Care Home: Rosewell Country Home

Similar services:

• The Vicarage
• Fairfields Country Rest Home
• 7 Hyde Road
• 5 Seafield Road
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home

What the care home does well The management of European Care UK Ltd have been working with the members of the Adult safeguarding team and the commission in response to the concerns raised as a result of the last key inspection and reviews completed by BANES PCT and Adult social care team. A staff training programme has been developed and implemented. Some training is currently on going. The registered nurses have completed some training with regard to their clinical practice and assessment of their competencies is currently being undertaken. We reviewed the care records for some people living at the home. In addition we received feedback from members of the PCT who were conducting reviews and reviewing a number of the care records. We found that for a number of people the system of planning their care had improved. We read three peoples care plans to find out more about thehelp and support that each person need and to check if the staff were following what was written in the care plans. We saw a detailed care plan in place for two of these people. The care plans contained information to guide staff to give the individual concerned the care and support that they need. We identified that for some people at the home that standard of the care and support that they received had improved. For example for some people pressure ulcers had healed and some people had put on weight. In some areas of the home we saw care staff helping people and giving them the care they require. Some of the care staff we saw talked to people in a kind warm and patient manner. We also saw the staff helping people to eat their lunchtime meals. We noticed that the staff assisted people who needed extra help in a polite and respectful way. Staff sat next to the person they were helping and took time to assist the person eat their food and they talked to them politely. This helps to maintain peoples dignity if they are helped to eat their meals in this way. We spoke to one registered nurse and two care staff about the care needs of one of the people living at the home. The staff explained to us the care and support that the individual concerned needs. These staff demonstrated to us that they had a good understanding of what care and support the individual concerned needed. We asked a registered nurse about the care needs of a second person who was sitting in the lounge. We also asked about the persons dietary needs and how the staff ensure these are met. The registered nurse conveyed a satisfactory understanding of the needs of the person concerned and what help they require. However the member of staff did call the individual a `feeder`, this term could be seen as impersonal and not fully respectful. Since the last key inspection European Care have reviewed the induction for new staff. The induction now meets required good practice guidelines What the care home could do better: Whilst some improvements at the home were observed the care and support for some people at the home remains unsatisfactory. The training that has been undertaken by staff is not reflected in the care and support that people at the home are receiving. We saw one individual ring their call bell for staff to come and help them. We saw a registered nurse go and see the person and tell them that someone would come soon to help them. We heard the call bell and timed that it rang for a further ten minutes before staff came to see the lady and help her with her care needs. This has a direct impact on peoples health and well being if people have to wait for periods of time before staff come to them to help and support them. We observed a registered nurse `making` beds while three call bells were ringing and not being answered. We timed how long two call bells took to be answered by staff. One person`s call bell took over eleven minutes and one took nearly thirteen minutes. We spoke to staff about these incidents. Staff told us that on each shift they are given the responsibility of supporting a number of people on that shift. Staff went on to tell us that if they only answer the bells for the people they are supporting that day. This would mean that if staff are busy supporting one person and another person who is `on their allocation` rings the bell the individual may have to wait some time before staff attend. This could have an impact on people if their call bells are not answered in a timely manner to ensure people get the help and support that they need. We spoke to the manager about this concern at the end of the inspection who agreed to address this as a matter of urgency.We observed two care assistants go into one person`s bedroom to help them with their care. We saw that neither of the staff knocked on the bedroom door before they went into the room. This means that people`s rights to privacy is not being fully respected. We observed one of the domestic staff asking one of the care staff to help them move a bed that they were trying to clean under. The care assistant was in the middle of helping one person with their care needs. They explained this to the domestic worker. However this could impact on people living at the home if care staff are being asked to assist in tasks of this nature while they are in the middle of helping people living at the home. The care records for one individual was viewed. The care plans said that the individual needed to be assisted to move with the use of a Zimmer frame. We observed the staff use a wheelchair to help the person move from the lounge. We asked the staff and they were unclear what was agreed as the safest and most suitable way to help the person concerned. This could impact on peoples care if staff are unclear how to give residents the care and support agreed in their care plans. We read in at least four care plans that the individuals concerned should be supported to have a bath at least once a week. The