Inspection on 04/06/09 for Roborough House

This inspection was carried out on 4th June 2009.

CQC found this care home to be providing an Adequate service.

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 10 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 09/04/08

Roborough House 18/06/07

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 15/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Roborough House Roborough House Tamerton Road Woolwell Plymouth Devon PL6 7BQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Anita Sutcliffe     Date: 1 6 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: Roborough House Roborough House Tamerton Road Woolwell Plymouth Devon PL6 7BQ 01752700788 01752721088 nicola@roboroughhouseltd.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Roborough House Ltd care home 51 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia physical disability Additional conditions: Maximum of 3 service users with mild learning disability needing to convalesce following surgery or other general health care needs - for a maximum of 6 weeks One service user named elsewhere under the age of 60 with mild learning difficulties may reside at the home This home is registered as a Care Home with Nursing for a maximum of 51 Service Users in the category of PD 51, PD(E) 51, DE 12 To include a maximum of 12 service users in the DE category Date of last inspection Brief description of the care home Roborough House is a 51 bedded home for young physically disabled and older people who may require nursing care. The home is situated on the outskirts of Plymouth. People need transport in order to get to local services. The home is a large older building which has a modern extension. Care Homes for Adults (18-65 years) Page 4 of 37 Over 65 0 51 12 51 Brief description of the care home There are extensive grounds suitable for use by wheelchair users, with ample parking for staff, visitors and people living in the home. Accommodation is arranged on two floors with access to most areas via passenger lifts and a step lift. There are three lounges, a dining room, activities room, hairdressing salon, independant kitchen and fitness suite available to people. There is 24 hour Registered Nurse cover. The Statement of Purpose and a copy of the inspection report are available in the reception area of the home. We were told that weekly fees at the time of this inspection ranged between £487 and £3,297. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at /www.oft.gov.uk . Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Information about the home has been collected since the last key inspection in April 2008. In April 2009 we did a review of the service which involved sending surveys to people who use the service, staff and three health care professionals. There have been some concerns raised about the service since April 2008, which were looked at under the Local Authority safeguarding arrangements. We have also received complaints about the home and had several anonymous contacts raising issues. We decided we must do a key inspection of the home and therefore brought the next inspection forward. This key inspection included two unannounced visits to Roborough House and one announced visit. We collected factual information and opinion from health and social care professionals. The information sent to us in December by the home gave us some information on the service provided and plans for improvement. Care Homes for Adults (18-65 years) Page 6 of 37 As part of the visits to the home we looked at all communal areas, and several bedrooms. We were accompanied for the first visit by an Expert by Experience. They are people who, because of their shared experience of using services, and /or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. We talked to people using the service, and asked staff about those peoples needs. We observed staff interacting with people. We looked at care plans, medical records and daily notes. This is called case tracking. We also looked at other records such as staff recruitment and medicines. People who use the service may be described within this report as residents, clients or service users. Care Homes for Adults (18-65 years) Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: There are many aspects of the service which have the potential to put people at risk. The home does not receive sufficient information about people before they are employed as staff to work with the vulnerable adults at Roborough House. We made an Immediate Requirement that satisfactory checks must be completed before new staff start work at the home. There was also a repeat requirement that records relating to the supervision of staff who have commenced working prior to the full completion of the checks, are clear. To promote peoples health the standards of health care assessment, planning and delivery must be of a consistently high standard. Health monitoring should be more robust and concerns followed up immediately. The home should be sure people have been involved in decisions about their care. Radiators are not guarded which will be of particular danger to some living at the home. There is much work being undertaken to improve the fabric and services at the home (such as the electrics) but environmental risks remain which may be serious. Risk must be fully assessed and managed. Records cannot be relied on as accurate, complete and up to date and this puts people at risk. It also means that where the home may be providing a safe and adequate service, they cannot always demonstrate this. There is a lack of knowledge relating to the law that protects people who use the service. Examples are the Care Standards Act 2000, under which we inspect, and the Mental Capacity Act 2005 and deprivation of liberty