Inspection on 18/06/07 for Roborough House

This inspection was carried out on 18th June 2007.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 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 14/08/06

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 & Bel Heginworth Unannounced Inspection 18th June 2007 9:00 Roborough House DS0000061085.V338429.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.V338429.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.V338429.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 Position Vacant Care Home 51 Category(ies) of Dementia (12), Physical disability (51), Physical registration, with number disability over 65 years of age (51) of places Roborough House DS0000061085.V338429.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 51 Service Users in the category of PD 51, PD(E) 51, DE 12 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 To include a maximum of 12 service users in the DE category One service user named elsewhere under the age of 60 with mild learning difficulties may reside at the home 12th December 2006 Date of last inspection Brief Description of the Service: Goldmax Resources, trading as Roborough House Ltd, own Roborough House. It is a 51 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. Roborough does not exclude individuals from the service by reasons of race, ethnicity/cultural practices, gender, sexuality, religion, age (adults only) or, diagnosis inclusive of those with a co-existing psychological/mental health needs (non-acute). The priority is compatibility with the whole community resident group living together.(Manager Roborough House 2007) 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. Fees charged are from £875 the actual fee is dependent on care needs and dependency of the person. The statement of Purpose and a copy of the inspection report are available in the reception area of the home. Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced Key inspection carried out by two inspectors, which took place on 18th June 2007 between 9.00 am and 3.30pm. Information received since the last inspection has also been taken into account. A tour of the home was completed, some individual peoples rooms and all the communal areas were visited. Four people had their care followed as part of this inspection. This included speaking to them in their own rooms about the care and services they received and seeing their care planning information records. Some of the comments made during the inspection by people living at the home and staff have been incorporated into this report. Personnel records for four staff and other records relating to the management of the home were also inspected. What the service does well: What has improved since the last inspection? The refurbishment of the internal environment have been completed and registration of the new extension has been finalised. This provides a pleasant homely environment that is easily accessible for the people who live there. The providers have ensured that the office working environments for the manager and clinical staff has improved. Office space has been reallocated and airconditioning provided. The appointment of an activities coordinator has improved the social activities and entertainment available for the people who live at Roborough house. A group of people spoken to said they were really looking forward to the Pool tournament they were having later that week at the home. Others commented how much they liked the trip they had over Dartmoor. Medication procedures and practices have been reviewed and updated and requirements made at the last inspection had been met. New storage systems and medication trolleys had been provided for peoples medication. Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 6 Overall the standard is spoken English for overseas staff has improved. The concerns raised at the last inspection about people not being able to understand staff had not been repeated. A system to ensure that all staff receive regular supervision has been put in place. Those staff spoken to during the inspection said they felt supported to do their work and the majority said they had received supervision. 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. The summary of this inspection report can be made available in other formats on request. Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 7 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.V338429.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with information that helps them to make an informed choice about the home and whether their needs will be met. The people who live at Roborough House can have confidence that competent caring staff needs will assess their care. EVIDENCE: The statement of purpose and service users guide had been up dated since the last inspection to provide more information for the people who use the service and their representatives. This was displayed in the reception areas of the home during the inspection. However not all the people asked were aware of why restrictions to some facilities i.e. kitchen and smoking had been put in place. Since last inspection new template has been introduced for the assessment of people who use the service. This provides more information than was previously available. The new manager confirmed that she is in the process of updating all care planning and assessment systems. On the whole assessments, care plans and risk assessments cover all areas of need. Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 9 Four people had their care followed during the inspection. Each person had a plan of care, which had been developed from an assessment of need. The manager who was contacted after the site visit advised that where possible each person 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. Contacts with health professionals prior to this inspection confirmed that they regularly assess the people who live at Roborough House. People funded by continuing care health budget have their care monitored by an NHS nurse. An NHS registered nurse also confirms the NHS funding for nursing care for people living at Roborough House. Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9. Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. On the whole care planning for individuals addresses their care needs. People who live at Roborough House are encouraged to make decisions about their day-to-day lives with assistance from a caring staff team. However by not having clear information about why restrictions have been introduced, which have been agreed with the person and the multidisciplinary team responsible for their care. The best interests of the person may not always be fully protected. EVIDENCE: The pre inspection information provided indicated the improvements made to the care planning system since the last inspection. New care plan folders, which are individually written for each person had been introduced. On the whole assessments, care plans and risk assessments cover all the areas of need. There needs to be some improvement in some of the details with in the care plans to ensure there is enough detail and explanation as to why Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 11 restrictions are in place. How to manage aggression when guidelines don’t work and who is involved in the decision making process should also be included. From discussion with the manager it was clear that there were contingency plans in place for when set guidelines in individual peoples plans of care failed. Health care needs are covered in care plans on the whole daily records show health needs are well met. However where interventions were set in care plans a named person had not been identified to monitor and work with the individual. Time scales had not been included where intervention had been designed to encourage improvement and a review sheet had not been included for each goal the person had agreed. The activities co-ordinator appointed advised that they had encouraged and provided opportunity for all the people who live at Roborough to spend time out side the home environment and meet others. She advised that a picnic was planed later in the week weather permitting and she intended to have more than one trip during the day to allow as many people as possible to take part. Although care plans for two of the people whose care was followed had restriction on the person, these did not appear to have all been agreed with the person. The care plan describes what should be in place before the person goes outside the home e.g. must have a mobile and say where they are going. An agency registered nurse had been employed to review the plans of care for individual people in the home. The issues above relating to restriction for people were discussed with this nurse. From discussion with the manager it was clear staff had been given the opportunity to work with individual people in the development of their plan of care. Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17. Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The people who live at Roborough House have their personal choices encouraged and respected by the staff that care for them. This creates a positive friendly atmosphere. EVIDENCE: The activities co-coordinator explained that the activities room had been moved down stairs to give more people access. The computers individual people could have access to were available in the activities room. One person was seen using this during the inspection. One carer spoken to during the inspection said activities for people living at the home were much better. Two of the people living at the home said they really enjoyed going out over Dartmoor on a trip that had been arranged. During the inspection people were being encouraged to take part in the activities arranged in the home. Other people who lived at the home had chosen to sit out side in the patio area talking with other people who lived at the home or smoking. Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 13 After lunch three people were in the patio area, a staff member was talking with the residents encouraging them to talk to each other. Another person was playing pool in the lounge with a staff member. Three people spoken to said they were looking forward to the pool tournament they had arranged. The systems and practices in the home enable the residents to be supported to take risks as part of an independent lifestyle. Re-enablement for individuals giving them the opportunity to progress to a more independent life style with in the home with support. Two rooms designed to encourage this had been made available since the last inspection. These contained a bathroom and a large sitting room/with a bed and kitchenette space. The way staff are deployed allows them to provided support for people who wish to take up activities out side the home with support. Such as going to the theatre or cinema in an evening. Visitors were coming and going through out the inspection. Some were seeing their relative in the privacy of their own rooms others were using the communal lounge. Staff observed greeting visitors to the home were friendly and helpful towards them. Staff were seen knocking on individuals bedroom doors before entering their room. Activities or personal care tasks were being explained to the person and their co-operation and consent obtained. Since the last inspection new electronic key fob locks have been introduce. People that had been assessed as able to use these had been given one. The nurse in charge advised that these gave access to areas with in the home, which had been agreed with the person. A small domestic style kitchen was provided for people who are able to use this. One person had continued to develop their skills for independent living using this facility. A drinks preparation area was provided in the dining area of the lounge. This gives people who are able access to drinks and biscuits during the day. Staff were seen preparing drinks for people who were unable to do this for themselves in this area. However one person advised that once the kitchen is closed after the evening meal, cups and mugs are not always washed up and cleared away. This could make it difficult for those people who are able to make drinks for them selves to do this. The lunchtime meal observed was unhurried with people eating their meals at their own pace. Staff was giving those people who required assistance to cut up or eat their food in a sensitive supportive way. The menus for the home were varied. People asked said they enjoyed the food one said “the food was wonderful and plenty of it”. Some people were eating their meals in the dining room others had chosen to eat their meals in their own rooms. Pureed food had been prepared to allow people to experience the different tastes of the food. Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 14 The catering manager advised that he was planning some themed evenings monthly and was planning to make the small kitchen more useable for everyone who used it. The pre inspection information indicated that this small kitchen is available for some people who live at Roborough House to prepare and cook meals. Discussion with the manager revealed that only people who have been risk assessed as able to use this are able to access this kitchen. Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team at Roborough House try to meet the physical, emotional and health care needs for the people who live at Roborough House in a way that they would do themselves if they were able. EVIDENCE: Four people had their care followed. One person asked said they were involved in the development of their plan of care: “I Tell staff what I want”. They also said they were able to chose what time they got up and went to bed. Staff observed caring for people during the inspection were treating them respectfully. Personal support for individuals was being given in the privacy. Staff observed were being patient, kind and caring towards the people they were caring for. It was clear staff and people who live at Roborough House had a good relationship and seemed to enjoy each other’s company. Registered nurses are on duty over a seven day 24 hour period to monitor and assess people’s health and personal care needs. Care planning records viewed show that peoples health and personal care needs are assessed and monitored by registered nurses who where possible involve the person in their care. Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 16 The registered nurses in the home have regular contact with specialist health care teams who advise and influence care delivery. The Huntington disease specialist nurse advised that they had been providing support and advise regarding the specific care needs and issues relating to this group. They also said staff were keen to learn had worked well with them when they visited the home. People have access to health care professional including their GP. One person advised that they had attended a hospital appointment that morning and staff had saved a lunch for when they came back. They also said they “find the staff very helpful and caring”. Another person had a GP appointment to review their diabetes care. The care plan of this person guided staff regarding their medication, possible complications with their care and how to manage this. The pre inspection information indicated that from July 2007 the home would employ a physiotherapist and an occupational therapist. A treatment room gym has been provided on the first floor for their use with the people living at the home. The manager advised that this would provide a more opportunities for people who need support to improve their mobility and life skills. A senior care manager from social service spoken to advised that the home staff were skilfully managing a client that had who presented with challenging behaviours at their last placement. They went on to say that the person was more outgoing and joining in with activities than they had done previously. They had also been encouraged by staff to compete some person care tasks themselves. One person spoken to during the inspection said staff are good at meeting their nursing care needs, they helped them to turn when they were in bed to reduce risk of pressure sores and answered call bells fairly quickly. They also said they managed some of their own medication. The requirements made at the last inspection for medication management have been met. The manager provided an improvement plan for the Commission, which detailed the actions taken to address this. The medication records were seen for the four people whose care was followed. These were easy to read and instructions were clear. A separate sliding scale insulin chart had been completed for one person who needed this. The nurse in charge advised that two of the people whose care was followed were self-medicating. One person takes responsibility for collecting their own prescription; the nurse advised that this person was awaiting suitable accommodation to move on to independent living. Lockable storage has been provided for individual people in their own rooms for storage of their medication. Two new drug trolleys had been purchased since he last inspection. The manager advised that she intended for these to have medication for different areas in the home to make medication dispensing easier. Staff were seen dispensing the medication from one of these during the inspection. The nurse in charge advised that at Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 17 present one trolley was being used for the whole home but it was the intention to use two. A new lockable drug fridge had been provided and staff had been recording temperatures regularly. These showed that the fridge meets the temperature standard for storage of medication. The controlled drug record was checked against the stock for one person as correct. A record of drug disposal was being kept this had been signed by two staff. The nurse advised that there was a medication link nurse in the home who takes responsibility for monitoring how medication was managed in the home. She also advised that they keep a record of any medication, which needs ordering and it is the responsibility of each nurse on duty to ensure this is actioned. Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 23,23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at Roborough house can have confidence that any concerns they raise will be dealt with by a caring staff team who have their best interests at heart. The policies procedures and practises with in Roborough House for the protection of vulnerable adults should protect the people who live there from harm. EVIDENCE: There was a clear complaints procedure that includes timescales. People, who were asked, indicated that they knew how to complain and to whom they complain if they had any concerns. A record was available of all complaints and issues raised. These included details of any investigations, actions taken and outcomes. The manager had 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 fully appraised of any issue that directly affect the people living at Roborough House. The management team have also provided information about how they have addressed the issues raised through regularly reporting mechanism in place. Thirteen issues relating to adult protection had been raised since the last key inspection in August 2006; five of these were since the last random inspection in December 2006. The majority of these were around how people with behaviour that challenged the service Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 19 were being managed. The home has undergone a change of management in this period. The working practices in the home have been changed and no further alerts have been received since March 2007. The manager provided an Improvement plan following the last inspection, which clearly showed the action that had been taken to reduce the risks identified. These included training for staff in managing challenging behaviour. In the pre inspection information the manager commented. “ The reflection and route cause analysis in recent months has helped staff lose their fear over a blame culture whist understanding the nature of their own responsibility and accountability”. The manager has been open and transparent in her management of the issues raised and has improved the way the service is managed. The staff files seen during the inspection showed the training they had received included managing challenging behaviour and adult protection. The Commission has been informed that the staff at Roborough House have accessed the training for adult protection provided by Plymouth City Council. A business manager completes billing accounts for individual people at the home. A system for providing individuals with information about their finances is in place. People spoken to during the inspection said staff listened to their concerns and they found the weekly meeting where they could talk about their views useful. Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at Roborough House have access to an environment that has been adapted and improved to meet their needs. The homes environment is kept fresh clean and free from odour. EVIDENCE: A tour of the home was completed as part of this inspection, all communal areas were seen and some people’s rooms were entered. Over all the environment provides a good standard of accommodation for people who live there. There are a variety of communal spaces including an activities room and treatment room/ gym. In addition to the new spacious open plan lounge dining room the people have access to a quite lounge on the first floor and a smaller lounge created between the old and new part of the building on the first floor. Wheel chair access has been provided to the patio and large grounds around the home. People were using the patio during the inspection; independent wheel chair users were easily able to access this independently. Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 21 The security of the home had been up dated since the last inspection. An electronic key fob system, which could control access around the home, had been introduced. People who had been assessed as able were given their own key fob to access agreed areas in the home. People were seen using these during the inspection. One staff member spoken to said they felt this had improved security with in the home. The nurse’s office had been moved to a new office close to the lounge. The open access to the old nurses office had been closed off and the room was being used as a quite room for staff to complete paper work or speak to people in private. One registered nurse spoken to confirmed that air conditioning had been provided for all the internal spaces with out natural ventilation used by staff and people living at the home. The new extension to the home provides and excellent standard of accommodation for the people who have rooms their and those that use the large communal lounge and dining room. The older part of the building has been up graded and redecorated to meet standards. However the majority of the older rooms in the home do not have en-suit facilities and 3 have below the amount of space recommended for younger adults private accommodation. However the additional communal space created by the redevelopment of the home does compensate for the smaller rooms. Two supported-living bed-sit rooms had been provided to enable people to progress towards independent living in the community. These had been allocated at the time of inspection. The manager had previously advised that these had been allocated after consultation with care managers and the person concerned. During the inspection visit the home was fresh and clean in all areas the people have access to. A senior housekeeper advised that more domestic staff had been appointed, which would enable all aspects of housekeeping for the home to be easily managed. A waste disposal system for clinical and domestic waste was in place. Staff were observed using gloves and aprons when attending to personal care for individuals. The training records confirmed that training had been provided for staff in infection control and information about infection control practices were available for staff in the office. The manager had previously advised that a link nurse would liaise with the Health Protection team regarding up date for information relating to infection control practices and issues. Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35. Quality in this outcome area is adequate, This judgement has been made using available evidence including a visit to this service. The people who live at Roborough House have a caring staff team with appropriate skills and knowledge to provide care for them. The recruitment practices in place should protect the people who live at Roborough House from unsuitable staff, when they are followed. However by not ensuring all pre employment checks are completed prior to staff starting work this may put the people who live at Roborough House at risk from unsuitable staff. EVIDENCE: People living at the home spoken to during the inspection said that staff are friendly and work hard. Staff were observed talking with the people who live at the home encouraging them to take part in the activities provided. All staff observed were respectful and polite when speaking to individuals they were caring for. The registered nurse confirmed that they have access to specialist health care professionals who provide training and support. One specialist nurse Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 23 commented that the staff are always helpful and want to understand the reasons behind the treatment being given. 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 two staff members started work, although there was evidence these have been applied for. Three of the five staff files had a copy of the CRB check completed for their employment at the home. Copies of application for police checks were being kept with individual staff files with the information used to prove identity. Checks against the protection of vulnerable adult register (POVA) had also been returned for three staff whose files were seen. The manager advised that one of the staff had transferred from another home in the group and their employment information had been transfer with them. The manager confirmed that one member of staff whose file did not contain references had previously work at the home as an agency worker before taking up permanent work at the home. The recruitment practices in the home and the information available for individual staff has greatly improved since the last inspection. Therefore the timescale for meeting this standard has been increased. The pre inspection information indicated that 9 staff had a National Vocational