Care Home: Rosemary Retirement Home

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What the care home does well The registered manager had responded to the previous inspection report with comprehensive improvements. All requirements and the majority of good practice recommendations required at the last inspection visit had been actioned. There was up to date, easy to understand information about the home, with alternative versions for people who may not be able to read or understand written information. Everyone living at the home had been given a comprehensive contracts and terms and conditions, which were clear and easy to understand. Comments were positive and included, " In my dad`s words "nowhere is like home but next to that I could not find or ask for anything better." The manager and staff make sure that each person, and as appropriate, their relatives are involved in the plan of how their care is to be provided. We saw one person had waited a considerable time for a vacancy for their spouse to be able to live at this home and was involved in the care plan during this inspection visit. The relatives surveys included the following very positive comments, "always very supportive especially during xx recent bereavement of her youngest daughter" and "the home has proven to us over the last month due to a bereavement that they are very dedicated to the people in their charge and I have nothing but praise for how they made time to comfort my sister in law through such a traumatic time, excellent" The sample of people`s care plans looked at, were up to date. Medication storage was secure, and medicine records were clear and generally accurate. This meant that each person`s medicine requirements were well managed in a safe environment. All of the improvements required at the last inspection visit relating to medication were now in place. The home had very good relationships with the local GP`s and other health care services, such as the community dietician and other specialist therapists, providing support for people living at Rosemary Retirement Home. We saw that staff noted that a person had become unwell and lost weight, and the advice of the GP and dietician was sought and acted upon. This demonstrated a good level of trust and professional respect between the home and primary care services. The people living at the home were encouraged to treat Rosemary Retirement Home as their own home and to be as independent as possible. People were encouraged to choose the decor of their own bedroom and personalise it with their possessions, furniture and bedding if they wished. We saw lots of examples of people being able to make choices about their daily routines, activities and meals. They were encouraged and supported to take an active part in meetings and surveys at the home. The residents meetings were well established and generally well attended, with notes of topics discussed and action taken as a result. Relatives were also welcome to attend meetings and it was positive that the registered manager had an `open door` policy to encourage relatives and people living at the home to talk to her on an individual basis. We noted that there was good involvement in the running of the home and people had contributed their views about the activities planned for the spring and summer months.The home had good links local churches and small groups of people enjoyed the activities provided by people who visited regularly to organise events such as activity classes, exercises and craft sessions. There was also a regular church service at the home. Arrangements were in place for ministers from other faiths to visit individual residents at the home, at their request. The menus offered a range of options for each meal, which were well prepared and appeared appetising and well presented. We saw members of staff ask each person what they preferred at each mealtime, with each person`s preferences recorded each day. The meals were a high standard and the majority of food was prepared using fresh ingredients. The home was inspected by Dudley Environment Services and achieved 4 Stars and a Gold Award for high standards of food safety, good environmental practices and availability of healthy food. The staff monitored mealtimes and made sure each person was supported to eat with a sensitive approach. The kitchen was generally well organised and there was a good budget for food. The cook took time and effort to obtain and prepare additional foods to meet individual food preferences. Comments from people during the visit were very positive and included, "wonderful" and " the food is very tasty." The home had a relaxed, homely ambience and it was warm, very clean and comfortable. We received comments such as, " the home always smells nice, and the home is always clean." Rosemary Retirement Home had a stable staff group, with many people who had worked at the home for a long time and knew the people living there very well. The staff were caring, committed and flexible, often willing to work extra shifts for the benefit of people living at the home. The following comments have been made, " they are wonderful here." There was a warm and friendly rapport between staff and people living at the home. Staff were aware of individual people`s likes and dislikes and how to meet their needs. A response from the home`s professional healthcare survey made the following comments, "all residents that I come into contact with are happy, look clean and well presented. I have visited at mealtimes and the food always looks gorgeous", "the residents are given choices about what they would like to eat, what they would like to do e.g. activities. The home always has enough staff", "staff are always really friendly and helpful when I visit to see the residents", and about the manager "she always shows concern for residents and is interested in the treatment we provide. She is caring and attentive to all." Good standards of health and safety continued to be maintained and the registered manager conducted regular quality audits and analysis of all accidents occurring in the home, any areas for improvement were identified and rectified. This inspection was conducted with full co-operation of the registered manager staff team and people living at the home. The atmosphere throughout the inspection was relaxed and friendly. What has improved since the last inspection? The management team had introduced improved care planning and care records. These provided improved care planning information and clear guidance so that all staff knew about each person`s needs, preferences and wishes. The records we looked at were very well completed and kept up to date. As identified as part of "what the home does well" improvements had been put in place to make the home`s medication system, as safe as possible, so that each person received their medicines as prescribed at the right time. The programme of redecoration and refurbishment had continued in a number of areas, notably the bedrooms and