Inspection on 24/07/08 for Roby House Care Centre

This inspection was carried out on 24th July 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Roby House Care Centre 04/09/07

Roby House Care Centre 15/11/06

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Roby House Care Centre Tarbock Road Huyton Liverpool Merseyside L36 5XW Lead Inspector Daniel Hamilton Unannounced Inspection 08:15 24 and 25th July 2008 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.V368766.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.V368766.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roby House Care Centre Address Tarbock Road Huyton Liverpool Merseyside L36 5XW 0151 482 4440 0151 289 4402 robyhouse@meridiancare.co.uk 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.V368766.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. 4th September 2007 Date of last inspection Brief Description of the Service: Roby House is a new, purpose built, three-storey residential care centre for older people that has been developed to provide 54 registered places, 30 of which are registered for older people with dementia. The care centre 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 snoozelum – (a room fitted out with sensory equipment which provides a soothing environment for residents). The lower ground floor accommodates the care centre’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 care centre and grab rails in each room / en-suite, 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 premises. Fees range from £357.00 to £472.05 per week. Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took place over two days and lasted approximately 19 hours. A partial tour of the premises took place and observations were made. A selection of care, staff and service records were also viewed. The acting manager, deputy manager, relatives, residents and staff were spoken with during the visit. ‘Care Home Survey’ forms were also distributed to a number of residents and / or their relatives prior to the inspection, to obtain additional feedback about the service. All the key standards were assessed and progress / action taken in response to the previous requirements and recommendations from the last Key Inspection in September 2007 was reviewed. What the service does well: Roby House presented as a modern and homely environment in which to live. The home was purpose built, accessible and generally provided the residents with a good standard of accommodation. Rooms viewed had been personalised by residents and contained personal possessions including pictures and ornaments. The general atmosphere in the home continued to be warm and friendly and residents were observed to follow their preferred routines and receive visits from family and friends at different times of the day. A care planning system had been developed and each resident had a care plan which outlined their needs and the level of support required from staff. Risk assessments and supporting documentation had also been completed to safeguard the welfare of the people using the service. Examination of medical records confirmed that each resident was registered with a general practitioner and feedback received from residents confirmed people had access to health care professionals subject to individual need. The Registered Provider (Meridian Healthcare Ltd) had developed a comprehensive range of policies and procedures for staff to reference. Records Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 6 showed that staff had been correctly recruited and this practice provided safeguards for residents. Systems had been established to protect the financial interests of the people using the service and money handled on behalf of residents had been appropriately recorded and receipts for expenditure maintained. A quality assurance process had been developed to monitor the service provided. Monthly visits were carried out by a senior manager and audits were undertaken on a bi-annual basis. An annual residents / representative survey was also undertaken and the findings were well presented and provided useful information for current and prospective residents, their representatives and other interested parties to view. What has improved since the last inspection? What they could do better: Feedback received from some residents and relatives identified a need for information on Roby House to be available in alternative formats e.g. large print. It is therefore recommended that the Statement of Purpose and Service User Guide be produced and available in an alternative format, to enable people with a visual impairment to read and understand the information more easily. Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 7 Some residents and their representatives reported that they had not received terms and conditions of residency or standard contracts on admission to the home. Although this could not be substantiated during the visit, it was noted that contracts had been dated and signed several months after people had been admitted to Roby House. Each resident should be issued with a Statement of Terms and Conditions of Residency / Contract upon admission to Roby House, so that they understand their rights and obligations. Pre-admission assessments had been completed for each resident however the date and details of the staff responsible for undertaking the assessments had not been recorded. This information should be recorded to provide a clear audit trail and accountability. Despite a requirement being issued at the last visit, it was noted that one type of medication had run out of stock for a resident. Arrangements must be made to ensure effective stock control systems are in operation for all medication, in order to ensure residents have access to their medication in accordance with the prescribed instructions. The Commission had also received notification of a medication dispensing error since the last visit. It is therefore strongly recommended that a suitable framework for assessing the competency of staff responsible for administering medication is developed, to ensure staff understand the arrangements for ordering, recording, handling, safekeeping, safe administering, and disposal of medicines. Action should also be taken to ensure the Controlled Drugs Cabinet is secured to the wall using the correct method of fixing, to ensure compliance with the Misuse of Drugs (Safe Custody) Regulations 1973 as amended. Furthermore, the temperature of the room in which medication is stored on the upper floor should be regulated to ensure the temperature does not exceed 25°C and handwritten medication administration records should be checked and witnessed by another suitably trained member of staff, to confirm the prescribed instructions are identical to the prescription details. An up-to-date record of all training undertaken, including induction training must be maintained and available for each member of staff employed at Roby House, to provide evidence that the people using the service are supported by trained and competent staff. Although a 20-hour activity coordinator’s role had been established since the last visit, a number of people continued to express concern regarding the range and frequency of activities provided. Action should be taken to ensure the activities programme in the home reflects the recreational needs, expectations and preferences of all residents. The catering service in the home should also be closely monitored in consultation with the people using the service and a record of the meals served Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 8 to each resident should be maintained. This will help to improve satisfaction levels and provide