Inspection on 14/08/06 for Roborough House

This inspection was carried out on 14th August 2006.

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 found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Roborough House 01/12/09

Roborough House 04/06/09

Roborough House 09/04/08

Roborough House 18/06/07

Roborough House 07/12/05

Roborough House 05/07/05

Roborough House 24/01/05

Roborough House 07/07/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

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

CARE HOME ADULTS 18-65 Roborough House Roborough House Off Tamerton Lane Roborough Plymouth Devon PL6 7BQ Lead Inspector Rachel Proctor, Second inspector Megan Walker Unannounced Inspection 14th August 2006 10:00 Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 1 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 Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 2 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 Adults 18-65. 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. Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roborough House Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Roborough House Off Tamerton Lane Roborough Plymouth Devon PL6 7BQ 01752 700788 01752 721088 Roborough House Ltd Mrs Patricia Mary Norman Care Home 44 Category(ies) of Dementia (12), Physical disability (35), Physical registration, with number disability over 65 years of age (35) of places Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. This home is registered as a Care Home with Nursing for a maximum of 35 Service Users in the category of PD 35, PD(E) 35, TI 4 Maximum of 3 service users with mild learning disability needing to convalesce following surgery or other general health care needs, max of 6 weeks To include DE (12) categories of care One named service user under the age of 60 years with mild learning difficulties may reside at the home 7th December 2005 Date of last inspection Brief Description of the Service: Goldmax Resources, trading as Roborough House Ltd, own Roborough House. It is a 35 bedded home for young physically disabled, terminally ill and elderly persons who require nursing care. It can also accommodate a maximum of 3 service users requiring personal care only. It is an old building that has a modern extension. The home is arranged on two floors with access to most areas via two passenger lifts and a step lift. There are two lounges, a dining room and a conservatory on the ground floor. The manager supports a team of Registered Nurses and Health Care Assistants who are able to deliver care to a wide variety of service users. The home has recently changed ownership and extensive refurbishments and building work is taking place to improve the environment. The grounds are extensive and suitable for use by wheelchair users with ample parking for service users, staff and visitors vehicles. The homes statement of purpose including the inspection report is kept in the clinical managers office Fees charged are from £575-£875 actual fee is dependant on dependency and care needs of the resident. Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection, which was completed by two Regulation Inspectors. Two site visits were undertaken as part of the inspection. During these visits a tour of the home was completed. Residents and staff were spoken to and some records were inspected. Three relatives comments cards, three health professionals comment cards, one GP comment cards and fourteen staff comment cards were received as part of this inspection. Comments made in these have been incorporated into this inspection report What the service does well: What has improved since the last inspection? What they could do better: 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. Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,5 The quality of the outcomes for service users in this outcome area is good. The residents can have confidence that their care needs will be assessed by competent caring staff who have their best interests at heart. EVIDENCE: Six residents were case tracked during the inspection. Each resident had a plan of care, which had been developed from an assessment of need. The manager advised that where possible each prospective resident is assessed prior to their admission to the home, to give them opportunity to meet senior staff. The assessments include risk assessments for the activities the resident likes to undertake, these include smoking and visits outside the home. The manager confirmed that an NHS registered nurse assesses each resident who requires nursing. Two residents files viewed indicated that they required physiotherapy to assist their rehabilitation. The assessment and care plan indicated that this was being done. However it was unclear how physiotherapy for these individuals has been accessed. Examples of contracts were seen for six of the residents. Some were being funded by health and others by social services. The manager confirmed that funding arrangements are reviewed when formal reviews take place with the residents, their care manager, nursing home staff and the resident’s family/representative. A record of the reviews, which had taken place, were available in the residents files. Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, 10 The quality of the outcomes for service users in this outcome area is good. The systems and practices in place should allow the residents to make choices about their lifestyle with the assistance. The storage of resident’s information should protect confidentiality. EVIDENCE: Each of the six residents case tracked had a plan of care, which had been developed and agreed with them. Where the resident was able the care plans had been signed. Goals for the resident care were recorded in their plans of care. The review process completed on a six monthly basis for each resident provides information on how the resident was working towards the goals they had agreed. Each care plan had been developed from a comprehensive assessment of need, which covered all aspects of personal care, social support and health care needs for the individual resident. How rehabilitation is planned with the resident is recorded. Specialist health care professionals involved with the residents care had provided instructions for staff to follow. Two health professionals comment cards received indicated that staff work well with them and carry out instructions they gave to assist the residents development/rehabilitation. Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 9 Documentation of formal reviews undertaken with the resident, professionals and others, which had been agreed with the resident, were available. Two social workers spoken to advise that they regularly carry out six monthly reviews for the residents on the caseload who reside at the home. They further commented that the staff are helpful and appear to understand the residents care needs and staff keep them informed of changes. The systems and practices in place encourage the residents to make decisions; their involvement in the care planning is recorded. The manager advised that where the resident’s activity had been restricted, for example, the number of cigarettes smoked, the plan had been discussed with the resident and recorded in the care plan. An example of this was seen in the care plan of one of the resident’s case tracking. The business manager advised that individual residents could have copies of statements for money held on their behalf in the bank account. Examples of these statements were shown on the computer screen. One resident commented that they had not received a copy of the bank statement. The business manager advised that they would ensure the resident had a copy of this made available to them each month. The systems and practices in the home enable the residents to be supported to take risks as part of an independent lifestyle. One resident case tracked had had been risk assessed for an activity they enjoyed using the home’s risk assessment process. The plan had been agreed with the resident and resources put in place to enable the resident to take part in their chosen activity. However this resident had been unable to participate in their chosen activity because of staffing constraints. The manager advised that she was in the process of making alternatives arrangements that would enable the resident to continue with their chosen activity. A telephone is available for the residents’ use in the reception area of the home. However screening which would enable the residents to make telephone calls in private had not been provided. The manager advised that the home’s telephone could be made available for the residents to use in their own rooms. Several residents spoken to during the inspection had their own private telephone line in their rooms. The residents care plans and records are stored in an office off the reception area in the home. Although there are locks on the storage cupboards where the records are kept, they were not locked. This area has an open access doorway, which cannot be locked. Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 The quality of the outcomes for service users in this outcome area is adequate. The manager should continue to consult with the residents about their chosen activities and life style preference in order to promote and enable the individuality of the residents as far as possible. EVIDENCE: Since the last inspection an area where the residents can use computers has been set up. The manager advised that she was exploring opportunities to provide training for the residents who wanted this. The manager advised that at present none of the residents are ready or able to take part in employment opportunities. Three residents spoken to advised that they enjoyed being able to go outside the home and meet different people. However one commented that there is limited opportunity to do this because there is only one mini bus available to them, and this has a limited number of wheel chair accessible spaces and only one driver. They also commented that this has to be booked well in advance making it difficult to go out at short notice. One resident advised that they liked to go shopping to get some items of food. They had found it difficult to do this because of the restricted transport availability. The manager confirmed that a new larger mini bus would be available shortly. Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 11 At the last inspection the manager had arranged for the residents to have gym sessions at a local gym. The local college was also providing courses in subjects in which the residents had expressed an interest. One resident had had a support worker who enabled them to continue to take part in an activity they enjoyed. However since the support worker left a replacement has not been found and the resident has been unable to continue the activity. The manager confirmed that she was in the process of finding a suitable replacement support worker for the resident. Three relatives’ comment cards received indicated that the home staff welcome them at the home at any time and they can visit their relative in private. Visitors were seen coming and going though out both inspection visits. The visitors appeared to have a good rapour with the staff who were caring for their relative. The routines at the home are flexible. The residents can choose where to eat their meals and what time to get up or go to bed. The residents asked said they usually enjoyed the food provided for them although they did express concern that the chef was leaving for another job. They further commented that when he prepared the meals they always liked them and they were always presented well. Staff were observed knocking on residents room doors before entering. The residents mail was being distributed unopened during one day of the inspection visit. Not all the residents have lockable doors to their rooms. One commented that they would prefer to be able to lock their door when they were not in their room. The new extension rooms and refurbished rooms in the old building do have facility to have