safeguards, which protect people who do not have the mental capacity to take care of their own interests. We have not been kept informed of events which affect people who use the service, not even the change of manager. An application for the person who is managing the Care Homes for Adults (18-65 years) Page 8 of 37 home to be registered should be made at the earliest opportunity. The home must produce literature describing the current service in sufficient detail that people can decide if the home is suitable to meet their needs. Medicine storage needs attention: the temperature of the room and whether controlled drugs storage meets the specialist requirement for this. Valuables should not be stored where medicines are kept. There must be a formalized system and ongoing review of the service people receive. This must include a monthly unannounced visit by a representative of the organisation. The home should also survey the opinion of people who use the service, staff and health professionals in contact with the home, anonymously where possible. Management and staff should be fully conversant with Local Authority safeguarding arrangements. Policies and procedures must provide staff with clear information about when and who to contact if they have concerns which might be abuse and how they are protected should they do so. Complaints management must also be effective and properly documented. Staff should follow Department of Health guidelines on the handling of soiled laundry. Food should be to the taste and preference of people using the service. The home have responded positively to the inspection findings and we believe are addressing shortcomings promptly. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot feel confident that they have full information about the service when deciding if it is suitable for them. Neither does the assessment of peoples needs fully ensure their care can be well planned. Evidence: In December 2008 nine people told us through survey that they had received enough information about the home before they moved in but six said they did not. We looked at the current information available to prospective residents. Information on the homes web site was out of date; confirmed by the current manager. Written information, which is required under the Care Standards Act 2000 to provide factual and current information, was also out of date, having last been updated June 2007. However, a small brochure about the home does contain some photographs and information. We looked at the assessment of a person recently admitted to the home and received information from health and social care professionals recently reviewing peoples care. Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: The standard of assessment information on records was varied. Whilst there was some good detail there was also some gaps in information which left the person using the service vulnerable. Examples include: Where the person had a catheter this was not mentioned. Nor was there a plan or risk assessment in place relating to the catheter. Neither did the staff know why the person had been discharged from hospital with it. Where a person had been admitted to the home as an emergency the original information about them had been shredded (also see Standard 41) and records of a serious medical condition lacked detail. This had the potential to put the person at risk from complications of the condition. We spoke with the last person admitted to the home. He told us that the staff are good. He said he had some initial problems fitting in at the home, which had led to a fight occuring, but he is now more relaxed. Care Homes for Adults (18-65 years) Page 12 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of consistency regarding care planning, risk management, decision making and consultation has the potential to put people who use the service at risk. Evidence: Each person at the home has a plan of how their care will be delivered, known as a care plan. Some people at the home have very complex needs, both physical and emotional. We were told that the format of the care plans is currently being reviewed. We looked at the plans of four people currently using the service and also spoke with health and social care professionals for their opinion on how peoples care is planned and delivered at the home. There is some good detailed care planning but this is inconsistent. For one person with diabetes the plan was comprehensive, containing good detail on what complications may occur and how they are to be reduced and managed. For another this information was very limited. We were particularly concerned with the minimal planning and risk management for one person with serious emotional needs. We spoke with them about Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: the plan and found that, although he was supposed to receive a weekly one to one meeting with staff to discuss his feelings, he was unaware of this. Nether did staff know about it. He told us that the proposed meetings would have been useful. We were told by the deputy manager at the home that this person is always involved in decisions which affect them but their lack of knowledge about the plan seemed to suggest that this was not the case. Health and social care professionals told us that where a person had a catheter in place this was not mentioned in their plan. Nor was there a risk assessment regarding the catheter and staff did not know why he had come home from hospital with one in place. It was also found to be difficult to marry up information within the daily notes and other records because they are kept in different books. This increases the risk of mistakes in care and support provision. For another person the home were: doing all the right things and risk assessments were up to