Care Home: Rosemary Lodge

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What the care home does well The people living there were well dressed and had been supported with their personal care helping to raise their self-esteem and well being. The assessment process is detailed so that before people move into the home it is clear that their needs can be met there. The people living there are offered a varied diet and could choose what they wanted to eat.Rosemary LodgeDS0000017019.V376267.R01.S.docVersion 5.2Activities are provided and people have an opportunity to go out of the home and do the things they enjoy. The people living there have the information they need so if they are unhappy with the service provided they know how to make a complaint. Before staff start working there the right checks are completed to make sure that ‘suitable’ people are employed to work with the people living there. Improvements to the building are made to ensure that people live in a safe, homely and comfortable environment. Staff have training so they know how to meet the needs of the people living there and keep them safe from harm. Staff have regular supervision to ensure that they are supported to meet the needs of the people living in the home. What has improved since the last inspection? The service user’s guide includes the fees charged to live there so that prospective service users have all the information they need. Individual’s weight records are regularly monitored. Where a person had lost or gained a significant amount of weight this was investigated to ensure their health and well being. The management of the medication had improved to ensure it is given to individuals as prescribed to meet their health needs. All staff have had training in safeguarding the people living there from abuse so they know how to safeguard the people living there from harm. There is more room in the dining room so that people can be more comfortable when eating their meals. Some parts of the home have been redecorated and new furniture bought to make it comfortable for people to live in. What the care home could do better: Care plans should be reviewed every month to make sure that staff know how to support people to meet their current needs.Rosemary LodgeDS0000017019.V376267.R01.S.docVersion 5.2All the people living there should be assessed as to all risks to their health to make sure these can be met. Consideration should be given to replacing the manual hoist with an electric one so that people can have more choice as to whether they have a bath or shower without putting staff at risk of injury. Records about testing of equipment should show this is done as required so that it is all safe to use. Key inspection report CARE HOMES FOR OLDER PEOPLE Rosemary Lodge 154 Alcester Road South Kings Heath Birmingham West Midlands B14 6AA Lead Inspector Sarah Bennett Key Unannounced Inspection 1st July 2009 09:30 DS0000017019.V376267.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 2 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 Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosemary Lodge Address 154 Alcester Road South Kings Heath Birmingham West Midlands B14 6AA 0121 432 1166 0121 442 6454 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr S.V. Chundoo Elizabeth Campbell Mrs Rajwantee Chundoo Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Old age, not falling within any other category (OP) 29 The maximum number of service users who can be accommodated is: 29 5th June 2008 Date of last inspection Brief Description of the Service: Rosemary Lodge is situated on the Alcester Road, Kings Heath. It is a short distance away from the main Kings Heath shopping centre where there is a good range of local facilities. Another smaller local shopping centre is in the opposite direction towards The Maypole. The home was originally two large Victorian houses which have retained many of their original features. The home is set back behind a parking area for up to five cars. Trees and shrubs that have been well maintained surround this area. The main entrance to the home is via some steps up to the front door; this access is unsuitable for wheelchair users. There is another front door, located to the front of the property where people with mobility difficulties can access the home at ground level. The home has a passenger lift to where the first floor bedrooms can be accessed; the second floor is office space. There is a garden to the rear of the property. The home caters for up to twenty nine older people. The bedrooms vary in size and all are decorated in individual colours. There is a large dining/sitting room, a ‘Victorian’ themed sitting room, a large quiet sitting room and a conservatory. Extensive building work has been completed to build the conservatory, a hairdressing room and additional bathing and toileting facilities for the people Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 5 living in the home. There is a notice board for people living in the home and visitors to read information such as the home’s news sheet and the complaints procedure. A copy of inspection reports for people living in the home and visitors are available in the office. The service user’s guide stated the fees charged to live there are from £360 – £390 per week. They have a contract with Birmingham City Council and the contracted prices are: Single room - £361.14 Shared room: £342.78 With en suite- £375.42 ‘Top up’ fees range from £15 - £30 weekly. This information applied at the time of the visit and the reader is advised to contact the care home for updated information on fees. Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. This inspection was carried out over one day; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2009 to 2010. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home about things that have happened there and an Annual Quality Assurance Assessment (AQAA) completed by the deputy manager. This tells us how they think the home is meeting the regulations and what improvements they are making. Three people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. The people who live at the home, the manager, owner and the staff on duty were spoken to. A partial tour of the premises took place. Care, staff and health and safety records were looked at. Time was spent observing care practices, interaction and support from staff. What the service does well: The people living there were well dressed and had been supported with their personal care helping to raise their self-esteem and well being. The assessment process is detailed so that before people move into the home it is clear that their needs can be met there. The people living there are offered a varied diet and could choose what they wanted to eat. Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 7 Activities are provided and people have an opportunity to go out of the home and do the things they enjoy. The people living there have the information they need so if they are unhappy with the service provided they know how to make a complaint. Before staff start working there the right checks are completed to make sure that ‘suitable’ people are employed to work with the people living there. Improvements to the building are made to ensure that people live in a safe, homely and comfortable environment. Staff have training so they know how to meet the needs of the people living there and keep them safe from harm. Staff have regular supervision to ensure that they are supported to meet the needs of the people living in the home. What has improved since the last inspection? What they could do better: Care plans should be reviewed every month to make sure that staff know how to support people to meet their current needs. Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 8 All the people living there should be assessed as to all risks to their health to make sure these can be met. Consideration should be given to replacing the manual hoist with an electric one so that people can have more choice as to whether they have a bath or shower without putting staff at risk of injury. Records about testing of equipment should show this is done as required so that it is all safe to use. 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. Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5 People using the 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 have the information they need so they can make a choice as to whether or not they want to live there. Arrangements ensure that people’s needs are assessed before they move in to ensure they can be met there. EVIDENCE: The service user’s guide and statement of purpose included the required and relevant information. Since we last visited it had been updated to include the fees charged to live there. This ensures that people have the information they need so they can make a choice as to whether or not they want to live there. It should be updated to reflect our change of name and contact details. Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 11 Records sampled showed that before people moved into the home their needs were assessed to ensure they could be met there. This gives people confidence that their needs can be met and the possibility of them having to move to another home is reduced. The manager said they would be visiting someone in hospital the next day to complete an assessment with a view to them moving into the home. Relatives of a person who is looking to move in visited during the afternoon. The manager was observed to make them welcome and informed them of the process including the need for an assessment to see if the person’s needs could be met there. They were given an opportunity to think about it and assured that if they wanted to visit again they were very welcome to do so. The home does not provide an intermediate care service. Therefore, standard 6 that relates to this was not assessed. Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of the people living there are met so ensuring their well being. EVIDENCE: The records of three of the people who live there were looked at. These included an individual care plan so that staff would know how to support the individual to meet their needs. They included information about what the person can do for themselves to ensure that they can maintain their independence as much as possible. Information about the person’s life was included in their care plan. This gave staff information about what the person had achieved during their life, relationships that are important to them and their hobbies and interests. This Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 13 helps staff to see the person they are caring for as an individual and what things they like and dislike. Each person has a key worker who is responsible for ensuring that their needs are met and helps them to settle into the home. Records sampled showed that health professionals were involved in individual’s care when needed to ensure their health needs are met. Staff had made referrals to health professionals when they had noticed that a person was unwell or needed medical attention. This included not only the person’s physical health but also their mental health showing that staff monitor the person’s whole well being. Records showed that staff had taken the advice of health professionals to ensure that the person’s health improved. People had regular check ups with the dentist and optician. A chiropodist visits the home regularly to treat people who need it to ensure their health needs are met and they are comfortable. Care plans had been reviewed monthly until May this year but most had not been reviewed since unless the person’s needs had changed significantly. They should be reviewed every month so that staff know how to meet the current needs of the individual. Records sampled included how people are to be supported to move around so that they and staff assisting them are not at risk of injury. Throughout the day staff were observed to support people safely to move around. Records showed that people are weighed regularly and their weight is monitored, as a