corridors. All issues identified at the previous inspection have been rectified. The garden has been improved with new planters and a bird table. People enjoying the warm spring sunshine in the conservatory area told us that they liked all the improvements, which made their lovely home even better. The registered manager had used the training matrix and training plan to make sure all staff were up to date with mandatory and good practice training, which meant staff were knowledgeable and skilled to meet the needs of people living at the home. The registered manager had achieved the Registered Manager`s Award, increasing her confidence, knowledge and skills for the benefit of people living at the home. What the care home could do better: There were a few areas requiring improvement at this inspection. The registered manager must continue to monitor the way peoples medication is administered at the home, taking action to assess the competency of staff to make sure any mistakes in recording are avoided and do not pose risks to peoples health and well being. As highlighted at previous inspections the improvements to provide more individual activities and more opportunities for outings must be built on. The registered manger must put into action her plan for more individual activities for people with dementia or sensory loss with each person`s participation or refusal accurately noted. Surveys contained some comments from relatives suggesting the home could further improve by providing more outings, even gentle walks, using wheelchairs as necessary to give people living at the home a change of scene. The registered manager`s plans to introduce a key worker system should be implemented to enhance the care and support provided in a more person centred way. Plans to employ senior carers should also be introduced to strengthen the management structure and make sure the needs of everyone living at the home are met at all times. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rosemary Retirement Home 65 Vicarage Road Wollaston Stourbridge West Midlands DY8 4NP     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: Jean Edwards     Date: 1 6 0 4 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 35 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 35 Information about the care home Name of care home: Address: Rosemary Retirement Home 65 Vicarage Road Wollaston Stourbridge West Midlands DY8 4NP 01384397298 01384393506 rosemary@yescomputers.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Rosemary Limited care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Rosemary Retirement Home is registered to provide residential care for up to 23 people over the age of 65, including 8 with a physical disability. The property is a large detached house located in Wollaston within a residential area close to shops and easily accessible by local public transport. Parking is provided at the front of the property with landscaped gardens at the rear. Ramps enable easy access for wheelchair users. Accommodation is provided over 3 levels. Access at the front is to the ground floor where there is a conservatory, dinning room, main lounge area, kitchen, laundry room, single toilet, and bathroom with single toilet, office, staff toilet and bedrooms. The lower ground floor is accessed via stair or open lift and forms part of the new Care Homes for Older People Page 4 of 35 Over 65 15 8 0 0 Brief description of the care home extension. This comprises a small open lounge, toilet, and six bedrooms with en-suit facilities. The remaining bedrooms, bathroom with toilet and walk in bath and toilet are on the 1st floor accessed by stairs or vertical lift. Care Homes for Older People Page 5 of 35 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 last Key Inspection was on 17 April 2008. We, the Care Quality Commission (CQC), undertook an unannounced key inspection visit. This meant that the home had not been given prior notice of the inspection visit. The inspector visited the home between 08:10 and 17:30 hours. We monitored the compliance with all Key National Minimum Standards at this visit. The range of inspection methods to obtain evidence and make judgements included, discussions with the registered manager, registered provider and staff on duty during the visit. We also talked to people living at the home, and made observations of people without verbal communication skills. Other information was gathered before this inspection visit including notification of incidents, accidents and events submitted to the previous Commission for Social Care Inspection. A number of records and documents were examined. The registered persons submitted the homes Annual Quality Assurance Care Homes for Older People Page 6 of 35 Assessment (AQAA) as requested prior to the inspection visit. We toured the premises, looking at communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and peoples bedrooms, with their permission, where possible. We circulated surveys prior to this inspection visit and received 10 responses from people living at the home, 8 responses from relatives, I response from a health professional and 7 responses from staff. The collated results form part of this report. The home had published the range of fees for the service, stating fees vary between 375 and 450 pounds per week, with individual third party top up fees by individual arrangement. Items that are not covered by the fee include hairdressing, toiletries, chiropody and newspapers. People are advised to contact the home for up to date information about the fees charged. What the care home does well: The registered manager had responded to the previous inspection report with comprehensive improvements. All requirements and the majority of good practice recommendations required at the last inspection visit had been actioned. There was up to date, easy to understand information about the home, with alternative versions for people who may not be able to read or understand written information. Everyone living at the home had been given a comprehensive contracts and terms and conditions, which were clear and easy to understand. Comments were positive and included, In my dads words nowhere is like home but next to that I could not find or ask for anything better. The manager and staff make sure that each person, and as appropriate, their relatives are involved in the plan of how their care is to be provided. We saw one person had waited a considerable time for a vacancy for their spouse to be able to live at this home and was involved in the care plan during this inspection visit. The relatives surveys included the following very positive comments, always very supportive especially during xx recent bereavement of her youngest daughter and the home has proven to us over the last month due to a bereavement that they are very dedicated to the people in their charge and I have nothing but praise for how they made time to comfort my sister in law through such a traumatic time, excellent The