date. However, in this case risks were not adequately recorded where he was refusing the care considered necessary. Records were not always clear. For one person there was no risk assessment regarding the possibility of pressure sores where the risk did exist. People are encouraged to participate in the way the home is run. A visiting staff training assessor told us that interaction between staff and people who use the service is good, adding: It is a culture which is laid back, which is very nice. It is structured but not institutional. There are meetings for people who use the service and, although information in the Service User Guide is very out of date, there was a good amount of information posted on notice boards about planned events. One person told us that he was part of a recruitment interviewing panel for new staff. Where restrictions are in place to protect the person we found some good planning. However, we also found some important questions unanswered; information incomplete. For example, where a section of a care plan asks: What can you do to help me understand you? nothing had been written. Written information about people is held confidentially and records are kept securely only being available to people who have the right to see them. Care Homes for Adults (18-65 years) Page 14 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Roborough House are well supported to live fulfilled lives within their capabilities. The standard of food needs some attention. Evidence: There is a team of activities workers at the home. We spoke with their lead worker who told us: I am very proud of the activities team. In December 2008 people told us through survey that they are always or usually satisfied with the activities arranged at the home. We saw, and were told about, the varied activities arranged for people. There are themed events, such as Guinness on St. Patricks Day, there are pet animals, plants being grown and plans to make the raised garden beds more accessible to wheel chair users. One person is having a greenhouse for their own use. People are able to follow their faith. Bedrooms are very personalized and individual. Activities are age and gender appropriate. The home reports that the activities service Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: is continually evolving and improving with peoples input. For example, a Nintendo Wii has been purchased. Visits from the home have included regular swimming, a military museum, shopping and Plymouth Barbican. A six monthly survey updates the information on peoples interests and gives staff the opportunity to find out what people want and if their interests have changed. The home benefits from a busy and vibrant activities room, open seven days a week. People who choose not to use it, or whose disability is too profound to benefit from it, are able to spend one to one time with activities staff. The aim is to reduce the possibility of social isolation. A small domestic style kitchen is provided for people who are able to use it. This gives people and their families access to drinks during the day. People told us that their family are welcomed into the home. However, one complaint has centered around the relationship between a persons family and the homes management. Social services have investigated their concerns and we also looked at areas of the complaint. We were unable to prove or disprove what the complainant had told us but do accept that the home have been placed in a difficult situation. Opinion about the food ranged from: This is what they excel at to food is appalling. The majority opinion, (said without any enthusiasm) was, Food is alright. People are given two choices of main meal with an alternative being found if neither suits. On the day of one visit the choice for lunch was either plated prawn salad or plated meatballs in cider with mashed potatoes and sweet corn. Whilst the salad looked attractive this could not be said of the plated meatballs, which looked unappetizing and perhaps could best be described as being of institutional cooking appearance. The meal we had on the second day was quite tasty. We asked some staff about the food. They told us it needed to be improved and that sometimes there are a bizarre combination of things. The activities manager told us she had purchased specialist moulds. These enable separate portions to be served where people require mashed or softened foods. She said they were not being used by the kitchen. Diners needing assistance or encouragement were given this in a discreet one to one manner by a carer sitting alongside them. Several people mentioned the tray of cake, buns and sandwiches left by the chef in the dining room for late night snacks. Cooked breakfast is currently available on Sundays and Wednesdays. On the occasion of a persons birthday a special buffet tea is laid out with a purchased birthday cake. Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: One person, who had expected to go to a restaurant on his birthday, claimed this had been cancelled due to staff shortage. We asked staff about this and found it was true. Care Homes for Adults (18-65 years) Page 17 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health care needs are generally met but some failings may put people at risk. Evidence: The home told us: Roborough House encourages personal expression and style, the personal care delivered is of a consistently high standard. Hair styles, beards or shaving, shopping to choose own clothing and toiletries are enabled. While routines are followed there is flexibility within this i.e. meal / bath times. We saw that peoples personal care needs at the home are very varied. Some need all of their care needs delivered by staff and some are able to attend to much of their own. Where staff deliver