documentation used for recording personal hygiene did not reflect that this was the case. For some individuals the documentation showed that the individuals had not been supported to have a bath for over a month. We asked staff if people were being supported to have a bath. We were told that currently staff were not able to help each person to have a bath on a weekly basis and sometimes the gap of time between them having a bath was longer then this. We read in one of the care plans that the individual concerned needed to have their sugar levels checked three times a day or they are at risk of severe health problems. We saw a number of dates when the persons sugar levels had only been checked once or twice that day. This would put the person at risk if their sugar levels became very high and staff were not aware of this as they had not recently checked them. We reviewed the weight records and supporting nutritional information for a number of people living at the home. The weight loss of one individual had been of concern in May 2010. In response to this concern the staff had contacted the GP and supplemented drinks were prescribed. Between the period of May and June the individual had put on some weight. The GP had discontinued the supplements in response to this weight gain. An additional weight recorded was seen to be held in the area of the home where the individual resides. This showed that an additional weight had been completed in July 2010. This additional weight showed that the individual has again started to loose weight. The care documentation had not been updated to reflect this weight loss. No reference is made to the weight loss nor is there evidence that staff sought advice from the dietitian or GP with regard to the weight loss. The care plan does not state how staff should encourage the individual to eat. The care plan did not state the types of food to offer to the individual between meals, how frequently this food should be provided or how to Random inspection report Care homes for older people Name: Address: Rosewell Country Home Church Hill High Littleton Bath & N E Somerset BS39 6HF two star good service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Justine Button Date: 3 0 0 7 2 0 1 0 Information about the care home Name of care home: Address: Rosewell Country Home Church Hill High Littleton Bath & N E Somerset BS39 6HF 01761472062 01761479124 rw2europeancare@aol.com www.europeancare.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Gillian Galloway Type of registration: Number of places registered: Conditions of registration: Category(ies) : European Care (UK) Limited care home 94 Number of places (if applicable): Under 65 Over 65 94 0 old age, not falling within any other category physical disability Conditions of registration: 0 6 6 Beds may be for young physically disabled persons age 18-50 years. Manager must be a RN on parts 1 of 12 of the NMC register. May accommodate one named individual requiring nursing care in the `Farmhouse` until such time as her nursing needs increase to the point that the `Farmhouse` is unsuitable to meet those needs, or she chooses to move May accommodate up to 40 persons aged 65 years and over requiring personal care only, in the Main House. May accommodate up to 60 persons aged 50 years and over requiring nursing care, in the Main House. Care Homes for Older People Page 2 of 15 May allocate up to 34 persons aged 65 years and over requiring Personal Care only, in the Farm House Staffing Notice dated 18/04/2001 applies. Date of last inspection Brief description of the care home Rosewell Country Home is an extended farmhouse situated in the village of High Littleton. The accommodation consists of an open style conservatory entrance area, which links the Farmhouse and Main house. The conservatory area provides a focal point for the home, housing the main reception, hairdressing salon, manager?s office, service user seating, a piano and a small bistro. The accommodation in the farmhouse consists of single and double en-suite rooms (WC & hand basin) with 3 stair lifts and is registered for social care (residential) service users. Not all rooms in the Farmhouse have level access from the stair lifts The main house provides accommodation over three floors. There is lift access to all floors and each floor has a separate communal lounge and dining facility. Bedrooms vary in size, most are ensuite (WC & hand basin) and there are assisted bathrooms and shower rooms on each floor. The home is registered for a maximum occupancy of 94 but the usual operational maximum is lower than this because few of the 12 double-sized rooms are in shared use at any one time. The home offers respite care subject to bed availability. Care Homes for Older People Page 3 of 15 What we found: This inspection was carried out by two inspectors with one inspector being present for the second day only. During this time we, The Commission, were able to speak with people living and working at the home, tour the building, view records and observe care practices. Concerns about the standards of care at the home were received by us in May 2010. As a result of this we conducted a key inspection on the 28th May 2010 and 1st June 2010. The outcome of this inspection resulted in a 0 star poor rating being given. (Please see key inspection report for additional details) At this time the main concerns related to the care and treatment of people with pressure ulcers, the number, care and support offered to people who had or who were at risk of loosing weight and the training of staff particularly the registered nurses and people who had been newly employed. Adult safeguarding strategy meetings took place on the 02/06/2010, 09/06/2010, 09/07/2010 and were attended by representatives from BANES PCT, BANES local authority commissioning team, members of the adult social care team and representatives of European Care UK Ltd. At these meeting assurances had been given by European Care Ltd of actions being taken in response to the concerns raised at the strategy