sample of peoples care plans looked at, were up to date. Medication storage was secure, and medicine records were clear and generally accurate. This meant that each persons medicine requirements were well managed in a safe environment. All of the improvements required at the last inspection visit relating to medication were now in place. The home had very good relationships with the local GPs and other health care services, such as the community dietician and other specialist therapists, providing support for people living at Rosemary Retirement Home. We saw that staff noted that a person had become unwell and lost weight, and the advice of the GP and dietician was sought and acted upon. This demonstrated a good level of trust and professional respect between the home and primary care services. The people living at the home were encouraged to treat Rosemary Retirement Home as their own home and to be as independent as possible. People were encouraged to choose the decor of their own bedroom and personalise it with their possessions, furniture and bedding if they wished. We saw lots of examples of people being able to make choices about their daily routines, activities and meals. They were encouraged and supported to take an active part in meetings and surveys at the home. The residents meetings were well established and generally well attended, with notes of topics discussed and action taken as a result. Relatives were also welcome to attend meetings and it was positive that the registered manager had an open door policy to encourage relatives and people living at the home to talk to her on an individual basis. We noted that there was good involvement in the running of the home and people had contributed their views about the activities planned for the spring and summer months. Care Homes for Older People Page 8 of 35 The home had good links local churches and small groups of people enjoyed the activities provided by people who visited regularly to organise events such as activity classes, exercises and craft sessions. There was also a regular church service at the home. Arrangements were in place for ministers from other faiths to visit individual residents at the home, at their request. The menus offered a range of options for each meal, which were well prepared and appeared appetising and well presented. We saw members of staff ask each person what they preferred at each mealtime, with each persons preferences recorded each day. The meals were a high standard and the majority of food was prepared using fresh ingredients. The home was inspected by Dudley Environment Services and achieved 4 Stars and a Gold Award for high standards of food safety, good environmental practices and availability of healthy food. The staff monitored mealtimes and made sure each person was supported to eat with a sensitive approach. The kitchen was generally well organised and there was a good budget for food. The cook took time and effort to obtain and prepare additional foods to meet individual food preferences. Comments from people during the visit were very positive and included, wonderful and the food is very tasty. The home had a relaxed, homely ambience and it was warm, very clean and comfortable. We received comments such as, the home always smells nice, and the home is always clean. Rosemary Retirement Home had a stable staff group, with many people who had worked at the home for a long time and knew the people living there very well. The staff were caring, committed and flexible, often willing to work extra shifts for the benefit of people living at the home. The following comments have been made, they are wonderful here. There was a warm and friendly rapport between staff and people living at the home. Staff were aware of individual peoples likes and dislikes and how to meet their needs. A response from the homes professional healthcare survey made the following comments, all residents that I come into contact with are happy, look clean and well presented. I have visited at mealtimes and the food always looks gorgeous, the residents are given choices about what they would like to eat, what they would like to do e.g. activities. The home always has enough staff, staff are always really friendly and helpful when I visit to see the residents, and about the manager she always shows concern for residents and is interested in the treatment we provide. She is caring and attentive to all. Good standards of health and safety continued to be maintained and the registered manager conducted regular quality audits and analysis of all accidents occurring in the home, any areas for improvement were identified and rectified. This inspection was conducted with full co-operation of the registered manager staff team and people living at the home. The atmosphere throughout the inspection was relaxed and friendly. What has improved since the last inspection? The management team had introduced improved care planning and care records. These provided improved care planning information and clear guidance so that all staff Care Homes for Older People Page 9 of 35 knew about each persons needs, preferences and wishes. The records we looked at were very well completed and kept up to date. As identified as part of what the home does well improvements had been put in place to make the homes medication system, as safe as possible, so that each person received their medicines as prescribed at the right time. The programme of redecoration and refurbishment had continued in a number of areas, notably the bedrooms and corridors. All issues identified at the previous inspection have been rectified. The garden has been improved with new planters and a bird table. People enjoying the warm spring sunshine in the conservatory area told us that they liked all the improvements, which made their lovely home even better. The registered manager had used the training matrix and training plan to make sure all staff were up to date with mandatory and good practice training, which meant staff were knowledgeable and skilled to meet the needs of people living at the home. The registered manager had achieved the Registered Managers Award, increasing her confidence, knowledge and skills for the benefit of people living at the home. 