full care the standard appeared very satisfactory, people looking well cared for. Information suggests that people are able to choose their level of support and staff respect this. Care delivered was done so privately and we saw staff engaging with people in a respectful, meaningful way. An external trainer who visits the home told us: The standard of care I have observed would range between good and excellent. In December 2008 we received surveys from people about the home. Most told us that Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: their health care needs are met by the home. Of the three health care professionals who responded to survey one told us: Roborough staff are responsive in seeking health input via G.Ps and other specialists. One told us the home had struggled to get a patient to the surgery with the relevant documents or a staff member that knew the person sufficiently. One told us the home always meets individuals health care needs and two said the home usually does. Health care professionals at this time, and our own findings from the visits, suggest that the standard of health care provision is usually satisfactory, but variable. The home could not evidence that the standard of care for one person was adequate when their family took concerns about this to the Local Authority Safeguarding team. Where safeguarding concerns led to review of peoples care we were told that in some cases the home were doing all the right things. A community psychiatric nurse told us she had no concerns. However, for one person there was no documentation about a huge fluctuation in blood sugar levels and a lack of urgency in dealing with this potentially serious situation. For another no risk assessment for pressure sore prevention. For another planned arrangements to support them through serious emotional problems were unknown to him and to staff who should have been aware. When touring the home we found oxygen storage was unsafe, but this was quickly corrected. We also felt that medicines were being stored in too high a temperature and contrary to manufacturers instructions. This has the potential to affect the action of the medicine. This concern was already known to the home. Medicines are securely stored within the home. Although more than one nurse is able to enter the medicine storage areas computer records can identify who has done so. The home uses a monitored dosage arrangement and one nurse takes the responsibility for ordering and disposal of medicines. Prescriptions are checked prior to reordering and where changes are made staff ensure this is correct. We looked at the storage of medicines called controlled drugs which need specialist storage. We found that the number in stock did correspond to the amount recorded in one place, but not to the amount recorded in another. All records must be correct. We also found valuables stored where the controlled drug cupboard was housed. This practice is advised against as people will need to access those valuables and access to medicines should be kept to a minimum. We were unable to determine if the storage for the controlled drugs complied with the Minuse of Drugs (Safe Custody) Regulations which specifies the quality, construction, method of fixing and lock and key for the cupboard. Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: Care Homes for Adults (18-65 years) Page 20 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be fully confident that complaints will be managed properly and they are fully safguarded from abuse. Evidence: Asked if they feel safe at Roborough House all said yes except one. Asked if they know how to make a complaint or raise a concern all said they did except one who said: If I needed to I would quickly find out. Asked if any complaint they had made was handled well only one person told us they actually had made a compliant. He said: I was satisfied with the outcome until the next time. Another said that he had been about to make a complaint about certain staff on two separate occasions but they each resigned before he did so. Complaints about the home and safeguarding alerts, which might have indicated abuse, led us to bring this key inspection forwards. Whilst some of the alerts and complaints were substantiated, some were not and there is strong indication some have been malicious. We did not look at current records of complaints at the home. However, we were told by the home that their complaints policy was of insufficient standard. We were shown a recently updated policy and documentation which, we were told, will soon be used for recording complaints, their investigation and outcome and deal with the shortcomings. Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: We asked the current manager of the home what she would do if she had concerns raised with her which might be evidence of abuse within the home. She told us that she would investigate the allegation herself and involve the provider of the home. She did not mention that she must always contact the Local Authority Safeguarding team. Neither should she ever investigate herself in case the alert leads to police involvement. The Local Authority Safeguarding team told us the home has been very proactive in protecting people where abuse may be from outside the home, for example, from family. At times the current manager has been in regular contact with them. We conclude that the manager may not always know the boundary of when to alert concerns to the Safeguarding Adults team and when not. We looked at the homes policy on whistle blowing (staff taking concerns which might be abuse to the correct authorities). It made no mention of staff protection in law if they do so and no mention of Local Authority safeguarding arrangements. Neither did it mention the Care Quality Commission