Random inspection report
Care homes for adults (18-65 years)
Name: Address: Roborough House Roborough House Tamerton Road Woolwell Plymouth Devon PL6 7BQ one star adequate service 16/06/2009 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: Anita Sutcliffe Date: 0 1 1 2 2 0 0 9 Information about the care home
Name of care home: Address: Roborough House Roborough House Tamerton Road Woolwell Plymouth Devon PL6 7BQ 01752700788 01752721088 nicola@roboroughhouseltd.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Roborough House Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 51 Number of places (if applicable): Under 65 Over 65 0 51 dementia physical disability Conditions of registration: 12 51 Maximum of 3 service users with mild learning disability needing to convalesce following surgery or other general health care needs - for a maximum of 6 weeks One service user named elsewhere under the age of 60 with mild learning difficulties may reside at the home This home is registered as a Care Home with Nursing for a maximum of 51 Service Users in the category of PD 51, PD(E) 51, DE 12 To include a maximum of 12 service users in the DE category Date of last inspection 1 6 0 6 2 0 0 9 Care Homes for Adults (18-65 years) Page 2 of 11 Brief description of the care home Roborough House is a 51 bedded home for young physically disabled and older people who may require nursing care. The home is situated on the outskirts of Plymouth. People need transport in order to get to local services. The home is a large older building which has a modern extension. There are extensive grounds suitable for use by wheelchair users, with ample parking for staff, visitors and people living in the home. Accommodation is arranged on two floors with access to most areas via passenger lifts and a step lift. There are three lounges, a dining room, activities room, hairdressing salon, independant kitchen and fitness suite available to people. There is 24 hour Registered Nurse cover. The Statement of Purpose and a copy of the inspection report are available in the reception area of the home. We were told in June 2009 that the weekly fees range between £487 and £3,297. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at /www.oft.gov.uk . Care Homes for Adults (18-65 years) Page 3 of 11 What we found:
We did a random, unannounced inspection of the service to check compliance with the unmet requirements from the key inspection, June 2009. We spent 5 hours at the home. The acting manager was available and helpful throughout. Prior to the visit we spoke with the local authority safeguarding lead who confirmed that there have been no new concerns raised about the home since the key inspection. Neither has the Commission received any complaints or information of concern. We found that the registration certificate of the service is now up to date and the written information about the home was reviewed in September. This leads us to believe it will now be accurate. Good information about the home will help people make a decision as to whether the home will meet their needs. There are people living at Roborough with very complex physical and mental health needs. We looked closely at the care of three people who use the service: one with high physical needs, one with high emotional needs and one with a medical condition which requires close monitoring and good management. We met each person, looked at records pertaining to their care, discussed their needs with staff and management and telephoned people who are involved in their welfare but not working at the home. This provided additional information. A health care professional told us: On the whole there are good systems for managing xxxs behaviour. The acting manager is a good person to have around. I have no concerns. Strategies have been good. However, the home have not always contacting the GP when there has been a mental health incident. Records we examined indicate that peoples care is planned in detail, risk is understood and measures are in place to remove or reduce any risk. Staff told us how much better the new care plans are. Each of the three people whose care we inspected was closely involved in decisions about their care and support. Where they are limited in their ability to do this advocacy has been arranged. We found that, not only had the acting manager been proactive in supporting people to lead their care she had taken steps to check this was done correctly. The home ensures that professional agencies, such as Independent Mental Capacity Advocates, health care and legal services are arranged for people as is necessary to act in their best interest. The manager, deputy and other staff were able to describe peoples needs. The family of one person told us: Carers are all friendly, jolly. My daughter likes them all. The home have been very diligent in looking after her. A person who uses the service said: Most staff are more than very competent; theyre good. We found that, where close monitoring of a condition was necessary, this was in place. We looked at aspects of the way medicines are managed at the home. Medicines are stored correctly; air conditioning has been installed into one of the two medicine rooms where the temperature might rise above that recommended by the manufacturer for safe
Care Homes for Adults (18-65 years) Page 4 of 11 storage. We were told of the changes to the storage arrangements of medicines called controlled drugs. We checked some of those medicines against the record and the final balance was correct. It is impressive that there are checks on a daily basis to ensure the balance is correct. We discussed the need for as necessary medicines to be part of planned care so their use is consistent and not open to misuse. We found that, where there were hand written entries on the medicines record staff had not always checked the medicine into the home as they must, without which a full audit is not possible. The homes complaints policy is displayed in the entrance and within the service user guide to the home, which is given to all. It contains the contact details for the organisation, the Commission and gives a timescale within which the home will do any investigation. We asked three staff and the acting manager what action they should take should they have concerns, which might be abuse. Their response was in line with the Local Authority safeguarding arrangements. We looked at the homes whistle blowing policy (how to respond to concerns which might be abuse) with the acting manager. There is no mention of abuse within the policy and no information for staff on how to alert concerns which might be abuse. However, it did include staff protection under the The Publish Interest Disclosure Act 1998, so they know how they are protected in law should they whistle blow. Neither was there the contact details, or any mention of the Local Authority safeguarding team within the policy, although the local authority Alerters Guide is displayed in the staff office. The acting manager said she would amend the policy. Staff confirmed that they have all received training in the safeguarding