meetings and as a result of the key inspection. On the 28th July 2010 we received additional concerns with regard to the care and support provided at the home. As a result of these concerns we conducted this random inspection. In conjunction with this random inspection BANES PCT reviewed the care and support for a number of people living at the home. The outcome of the inspection visit was discussed verbally with the home manager and during a telephone conversation a representative of European Care UK Ltd at the end of the visit. As this random inspection was conducted as a response to concerns received we did not review all the requirements made at the last key inspection. What the care home does well: The management of European Care UK Ltd have been working with the members of the Adult safeguarding team and the commission in response to the concerns raised as a result of the last key inspection and reviews completed by BANES PCT and Adult social care team. A staff training programme has been developed and implemented. Some training is currently on going. The registered nurses have completed some training with regard to their clinical practice and assessment of their competencies is currently being undertaken. We reviewed the care records for some people living at the home. In addition we received feedback from members of the PCT who were conducting reviews and reviewing a number of the care records. We found that for a number of people the system of planning their care had improved. We read three peoples care plans to find out more about the Care Homes for Older People Page 4 of 15 help and support that each person need and to check if the staff were following what was written in the care plans. We saw a detailed care plan in place for two of these people. The care plans contained information to guide staff to give the individual concerned the care and support that they need. We identified that for some people at the home that standard of the care and support that they received had improved. For example for some people pressure ulcers had healed and some people had put on weight. In some areas of the home we saw care staff helping people and giving them the care they require. Some of the care staff we saw talked to people in a kind warm and patient manner. We also saw the staff helping people to eat their lunchtime meals. We noticed that the staff assisted people who needed extra help in a polite and respectful way. Staff sat next to the person they were helping and took time to assist the person eat their food and they talked to them politely. This helps to maintain peoples dignity if they are helped to eat their meals in this way. We spoke to one registered nurse and two care staff about the care needs of one of the people living at the home. The staff explained to us the care and support that the individual concerned needs. These staff demonstrated to us that they had a good understanding of what care and support the individual concerned needed. We asked a registered nurse about the care needs of a second person who was sitting in the lounge. We also asked about the persons dietary needs and how the staff ensure these are met. The registered nurse conveyed a satisfactory understanding of the needs of the person concerned and what help they require. However the member of staff did call the individual a feeder, this term could be seen as impersonal and not fully respectful. Since the last key inspection European Care have reviewed the induction for new staff. The induction now meets required good practice guidelines What they could do better: Whilst some improvements at the home were observed the care and support for some people at the home remains unsatisfactory. The training that has been undertaken by staff is not reflected in the care and support that people at the home are receiving. We saw one individual ring their call bell for staff to come and help them. We saw a registered nurse go and see the person and tell them that someone would come soon to help them. We heard the call bell and timed that it rang for a further ten minutes before staff came to see the lady and help her with her care needs. This has a direct impact on peoples health and well being if people have to wait for periods of time before staff come to them to help and support them. We observed a registered nurse making beds while three call bells were ringing and not being answered. We timed how long two call bells took to be answered by staff. One persons call bell took over eleven minutes and one took nearly thirteen minutes. We spoke to staff about these incidents. Staff told us that on each shift they are given the responsibility of supporting a number of people on that shift. Staff went on to tell us that if they only answer the bells for the people they are supporting that day. This would mean that if staff are busy supporting one person and another person who is on their allocation rings the bell the individual may have to wait some time before staff attend. This could have an impact on people if their call bells are not answered in a timely manner to ensure people get the help and support that they need. We spoke to the manager about this concern at the end of the inspection who agreed to address this as a matter of urgency. Care Homes for Older People Page 5 of 15 We observed two care assistants go into one persons bedroom to help them with their care. We saw that neither of the staff knocked on the bedroom door before they went into the room. This means that peoples rights to privacy is not being fully respected. We observed one of the domestic staff asking one of the care staff to help them move a bed that they were trying to clean under. The care assistant was in the middle of helping one person with their care needs. They explained this to the domestic worker. However this could impact on people living at the home if care staff are being asked to assist in tasks of this nature while they are in the middle of helping people living at the home. The care records for one individual was viewed. The