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 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 10 of 35 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 11 of 35 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. The home has a comprehensive and easy to read statement of purpose and service user guide and people living at the home have contracts terms and conditions of occupancy. This has the effect that people and their advocates have good information regarding their rights and entitlements, and how care will be provided. The home uses comprehensive assessment tools, which means that each persons needs are thoroughly assessed to ensure that their needs and preferences will be met. The home actively encourages introductory visits and there is evidence to demonstrate that people have been given the opportunity and time to make decisions, which are right for them. Standard 6 is not applicable. This home does not provide intermediate care. Evidence: The information contained in the homes AQAA about what it did well stated, we Care Homes for Older People Page 12 of 35 Evidence: provide a clear statement of purpose, and we provide brochure. All residents have a contract of residence. All future residents are fully assessed and evaluated before coming into the home so that we can demonstrate the homes ability to meet the residents needs. Family and representatives are always involved during these assessments and when making choices the resident is invited to spend an afternoon or morning at the home. All residents come into the home on a trial basis (one month). We do not have dedicated accommodation for intermediate care. There is always a pre admission care plan in place ready for admission. The care plan and DOLs assessment are developed within a week. The care plans are drawn up with the help of residents and family members. The homes AQQA cited the following supporting evidence to demonstrate improvements in the past 12 months, extra training for staff, manager has now completed the registered managers award, revisited our complaints procedure, a copy of which is in each bedroom, residents meetings have increased, and developed a new support plan for each resident. We looked at copy of the homes statement of purpose and service user guide, which had been updated and were clear and easy to read. The documents clearly set out the aims and objectives of Rosemary Retirement Home and provided good clear information about the services provided. Information about the range of fees and third party top up arrangements had not included in the service user guide. We discussed this omission with the registered proprietor and registered manager and the information was added to the service user guide during the inspection visit. We commended this prompt action, which gave people full information about the service to help them make decisions about the choice of home. We looked at a sample of case files of the two people admitted to the home since the last key inspection on 17 April 2008, which provided evidence that each person was provided with a contract and statement of terms and conditions. The documents were easy to read and understand, set out in detail what was included in the fee, the role and responsibility of the provider, and the rights and obligations of the person living at the home. From the information provided at the home we noted that six people were funding the costs of their own care the majority of other people were funded through Local Authorities. We saw evidence from examination of a sample of care records at the home, from responses and during discussions, which confirmed the good practices in the homes Care Homes for Older People Page 13 of 35 Evidence: AQAA. Such as pre admission assessments, which were conducted professionally and sensitively and had usually involved the family or representative of the person. The pre-admission assessment documentation was well completed and individual preferences were recorded such as rising, retiring, preferred activities, likes and dislikes. This meant that staff had good and accurate information about each persons needs and how they wished their care to be provided. Care Homes for Older People Page 14 of 35 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. There is comprehensive care planning, risk management and monitoring, which provides staff with the information and guidance to meet peoples needs and preferences well. Good multi disciplinary working takes place on a regular basis, giving people assurances that their health needs care needs are identified and well met. The service has a medicine policy that reflects good practice and staff can identify through records exactly what has been given to people living at the home. This means that each persons medicines are stored safely and that records show that the right medicine has been given to the right person at the right time. People living at this home can be assured that they will receive dignity and respect at all times. Evidence: We looked at a sample of care records for new people admitted to the home and for a person who had lived at the home for a longer period of time. We saw that each person had a comprehensive care plan, using improved formats. There was evidence Care Homes for Older People Page 15 of 35 Evidence: demonstrating the good practice of involving the person and their relatives or representatives in the development and review of their planned care. We noted that the care plans were based on comprehensive assessment information and included all essential basic information and identification of any associated risks. The addition of personal preference information and the plan to introduce life histories to record each persons preferred daily routines for staff guidance making sure that care was delivered with a person centred approach was a good initiative, which is being implemented well. There was evidence from records and discussions that each persons health was carefully monitored with appropriate action taken. We saw evidence of well documented health care assessments, screening, treatment and intervention. An example was where there were significant changes in one persons condition, with weight loss, some loss of mobility and general deterioration. This was reflected in a review of the moving and handling assessment and nutritional assessment and a referral to the GP and district nurses for advice and support. We noted that following a number of falls the registered manager had requested a medication review and a lower bed had been provided. These good practice initiatives were appreciated by the relatives and commended by other professionals in a review of the persons care at this home. We saw that all persons living at the home had good access to health care services to meet their assessed needs both within the home and in the local community. Some people were able to choose their own GP within the limits of geographical borders and there was documentary evidence to demonstrate that all persons had good access to dentists, opticians, and other community services. The home does not currently have a key worker system. We were told that all staff at Rosemary Retirement Home monitor all residents equally and report any changes both in the daily report and on care plans. The registered persons informed us that there were no plans at present or in the future to use this system. The key worker system is recognised as a good practice initiative and would enhance the quality of individual person centred care for people living at home. We looked at the homes system to manage the medication for people accommodated. We noted a considerable number of improvements. These included a new supplying pharmacy, which had supported the home and provided