lockable doors. The manager confirmed that these rooms would be used as soon residents had been identified to occupy them. Staff were seen to involve the residents in discussion as they cared for them. Four residents asked said they were able to choose to be on their own or join in with other residents. Since the interior of the home has been refurbished and corridors widened the residents have easier access within the home and grounds. Corridors have been widened to allow access for independent wheel chair users. A patio adjacent to the new extension has a ramp from it that allows easy access to the gardens and grounds. Residents were seen using this during the inspection visit. The manager advised that the new residents’ kitchen set up to enable the residents to improve there housekeeping skills prior to moving on, is being used. Two self-contained bed-sit rooms have been created to enable residents who are assessed as ready to have greater independence in preparation for discharge. One resident who has pet has been provided with a ground floor room that enables their pet to have access to the gardens. The home has recently become a no smoking home. Several residents still like to smoke and continue to do so using the patio area. The manager confirmed that a shelter is due to be erected before the winter to allow residents to have cover when they smoke out side. Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 The quality of the outcomes for service users in this outcome area is good. The staff team at Roborough house endeavour to provide care for the resident’s physical, emotional and health care needs in a way that they would do themselves if they were able. EVIDENCE: Registered nurses are on duty over a seven day 24 hour period to monitor and assess the resident’s health and personal care needs. Three residents asked said they could choose the time they got up and went to bed and they were able to choose the clothes they wore each day The residents were moving freely around the home during the inspection. One independent wheel chair user said it was much easier to move around the home now the corridors had been widened. One resident advised that they had been enabled to choose the staff who worked with them. The plans of care viewed set out the individual resident’s personal preferences and choices. The manager advised that each resident had a manual handling plan which give staff clear instruction how to handle the resident. Manual handling assessments were available in all the care plans of the residents who were case tracked. Several aids and adaptations are provided for residents’ use. New disabled access en-suite facilities and disabled bathrooms have been provided in the Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 13 new extension, and refurbished bathrooms in the existing building have been improved. A new therapy room has been provided since the last inspection. During the inspection the acupuncturist was providing treatment for three residents in this room. The manager confirmed that they intended to recruit physiotherapists and occupational therapists to the staff team to give the residents greater opportunity for rehabilitation. Registered nurses supervise the health and personal care of the residents. Where challenging behaviour had been identified within one care plan a clear action plan had been developed with the resident to help them understand and manage their behaviour. The manager advised that a senior registered nurse with experience and qualifications in mental health, had developed an assessment tool and care planning tool to assist in the care of these residents. Examples of these assessments were provided. However another resident who the manager identified as having challenging behaviour that was affecting other residents, did not have a plan of care regarding the management of their challenging behaviour. The residents asked said staff had discussed the care needs with them and agreed the plan of care, although two residents indicated that their plan of care was not always followed by all staff. The individual plans of care for the six residents case tracked had a record of their health care needs and assessments. The resident’s ability for self care had been identified within their plans of care. One resident told the inspector that staff assist them with the things they are unable to do for themselves. The manager advised that one resident had been encouraged to make decisions about how their health care was managed and the treatment regime they were receiving. As a result of their involvement, improvements in their health had been made. The involvement of the primary care team such as dentists, opticians, chiropodist, therapists and specialist nurses was clearly recorded in the resident’s plans of care viewed. During the inspection one resident was assisted and supported to attend an outpatient appointment. GP visits and recommendations were recorded in the individual plans of care. One GP comment card received indicated that they were unable to see the residents in private. Two residents who had physiotherapy identified as a need within their care plan did not appear to be having this at the home. The manager confirmed that one resident had arranged their own appointment to see a physiotherapist. Two residents commented that there were concerns their rehabilitation was not moving forward as quickly as it could without the support of a physiotherapist at the home. Medication for the residents is stored in a locked treatment room. This is a small room in the centre of the building. A lockable trolley that is chained to the wall, is available for the registered nurses to take medication to residents. The manager confirmed that only registered nurses are responsible for assisting residents with medication. She also confirmed that where possible the residents are encouraged to be responsible for their own medication. A risk assessment processes in place for the residents who are able to self Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 14 medicate. The records of medication were viewed for six residents. These have been recorded and signed for as expected. The controlled drug register was checked against the stock held for one resident as correct. A drug fridge was available for the medication that needed to be kept in this way. A record of returns and receipt of medication was provided. The manager confirmed that the supply pharmacist has been helpful providing advice and support for the home in relation to the residents’ medication. Reference materials were also available with regard to medication. The care plans clearly showed that staff monitor the conditions of the residents receiving medication and contact the GP if any concerns are highlighted. Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The quality of the outcomes for service users in this outcome area is adequate. The manager will need to make certain that all staff understand the adult protection procedures and policies within the home to ensure the residents continue to be protected. If residents don’t feel the staff always understand them it may make it difficult for them to raise concerns. EVIDENCE: There is a clear complaints procedure that includes timescales. Residents who were asked, and residents’ comment cards received, indicated that residents knew how to complain and to whom they complain if they had any concerns. A record was available of all complaints and issues raised by the residents. These included details of any investigations, actions taken and outcomes. The manager advised that the complaints and concerns raised are kept under review and any actions that can be taken to prevent reoccurrence are completed. The Commission has been kept informed of complaints and concerns raised by the manager. Six complaints have been received since the last inspection. A record of these was available for inspection. They showed that the home’s policy is followed and all concerns and complaints are taken seriously. One relatives comment card indicated that staff respond appropriately to any concerns raised. The manager advised that she keeps an open door policy and residents can choose who they wish to speak to if they have concerns. Some of the foreign staff on duty during the inspection were able to speak English clearly. Three residents commented that they were unsure if some of foreign staff understood what they were asking all the time, although they did say these staff were all very hard working and friendly towards them. Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 16 Some staff comment cards received indicated that they had received training for the protection of vulnerable adults and they understood the company’s policy if the complaint or concern was raised against them. Since the last inspection one incident had not been reported to the management using the home’s procedure for adult protection/whistle blowing. The manager confirmed that training was planned for staff in relation to adult protection. She also advised that a review of the policy guidance was planned to ensure that staff understood what their roles and responsibilities in relation to adult protection. The pre-inspection questionnaire training information showed that the majority of staff had received POVA (Protection of Vulnerable Adult) training in February and August 2006. Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 The quality of the outcomes for service users in this outcome area is good. Once the refurbishments of the older part of the home have been completed all the residents will have access to excellent living space that meets their needs and aspirations. EVIDENCE: The new extension has been completed since the last inspection. This provides a new lounge/dining area for the residents and a new kitchen. The extension also includes purpose-built residents’ rooms with wheel chair accessible ensuites. New disabled access bathrooms have also been created in this area to allow the residents more choice. A large lift suitable for use by independent wheel chair users has been installed. Several of the residents commented how much easier it was to access areas within the home since the corridors had been widened and a new lift provided. The majority of the existing building has been re-planned and refurbished creating wider corridors. The refurbishments include the provision of a residents’ activity room that includes a pool table and computers for residents use. A treatment room/gym for use by visiting therapists to treat residents has been created close to the office and entrance to the home. However Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 18 during the inspection screening had not been provided for this room and any residents receiving treatment in this room could be seen from the corridor. A quiet lounge had been created in the centre of the first floor with natural light provided by a large ceiling window structure. Two residents told the inspector this room was a pleasant room to sit and read because it was quiet and had natural overhead lighting. Two supported-living bed-sit rooms had been provided to enable residents to progress towards independent living in the community. These had not been allocated at the time of inspection. The manager advised that these would be used for residents who had shown potential for independence. They would be allocated after consultation with care managers and the resident concerned. Several of the residents’ rooms in the existing building had been decorated and re-carpeted. The manager explained that one area of the existing building on the ground floor had been allocated as a re-enablement area. This area had a small domestic style kitchen where residents assessed as able could prepare meals. There were still some rooms in the older part of the building with stained carpets and poor décor. The lift in this area is difficult for independent wheel chair users to access. The manager confirmed that this area was used for residents needing more personal and health care support from staff. The manager confirmed that all the residents’ rooms would be redecorated and re carpeted as part of the ongoing upgrades for the home’s environment. A new treatment room had been created on the ground floor of the home close to the manager office. This room has no natural light, and the wash hand basin had stored items on top of it. The manager confirmed that she was awaiting the drainage to the sink to be repaired. She also commented that she was planning to fit shelving for storage above the wash hand basin so it would be easier to access. The manager commented that she was exploring the possibility of a second treatment room for the residents’ medication and storage of dressings and treatments in the new extension. The business manager and the nurse manager offices has been moved as part of the redefining of the existing building. The nurse manager’s office has open access to the reception area. Although lockable storage cupboards was provided for residents’ care plans, these were not locked during the inspection visit and at times the office was unoccupied. The business manager’s office has a glass panel/window that overlooks the nurse manager’s office. The business manager’s office is lockable. The business manager and the nurse manager offices have no natural light or ventilation and both offices were hot and airless during both days of the inspection visit. During both days of the inspection visit the home was fresh and clean in all areas the residents have access to. One domestic commented that they had worked extra hours during the building work to keep the home clean. A waste Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 19 disposal system for clinical and domestic waste is in place. Staff were observed using gloves and aprons when attending to the residents. The manager confirmed that training had been provided for staff in infection control and information about infection control practices were available for staff in the office. Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 The quality of the outcomes for service users in this outcome area is adequate. Although residents reported that all the staff are friendly and helpful towards them, the manager should ensure that all staff employed feel supported and have sufficient understanding of spoken English to be able to understand and care for the residents. This should enable the residents to continue to be cared for by staff team who can understand and listen to their needs. EVIDENCE: The residents spoken to during the inspection said that staff are friendly and work hard. However three residents spoken to during the inspection said they werent sure that the foreign staff always understood what they said. One residents’ comment card received also said, sometimes foreign carers dont understand what I say. The manager confirmed that sometimes when particular foreign carers spoke English it was difficult to understand them, although they had improved during the time they had been working in the home. Since the inspection visit the business manager has confirmed that two training organisations have been approached to provide courses in English as a Second Language for those foreign staff who need this. She is also considering that English languages lessons become mandatory and contractual for all nonEnglish speaking staff. In particular those who make little or no progress and who do not take independent classes in their own time to promote their knowledge and literacy skills in the English language. Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 21 The manager confirmed that staff have access to specialist health care professionals who provide training and support. One specialist nurse commented that the staff are always helpful and want to understand the reasons behind the treatment being given. The manager also advised that the health care assistants are encouraged to complete an NVQ in care. Fourteen comment cards were received from staff employed at Roborough House. These comment cards were sent to a cross section of staff that included Ancillary staff, Health Care Assistants and Registered Nurses. Five staff were spoken to during the inspection. The comment cards revealed that ten staff indicated that they did not receive regular supervision and of these five did not feel supported to do their work. Three staff comment cards indicated that there are regular group meeting, six comment cards indicated they did not have group meetings. The records of supervision provided did not support staff have regular supervision. The manager advised that she was in the process of starting to complete appraisal and supervision for staff and these would include reviewing staff training and development plans completed last year. The manager confirmed that all staff are encouraged to access training relevant to their roles and this is funded from the home’s training budget. All the comment cards received from staff indicated that they receive funding and time for relevant training completed. Other comments recorded in the staff comment cards included responses to the comments card question “what you would change”: the common themes recorded here were more staff to care for the residents and a duty rota that doesn’t keep changing. The pre-inspection questionnaire indicated that 11 of the 25 Health Care Assistants employed had achieved an NVQ level 2 or above in care. The home’s policies and procedures included a recruitment policy. Not all of the five staff files seen during the inspection had all the information required: references had not been returned before one staff member started work, although these have been applied for; two other staff files did not have a contract of employment. All five staff files had a copy of the CRB check completed for their employment at the home. None of the staff files had a record of supervision they had received, although four of the five staff files did have a training and development plan. Eight of the ancillary staff had transferred from their previous employer who contracted with the home to the home’s own staff team. Not all records of these employees held by the contracting agent had been provided for the home despite evidence that these had been requested. The majority of the staff who transferred were well know to the residents because they had worked at the home for some time. Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42 The quality of the outcomes for service users in this outcome area is adequate. The manager should make certain that all staff are aware of their responsibilities and the homes policies and procedures relating to health and safety and protection of the residents, to ensure the residents continue to be protected. EVIDENCE: The results of the residents’ comment cards received and residents spoken to during the inspection made reference to wanting more varied activities to be provided or available to them. One resident advised the inspector that the driver employed by the home regularly asks if anyone wants to go anywhere. Individual trips out are organised in conjunction with the staff team, the resident and the home’s driver, however, the mini bus size makes it difficult for the residents to be able to go out exactly when they wish because of the small number of wheel chair places/space. The manager confirmed the second larger minibus to be provided should enable more of the residents to go out when they wish. Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 23 Roborough House has had a large extension completed since the last inspection. The residents asked said the manager had kept them informed of progress and they were pleased with the improved environment this provided. Two of the residents whose view was now obscured by the new building said they were still satisfied with their rooms because of their size and location and had chosen not to move although this had been offered. A fire escape had been added to the new extension at the request of the building control officer. However this was still awaiting approval from the building control officer at the time of the inspection visit. The manager advised that the first floor rooms in this part of the new extension will not be used until the building officer has approved the fire escape access. The policies and procedures for Roborough house were available to staff in the office. However from the comment cards received from staff it appeared that not all were clear about the home’s policies for adult protection, grievances against them or who to contact in an emergency. Some of the comment cards received indicated that staff did not always feel supported by the management team. On both days of the inspection, however, there did appear to be an open inclusive atmosphere in the home with staff interacting well with the residents, each other and the management team. Records of Health and Safety checks for the prevention of fire and legionella were provided for inspection. Environmental risk assessments were also available. The manager advised that these are reviewed on a regular basis to ensure that risks are reduced. Discussion with the business manager and clinical manager revealed that they were intending to include English Language tuition as part of the contract for foreign staff. Two training organisations have been contacted since the inspection visit to provide English language training for the existing foreign staff who require this. Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 2 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 2 3 X X 2 X Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 25 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 YA34 Regulation Sch 2 Requirement The manager must ensure that all pre employment checks are completed prior to employing staff. The manager should ensure that staff have sufficient understanding of spoken English to be able to understand and speak to the service users about their care needs. The provider must ensure that the office working environment for the business manager meets current guidance for health and safety in the work place. Timescale for action 01/12/06 2 YA32 19(5)(b) 01/02/07 2 YA42 23 (3a) 01/03/07 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 Refer to Standard YA10 YA12 Good Practice Recommendations Systems and practices with in the home should protect the confidentiality of service users. The manager should continue to support and enable the residents to participate in education and activities that DS0000061085.V306859.R01.S.doc Version 5.2 Page 26 Roborough House 3 4 5 YA13 YA14 YA16 6 YA19 7 8 YA23 YA24 9 10 11 YA36 YA38 YA42 encourage and promote their personal development. The transport provided should enable the residents to participate in the activities of their choice with in a risk managed way Where activities have been agreed through a care planning process the resident should be enabled to participate in these. More information about the homes no smoking policy should be provided for the service users who still wish to smoke now the home has been designated a none smoking home. Where service users have been identified as having challenging behaviour a plan of care should be provided to enable the service user to manage their behaviour and give guidance for staff. The manager should ensure that all staff are aware of the home’s policies and procedures for adult protection and their roles and responsibilities within this. The providers should continue the refurbishments in order that it meets the service users’ individual and collective needs in a comfortable and homely way (carried forward from the last inspection) The manager should ensure that all staff receive the supervision and support they need to carry out their jobs The manager should ensure that all staff feel supported The manager should obtain written confirmation that the new fire escape meets the approval of the fire officer and building control officer. Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Roborough House DS0000061085.V306859.R01.S.doc Version 5.2 Page 28 - 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. 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