of adults. They also have the contact details of the Local Authority safeguarding team displayed in the staff room. We looked around the home. It was clean, fresh and appeared to be pleasant throughout. We only visited two bedrooms and the occupants told us they were happy with their room. There has been investment in the fabric of the home, which includes: 1. A pool table recovered and better placed, with the agreement of people at the home 2. New furniture for the first floor and a warmer decor 3. An electric door for the lounge (making it easier for people and less disruption) is now ordered 4. A sluice now has a liquid soap 5. Office rooms have now been relocated to top floor. This provides more space for confidential discussion, including the supervision of staff 6. The home now only uses its own cleaning staff. Two have recently been employed each doing 37.5 hours a week. Two others are about to be employed, when recruitment checks are completed. The only identified area of concern was the cleanliness of toilet bowls stored in one of the sluices. This was brought to the attention of the acting manager. There had been previous repeat requirements for assuring adequate supervision of staff who start working at the home before the completion of the recruitment checks;
Care Homes for Adults (18-65 years) Page 5 of 11 recruitment was not robust. We looked at the records of the last three people to be recruited at the home. One had yet to start work. Each had a full employment history, two written references and the list of people unsuitable to work with vulnerable adults was checked before the two started in the home. Where they started before the full criminal records check (CRB) was returned there was a named supervisor ensuring they were not working alone. Recruitment was robust. We asked the acting manager how she ensures staff are knowledgeable. Recent staff training, and that booked for the New Year, includes: The safeguarding of vulnerable adults, Huntingdons Chorea, the Mental Capacity Act and deprivation of liberty safeguards, infection control, moving and handling and the care of people with terminal illness. Training is given a high priority at this time. There appeared to be adequate staff available at the home and we were given an example of more staff allocated where this has been necessary to protect people. We found that the hours of duty of the acting manager are not recorded on the duty rota as they must be. The provider organisation has ensured very close monitoring of the service since the key inspection. There are monthly unannounced visits resulting in a detailed report to the acting manager on how to further improve the service. The acting manager now keeps the Commission very well informed of events through the required notifications. Health and safety improvements have ensured that the electrical system is now safe, all hot water outlets have safety control valves, all radiators have any risk to people assessed and many have as a consequence been covered to prevent contact burns. We saw no environmental health concerns during our tour of the building. The maintenance worker again appears committed to ensuring a safe and pleasant environment is maintained. Peoples opinion is sought through residents meetings. We were given the minutes from meeting dated 22/10/09 where the menu, activities, maintenance, safety and chairs in bedrooms were discussed. We found that the standard of record keeping was very much improved. We were unable to determine if the person running the home and known as the manager is fit to be in charge as they have not been registered with us. This means that checks to ensure the fitness of the person in charge (the manager) have not been completed. What the care home does well:
The home continues to provide a high standard of activities and people are enabled to live fulfilled lives within their capabilities. They are consulted and listened to. There has been much improvement at the home since June 2009. There are now systems in place which are ensuring continual improvements in standards which will improve the outcomes for people who live at Roborough House. Those systems include: record keeping, detailed care planning with the involvement of the person using the service or their advocate, upgrading and maintenance of the environment, good monitoring by the provider organisation and the training of staff. Care Homes for Adults (18-65 years) Page 6 of 11 Risks to the individual are assessed and measures put in place to remove or reduce the risk, with as little adverse affect to the person as possible. The home has been very active in ensuring peoples rights are protected through the use of the legal arrangements available to them. People who use the service benefit from an acting manager who is committed to their wellbeing, knowledgeable and skilled in the care of people with complex physical and mental health needs. The provider organisation has made much investment in the physical environment and toward the well-being of people living at Roborough House. Recruitment is now robust and protects people from staff who may unsafe or unsuitable to care for and support them. There is a wide range of training available to staff. The acting manager considers the deployment of staff so as to improve their effectiveness. 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 2. Care Homes for Adults (18-65 years) Page 7 of 11 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 2 14 People must not be admitted 31/08/2009 to the home unless there is full and sufficiently detailed information available on their needs and wishes. So that the home can be assured that they can fully meet the persons needs and wishes and plan how they will do so. Not inspected for this random inspection visit. Care Homes for Adults (18-65 years) Page 8 of 11 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 1 9 13 All medicines must be checked into the home. So that a full audit is always possible as this measure helps to protect people. 31/12/2009 2 37 17 The hours of duty of all staff must be recorded on the duty rota, including the acting manager. For the protection of people and the efficient and effective running of the home. 31/12/2009 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 13 There should be a planned approach to the covering of all radiators within a reasonable period, so as to remove any risk of contact burns. The whistle blowing policy (how staff should respond to concerns which might be abuse) should make clear that concerns, which might be abuse, must be reported to the
Page 9 of 11 2 18 Care Homes for Adults (18-65 years) 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 correct authority and it should contain the contact details for the Local Authority safeguarding team. 3 31 There should be a manager which has been registered with the Commission. Care Homes for Adults (18-65 years) Page 10 of 11 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 Adults (18-65 years) 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 11 of 11 - 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!
