Inspection on 15/11/06 for Roby House Care Centre

This inspection was carried out on 15th November 2006.

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

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

Other inspections for this house

Roby House Care Centre 24/07/08

Roby House Care Centre 04/09/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Roby House Care Centre Tarbock Road Huyton Liverpool Merseyside L365XW Lead Inspector Daniel Hamilton Unannounced Inspection 09:00 15 & 16th November 2006 th X10015.doc Version 1.40 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 Roby House Care Centre DS0000067698.V308769.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roby House Care Centre Address Tarbock Road Huyton Liverpool Merseyside L365XW 0151 289 9201 0151 289 4402 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) Meridian Healthcare Ltd Pamela Alice Case Care Home 54 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (30), Old age, not falling within any other of places category (24), Physical disability over 65 years of age (24) Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 30 Dementia - over 65 years of age, of which 5 beds may be used for Dementia. Persons under pensionable age may be admitted under the category of Dementia. Not Applicable as New Service. Date of last inspection Brief Description of the Service: Roby House is a new, purpose built, three-storey residential care home for older people that has been developed to provide 54 registered places, 30 of which are registered for older people with dementia. The home is situated in Huyton and is close to all local amenities and transport routes. The reception area and manager’s office is located on the ground floor, which is accessible via a ramp and an electric front door with intercom system. This level has also been designed to accommodate 24 older persons who may have a physical disability. The upper floor is designed to accommodate 30 older persons with dementia care needs. Each room is equipped with ensuite facilities that include a toilet and hand basin. The ground floor rooms also have en-suite showers. Communal areas are situated on each floor, which consist of a main lounge, a small quiet lounge and dining rooms (with tea making areas). Toilet and assisted bathing facilities are located throughout. The ground floor has a hairdressing salon and the upper floor is fitted with a snoozeleum. The lower ground floor accommodates the home’s kitchen facilities and food storage, laundry, staff room, staff training room, storage rooms, cinema, staff changing rooms and two spare bedrooms for staff / guests. A passenger lift has been installed and loop systems have been fitted in each of the lounges. Handrails have been fitted in all areas of the home and grab rails in each room / ensuite, subject to the needs of the people using the service. A call bell system is fitted throughout the home. A patio area with seating and a water fountain is accessible via the ground floor lounge. Car parking facilities are available at the rear of the home. Care Home Fees range from £327.47 to £450.00 per week. Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the Commission for Social Care Inspection’s first inspection of Roby House. The unannounced inspection took place over two days and lasted approximately 16 hours. Fifty-two residents were living in the home at the time of the visit. A partial tour of the premises took place and observations were made. This included a two-hour observational inspection in the dementia unit. This involved watching how residents and staff interact with each other. Details from this observation are included in the main part of the inspection report. This tool assists the inspectors when people have communication difficulties. It has been used as well as talking directly to residents and asking their opinions on the home. A selection of care, staff and service records were also viewed. The Registered Manager, five staff members, four relatives, ten residents, a social worker and district nurse were spoken with during the visit. Satisfaction survey forms “Have Your Say About…” were also distributed to a number of residents and / or their relatives prior to the inspection, to obtain additional views / feedback about the service provided. What the service does well: Overall, Roby House presented as a warm and caring environment. The home had a pleasant atmosphere and residents generally appeared relaxed and comfortable in their home environment. Staff were observed to spend time talking with residents and engaging in recreational activities. Residents were observed to receive support and assistance from staff throughout the day and many spoke highly of the care provided. A resident reported; “The staff are wonderful to me” and a visitor stated; “The residents seem really relaxed and there is good interaction from staff.” The home was accessible and provided residents with a very good standard of accommodation. The building was decorated to a high standard and furnished with quality fixtures and fittings. Residents spoke highly of the physical environment and one resident reported; “It’s a lovely place to live.” The home had produced a Statement of Purpose / Service User Guide for residents and their representatives to view. Residents had also been consulted on the service provided and the results of a recent quality assurance survey were displayed in the reception area of the home for prospective and current residents to view. This information enabled people to make an informed decision on the service provided and whether it was suitable for their needs. Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 6 A care planning system had been established and each resident had a plan of care that had been developed in consultation with residents and their relatives. This ensured that the health, personal and social care needs and individual support requirements of residents were identified. Staff spoken with demonstrated a good understanding of the needs of residents. Residents had access to health care professionals as required and records of all health care appointments were maintained. Residents were encouraged to receive visits from family and friends at any reasonable time and this was confirmed in discussion with relatives and residents. For example, a resident said; “My daughter visited today and we went shopping together.” The home had a four-week rolling menu, which showed that residents received a nutritious and wholesome diet. The people living in the home reported that they were generally happy with meals provided in the home. Comments received included; “The meals are OK. We get alternatives” and “The food is excellent. They could not look after me better.” Special diets were provided subject to individual needs. Recruitment practice was sound and systems had been established to protect the financial interests of the people living in the home. Good progress was being made in supporting staff to achieve National Vocational Qualification. What has improved since the last inspection? What they could do better: The home had established an assessment and care planning system. Some assessments viewed lacked detail of the needs of residents in relation to their mental health. There was also evidence that assessments had not always been updated to reflect the changing needs of residents. Furthermore, some care plans and risk assessments were not dated and some records were vague and did not provide sufficient information on observations and / or the care provided to residents. The home was advised to address these matters to improve record keeping and accountability. Some medication records had not been completed to account for medication prescribed to residents. This practice is not safe and must stop in order to protect the health and safety of residents. Arrangements should also be made to establish a second medication round to ensure residents receive their medication at the correct times. The manager was advised to date medication boxes upon opening, to provide an audit trail and to establish a system to monitor the competency of all staff that Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 7 administer medication. It is recommended that the home also obtain a copy of guidance issued by the Royal Pharmaceutical Society of Great Britain for the manager and staff to reference. There had been incidents were residents had received laundry that belonged to other residents and some residents and relatives expressed concern regarding the range of activities available for residents with dementia. These concerns had been noted by the Provider (Meridian Healthcare Ltd) following a quality assurance audit. Action should be taken to address these matters. All of the bedroom doors and assisted toilets on the dementia unit were locked through the day. The manager reported that this action had been taken because some residents had been found wandering into other residents’ bedrooms and relatives had requested that the doors be locked. This practice should be reviewed to ensure residents have the freedom to access their rooms at all times and / or individual wishes should be recorded in care plans. The home had developed a complaints procedure with clear timescales for response. The relatives of one service user reported that a member of the family had written a letter of complaint and had not received a response within the required timescale. Complaints must be responded to in accordance with Regulation 22 of the Care Home Regulations 2001. Some parts of the dementia care unit were in need of cleaning. For example, a number of chairs were stained and dirty and one bedroom had an offensive smell. Cleaning schedules should be developed to ensure all parts of the home are clean and hygienic at all times. It was noted that some residents had difficulty in choosing their preferred meal when asked by the chef. The home should consider the use of picture cards to assist residents on the dementia unit to make complex choices. The representatives of two residents had raised concern regarding the staffing levels in the home and provided examples of poor care / supervision. Examination of the staffing rota showed that the home had not always been staffed as specified in the Statement of Purpose. The manager must ensure that the home is appropriately staffed at all times of the day and night to ensure the health and welfare of service users. Some training records viewed were not up-to-date. Staff must have an up-todate record of all induction and training completed, to provide evidence that staff are trained and competent to undertake their roles. Furthermore, staff should receive refresher training in the Protection of Vulnerable Adults, to ensure they fully understand how to recognise and respond to abuse. 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. Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There is written information on the home available for new and prospective residents and this is generally a useful guide so that residents can make an informed choice about where to live. Some assessments lacked information on the needs of residents. Unless assessments are clear and accurate, there is no assurance that the care needs of residents will be met. EVIDENCE: The home had produced a Statement of Purpose to provide current and prospective residents and their representatives with information on the service provided. A copy was seen in the reception area of the home. Feedback received from residents and their representatives via Care Home Survey forms and discussion confirmed that they had received information / literature on the home. One relative expressed concern that a copy of the home’s inspection report had not been made available to them. This matter was brought to the attention of the manager, as this was the home’s first inspection. Consequently, an Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 10 inspection report for Roby House had not previously been available for the home to display. The home had also developed a Contract / Statement of Terms and Conditions. Feedback received from residents and their representatives via Care Home Survey forms and discussion identified that some people had not received a Contract. One relative reported that the home had taken approximately three months to provide a Contract for a resident who was privately funding. These issues were brought to the attention of the manager during the visit. The manager reported that the needs of all prospective residents were assessed, before they moved into the home. Six of the residents’ files were viewed during the inspection. Three were for residents who had recently moved into the home and the remainder were for residents who had transferred from the Connaughtons. Records showed that all the residents who had recently moved into the home had undergone assessments prior to and following admission. Pre-admission assessments had been completed for only two of the three residents who had transferred from the Connaughtons. Some assessments viewed lacked detail regarding the needs of residents, especially in relation to their mental health. For example, “EMI” “Dementia” or “Confusion” had been recorded on some assessments viewed. Furthermore, there was evidence that some assessment information was not accurate or being kept under review. For example, a relative reported concerns regarding the support a resident required to manage her continence. The assessment completed by the home detailed that the resident was “continent”, however the resident’s room had an offensive smell. This was addressed by the manager during the visit. Copies of social work assessments and care plans were also on file for residents referred via social services. Assessment information provided a range of information that was used to develop plans of care for each resident. Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Care plans had been developed in consultation with residents and their representatives, to ensure the needs of residents were identified and planned for. Some medication records had not been correctly maintained to account for prescribed medication. These shortfalls have the potential to place the welfare of residents at risk. The management of personal care and laundry is in need of attention, to ensure the dignity of residents is fully safeguarded. EVIDENCE: Six of the residents’ files were examined during the inspection. Three were for residents who had recently moved into the home and the remainder were for residents who had transferred from the Connaughtons. Care plans viewed were well structured and detailed the ‘needs’, ‘goals’, ‘action to be provided’ and review periods. Five of the six care plans seen had been signed by residents or their representatives and all had been kept under monthly review. Two care plans had not been dated. The manager had developed an audit system to monitor care plans and to ensure they were reviewed on a regular basis. Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 12 Supporting documentation including; declaration of wishes in relation to the administration of medication, monthly weight charts, risk assessments, daily reports, personal property / inventories and personal care, health care and activity records were also in place. One moving and handling risk assessment viewed had not been dated and there were no details of who had completed the assessment. This was brought to the attention of the manager. The relatives of one resident expressed concerns regarding the arrangements for supporting residents with toileting, the provision of regular fluids and the time that residents were supported to get out of bed in the morning. Concern was also noted regarding three injuries / bruising to the resident, for which the family had received no explanation. During the two days of the inspection, staff were observed to offer support to residents who required assistance with their personal care. Furthermore, residents were offered refreshments at different times of the day. An inspector who was undertaking an assessment on the dementia care unit noted that some residents were still being supported to get up at 8.30 am. Staff and residents spoken with reported that residents could remain in bed for as long as they wished and that there was no expectation for residents to be woken and dressed before 8.00 am. Examination of daily report records detailed that the resident had chosen to remain in bed on one occasion until lunchtime. Records showed that a senior carer had faxed a referral to the local health authority for a Continence Assessment for the resident. Furthermore, the home had purchased a bedside floor pressure mat alarm, to provide an audible alarm for staff to respond to during the night as, the resident was unable to use the home’s call bell system. This is good practice and should be made available to other residents with dementia, subject to an assessment of their individual needs. Photographs of the injuries / bruising sustained by the resident were available on the resident’s personal file. The manager was advised to establish suitable records, to account for all the care provided, including fluid intake / output. Furthermore, the manager was advised to request staff to record more detailed information to account for any incidents and the care provided through the