advice related to medication at the first planned audit visit, with a very positive outcome. The medication administration had changed to the MDS (Monitored Dosage System), which the staff Care Homes for Older People Page 16 of 35 Evidence: found easier to use. New medication trolley, controlled drugs cabinet and medication fridge had been provided, making the storage of medicines safer and more secure. This ensured that each persons medication was kept in a safe environment. We were shown a copy of the homes revised medication policy, which had also been expanded to include a procedure and monitoring records for when any person living at the home needed to take their medication away from the home, such as on outings. We recommended that the new revised and updated medication policy should be further expanded to include the instruction that any medication errors must be notified to the Care Quality Commission as a Regulation 37 notification. We saw evidence that all staff involved in the administration of medicines had undertaken additional medication training and were in the process of completing ASET accredited medication training. We noted that all medication was appropriately stored in accordance with manufacturers guidance. The new lockable medication refrigerator was checked daily, with the minimum and maximum temperatures documented and recorded. The correct temperature range of between 2 C and 8 C was being maintained. This meant that peoples medication requiring refrigeration was stored at the correct temperature to maintain its integrity and effectiveness. We looked at a sample of MAR (Medication Administration Records) sheets, which documented each persons current medicine requirements and regime. These were well maintained, which meant that there was an accurate record to show medicine prescribed by their doctor was recorded, checked, monitored and administered in accordance with instructions. There were good procedures and checks in place to make sure that generally persons received their correct medicine at the right time. However we noted that one persons Ibuprofen gel prescribed TDS, was only signed for at 2200 hours, the registered manager stated it should be administered twice daily. This prescription should be clarified and be administered in accordance with the prescriber instructions. The receipt, administration and disposal of medicine were recorded. The date of opening of medicine in original containers was documented, which meant audits could be carried out accurately. We carried out audits on a random sample of medication to ensure that medicine had been given to each person as prescribed by the GP, which were found to be accurate. This gave assurances that each person received all their medication as prescribed by their doctor at all times. Care Homes for Older People Page 17 of 35 Evidence: From our observations and in discussions it was evident that all staff were aware of how to treat each person with respect and to consider their dignity when delivering personal care. All persons living at the home were well groomed and particular care had been given to assist them with their preferences for their personal appearance and clothing. Care Homes for Older People Page 18 of 35 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. There is evidence of planned and spontaneous activities available on a regular basis offering people opportunities to take part in socially stimulating activities. People are enabled and encouraged to maintain good contact with family and friends. The dietary needs of each person are well catered for with a balanced and varied selection of foods that meets their preferences and nutritional needs. Evidence: The homes AQAA cited the following evidence of what was done well, residents rise and retire at their chosen time. Visiting is open and contact with family and friends are encouraged. Activities are provided and residents encouraged to take part but this is their freedom of choice. All meals cooked fresh with weekly sourced ingredients. All residents receive a nutrition assessment and a staff member is in the dining room at mealtimes. Treats are provided. Mealtimes are treated as social occasions and no resident is hurried when eating, time is taken at their place. Meals can be taken in their bedrooms. Staff have been trained in nutrition, which covers feeding. Residents wishes regarding religion are respected. One resident goes to a day centre weekly. All residents have the choice of meeting with their family and friends in the privacy of their rooms. The home does not handle any residents finances. Residents are Care Homes for Older People Page 19 of 35 Evidence: encouraged to bring in personal items. Residents are made aware that they can access their own records. The homes AQAA cited the following improvements over the past 12 months, we have extended our paperwork, produced to support plans, and produced talking cards. We were able to verify as accurate the claims made in the homes AQAA. There was evidence during the inspection, which indicated that staff listened to people living at the home and made considerable efforts to provide flexible daily living routines, which enabled people to enjoy a good quality of life according to their personal preferences. We saw that people were assisted to get up and have breakfast over an extended period, up until approximately 10:30am. We also noted that one person chose to spend the majority of their time in their own room, only having some meals in the communal dining room, which was respected by staff. We noted earlier in the report that the registered manager would be considering the introduction of a key worker system, which when operated well would enable closer relationships between people accommodated and staff, where likes, dislikes and needs were known in more detail and would be met in a person centred style. There was a range of activities provided at the home. We were told that new ideas from training, the Alzheimers Society and residents meetings had been introduced. These included, afun box for everyone living at the home. We saw one person making particular use of the fun box, they especially liked a large bunch of keys. We were told that this person used to take other peoples keys and since a large bunch of keys had been provided, personal keys were safe from interference. The Fun Boxcontained items with lots of different textures, such as books, soft toys, and squashy balls, which some people with sensory loss appeared to enjoy. We saw information displayed bringing peoples attention to events and activities. It was very positive that it was understood and respected that some people preferred to spend their time in their own bedrooms, and they were supported with individual interests. We observed an activities session, gentle exercises to music, using a large lightweight ball. We also saw pictorial evidence of craft activities and noted that regular entertainers were engaged to provide musical events at the home. We