who may also be contacted. Care Homes for Adults (18-65 years) Page 22 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Roborough House benefit from an environment which is clean, comfortable and well-equipped but hygienic practices could be further improved. Evidence: We visited all shared areas of the home and several bedrooms. There are a variety of communal spaces including an activities room and treatment room. In addition to a spacious open plan lounge and dining room people have access to a quiet lounge on the first floor and a smaller lounge created between the old and new parts of the building on the first floor. Wheelchair access has been provided to the patio and large grounds around the home. We found the home to be clean, fresh and quite homely. Some bedrooms were extremely individual and personalised. People are able to lock their rooms and some were doing so. The home told us: All clients have their own bedrooms, most with ensuite facilities. We promote independence by making the fob system available to the residents which enables protection for vulnerable clients and separation without segregation; they are also available to regular visitors. The maintenance and decoration of the building is ongoing. There is one new walk-in wet room and two new bathrooms equipped, we were told, with brand new top of the Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: range multi positional baths. There is a new hair salon built within the home. We were told that future plans include refurbishing the lounge and dining room area with automatic doors for easy access for disabled / wheelchair users. The patio will be revamped including a heater in the smoking area. Laundry trolleys were in use for transporting soiled laundry and separate containers were used for clean laundry. Sluicing facilities were available and the laundry was equipped with industrial standard washers and dryers. Hand washing facilities and antibacterial gel was available for use in the laundry. However, we found that soiled laundry was being soaked in a laundry sink. Soiled laundry should not be handled. 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. We saw protective clothing was available to staff to reduce the possibility of cross contamination. Care Homes for Adults (18-65 years) Page 24 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment practices put people who use the service at risk. Staff numbers are generally satisfactory and training standards are high. Evidence: We asked people if they thought staff knew what they were doing and they told us they had confidence in the ability of the staff to undertake their duties. Asked if there are enough staff people thought that there were sufficient staff at most times although one person added, sickness can mean there arent enough referring to a recent period when many staff and residents were said to have had a flu like illness. One person was unable to leave the home for a birthday meal due to a staffing shortage. People told us they were generally content with the call bell response times although it was said to be slower in the mornings. One person said a wait of 40 minutes had been unacceptable. It seems normal practice for staff to attend, ascertain need and advise callers if there is to be a delay in giving attention. We interviewed four staff. Asked about staff numbers one said: Yes, it is better. Another told us more are needed to give the care people want, such as a bath when Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: they choose. The home meets staffing shortfalls by reorganising the staff rota so that the homes regular staff are available, using bank staff or, as a last resort, the use of agency staff. We asked the Expert by Experience to ask people what they thought of the staff as we had received various contacts and complaints, sometimes anonymous, about them. People spoke well of the staff, saying, Mostly very well, Fine, they treat me like a human being and we enjoy good banter, Everyone is thoroughly helpful and pleasant, Generally alright, and Good enough. One person said, One or two staff can be a bit cocky at times. Mention was made of the initial (but soon overcome) difficulty sometimes with new staff for whom English is a second language. Staff felt they had a good team. We spoke with a visiting staff training assessor. He told us: The standard of care I have observed would range between good and excellent. Asked about interaction between staff and people who use the service he said: It is a culture which is laid back, which is very nice. It is structured but not institutional. Staff are advocates of choice. Residents respond well to that. He told us that mandatory training, such as first aid, is up to date and that shortfalls he has mentioned to management have been actioned. The three staff who responded to the December 2008 surveys told us they were receiving training relevant to their role, helping them understand and meet individual needs and keeping them up to date. They felt the induction training people receive covers what they need to do the job well. Staff we spoke with at the home told us they felt the training available to them was very good. The home reports that twelve of the twenty six care staff employed have achieved National Vocational Qualifications (NVQ) in care or above. This qualification is an indicator of staff competence. We looked at whether the homes recruitment practice ensures people are safe from staff unsuitable to work with them. There had been a previous requirement that there must be clear records relating to staff supervision if they do start work prior to the full completion of criminal records checks. We looked at the recruitment records of five staff and found staff are starting work at the home before it is confirmed if they