significant loss or gain of weight can be an indicator of an underlying health problem. A risk assessment is also completed to ensure that people are not at risk of being malnourished and if they are, action is taken to minimise this risk. One person’s records did not include a risk assessment for nutrition. However, their records indicated that some of their needs may affect their diet and nutrition, which may impact on their well being. Records included a ‘mental test score’ which shows if there is a deterioration in the person’s mental health if the score changes. However, there was not a reference to the score on any of the records sampled so it was not clear what the relevance of this was. These should be recorded appropriately so that staff can monitor accurately if there is a deterioration in the person’s memory and mental well being. Two staff were observed giving medication to the people living there at lunch time. This helps to ensure that checks are made to ensure people receive their medication as prescribed. Records sampled showed that people have their medication regularly reviewed by health professionals to ensure it is still effective in meeting their health needs. All staff are trained to give medication to the people living there and had recently had updated training in this. Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 14 Medication Administration Records (MAR) had been signed appropriately. These matched the medication left in the blister pack indicating that medication had been given as prescribed. There was not a photo of each individual at the front of their MAR. It is recommended that this is done so that if unfamiliar staff had to give out medication they would know who to give it to. Some people are prescribed Controlled Drugs that have to be stored and recorded separately to ensure they are not being misused. These were stored in a separate cabinet as required. They were recorded appropriately to ensure they are not being misused. Copies of prescriptions are kept to ensure that people are getting the medication as prescribed by their GP. The people living there were well dressed in individual styles of dress and attention had been given to their personal care. A hairdresser visits the home regularly and people said they like to have their hair done and it makes them feel good about themselves. Throughout the day staff were observed assisting people in a way that respected their dignity and privacy. Staff spoke to each person in a respectful way and addressed them by the name stated on their records that they preferred. Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that people who live in the home experience a meaningful lifestyle and have a varied and balanced diet so ensuring their well being. EVIDENCE: Care plans stated the likes and interests of the person and what activities they would like to be involved in. Some people are able to go out by themselves and said that they can come and go as they please. They said if they are late back for their meal, this is always kept for them and they can have it when they want. The owner said that the activity worker was not working there now but would soon be returning for three days a week so that regular activities could be organised. Since we last visited some people had been registered with the Ring & Ride service so that they had an opportunity to go out more in the local community. An exercise class is held regularly at the home, this took place in Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 16 the afternoon. Some people chose to take part and seemed to enjoy this whilst other people chose not to and moved to other rooms. A hairdresser visits the home weekly and people can choose whether or not they have their hair done by them and how often. Some trips to local places of interest had been arranged such as the Botanical Gardens, parks and to see the Christmas lights and German market in Birmingham. There had also been a picnic in a local park, visit to a coffee shop for tea and cakes, pub lunches and the cinema. People can decide whether or not they want to do these activities and have a choice in what activities take place. A ‘fashion show’ was arranged at the home so people had the opportunity to choose clothes to buy. This is particularly important for people who are no longer able to go out and do their own shopping. During the day relatives and friends of the people living there visited and staff made them welcome. They chose where they spent time during the visit. Records sampled showed that some people had regular visits from family and friends. It stated in their records who the people important to them were and how contact with them was to be maintained. Meetings with relatives had been held and minutes of these showed that they discussed activities, the redecoration of the home, a planned garden party, people’s clothing and money, care plans, medication, menus, staff training and how to make complaints and compliments. There are a few small tables in the dining room so that people do not all have to sit together. One person chooses to sit at their own table and this wish is respected. One person chose to eat their lunch in the lounge and staff supported them to do this. People had a choice of liver and onions or egg and chips at lunch time. One person did not want a cooked meal but wanted a sandwich and this was made for them. People were observed coming to the dining room at different times to eat their lunch and staff ensured that people had their lunch when they wanted it. Staff supported the people that needed support to eat in a discreet way that respected their dignity. A choice of sponge cake and custard or fresh fruit was offered for dessert. Menus showed that a variety of meals were offered that reflected the tastes and cultural background of the people living there. Menus showed that at tea time people have a choice of a snack or sandwiches and a dessert. One person said that they had the same food every day but their records indicated that they had a variety of different meals. One person said that it took ages to get the food served. Observations at lunchtime showed that it did take about 20 minutes for this person and some others to be served. However, it seemed relaxed and not rushed which some people may prefer. This was discussed with the manager as some people may not want to eat in a relaxed Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 17 way so it may be helpful for them to be served first. People were offered salt and pepper and sauces where appropriate and a drink with their meal. Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the views of the people living there are listened to and they are safeguarded from abuse. EVIDENCE: The owner said they have not received any formal complaints in the last 12 months just a few ‘grumbles’. All of these are recorded and action taken to resolve them. At a recent relatives meeting people raised some things that needed addressing to improve the service. Minutes of this showed these had been addressed and people were reminded of how to make a complaint. Records showed that where concerns had been raised the person raising them had been informed of the outcome and said that they were happy with this. We have not received any complaints about this home since we last visited. All staff have had training in how to safeguard the people living there from abuse. The manager, deputy and owner were attending training later in the month on the Deprivation of Liberty Safeguards. This ensures that they are aware of how this legislation may affect the people living there. They said they Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 19 will then ensure that all staff are aware of this. Appropriate action has been taken where staff have been concerned about a person living there to ensure they are safeguarded. Staff have informed us and the person’s social worker where they have had any concerns about the safety and welfare of a person who lives there. Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24,26 People using the 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 homely, comfortable, clean and safe home that generally meets their individual needs. EVIDENCE: The home was generally well decorated, homely and comfortable. Since we last visited the dining room and lounge have been swapped over so the lounge is now at the front of the home. This has made the dining room larger. The lounge seemed a bit crammed although there are other areas for people to sit in such as a separate lounge and the conservatory. This means that people do not have to all sit together in one big lounge. People were observed moving from lounge to lounge when they wanted to during the day. The owner said Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 21 that the carpet in the dining room was to be replaced the next week with wooden flooring to make it more hygienic. People said they have their own possessions in their bedrooms and they enjoy spending time in their bedroom when they want to. Bedrooms seen were personalised and included people’s personal belongings and furniture where they wanted to bring this to the home. There are some shared bedrooms and those seen had a screen so as to give privacy and each person’s part of the room had been personalised. Some redecoration was needed in the shared bedroom seen. The manager said that all bedrooms are on a redecoration programme to be done as needed. People who smoke can do so in the conservatory and in the separate lounge. Both of these rooms lead to the garden so they are well ventilated. The garden is accessible to the people living there. There is a large decking area from the conservatory to the garden that can be accessed by people who have mobility difficulties. The garden is well maintained and throughout the day people were observed going in and out as they wanted to. On the ground floor there is a bath with an electric hoist so that people can be assisted to get in and out of it easily. There is also a walk in shower room with level access so that people have a choice of a bath or shower. On the first floor there is a bath with a manual hoist. The manager said this is not used very often. At previous inspections staff raised concerns about using this as it was difficult to assist people in and out of the bath. As recommended previously replacing this bath should be considered so that people can have more choice as to whether they have a bath or shower without putting staff at risk of injury. Separate cleaning staff are employed so that care staff do not have to do this but can concentrate on supporting the people living there. The home was clean and free from offensive odours. The owner said that she does audits of cleanliness of the home and has shown cleaning staff how to do certain tasks and the standards that are expected. Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing, their recruitment, support and development ensure that individual’s needs are met and they are safeguarded from harm. EVIDENCE: Staff rotas sampled showed that there is sufficient staff on duty to meet the needs of the people living there. In addition to care staff laundry and domestic staff are employed and also a cook. The owner said that there is one vacancy for a night staff. This is covered by some night staff taking on extra shifts to provide consistency of care for the people living there. People who live there told us ‘The staff are alright’ and ‘Staff are good to me.’ Staff were observed talking to people as individuals and respecting their dignity. The people living there seemed comfortable in the company of staff. The AQAA stated that 75 of the staff have National Vocational Qualification (NVQ) level 2 in care and the other staff are working towards achieving this. This exceeds the standard that at least 50 of staff have this qualification so ensuring they have the skills and knowledge to meet the needs of the people living there. Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 23 The records of three of the staff that work there were looked at. These included the required recruitment records and a satisfactory Criminal Records Bureau (CRB) check. This ensures that ‘suitable’ staff are employed to work with the people living there. Staff records showed that when they started working at the home they completed an induction. This ensures that they know how to meet the needs of the people living there. Records showed that staff have the training they need so they know how to support the people living there and ensure they are safeguarded from harm. Records showed that staff meetings are held where staff have an opportunity to be informed of the changing needs of the people living there and keep updated with ‘best practice’. Staff said and it was observed that a handover between each shift takes place so that staff know how to support the people living there. Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements generally ensure that the home is run in the best interests of the people living there and they are safeguarded from harm. EVIDENCE: The Registered Manager has NVQ level 4 and the Registered Managers Award so she should have the skills and knowledge to manage the home. When we last visited there were concerns about the competence of the manager who had recently returned to the home. The owner has mentored the manager, has given her lists of tasks to complete and set targets for her to achieve. The owner monitors how these are achieved. This has improved the performance of Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 25 the manager to ensure that the home is run so to benefit the people who live there. The owner visits the home regularly and these visits are unannounced. They inform the staff and manager of what actions need to be taken to improve the service. The manager also completes audits and takes action to improve the performance of staff where needed. Records of people’s belongings showed that these had been regularly completed so as to record all the belongings that the person had. One person’s record included items of jewellery including their wedding and engagement ring. It was not clear how staff check that people who may not be able to look after their own belongings still have these items. This was discussed with the manager who said that they will ensure that this is recorded as part of the key worker role. The home is not responsible for managing the money of any of the people who live there. This is done by their family, friends, solicitors or the Local Authority Appointeeship Department. The manager said that small amounts of money are held for people who live there that are given by whoever is responsible for managing their money. Individual transaction records are kept, receipts are given to the person that gives the money and these are signed by two staff. These were seen and matched the records. Receipts are kept of any money that is spent and entered on their transaction record. Where people are able to they look after their own money. The manager and another member of staff regularly check the money held in the home to ensure it is being kept safe. Staff records sampled showed that staff receive regular supervision so they are supported in their role. Staff are regularly observed in their practice to ensure this meets the needs of the people living there. Fire records showed that staff regularly check the fire alarm to ensure it is working. Records showed that the emergency lighting had not been tested since January this year. The manager said it is always checked with the fire alarm but had not been recorded. The manager said that they do not have fire drills where everyone is evacuated from the building as it is not their policy to do this if there was a fire. Staff have fire safety training every six months where they are informed of the fire procedure. The procedure is that the person in charge would ensure that all people are moved to a safe place, phone the fire brigade and all doors are fire doors that protect the room from the fire for half an hour. The fire risk assessment that was completed by a fire safety officer confirmed that this procedure was safe. Records sampled showed that all equipment in the home is regularly serviced to ensure it is safe to use. The electrical wiring should be tested every five years by an electrician to ensure it is safe. Records showed it had not been tested since May 2002. The manager thought this would have been done as Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 26 required but was to check with the owner about this. Evidence of this should be forwarded to us to show that it is safe. Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x 2 x 3 x 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 2 Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP8 OP8 OP9 Good Practice Recommendations Care plans should be reviewed monthly to ensure that staff know how to support each person to meet their current needs. Each person should be assessed as to the risks of malnutrition to ensure their health needs are being met. ‘Mental test scores’ should be recorded accurately so that staff can monitor if there is a deterioration in the person’s memory or mental well being. There should be a photograph of the person at the front of their Medication Administration Record. If unfamiliar staff were giving the medication they would know who to give it to. Consideration should be given to replacing the manual hoist with an electric one so that people can have more choice as to whether they have a bath or shower without putting staff at risk of injury. Records should be kept of the testing of the emergency DS0000017019.V376267.R01.S.doc Version 5.2 Page 29 5. OP22 6. OP38 Rosemary Lodge 7. OP38 lighting to show it is working so that it can safeguard people if there is a fire. Evidence of the five year electrical wiring test should be forwarded to us to ensure it is safe. Rosemary Lodge DS0000017019.V376267.R01.S.doc Version 5.2 Page 30 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Fax: 03000 616171 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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