spoke to the activity provider for the music and movement who had been visiting the home for more than 11 years, and she told us, its very homely and one of the best homes she visits with the friendliness of staff and residents. We were told that though none of the people living at the home were able to go out unescorted, some people went out on shopping trips with relatives. We saw that one Care Homes for Older People Page 20 of 35 Evidence: person went out to lunch with their daughter during inspection. We were told this was a weekly event, which was very much enjoyed. In discussion one of the care assistants we were told that she often takes people for a walk and the end of her shift. We saw evidence that family and friends were welcomed and people we spoke to told us they knew they could visit the home at any time. We were told that the management team always made time to talk to visitors and share information with the consent of the person concerned, where possible. During the tour of the home there was good evidence that people were encouraged to bring in their personal possessions to personalise their room. We saw inventories of personal possessions on the sample of files examined. However, these were not fully completed and were not signed and dated by the person or their representative and witnessed by the member of staff. We discussed nutrition with care staff and catering staff, who were knowledgeable about each persons nutritional needs. We were told that a choice was always offered, and there was also added calorific value at mealtimes for people with poor appetite or at risk of weight loss, using cream, butter, cheese and pulses. We discretely observed mealtimes and saw that staff were aware of the needs of people who found it difficult to eat and we noted that they offered sensitive assistance with feeding. They were aware of the importance of offering food at the persons pace, so that they were not hurried. We also noted that hot and cold drinks were frequently offered throughout the day. The dining room looked inviting with attractive tablecloths, crockery and condiments. The meals looked and smelled appetising, and meal times were protected to provide a sociable, enjoyable experience. We asked a sample of people about the food at meal times, and received very favourable comments, food very good and plenty of it, and lots of choice. The registered manager told us that following advice at training sessions and suggestions at residents meetings talking cards to aid communication, including laminated pictures of meals and snacks had been put together. These were very colourful and displayed meals, which looked appetising and appealing. We were shown large print daily menus, which were also being developed, to be laminated and displayed to show daily meal choices. These are very good initiatives to assist people make real choices for their meals. Care Homes for Older People Page 21 of 35 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. People can be sure that any concerns and complaints are listened to and action is taken to look into them, with systems in place to record investigations and outcomes. There are good arrangements in place to safeguard people living at the home from risks of harm. Evidence: We saw that Rosemary Retirement Home had an up to date, revised and improved complaints procedure, which was displayed in the reception area and contained in the service user guide. Information supplied as part of the Homes AQAA indicated that the home had not received any complaints, over the past 12 months. There were complaint forms to record formal complaints, which provided detailed information. The responses during the inspection indicated that people were aware of how to raise concerns or use the homes complaints procedure. This demonstrated positive practice and the homes proactive response to peoples experiences and perceptions of the service. We were told that the home had not received any allegations, which required considered under the Safeguard and Protect multi agency procedures for dealing with abuse of vulnerable persons. There was a copy of Dudley DACHS (Directorate of Adult Community and Housing Services) multi-agency procedures relating to safeguarding Care Homes for Older People Page 22 of 35 Evidence: vulnerable persons living at the home. The organisations policies and procedures to safeguard vulnerable people were satisfactory and had been reviewed and updated to be in line with regulations and other external guidance. We were given documentary evidence that all staff have been made aware and have been given time to read and understand procedures for the protection of vulnerable adults. The majority of staff had been provided with training, which provided appropriate awareness of safeguarding vulnerable adults and staff were aware of what they needed to do should an incident occur. Care Homes for Older People Page 23 of 35 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. The standard of the decor within this home is good with evidence of improvement through proactive planning and continuous maintenance. The home presents as a safe, homely and comfortable environment for people living there. There are effective systems in place for maintaining infection control. Evidence: The premises were homely and domestic in style, with a bright, cheerful and well maintained interior. There were attractive gardens and garden furniture for the comfort and enjoyment of people living at the home and the rear and side gardens had been improved with attractive planters and spring flowers. The tour of the building identified that improvements claimed in the AQAA had been made and a programme of redecoration and refurbishment had been continued. People living at the home told us how much they liked living there and one person who proudly showed us her bedroom commented, they are absolutely wonderful here. The tour of the premises identified that a number of improvements have been made, and requirements for repairs and redecoration issued at the last inspection were completed. Some examples were a new mirror in the refurbished bathroom, new blinds at the residents suggestion, new carpets and new brighter decor in the first floor corridors, creating a light airy and safer environment for people living at home. Care Homes for Older People Page 24 of 35 Evidence: We looked at a sample of bedrooms with peoples permission where possible. All were attractively decorated and personalised according to individual preferences. The majority have many treasured personal possessions such as family photographs, ornaments and small items of personal furniture. The bedroom had been attractively decorated to high standards, with new furnishings where needed. Many bedrooms had pleasant views and those on the lower ground floor had pleasant views through their patio doors. During discussions with people they told us that the home was always clean, warm, and comfortable. The small laundry, located on the ground floor