring interactions were observed throughout the day between staff and people living in the home. Staff engaged positively with people who had dementia and demonstrated good skills in engaging those individuals. Information sent by the provider told us that 75 percent of staff hold an NVQ in care, which ensures that staff have knowledge about safeguarding people. Additionally, staff told us that policies and procedures are discussed with them. Information sent to us by the manager verified that further new staff will be recruited once the home Care Homes for Older People Page 18 of 29 Evidence: expansion has been completed. They will be sent on courses for the protection of vulnerable adults and update existing staff, taking into account the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The provider verified that no safeguarding or Independent Safeguarding Authority referrals had been made in the last 12 months. This demonstrates that the provider has improved this area and people are protected and safeguarded from abuse. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Rosehill live in a clean, well maintained home which meets their needs. Evidence: Buidling work is underway to extend the home and improve some of the facilities there for people. As part of this, a new conservatory will be built that will provide a large communal room with countryside views. We talked to people about how this is being managed and whether it had been disruptive to them. People told us that the builders had been very careful not to disturb them and that the manager had continuously explained what was going to happen next. They made comments like were using the other lounge for a short while but dont mind this while the work is going on and I really like watching the new extension progress, the builders are very friendly and we wave to each other. 100 percent of people responding in a survey felt that the home was always fresh and clean. Information sent to the Commission verified that most of the maintenance is done by the providers husband. 1 person that we met verified this and said xxx does checks and mends things. The manager showed us the refurbishment plan, which demonstrates that there is continual replacement and renewal of furniture and planned decoration of areas that look tired. Since the last inspection, two bathrooms had been refurbish, 3 bedroom carpets had been replaced, and 2 new tables and 8 chairs for the dining room and 2 lounge chairs purchased. Care Homes for Older People Page 20 of 29 Evidence: We met 2 people that choose to spend their time in their own room. Bedrooms varied in size and layout. All were personalised and spotlessly clean and provided comfortable private space for the individual concerned. A person that we met said I like my room its very comfortable. We tested lights in corridors and some bedrooms, all of which were in full working order. People showed us the furniture they have, which includes bedside tables and lights for subtle lighting during the evening and at night. Information sent to us by the provider verified that the department of health guidance has been used to find out the effectiveness of infection control practices in the home. Additionally, 100 percent of staff have attended training about the prevention and management of infection control. We observed that there was a plentiful supply of aprons and gloves, which staff used appropriately. We also observed that staff follow good handwashing techniques after caring for a person. The laundry was clean and well organised. People told us that they had been asked whether they wanted to have a flu vaccination in the autumn, which most had chosen to have. As a result of these measures, people living in the home had only experienced the usual seasonal colds and there had been no outbreaks of other types of infection. Care Homes for Older People Page 21 of 29 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. Recruitment practices are not robust and fail to protect residents. The training and development programme ensures that knowledgeable staff cares for people. Evidence: 6 people living in the home returned surveys, and all verified that they always received the care and support they needed. Their comments included the always come as soon as they can and anything I need they will get for me. The staff are described as very caring and helpful. At the home, we asked people whether staff were available when they needed help, and they told us that staff are very attentive to them. We also observed this to be the case for people that had difficulty communicating their needs. We spoke to the manager about recruitment and they told us that they had appointed 3 new staff since we last inspected. We examined the files for these individuals to establish whether the recruitment procedure was robust and had been followed. CRB and Independent Safeguarding Authority checks had been obtained for all but 1 of the new staff. However, indpendent safeguarding checks had been done after staff had been employed. Other pre-employment checks such as references had been not been obtained or received after the individual had been employed and had started shifts at the home. Care Homes for Older People Page 22 of 29 Evidence: In the first file the person had started employment on 21/1/09, which was verified by their contract. No written references, an independant safeguarding authority or CRB check was on file. However, we did see evidence, a photocopy of an application form, demonstrating that a CRB had been sent for. The manager later told us that they had phoned the organisation doing checks and been told that this indivduals independant safeguarding authority check was clear. At the end of the day, we saw an email confirming this. This person was working on 12/3/09 and on the duty roster for other shifts. No written record of induction had been kept on file. We spoke to this individual who told us that they had had a good induction and felt supported. The induction covered health and safety matters and they had shadowed a senior for 2 weeks. We made an immediate requirement that this person must not work as a care worker until 2 written references had been obtained by 31/3/09. In the second file, the person had started employment on 21/7/08, which was confirmed by contract. No written references had been obtained. We looked at old duty rosters