have a criminal record or have been placed on the list of people unsafe to work with vulnerable people. Neither were there always suitable reference received prior to employment commencing. Where staff were Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: supposed to be supervised until the criminal records checks were complete we found one was not even recorded on the staff rota. We left an Immediate Requirement that the situation be made safe and we must be informed when this was complete. The home responded quickly as required. They provided a named supervisor and the staff involved were taken off duty. We were told that dates are booked for staff supervision of their work and saw that a programme of supervision is now organized, having recently been restarted. However, staff told us they feel supported in their work and the manager is very approachable. Care Homes for Adults (18-65 years) Page 27 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The intensive programme of improvement of the service is very much needed so that people who live at Roborough House will be safe and their well-being properly promoted. Evidence: It came to our attention in February of 2009 that the person registered to manage the home was no longer in post. It transpired that there had been two managers since she had left the home. We had not been informed as we are required to be. The current manager told us she is a registered mental nurse with ten years experience and that she has no management qualifications or experience. However, she said she is booked to undertake National Vocational Qualification (NVQ) to level 4 in Management this autumn, as is the deputy manager. At the time of the inspection she had not made an application to register with the Commission and we were therefore unable to determine if she is fit to be in charge. The current manager was known to people using the service but no comments were Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: received during the visits about the way the home is managed. One complaint relates to management, but this could not be proven or disproven. We also believe that several anonymous contacts have probably been of a malicious nature. We found no evidence to substantiate the information given and a care manager told her client may have been responsible. In discussion with the manager, deputy manager and responsible person for the provider organisation we found areas where their knowledge of regulation appeared weak. For example, regarding the regulations which govern care homes and protect people (Care Standards Act 2000). Also, those relating to recent changes in the law (the Mental Capacity Act 2005 and deprivation of liberty safeguards), which protects people unable to make decisions on their own behalf. The manager agreed that she and the deputy lacked the information. However, since January 2009 the Directors of Roborough House Ltd. have been in negotiation with a large care provider organisation which, it is planned, will provide the home with considerable support and information. We met representatives of that organisation during our visit. Throughout the visit staff were seen to be engaging with people in a respectful and meaningful manner. Staff appeared to be working well with people and each other. A training assessor with knowledge of the home told us the management were always helpful and responsive and committed to listening to the staff. Staff told us: We have a great team here and The manager is very approachable, but professional boundaries are there. We looked at how quality is managed at the home. Meetings are held for people who use the service and staff. Staff receive supervision of their work and are able to bring training needs and their opinion to those meetings. Although nursing and health care is to some degree monitored we were told there is currently no system of ongoing audit and review. Neither has the home initiated any surveys, so people can make their opinion known, anonymously if they wish. We asked to see reports of provider visits to the home. It is required that an unannounced visit to the home is undertaken at least monthly so as to feed back to the manager on the state of the service. Although we were shown some visit reports, they were not monthly visits and not unannounced as they must be. There is currently no formalized system and ongoing review of the service people receive. The standard of record keeping had the potential to put people at risk and does not conform with that expected of a qualified nurse or with regard to the running of a care home. Some records had been shredded, not kept for the three years required. Information about people is kept in different books so it was not always easy to marry Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: it up which can lead to mistakes. Some information was detailed, up to date, relevant and accessible. Some lacked detail, dates and important information. We saw that steps are already being taken to improve the standard of care planning records. We discussed health and safety at the home. Staff told us: Were up to date with health and safety training and there is extra if you want it. When we observed staff assisting people it was gentle and confident. Staff confirmed they have the equipment they need and the personal protective clothing they need. We discussed the environment with the homes maintenance worker. He told us he had recently completed four days of health and safety training. We found he had a good understanding of risk and health and safety. Serious concerns, identified by the provider organisation, have led to major electrical updating. This was almost completed during the inspection visits. Quotes have already been received toward updating the fire safety system. We were told