Qualification (NVQ) level 2 and a further 11 were working towards this qualification. The information indicated that 7 registered nurses are employed excluding the manager, 18 senior support workers and 2 rehab assistants. A senior nurse is also employed though an agency, they said that they had taken responsibility for up dating individual peoples plans of care. In addition to this the home also employs housekeeping, domestic, kitchen staff and a chef. The duty rota provided for inspection showed the number of staff on duty and in what capacity they are employed. A separate duty rota was provided for housekeeping staff. Staff spoken to during the inspection general said they had been supported to do their job. Records of supervision staff had received were provided for inspection. Training information discussed with the manager included a matrix for training, which showed the training staff had planned and the training they had completed in the last 12 months. A copy of this was provided for inspection. Staff spoken to during the inspection said they had received mandatory manual handling and fire safety training. The training information showed that the training planned linked to the needs of the people living at Roborough House as well as the training needs of the staff. One member of staff asked about the care needs of two of the people they were caring for knew their needs well. Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42. Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The new manager has introduced systems and practices that should ensure the health safety and welfare of the people living at Roborough House are protected. People who use the services at Roborough house and the staff who worked there are consulted and encouraged to influence the way the home is managed and run. However by not ensuring chemicals used for cleaning are securely stored when not in use this may put people at risk. Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 25 EVIDENCE: The home has not had a registered manager since the previous manager left in December 2006. Three new managers have been appointed and left since that time. The clinical nursing director for the company who is a first level registered nurse has several years experience in the NHS in a management role, has been put forward as the registered manager. The manager advised that this appointment would be an interim arrangement to give the home a period of stability. Several improvements have been made to the way the home is managed since the last inspection. Documentation relating to the way individuals care is managed and staff records has improved. Staff also reported that they felt supported by the new manager. A system for monitoring quality and auditing the services provided is in place. The Commission has been kept informed of changes made as a result of discussion with staff, community professionals and people who use the service. The pre inspection information stated that the improvements planed for the next 12 months would include. “ Considering best practice for quality assurance in particular using the staff and clients survey to inform and change practices and customs in the home. The pre-inspection information gave dates when equipment had been maintained and necessary servicing completed. The information provided shows that equipment was regularly maintained and serviced in the home. The home has a written assessment of hazardous substances available for staff. Copies of these were seen in the housekeepers office. However one trolley containing cleaning chemicals one of which was not labelled was left unattended in a corridor. This corridor was accessible by the people who live at Roborough house. This practice could put individuals at risk of ingestion of the chemicals. Evidence that policies and procedures are in place was provided with the preinspection questionnaire however not all had been updated recently. The manager had stated in the information provided that the plans for the next 12 months would include reviewing the policies and procedures. All staff spoken to during inspection confirmed that they had had manual handling training and fire safety training in the last six months. A training matrix provided showed the type of training planed for the future. This show that the organisation has a commitment to ensuring the staff receive the training they need to do their jobs well. A written statement of policy and organisational arrangements for maintaining safe working practices was in place. As is a system for ensuring the risk Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 26 assessments are carried out for all safe working practices. A record of accidents and incidents that occurred in the home is being kept. They showed the actions taken following the incident. The Commission has been kept informed of any incidents of accidents that have adversely affected individuals living in Roborough House. Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 27 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 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X X X X X X X X Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 28 Yes 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. Time scale extended from 01.12.06 & 01.02.07 Timescale for action 01/09/07 2 YA42 13(4)(a)(c) All chemicals must be securely 18/07/07 stored when not in use. A system for ensuring trolleys with cleaning chemicals are not left unattended in corridors must be in place. All chemicals must be clearly labelled 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 Refer to Standard YA1 Good Practice Recommendations The new statement of purpose which details facilities and service and possible restrictions to the use of some facilities and areas, should be made clearer to prospective and existing individuals who use the service. DS0000061085.V338429.R01.S.doc Version 5.2 Page 29 Roborough House 2 YA6 Interventions recorded in individual’s plans of care should include more detail to ensure staff fully understand how someone’s needs should be met. A named member of staff should be responsible for ensuring the goals set with the person are timely and reviewed regularly Clear details of and reasons why restrictions that may infringe on someone’s right have been introduced e.g. smoking, holidays and use of the kitchen should be recorded in the individual’s plan of care. Risk assessments in some individual’s plans of care should contain more information. i.e. use of bedrails and challenging behaviour. 3 YA7 4 YA9 Roborough House DS0000061085.V338429.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V338429.R01.S.doc Version 5.2 Page 31 - 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!