care plans said that the individual needed to be assisted to move with the use of a Zimmer frame. We observed the staff use a wheelchair to help the person move from the lounge. We asked the staff and they were unclear what was agreed as the safest and most suitable way to help the person concerned. This could impact on peoples care if staff are unclear how to give residents the care and support agreed in their care plans. We read in at least four care plans that the individuals concerned should be supported to have a bath at least once a week. The documentation used for recording personal hygiene did not reflect that this was the case. For some individuals the documentation showed that the individuals had not been supported to have a bath for over a month. We asked staff if people were being supported to have a bath. We were told that currently staff were not able to help each person to have a bath on a weekly basis and sometimes the gap of time between them having a bath was longer then this. We read in one of the care plans that the individual concerned needed to have their sugar levels checked three times a day or they are at risk of severe health problems. We saw a number of dates when the persons sugar levels had only been checked once or twice that day. This would put the person at risk if their sugar levels became very high and staff were not aware of this as they had not recently checked them. We reviewed the weight records and supporting nutritional information for a number of people living at the home. The weight loss of one individual had been of concern in May 2010. In response to this concern the staff had contacted the GP and supplemented drinks were prescribed. Between the period of May and June the individual had put on some weight. The GP had discontinued the supplements in response to this weight gain. An additional weight recorded was seen to be held in the area of the home where the individual resides. This showed that an additional weight had been completed in July 2010. This additional weight showed that the individual has again started to loose weight. The care documentation had not been updated to reflect this weight loss. No reference is made to the weight loss nor is there evidence that staff sought advice from the dietitian or GP with regard to the weight loss. The care plan does not state how staff should encourage the individual to eat. The care plan did not state the types of food to offer to the individual between meals, how frequently this food should be provided or how to accurately record food intake, such that this record could be effectively used to monitor calorie intake. The recording of food intake was very spasmodic. It did not accurately quantify the amount of food eaten by the individual. There is little evidence that snacks or supplements being given between meals. It was therefore of little use in monitoring food intake and thereby in helping to maintain weight. The documents showed that no snacks or supplements were given in the evening. The charts showed that the evening Care Homes for Older People Page 6 of 15 meal is served at around 17:00 hrs on daily basis. The individual concerned received her breakfast at around 08:30 Hrs every morning. This is a period of 15:5 hours with no snacks or meals being provided. This would exacerbate weight loss. During the site visit we asked the cook how she received information about any specialist diets people may require. The cook told us that information is received on the menu sheet which is sent out daily in order to ascertain peoples menu choices. The need for a fortified diet was not seen on the menu sheet. We looked at an additional two peoples care records. These people had also lost weight. The care records for these individuals demonstrated that robust action had not been taken in response to the weight loss. We also identified similar issues for three people with regard to the recording of fluid intake. Additional concerns were identified with regard to the diet received for an individual who has anemia. Concerns have also been observed with to the anemia medication this person received. The individual was on ferrous sulphate used to treat anemia. The instructions on the Medication Administration Record state do not take indigestion remedies at the same time of day as this medicine. The MAR chart also showed that Gaviscon Advanced liquid (an indigestion remedy) was also given at 08:30 and 17:00 Hrs for the period 5th to 30th July 2010. This could prevent the absorption of the ferrous sulphate and thus increased the individuals anemia. We saw that the main care plans are kept on the ground floor with some additional records, which are completed by the care staff such as the most recent weights, are kept in the area where the individual resides. This could be on one of the upper floors. It is difficult to assess how the care plans are used by the care staff to guide the care and support they offer to people living at the home. This also causes a delay in the most recent information about a persons condition being transferred to the care assessments and plans. The care needs for individuals are not evaluated and care practice changed in response to this information in a timely way. We saw no information in the care plans with regard to how people are supported to make choices and decisions. The care records for one individual living at the home showed that she sometimes refused the help and support of staff. This could result in the individual becoming aggressive to wards staff. The care plan for mental state and cognition had not been update following the refusal of care. No guidelines are in place to support staff when care is refused nor if the individual becomes aggressive during care. No reference is made in any of the documentation seen with regard to the individuals ability to make decision or choices as required under the Mental Capacity Act 2005. The care plan did not show what decisions she could make for herself, how staff could support her to make choices and decisions and