and established that the individual had worked since 21/7/08. An independent safeguarding authority check had been done 23 days after the person started working. A CRB check had been obtained and was dated 25/9/08. No written record of induction had been kept on file. We spoke to this individual who told us that the induction was thorough and had prepared them for caring with people living in the home. A third file we looked at was for someone that had been employed at the home for 3 years. This had 2 written references, POVA and CRB checks all of which were satisfactory. However, the person had been employed since 21/8/06, which was verified on contract, but the PoVA check was dated 16/10/06 nearly 2 months after the person started work at the home. We concluded that recruitment procedures are not robust and people living in the home are unprotected because of this. We discussed our findings with the manager and made them aware of the Commissions publication on recruitment practice. The manager said I have difficulty getting references, I have sent for them but people dont send them back but I will get this sorted. We have since received written confirmation from the provider that this has been dealt with satisfactorily. Information sent to us by the manager tells us that 75 percent of staff hold NVQ level 2 in care and 100 percent have completed the induction training. Additionally, staff in a survey verified there are regular training sessions about dementia, manual handling, first aid. New staff said that their induction was thorough, although as previously discussed no record had been kept of this in the files we looked at. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well run home, in which their views are actively sought about how the quality of the service can improve. Evidence: The manager is also the registered provider and has many years experience of running Rosehill. She has obtained the Registered Managers Award and NVQ level 4 in care management. The provider/manager gave the Commission a good picture of the current situation in the service, in a document entitled AQAA (Annual Quality Assurance Assessment). Information within the AQAA verified that the home has a business plan. As discussed under the staffing section, our main concern is that the recruitment procedures are not robust and therefore do not protect people living in the home. We are confident, however that this matter was rectified quickly having had written confirmation from the provider that demonstrated satisfactory references had been obtained for all of the staff whose files we saw. We have also been assured that the recruitment practices have been improved since our visit. Care Homes for Older People Page 24 of 29 Evidence: Throughout the inspection and the information provided demonstrated that the provider/manager aims to constantly improve the service for people living in the home. We observed that people are consulted about changes and asked for feedback. People we spoke to had been asked to complete a survey. In surveys we sent, 6 of the people responding made comments like it was the best I saw in the area and I chose to live at Rosehill because it is very homely feeling and the staff are very caring. We looked at records showing how money is managed on behalf of 3 people that live in the home. All were accurate when crosschecked with the balance kept for safekeeping. Entries had been signed for. We concluded that peoples money is well managed and their financial interests are protected. We toured the building and observed that cleaning materials were stored securely. Data sheets were in place and staff spoken to understand the risks and strategies to minimise those risks from chemicals used in the building mainly for cleaning and infection control purposes. We observed hand sanitizer being used by staff to minimise the risk of cross infection. Records of accidents were kept and showed that appropriate action had been taken. The fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. People living in the home, relatives and staff told us that the alarm was regularly checked and sounded. Certificates verified that an engineer had checked the hoists. First aid equipment was clearly labelled. 3 staff on duty verified that they held a current first aid qualification. Good manual handling practice was observed as carers transferred a person from chair to chair at lunchtime. Maintenance certificates were seen for the fire alarm system. The provider had verified in information sent to the Commission that a local electrician had inspected both the electrical system and appliances. Therefore, the health and safety of people living in the home is maintained. Care Homes for Older People Page 25 of 29 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 29 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 29 19 The provider must ensure 30/06/2009 that no member of staff is employed to work at the home without first obtaining all the necessary information required, in this case two satisfactory written references. This will ensure that people are not put at unnecessary risk of harm. We issued an immediate requirement that had to be met by 31/03/2009. To ensure that people are not put at unnecessary risk of being cared for by staff that have not been properly vetted. Care Homes for Older People Page 27 of 29 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 3 Peoples assessments should provide sufficient detail to ensure that staff have a complete picture of an individuals needs. Storage facilities for controlled medicines should be upgraded so that peoples medicines are kept secure in a way that meets the law. The recreational needs of people, particularly those with dementia or communication difficulties, should be assessed using a tool such as the Pool Activity level instrument. Activities would then be person centred and pitched at a level that is suitable for the individual. 2 9 3 12 4 30 A record of induction of new staff should be kept so that the service is able to demonstrate when this took place and what was covered. This will ensure that people are cared for by appropriately by new staff that have been inducted. Care Homes for Older People Page 28 of 29 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. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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