of the building was well equipped with commercial washers and tumble dryers. The laundry service was generally well organised and the staff demonstrated good standards of infection control. There was a laundry procedure and measures in place for supplies of disposable gloves and aprons to be readily available in the laundry at all times. The homes kitchen was maintained in very good order, and it was clean and tidy and well organised. We noted that appropriate food hygiene and safety measures were in place, with well kept records, monitored by the registered manager, and Environmental Services. The home had achieved the Dudley MBCs Environmental Health Four Star Food Award for healthy eating and food hygiene. Throughout the home good standards of cleanliness continued to be maintained and there were no discernable malodours during this visit. We received a number of comments, which all gave a similar view, the home always smells nice, cleaners come around every day. There were some additional improvements required at this visit, such as the ground floor bathroom, which was in the maintenance plan for refurbishment needed a thorough clean, especially the underside of the bath seat and in an areas where dust and debris had built up between the bath and the base of the bath hoist. There were also a number of items, such as toiletries, perfumes and creams, which could have been used communally in the bathroom cupboard. These issues were dealt with at the time of the inspection visit, which was positive. There was corrosion on the base of the bath hoist and a damaged surface in the bathroom, which we were told would also be rectified as soon as possible. This was important to rectify to maintain infection control integrity, especially as there had been someone discharged from hospital with MRSA. There was a loose headboard in one bedroom and this was secured immediately again demonstrating good practice. Care Homes for Older People Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home continues to maintain stable substantive staffing levels and people receive consistent and good standards of care. The staff recruitment processes are generally robust, which means that there are effective safeguards for people living at the home. The organisation and registered manager demonstrate a strong commitment to staff training and development. Evidence: The homes AQAA cited the following as evidence of what they do well, staff are highly trained and motivated. NVQ staff training above requirement level. Our staff all receive for holiday entitlement plus 3 training days allowance. Residents needs are met fully by numbers and skill mix of staff. All policies procedures relating to recruitment are up to date. The responsible person marked on the rota. Registered manager has now completed the RMA award. The staff are motivated and work well together. We were able to verify the good practices claimed in the homes AQAA during observations, discussions and examination of samples of records during this visit. We noted that there were 22 people accommodated, with a variety of dependency levels and diverse needs. The registered manager told us that she reviewed staffing levels on a regular basis, taking account of the occupancy and dependency levels of Care Homes for Older People Page 26 of 35 Evidence: the people accommodated, which demonstrated good practice. Assessment of staffing rotas and information from the AQAA and staff personnel records demonstrated that the home was generally maintaining satisfactory staffing levels. The Home had a stable staff team of 25 people including 19 care staff, domestic staff, a gardener/maintenance person, and the Registered Manager, catering staff and administrator. We were told that there was no change to the structure of the staff team at present and the home did not have designated senior staff but there were plans to create senior posts. There was an improvement in that we were told there were named designated persons in charge of the home, on a day to day basis when the manager is off duty, and there was now documentary evidence on the staff rota. Two staff had left the homes employ since in the past 12 months for valid reasons, and there were no staff vacancies at the time of this inspection. We looked at a random sample of staff personnel files, which were satisfactory. The registered manager had improved the recruitment and selection processes to demonstrate generally robust practice, with well ordered staff files and essential documentation. We noted that the organisation continued to demonstrate a strong commitment to staff training and development and had continued to provide all staff with appropriate training to raise awareness and skills to respond to peoples changing needs. The homes had a training needs analysis and training plan and individual staff training profiles in place and these show commitment to staff training and development. However we recommended at the last inspection there should be documentary evidence of the competence of the trainer, who had provided training for every training area, which was not available to verify. We were told that the training had sent evidence in an email and unfortunately this had been lost when the homes laptop had been stolen in a recent burglary. We highlighted that documentary evidence should be retained at the home to be available for inspection and insurance purposes. The registered persons contacted the trainer and assured us that evidence of competence would be forwarded to the Commission. We saw evidence that all except one care staff had achieved an NVQ level 2 care award with additional candidates registered for NVQ level 3 training. We spoke to the NVQ Assessor who was visiting the home, she told us, this is one of the best homes, very friendly. We were told that staff annual appraisals had commenced and saw evidence that a formal structured supervision system had been introduced. We recommended that a matrix be displayed to show dates that all care staff had planned Care Homes for Older People Page 27 of 35 Evidence: minimum of 6 one-to-one supervision meetings. During discussions it was evident that staff felt supported. The comments received from staff included, the training in our home is excellent Care Homes for Older People Page 28 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is generally effective leadership, direction, and good communication. There are systems for consultation with the people who live at Rosemary Retirement Home, and views are sought and acted upon. The management systems and health and safety compliance minimises the potential for risks of harm for people living at the home. Evidence: Kathleen Oakley, the registered manager at Rosemary Retirement Home, had worked at the home for many years. She had achieved the NVQ level 4 Award in Management and Care and had recently achieved the RMA (Registered Managers Award) and demonstrated commitment to maintain training for her own professional development. It was positive