who should be contact if the individual could not give consent or choices about the care and support she was to receive. Poor care panning could put both the individual and staff at risk of abuse. At the key inspection we identified that some areas of the home had offensive odours. At this inspection some odours remain. Some carpets are in the process of being replaced. The kitchen areas on the nursing floors are in a poor state of repair such that they are not hygienic. We were told that quotes have been obtained to replace these. Works are due to commence in the near future. We met with senior management of European Care UK Ltd on the 11th August to discuss our continued concerns following this inspection. We are currently considering what additional action to take in response to these concerns. Care Homes for Older People Page 7 of 15 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 2. Care Homes for Older People Page 8 of 15 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person shall 30/06/2008 ensure that care plans detail the health, personal and social care needs of each service user. Repeated requirement All people living at the home 19/07/2010 must have plan of care that reflects their current care needs and gives clear guidance to staff on how to address these needs This will ensure that the healthcare needs of people living at the home are met. 2 7 15 3 8 12 People at the home should be supported to complete oral hygiene in line with the assessed need and plan of care This will ensure that peoples preferred level of personal hygiene and maintains peoples comfort 21/07/2010 4 8 12 Charts and records used to monitor care such as fluid charts, positional change charts and nutritional charts are completed accurately where applicable 21/07/2010 Care Homes for Older People Page 9 of 15 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action This is required so that the health care needs can be monitored and appropriate care and support provided 5 8 12 People who are risk of choking are supported with diet and fluids in line with a completed risk assessment and up to date care plan This will ensure the safety of people living at the home and ensure that people receive the correct support and care 6 8 12 Staff at the home should 21/07/2010 ensure that all people have a nutritional assessment and are provided with diet and fluids in line with this assessment. This will ensure the healthcare needs of people living at the home 7 8 12 People who require staff 21/07/2010 support with regard to mobility should have a clear risk assessment and plan of care detailing the support required and the equipment to be used and the frequency of positional change . This will ensure that people are supported appropriately. This will help reduce the risk of injury to both people living at the home and staff. 21/07/2010 Care Homes for Older People Page 10 of 15 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 8 9 13 Action must be taken to ensure that medicines are given as prescribed and that accurate records are kept of all medicines given by staff, including creams and ointments. If regular medicines are not given a reason must be recorded. This is to safeguard peoples health and ensure that medications are given as required. 21/07/2010 9 15 16 Snacks should be available to 21/07/2010 all people at the home. This should include those on specialist diets. Snacks should be given in line with the plan of care This will ensure that people on specialist diets have access to a range of snacks. 10 15 16 People should be supported 21/07/2010 to have meals and snacks at regular intervals. This will ensure that people have access to sufficient amounts of diet and fluids 11 22 13 The management must 21/07/2010 ensure that the home is adequately equipped to meet the needs of people living at the home. This should include pressure relieving equipment This will ensure that staff can meet the needs of people at Care Homes for Older People Page 11 of 15 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action the home. 12 26 16 Food and beverages in the kitchenette must be stored hygienically. . This will reduce the risk of cross infection and ensure hygiene levels are maintained 13 26 16 Any environment within the home used to cook and prepare or serve food must be safe and suitable and hygienic . This requirement relates to the need to ensure the risk from flies and insects are minimised and the need for a bin that hygienically stores rubbish. 14 26 16 Action must be taken so that 30/06/2010 the home is free from offensive odour This will ensure that the home is pleasant place in which to live and work. 15 26 15 The kitchenette on the first floor nursing area must be updated and refurbished This will ensure it is easy to clean and reduce the risk of cross infection. 16 30 18 The management should 21/07/2010 complete an audit of the skills of the registered nurses. Where training needs are identified the Page 12 of 15 02/07/2010 02/07/2010 19/07/2010 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action management need to develop a plan as to how these training needs will be addressed This will ensure that staff at the home can meet the needs of people living at the home. 17 30 18 All staff should receive all 21/07/2010 mandatory training according to their job role. This may include moving and handling, fire training, Abuse prevention, health and safety and Control of Substance Hazardous to Health (COSHH). This will ensure that staff can safely meet the needs of people living at the home 18 33 24 Quality Assurance systems must be more robust. The quality assurance systems must review care planning, staff supervision, staff training and dependency levels. To ensure that shortfalls in the service are identified and action is taken to address them. 21/07/2010 Care Homes for Older People Page 13 of 15 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 14 of 15 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 15 of 15 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!