Inspection on 28/06/05 for Richard Cox House

This inspection was carried out on 28th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Richard Cox House 01/12/08

Richard Cox House 07/03/07

Richard Cox House 16/01/06

Richard Cox House 27/01/05

Richard Cox House 16/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Richard Cox House Dog Kennel Lane Royston Hertfordshire SG8 7AB Lead Inspector Alison Butler Unannounced 28 June 2005 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Richard Cox House Address Dog Kennel Lane, Royston, Hertfordshire, SG8 7AB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01763 249111 01763 243758 Quantum Care Limited Vacant CRH Care Home 29 Category(ies) of DE(E)-29, OP-29, PD(E)-29 registration, with number of places Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: There are no additional conditions of registration. Date of last inspection 27 January 2005 Brief Description of the Service: Richard Cox House was first registered with Hertfordshire County Council on 1st July 1992. It is a large two-storey building in quiet residential area of Royston, within walking distance of all local ameneties. It is divided into four units, three on the gound floor and one on the first floor. The first floor is served by a passenger lift. Each unit has its own loung/dining area and domestic style kitchenette. All residents have a single bedroom. There is a hairdressers salon, a conservatory, a large day care area, several offices and a central kitchen. Outside the home is limited car parking and there are two garden courtyard areas to the rear. The purpose of the home is to provide a high standard of care in a homely, friendly and safe envronment. The aim is to treat each indidvual and help them live as full a life as possible. They will assist residents to fulfill their social, emotional, spiritual and psychological needs. Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out with the recently transferred manager from another home within Quantum Care, the care team manager and staff on duty. The residents and staff were both extremely welcoming and were happy to discuss their work and lives at Richard Cox House. The majority of the inspection was spent with the residents talking about their life at Richard Cox House and talking with visitors to the home. Interaction between the residents and staff was seen as warm, caring and providing encouragement as appropriate. Care and administration records were checked. What the service does well: What has improved since the last inspection? What they could do better: The medication procedures must be tightened up to ensure that no residents go without their medication because none is available. Cleaning routines should be set up for the medication cupboards and storage boxes. (this could possible be a task carried out at night). Medication no longer required should Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 6 be disposed of as soon as possible or at least removed from the unit cupboards. Separate container should be available for all external medication as this should not be stored with internal medication. Information should be recorded exactly from the dispensing label when added to the medication, administration record sheet. The monthly reviewing that is carried out should also include reference to the care plan and not just to the daily notes. Staff should sign and date any amendments they make to the care plan. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 Information is available to prospective residents although it will require updating once the manager has completed the registration process. It gives information that allows them to make an informed choice. EVIDENCE: A Statement of Purpose and Service User Guide is available and once the manager has completed the registration process this will require updating, to include details of the manager. A copy must be forwarded to the Commission For Social Care Inspection once the amendments are complete. Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 The quality of information recorded is generally good, but progress is not always monitored and recorded. Residents receive a good quality of care and are supported by knowledgeable and experienced staff. EVIDENCE: Examination of four care plans showed that information was recorded on the daily notes that had not been transferred to the care plan. Where a care plan states that a person should receive hourly checks this is not reflected within the daily notes. One resident has a need for bedsides and this had been agreed with the family and the GP. All the information is held on the care plan. Although monthly reviewing is taking place this only reviews the daily record and makes no specific reference to the care plan. Where amendments are made to care plans, staff should remember to sign and date them. Good interaction was seen during the inspection and staff offered appropriate support and/or encouragement. Residents spoken to felt they wee treated with respect and staff always knock on their bedroom door before entering. Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 10 A number of issues were raised in regard to the medication during this inspection. It is recommended that as controlled drugs are recorded in a separate book with the two staff signatures, a note is made on the medication, administration record sheet (MAR) to inform staff of this. However, looking at the MAR sheet shows that there has been missing signatures. A carriedforward system has yet to be introduced so reconciliation can be carried out at any time. When examining the storage boxes of individuals’ medication it was noted that there were four loose tablets that had obviously dropped from the blister packs and these must be destroyed. Also where medication is no longer required, (for example a tube of eye cream that had been opened in April 05 and instructions stated that it has to be discarded 4 weeks after opening), must be returned to the pharmacy as per the disposal policy. Again, it was discovered that internal and external medication was being stored together and the recommendation has been brought forward that they are kept separatly. The medication cabinets should be cleaned on a regular basis as a number of the individual storage boxes and cupboards were not clean. Staff should be reminded that where liquid medication is spilt that it is wiped up immediately so as not to create sticky bottles, dirty cupboards and storage boxes. All bottles were dated on opening. All creams should be labelled appropriately with the residents name and date of opening etc. Residents at no time should run out of their medication if policies and procedures are adhered to. Where staff need to record the medication on the MAR sheet they must ensure that information is recorded the same as on the dispensing label. Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 14, & 15 Autonomy and choice are promoted within the home. Visitors are welcomed and contact is maintained within the local community. EVIDENCE: Work on recording the social care of residents could be improved and more up to date information should be recorded on the care plan. For example, discussions with a resident who used to enjoy knitting and reading, revealed they are no longer able to knit due to the change in need. Although they may not be able to read alone staff, could support them in reading material of their choice to them. Residents spoke to stated, “ it would be nice at times to do a bit more but the staff are always busy”. Visitors said they were made to feel welcome whenever they came to the home and were always kept informed on issues relating to their loved ones. A member of staff on the dementia unit has purchased a storage unit and is looking into providing games, materials and music to provide a more stimulating environment for the residents on the unit. This will be looked at further at the next inspection. Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 12 It would be useful to have the meals of the day displayed on each unit in a format appropriate to the residents. The lunch was nicely presented and appropriate support was offered to the residents. Staff were seen to try and encourage the residents on the dementia unit to eat some of their lunch and remind them that they had not eaten much that day. They offered them the desert and when that was not eaten they offered an alternative. Drinks are available at all times throughout the day and the residents are actively encouraged to drink. Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 & 18 Robust procedures are in place to ensure the protection of the residents. EVIDENCE: A copy of the complaints procedure is available. Visitors and residents are aware of who they would speak to if they were unhappy about any aspect of the care that is provided at Richard Cox. Staff confirmed that Protection of Vulnerable Adults training is on the training programme. Not all staff were aware of the whistleblowing policy although said they would report anything they were unhappy about. It is recommended that whistleblowing is re-enforced in staff meetings and through the review and discussions. Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not inspected on this occasion EVIDENCE: These standards were not inspected on this occasion. Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 & 30 The numbers of staff available to meet the needs of the residents was felt not to be sufficient. Staff are trained and competent to do their jobs. EVIDENCE: From discussions with staff and observations during the inspection it was felt that a increase in staffing levels should be introduced. Single cover was provided on two units and staff confirmed that if a resident requires 2 staff to meet their personal care needs they would call for extra help. On one unit the member of staff took their fifteen-minute break leaving no staff member on the unit for approximately twenty minutes. One of the residents was were waiting to go into the garden but felt that they should not do this until the staff member returned in case one of the residents required assistance and they would be able to summon help. Discussion with staff on another unit found this to be the case also. A review of staffing levels must be carried out to ensure the safety of residents at all times. Residents stated “ staff to a good job and are always kind “. Good interaction was observed. Residents were appropriately encouraged to maintain their independence. Staff receive a full induction and foundation package on commencing employement. Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36 37 & 38 There are good systems in place for the monitoring of care, health and safety requirements. The manager ensures the smooth running of the home and keeps updated to ensure the standard are being met. EVIDENCE: The manager has recently transferred to Richard Cox House from another home within Quantum Care. She regularly attends training to ensure her skills and practise remains up to date. An annual questionnaire is prepared and sent to all residents, families and professionals who have contact with the home. A report is prepared and an action plan is included to covering improvements or changes for the coming year. This ensures standards are reviewed and/or maintained. The fire records demonstrated that this area is regularly reviewed. Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 17 A supervision matrix has been put in place and the majority of staff have/ or arrangements made to ensure they receive supervsion at leats six times a year. Good records are kept of all accidents and incidents within the home and a monthly audit with any action required is carried out. The Commission For Social Care Inspection has been notified appropriately of anything that has affected the well being of the residents. All records are stored and kept locked appropriately. Staff are aware of the need for confidentiality. Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 2 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x x 3 3 3 Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 19 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) Timescale for action The manager must ensure that immediate all residents have the required as of 16th amount of medication and do not June 2005 allow it to run out. and henceforth The manager must carry out a by 31st July review of the staffing levels and 2005 ensure that no unit is left uncovered at any time to ensure the safety of all residents Requirement 2. 27 18(1)(a) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 7 7 9 Good Practice Recommendations Staff should be reminded that where additional care is noted within the daily notes this is brought forwqard on to the care plan and the staff sign and date the changes. The monthly review should include details of how the residents needs have been met from the information provided on the care plans. The recording of controlled drugs shuld be held in one place. a note made on the MAR sheet to that effect. Internal and external medication should be kept separately. Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 20 A cleaning regime should be set up for the medication storage boxes and cupboards. Medication no longer required should be removed from the unit cupbards and disposed of appropriately. Where instructions are being placed on the MAR sheet they should be copied exactly as to that on the dispensing label. The recording of residents social activities sould be improved and made relevant to the here and now. The manager should plan to increase the activities on offer in consulatation with the residents. 4. 12 Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Richard Cox House I52 s19508 Richard Cox house v232734 280605 Stage 4.doc Version 1.30 Page 22 - 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. 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