the home is certified as safe against Legionella infection and he keeps the nurse call system running. Currently there are no formal risk assessments relating to risk; risk has been assessed mentally. However, the maintenance worker had a clear understanding of the risks that remain (such as uncovered radiators which would have the potential to cause contact burns) and concerns are being systematically addressed. All indicators suggest that people benefit from competent and accountable management of the service. Much upgrading was in progress, there are good lines of accountability with the home and organisation and we saw that insurance cover for the home was in date. We were also informed of planned changes which should improve the home environment for people who live there. Care Homes for Adults (18-65 years) Page 30 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 34 19(11) The Registered Person must 01/06/2008 ensure that there are clear records relating to the supervision of staff who have commenced working prior to the completion of criminal records checks Care Homes for Adults (18-65 years) Page 31 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 34 19 (1) People must not start 17/07/2009 work at the home unless all checks, as detailed in Schedule 2 of the Care Homes Regulations 2001, are completed and a clear judgment can be made about the staff suitability for the position. So that recruitment practice protects people who use the service from those who may be unsafe or unsuitable to care for them. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 There must be written 30/09/2009 information about the home, which includes the matters listed in Schedule 1. This must be up to date and accurate. So that people can be accurately and fully informed on what the service does and does not have to offer. Care Homes for Adults (18-65 years) Page 32 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 2 2 14 People must not be admitted 31/08/2009 to the home unless there is full and sufficiently detailed information available on their needs and wishes. So that the home can be assured that they can fully meet the persons needs and wishes and plan how they will do so. 3 9 13 (4) Risk must be managed. 30/09/2009 Risk must be fully assessed, fully recorded, measures put in place to remove or reduce risk as appropriate and the risk regularly reviewed. So that any risk people are supported to take is fully understood and managed appropriately. 4 19 12 (1) The standard of health care management must be of a consistently high standard. So that peoples physical and emotional health care needs are properly promoted. 31/07/2009 5 23 13 (6) Management and staff at 30/09/2009 the home must be fully conversant with the Local Authority Safeguarding arrangements and policies Care Homes for Adults (18-65 years) Page 33 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action and procedures must reflect this knowledge. So that people are protected from abuse. 6 37 37 The home must notify the 22/07/2009 Commission, within a reasonable timescale, of any event which may affect the well being of a person who uses the service. It is a requirement which protects people who use the service. 7 39 26 A provider representative 18/08/2009 must visit the home unannounced at least monthly and a report of that visit compiled. So that they are able to form a true view of the standard of service provided 8 41 17 Records must be complete, adequately detailed, accurate, signed and dated and retained for a minimum of not less than three years. So that peoples rights are best interests are safeguarded. 18/08/2009 Care Homes for Adults (18-65 years) Page 34 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 9 42 13 Hazards within the home 30/09/2009 must be assessed and where risk exists it must be removed or reduced to an acceptable level. To protect all people within the home environment. 10 42 13 The individual risk to people 30/09/2009 from unguarded radiators must be assessed and where the risk is high it must be reduced to a safe level as a priority. To prevent people receiving contact burns. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 6 7 Peoples changing needs and personal goals should be fully reflected in their individual care plan. People who use the service should be fully involved in making decisions and planning their support and care and provided with the information to do this. The standard of food provided should be improved so it is more to peoples liking for taste, choice and presentation. There should be no confusion over the number of medicines in stock as records should be accurate and consistent. The home should ensure that it complies with the Misuse of Drugs (Safe Custody) Regulatinos 1973 as amended to confirm that they are stored according to this legislation. The home should ensure that medicines are stored according to the manufacturers instruction with regard to Page 35 of 37 3 4 5 17 20 20 6 20 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations temperature. 7 8 20 22 Valuables should not be stored with medicines as this raises the possibility of mishandling. Complaints should be fully recorded, investigated within a reasonable period and lead to a satisfactory outcome for the person who uses the service where at all possible. Soiled laundry should be managed in a non-touch manner and never handled and soaked in a sink. The person running the home should make application to register with the Commission at the first opportunity to ensure she is not managing the home unlawfully. There should be a formalised system and ongoing review of the service provided, including that of nursing care. 9 10 30 37 11 39 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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