day and night, as some records viewed were generalised and vague. Feedback received from residents and their representatives via Care Home Survey forms and through discussion confirmed the people living in the home received the medical support they needed. Medical intervention records viewed detailed that residents had access to a range of health care practitioners subject to individual need. These included; doctors, dentists, district nurses, continence advisors, hospital staff, Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 13 chiropodists and community psychiatric nurses. Discussion with the manager and examination of records highlighted that some residents had experienced delays in receiving visits from the chiropodist. The manager reported that she was monitoring the situation. The home had a copy of the organisation’s corporate medication policy, which covered self-administration. The manager reported that none of the residents self-administered medication at the time of the visit. Declaration of wishes with regard to the administration of medication were available on files viewed and senior staff responsible for the administration of medication had completed appropriate training. The home used a blister pack system that was dispensed by a local pharmacist on a monthly basis. Suitable storage facilities were in place and a resident identification system had been established. A staff signature checklist was also available. The senior carer on duty was responsible for administering the medication to the residents on the residential and dementia care unit four times per day. The senior carer reported concerns that the medication round could take approximately two hours to complete, dependent upon the time of day and the number of residents who required medication. The relatives of one resident reported that the home could not always administer medication to their relative at the preferred time of the day. The manager was advised to review the procedures for the administration of medication and to introduce a medication round for each floor, to reduce the potential for error and to ensure residents received their medication at the correct times. Five Medication Administration Records [MAR] were viewed during the inspection. One MAR did not account for the administration of Stemetil Effervescent Sachets 5 mg for a period of one day. Likewise, there was no Medication Administration Record in place, to account for the administration of two Aspirin Soluble tablets 75 m/g for another resident. Systems were in place to monitor stock levels and records were in place to account for medication returned to the pharmacist. The manager was advised to date medication boxes to provide an audit trail, to establish a system to monitor the competency of staff responsible for medication and to obtain a copy of guidelines issued by the Royal Pharmaceutical Society of Great Britain for staff to reference. Staff spoken with during the inspection demonstrated a good understanding of how to promote and safeguard the social care values of respect, privacy and dignity in their day-to-day practice. Staff confirmed they had received training Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 14 in this subject as part of their induction and policies and procedures had been produced by Meridian Healthcare for staff to reference. Staff were observed to be respectful and sensitive to the needs of residents during the visit. Overall, feedback received from residents and their representatives via Care Home Surveys and discussion confirmed the people living in the home received the care and support they needed. The representative of one resident reported that “This is very much dependent upon individual staff members. Some of whom are very good.” Feedback received from the relatives of one resident highlighted concerns regarding basic personal care. The relatives reported that the resident had also been found wearing clothing on several occasions that was not ironed and belonged to other residents. This view was also shared by another resident who stated that; “Sometimes you get other residents’ clothes”. The concerns surrounding personal care could not be substantiated during the inspection, however one item of clothing belonging to another resident was found to have been stored incorrectly. This was reported and rectified by the manager during the visit. Comments received from other residents included; “I am treated very well”; “The staff are very caring” and “They [Staff] look after me as best they can.” Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The range of activities and care practices for people with dementia should be reviewed, to ensure the lifestyle experienced in the home satisfies the recreational needs and protects the rights and freedom of residents. Visiting times were flexible and residents were supported to maintain their relationships. The dietary needs of residents were well catered for, with a balanced and varied selection of food available that met resident’s needs and choices. EVIDENCE: The home had developed an activities programme that was updated on a monthly basis. The programmes for October and November were viewed. The content of the programme for each month was very similar and detailed that a choice of activities were arranged on a Monday i.e. cards, quizzes, games, sing-a-longs etc; Church Services on a Tuesday; Activities with a Volunteer on a Wednesday; Bingo or Questionnaire on a Thursday; hand and nail therapy on a Friday; choice of video or reminiscence on a Saturday and choice of activities on a Sunday. The programme welcomed residents to also assist with dusting, setting tables and drying dishes etc, in order to maintain residents’ daily living skills. Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 16 Feedback received from residents and their representatives via Care Home Survey forms and discussion confirmed that the home arranged activities for residents to participate in. Different views were expressed regarding the frequency and range of activities provided. Some residents reported they were satisfied with the activities provided and others felt the range was limited. For example, a resident spoken with stated; “In my opinion, there are not that many activities.” Some relatives spoken with felt the activities / stimulation for people with dementia / cognitive impairments was limited and could be improved. A selection of activity records were viewed. Some records were incomplete and provided no details of activities for up to six days. Others detailed that residents had; enjoyed visits from family and friends, listened to music, watched videos and participated in ball games, jigsaws, cards, reminiscence, hand and nail therapy, skittles and singing and dancing activities. A volunteer continued to offer assistance with activities on a Wednesday and Thursday each week and the manager reported that representatives from the local Roman Catholic and Church of England churches visited the home each week to offer communion. The Church of England minister also visited the home on the third Sunday in every month, to offer a Sunday service. Arrangements had been made for Knowsley library to visit the home to supply a range of books & audio books each month. Some residents spoken with reported that a firework display party had been organised on 5th November 2006 and photos were displayed in reception. The manager reported that six residents from the dementia unit had also visited Blacklow Primary School, to attend the Harvest Festival during November 2006. Two entertainers had been booked for the Christmas period. A two-hour observational assessment was undertaken on the dementia care unit as part of the inspection. Residents were observed to be enjoying a state of well being for the majority of the 2 hours. This means that they were content and happy in their surroundings. Staff showed they had very good communication skills and the unit appeared calm and tranquil. Staff on the dementia unit showed they had a good understanding of how to care for the residents living there. Staff and residents laughed and joked together, which created a friendly and warm unit. Staff were able to discuss the various likes and dislikes a resident has as well as knowing how they liked to be looked after. Residents had good relationships with each other. Many knew each others names and reacted when they saw each other. Staff were observed to be playing a memory game with 6 residents. This game enabled residents to use Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 17 their memories and was a social and interactive activity that was enjoyed by all. One resident was noted to show signs of being in pain. She was also sleeping for large periods of time. This was fed back to the manager for her to investigate. Visitors were encouraged on the unit and made to feel welcome by staff and residents. Policies and procedures had been developed regarding the value base of the home. These included a Visiting and Decision Making policies. The home’s Statement of Purpose detailed that visitors would be welcome at the home at all reasonable times and the visitors record book showed that residents received visitors at different times of the day. Residents spoken with reported that they were able to meet with visitors in the communal areas of the home or in the privacy of their own bedrooms. Comments received from residents included; “My daughter visited today and we went shopping together” and “I have regular visits from my sons and grandchildren which I very much enjoy.” Overall, the routines in the home appeared to be flexible and determined by the residents. Residents spoken with during the inspection confirmed they were able to exercise choice and control over their lives and that they could follow their own routines. For example, one resident said; “No-one tells you what to do. I do as I please.” Rooms viewed had been personalised by residents and contained personal possessions including pictures and ornaments. Concern was noted regarding the dementia care unit as all of the bedrooms and assisted bathrooms were locked during the day. The manager reported that some residents’ relatives had requested staff to lock bedroom doors, as some residents had been found to wander into other residents’ rooms and assisted bathrooms. Feedback received from one resident’s relative confirmed there had been two incidents of this nature. Another relative expressed concern regarding the home’s policy on restraint. Residents’ choices / wishes in relation to locking doors had not been recorded on care plans viewed. The manager was advised to review care practices and the widespread locking of doors, to ensure the rights and freedom of residents is safeguarded in accordance with the home’s policy on restraint. The home had introduced a four-week rolling menu. Alternative choices had been listed on a separate sheet of paper and the manager confirmed that the menus would be kept under review in consultation with residents. A copy of the menu was displayed in each dining room. Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 18 Examination of the menus and discussion with residents confirmed the people living in the home had a choice of meals and that they received a nutritious and wholesome diet. Records showed that the dietary needs of residents were assessed as part of the assessment process. The residents on the dementia unit were offered a choice of meals by the chef. This was a long list and was not understood by all the residents. It is recommended that picture cards be used as an alternative to help those people who find making complex choices difficult. Meals were served in the dining rooms on each unit. Dining rooms were pleasantly decorated and furnished. Tables were set with placemats, condiments and coasters. Napkins were not available for residents to use and this was brought to the attention of the manager. Staff were observed to be present during mealtimes offering support to residents in a discreet and sensitive manner. Although meals were served at set times, the manager reported that alternative arrangements could be made in order to accommodate individual needs. Additional drinks were served throughout the day and residents were able to eat their meals in their rooms if they wished. Separate facilities were available for residents to prepare drinks and snacks and special diets were catered for, subject to individual needs. Overall, feedback received from residents and their representatives via Care Home Surveys and discussion confirmed the people living in the home enjoyed their meals. Comments included; “The food is excellent. They could not look after me better”; “The meals are OK. We get alternatives” and “I very much enjoy the mealtimes.” Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has developed a complaints procedure however there is some evidence that complaints are not always acted upon. Some staff lacked awareness of the different types of abuse and how to respond to suspicion or evidence of abuse. EVIDENCE: A corporate complaints procedure was in place, which detailed that written complaints would be responded to within 21 working days and that complaints received by the home would be responded to within 28 days. The home’s complaints record detailed that no complaints had been received by the home since the service was registered. However, the relative of one resident reported that a family member had sent a letter of complaint to the manager during August 2006 and that they had not received a reply. The manager was unable to locate the letter during the inspection but agreed to respond to the issues raised as a matter of urgency. Overall, feedback received from residents and their representatives via care home survey forms and discussion confirmed that residents and their representatives were aware of whom to talk to if they had a problem and that they felt listened to. The manager was advised to display a copy of the home’s complaints procedure in the reception area of the home, as some residents were unsure of the procedure and one relative reported; “We haven’t been informed about a specific complaints procedure”. Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 20 Comments received included; “Pam [Manager] and her senior staff are always prepared to listen to any problems or concerns we may have”; “I don’t have any concerns at the moment but I am sure the staff would help me if I did” and “I am generally satisfied with the care provided.” The home had developed an Abuse and Whistle blowing policy and the manager had obtained a copy of the local authority adult protection procedures. Training records showed that the majority of staff had completed training in the protection of vulnerable adults from the manager. Staff spoken with demonstrated different levels of understanding regarding the different types of abuse, their duty of care to protect the welfare of vulnerable adults and reporting procedures. Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home had been decorated and furnished to a high standard and was modern, safe and wellmaintained. Some areas of the home required more frequent cleaning and attention, to ensure the comfort of residents is not compromised. EVIDENCE: Roby House is a purpose built home that was recently developed in order to provide a modern and homely environment for the residents who previously lived in the Connaughtons. The home was accessible to residents. The front entrance had ramp access and an electric front door with intercom system. A passenger lift had been installed which was compliant with disability discrimination act guidelines and a call bell system was fitted throughout the home. Handrails had been fitted along the corridors of the home and grab rails were sited in each room / ensuite, subject to the needs of residents. Each lounge was equipped with a loop system. Although Close Circuit Television cameras had been fitted to the perimeter of the home, the cameras did not intrude on Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 22 the daily life of residents. Residents had access to personal mobility aids, subject to individual needs. The home was decorated and furnished to a very high standard. Residents spoken with complimented the environment. Comments included; “It’s a lovely place to live” and “I never imagined I would live in such a pleasant home.” The home employed a part-time handy person who was responsible for general maintenance and repair. Contractors were hired to look after the grounds and building work as required. A maintenance book was in place to record jobs in need of attention. At the time of the visit, the roof was being repaired due to a leak. The home employed two part-time domestics. The manager reported that the home also had vacancies for two 36-hour positions. Policies and procedures were in place to control the risk of infection and staff spoken with confirmed they had completed training in infection control. The laundry was appropriately equipped and sited away from food preparation areas. Overall, feedback received from residents and their representatives confirmed the home was kept tidy and clean and areas viewed during the inspection appeared generally fresh and hygienic. Some activity records detailed that residents had been offered support on an individual basis, to clean their rooms and this was confirmed in discussion with staff and residents. Some of the seats in the lounge area on the dementia care unit were stained and dirty and one bedroom had an offensive smell. These issues had also been highlighted by two residents’ relatives via Care Home Survey forms. This doesn’t create a homely place in which residents want to sit. Such seats need cleaning on a regular basis and this matter was brought to the attention of the manager. Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Some aspects of staff training and deployment are in need of review, to ensure the welfare of residents is protected by appropriate numbers of trained and competent staff. Recruitment practice was sound and offered protection to the people living in the home. EVIDENCE: Overall, feedback received from residents and their representatives confirmed the people living in the home received the care and support they required and that staff were available when needed. Two relatives highlighted concerns regarding the staffing levels and shift patterns in the home. The relatives reported that there were regularly only four staff working in the dementia care unit and only two members of staff were based on the unit through the night. One relative reported that a resident had sustained three incidents of unexplained bruising and another reported examples of poor personal care. These incidents had been brought to the attention of the manager. The manager reported that the home was usually staffed with two care staff and a senior on the residential unit and five staff on the dementia care unit through the day. The manager worked Monday to Friday each week or as required by the service. During the night, the home was staffed with four waking night staff. This staffing level was not in accordance with the details specified in the Statement Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 24 of Purpose, which indicated that four waking night staff and one senior carer would be on duty through the night. Rotas were viewed for week ending the 12th and 19th November 2006. Records showed that the staffing levels had not always been maintained at the specified levels during the day and on one occasion had fallen to six staff. The manager reported that she had helped out when staffing levels were lower, but this had not been recorded on the rota. At the time of the inspection, the home had vacancies for five care posts. Many relatives and residents spoken with complimented the staff team and service. Comments included; “The staff are wonderful to me”; “I am more than satisfied with the care provided by the staff” and “The residents seem really relaxed and there is good interaction from staff.” The home had a corporate recruitment policy. Records showed that a handyperson and eight care staff had recently commenced employment at the home. The personnel files of the nine staff were viewed. Each file contained a copy of an application form and recruitment records, two satisfactory references and evidence that a Protection of Vulnerable Adult (POVA) and /or Criminal Record Bureau (CRB) had been undertaken. Records showed that the home employed 28 care staff. Examination of training certificates confirmed that 5 staff (17.8 ) had a National Vocational Qualification (NVQ) at level 2 or above in care. The manager reported that a further 4 staff (14.2 ) were waiting to receive certificates from the Care Sector Trust and a further 9 staff (32.14 ) were working towards the award. Once the outstanding staff have completed the training, (64.2 ) of the staff will have attained the qualification. The home had developed an induction package that was linked to the National Training Organisation standards. Records were viewed for the nine new employees. Four of the nine induction records were incomplete and seven of the files contained no evidence of staff supervision. Staff spoken with during the visit confirmed they had received induction and that they had opportunities to access training. Examination of training records indicated that the majority of new staff required training in a range of Safe Working Practice topics. It was not possible to assess the training needs of the full staff team, as some files did not contain a training record and the home’s training matrix did not identify the dates that training had been completed. The manager reported that all the staff required first aid training and that fifteen staff required training in dementia care. The manager had allocated training for ten staff in this topic. Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 25 The Provider, (Meridian Health Care), is currently reviewing the provision of inhouse training and the possible use of external training providers for all training except dementia care and moving and handling. Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents and their representatives were consulted about the service periodically, to ensure their views were obtained. Systems had been developed to protect the financial interests of residents who required support with personal allowances. Some administration and staff training was in need of attention, to safeguard and promote health and safety. EVIDENCE: The Registered Manager of the home (Mrs Pamela Case) was registered with the Commission for Social Care Inspection. Mrs Case had managed Roby House since its initial registration in July 2006. Prior to that date, Mrs Case had managed the Connaughtons for approximately 10 years. Mrs Case had attained the National Vocational Qualification (NVQ) level 4 Registered Managers Award; the Alzheimers Society dementia course ‘Yesterday, Today and Tomorrow’ and a range of safe working practice and other training, that was relevant to the management of a residential care home Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 