that the registered manager had allocated managerial hours to achieve sufficient managerial time to develop the staff and service to meet and exceed the Legislative framework and National Minimum Standards. We noted that these achievements had increased her self confidence, which meant that her organisational and delegation skills had improved. Care Homes for Older People Page 29 of 35 Evidence: We saw evidence that the registered proprietor visits the home very regularly and is part of the managerial decision making for the home. We were told that the registered persons had purchased a new quality assurance system through the West Midland Care Association, based on KLORA (Key Lines of Regulatory Assessment). The implementation was at an early stage, however this was promising for positive outcomes for people receiving the service. There were clear lines of accountability within the home, and through the management structure. We noted that the registered manager had devised and implemented the homes annual development plan for the current year. We saw excellent evidence that the registered manager had used good self auditing systems, and these included monthly audits of areas such as peoples case files, staff personnel files, staffing levels and accidents, incidents and falls, with remedial actions to minimise risks identified. The registered manager and staff team have continued commendable efforts to involve people living at the home, their relatives, representatives and other community stakeholders in the running of the home. We noted that there were regular residents meetings, with minutes available. The homes survey questionnaires had been distributed to residents and families and stakeholders, with completed forms awaited for results to be collated and published. We saw evidence that the results had been acted upon in any area where there were concerns or where performance needed improvement. An example was people living at the home suggested they would like blinds instead of curtains in some areas and these had been provided. We noted that staff meetings were taking place, though these were infrequent. We strongly recommended that staff meetings should be planned for increased frequency, with minutes posted on notice boards. The structured formal supervision system still appeared to be at an early stage of implementation. We discussed the benefits of formal supervision sessions such as identifying strengths and weaknesses, training needs, personal development and support. This would improve the knowledge and skills of staff, with obvious benefits for people living at the home. The registered manager had not achieved the minimum of 6 recorded one to one supervision meetings with each member of staff, each year. As discussed at the inspections in April 2007 and 2008, we have again strongly recommended that the home needs to seriously consider employment of senior care assistants as part of the staffing structure to make the supervision and development of staff workable. As identified at the Staffing section of this report the registered manager told us that there were plans Care Homes for Older People Page 30 of 35 Evidence: to create senior care posts, which would be a very positive development. We were told that the home was not responsible for residents finances and did not hold any monies on their behalf. Invoices were sent to families or Dudley MBC monthly for any purchases such as hairdressing or chiropody. We looked at a sample of heath and safety, fire safety and maintenance documentation, which was satisfactory and very well organised. There was evidence that all staff receive mandatory training commensurate with their roles such as fire training, drills twice each year, moving and handling, first aid, food hygiene, health and safety and infection control training, commensurate with duties undertaken. However as identified at the Staffing section of this report, the home did not hold documentary evidence of competence of the trainer. We also discussed with the registered persons that the training certificates indicated that training in all areas was required annually, despite good practice guidance from organisations such as ROSPA and the HSE that accredited moving and handling training could be valid for up to three years. We highlighted this matter at previous inspections. There had been 86 recorded accidents involving people living at the home in the past 12 months. The registered manager had an effective system for auditing, analysing and evaluating accidents involving residents, with effective measures implemented. At the previous inspection we recommended that the analysis would have added benefits if it were expanded to include more information such as times of accidents, which had been actioned. This demonstrated improved and effective measures, for example one person who had experienced repeated falls, especially during the night, had been referred to the GP for medication reviews and additional monitoring and support had been put in place. Care Homes for Older People Page 31 of 35 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 32 of 35 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 9 13 The registered persons must 01/05/2009 clarify the prescription for Ibuprofen gel prescribed TDS, only signed for at 2200 hours, and ensure this and all medications are administered in accordance with the prescribers instructions. This is to promote and maintain the health and well being of people living at the home. 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 8 It was recommended that a key worker system should be introduced to enhance the quality of individual person centred care for people living at home. It was recommended that the new revised updated medication policy should be expanded to include the instruction that any medication errors must be notified to the Care Quality Commission as a Regulation 37 Page 33 of 35 2 9 Care Homes for Older People 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 notification. 3 14 That each persons property inventory be fully completed on admission with clothing, furniture, valuables, hearing aids etc. and thereafter kept up to date signed and dated by staff, the person and/or relative. It is strongly recommended that the registered persons ensure that the home has documentary evidence of any training providers accreditation and competence to deliver training to staff It is recommended that all staff receive training relating to the Mental Capacity Act and have an awareness of its implications for all aspects of their work. It was strongly recommended that staff meetings should be planned for increased frequency, with minutes posted on notice boards to encourage participation. That a documented annual schedule of supervision sessions be devised and displayed to encourage participation 4 30 5 30 6 32 7 36 Care Homes for Older People Page 34 of 35 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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