27 for older people. It was not possible to verify all the training completed by the manager, as some certificates / training records were not available for inspection. The manager was aware that she needed to complete a NVQ level 4 in Health and Social Care or equivalent and reported that she had spoken with her line manager regarding this outstanding training need. Mrs Case demonstrated a good awareness of the needs of the people living in the home and a commitment to the development of the service. Residents and staff spoken with reported that Mrs Case was a supportive manager, who applied a “Hands On” approach to her management role. The Operations Manager was responsible for undertaking visits and the production of reports in accordance with Regulation 26. The manager reported that no resident meetings had been coordinated since the home was opened and that this would be addressed shortly. A residents / representatives survey had been completed during October 2006. The findings were well presented and provided useful information for current and prospective residents, their representatives and other interested parties to view. Copies of the report were displayed in the reception area of the home. The home had a policy on residents’ finances. Pre-inspection records detailed that the manager acted as an appointee for two residents. All other residents received support to manage their financial affairs from family members or solicitors. The organisation’s head office was responsible for sending out invoices and a system was in place to enable payments to be made by standing order. At the time of the visit, the manager looked after the personal spending money for 44 residents. Records were checked for three residents. All transactions had been recorded, receipts were available for expenditure and balances were correct. Personal money had not been pooled. A health and safety policy was in place. Some staff required training in safe working practices as identified in standard 30. Fire records were checked. Records showed that the fire alarm panel was checked on a daily basis and the fire alarm system and means of escape had been tested / checked on a weekly basis. Monthly visual inspections of the emergency lighting and fire extinguishers had also been completed. The manager was unable to locate a fire or building risk assessment. A record of fire drills and training was in place. The manager was advised to identify the capacity of staff i.e. whether they are day and night staff. Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 28 All service / commissioning certificates were checked prior to the home being registered. Monthly water temperature records had been completed. Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 4 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? N/A 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 OP9 Regulation 13 (2) Requirement Timescale for action 16/01/07 2 OP16 22 (4) 3 OP27 18 (1) 3 OP30 18 (1) The Registered Person must ensure that Medication Administration Records are completed to account for all medication administered. The Registered Person must, 16/01/07 within 28 days after the date on which the complaint is made, or shorter period as may be reasonable in the circumstances, inform the person who made the complaint of the action (if any) that is to be taken. The Registered Person must, 16/01/07 having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Each member of staff must have 16/02/07 an up-to-date record of induction and training completed. Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 8 9 10 11 12 13 Refer to Standard OP2 OP3 OP3 Good Practice Recommendations Residents should be issued with terms and conditions of residency or standard contracts on admission to the home. Assessments should be kept under regular review and updated to reflect the changing needs of residents. Assessments should be updated to provide more information on the needs of service users in relation to their mental health. Care Plans and Risk Assessments should be dated. Fluid Intake / Output charts should be completed where necessary, to account for the care provided. Day and Night staff should record more detailed information in daily records. A medication round should be established for each unit in Roby House. Medication boxes should be dated upon opening, to provide an audit trail. The manager should establish a system to monitor the competency of staff who administer medication. A copy of the Royal Pharmaceutical Society of Great Britain Guidelines; ‘The Administration and Control of Medicines in Care Homes’ should be obtained. The management of residents’ laundry should be reviewed to ensure residents receive and wear their own clothes at all times. The home should explore and introduce additional activities, which are suitable for people with dementia / cognitive impairments. The widespread locking of doors on the dementia care unit should be reviewed in consultation with residents and their representatives. Individual wishes should be recorded in care plans. Picture cards should be used as an alternative to help people who find making complex choices difficult. Staff should receive refresher training in the Protection of Vulnerable Adults of Abuse Cleaning schedules should be developed to ensure all areas of the home are kept clean and hygienic at all times. DS0000067698.V308769.R01.S.doc Version 5.2 Page 32 OP7 OP7 OP7 OP9 OP9 OP9 OP9 OP10 OP12 OP14 14 15 16 OP15 OP18 OP26 Roby House Care Centre 17 OP38 A fire risk and building risk assessment should be available for inspection / developed. Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Roby House Care Centre DS0000067698.V308769.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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