information on meal choices / dietary intake. Examination of the complaints log and feedback received from residents revealed some common themes, which had also been noted during previous inspections. Action should be take to fully address recurring complaints and concerns in order to demonstrate that the views of the people using the service and / or their relatives are fully acted upon. The seats and carpets in the lounge areas should be repaired or cleaned (where necessary) in order to maintain the comfort and dignity of the people living at Roby House. Similar issues have been noted at the last two inspections and this matter should be given priority attention. Feedback received from a number of residents and relatives highlighted that some people living in the home had concerns regarding the standard of care provided. Staff spoken with during the visit lacked knowledge of the principles of best care practice, adult protection and equality and diversity issues and training records viewed were either missing, incomplete or not up-to-date. Training records / certificates available for inspection highlighted gaps in induction, safe working practice and care related topics for a number of staff. Action must be therefore be taken to ensure records of induction and training completed are up-to-date and available for inspection. Furthermore, all care staff should complete training and / or refresher training in safe working practice and care related subjects, subject to individual need. This will help staff to fully understand and demonstrate competence in: the principles of best care practice; equality and diversity issues; how to recognise and respond to abuse; the care needs of older people and those with dementia and how to promote and safeguard health and safety. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 9 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.V368766.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The format and sharing of key information on the service is in need of review so that the people using the service and their representatives are able to make an informed decision about where to live. EVIDENCE: Since the last visit, the Registered Provider (Meridian Healthcare Ltd) has developed a new combined Statement of Purpose and Service User guide. A copy of the document was displayed in the reception area of Roby House in a standard format and the manager confirmed that additional copies were available for residents and their representatives to view upon request. Feedback received from the majority of residents and their representatives via surveys and through discussion confirmed that people had received information on the service before deciding whether to move into the home. Some people reported that they would have preferred the information in alternative formats, for example large print. The acting manager reported that Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 11 the document had been produced in alternative formats however no examples were available in the home for people to reference. Information received from the manager prior to the inspection in the form of an ‘Annual Quality Assurance Assessment’ confirmed the Registered Provider had developed Policies and Procedures for referral and admission. Information on ‘Becoming a Resident’ had also been included in the Statement of Purpose for Roby House. The files of six residents were viewed during the visit. Each file contained a pre-admission assessment. Assessments viewed contained brief information on the needs of residents and three did not include the name of the assessor or the date of the assessment. Following the pre-admission assessment a more detailed assessment had been completed and copies of social work assessments and / or care plans had been obtained for the majority of people referred via Care Management arrangements. The manager was recommended to review assessments to ensure they included information on equality and diversity issues such as religion, gender and ethnicity, as this information had not always been recorded. A Contract / Statement of Terms and Conditions had been developed by the Registered Provider. Feedback received from some residents and / or their representatives revealed that some people had not received a Contract. The manager reported that she had not received contracts from local authorities for some people who were not self-funding and was able to provide documentary evidence that she was in the process of obtaining copies. All files checked during the inspection were found to contain copies of Contracts from the Registered Provider however it was noted that all the contracts had been signed and dated several months after people had been admitted into Roby House. Arrangements should be made to ensure the people using the service and / or their representatives receive a ‘Statement of Terms and Conditions / Contract’ at the point of moving into the Roby House, so they are aware of their rights and obligations. Similar issues were noted at the last inspection. One relative also expressed concern that a vulnerable family member had been asked to sign a contract without the involvement of next of kin. This matter was brought to the attention of the acting manager so that consideration could be given to balancing rights, risks and responsibilities when issuing future contracts. Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit the service. Staff lack knowledge of the principles of good care practice and this issue should be addressed in order to ensure the personal care needs of the people using the service are appropriately met. EVIDENCE: The Annual Quality Assurance Assessment for the service confirmed that the Registered Provider had developed corporate policies and procedures covering ‘Individual Planning and Review’ and the ‘Control, Storage, Disposal, Recording and Administration of Medication’. The files of six residents were examined during the visit. Each file contained an individual care plan, which outlined how the individual needs of the people using the service were to be met. Plans had been signed by residents (where practicable) and had been kept under monthly review. Supporting documentation including; declaration of wishes in relation to the administration of medication, monthly weight charts, accident records, risk assessments, daily reports, personal property / inventories and personal and health care reports were also in place. It was noted that some accident records Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 13 were vague and required more information. The acting manager agreed to address this matter with staff. 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 required. Health care records viewed detailed that residents had received visits from: general practitioners; opticians, physiotherapists, district nurses, hospital staff, audiologists and / or chiropodists, subject to individual need. Medication was dispensed by a local pharmacist on a monthly basis in a blister pack system. Medication was stored in medication trolleys, which were secured to walls in storage cupboards when not in use. Advice was given regarding the storage of controlled drugs, as the controlled drug cabinets had not been secured to the wall using the correct method of fixing. Likewise, advice was given regarding the storage of medication on the upper floor, as the temperature in the room exceeded 25°C. A resident identification system had been established and a staff signature checklist was available for reference. The deputy manager reported that all staff completed training via the primary care trust and meridian healthcare prior to administering medication. A copy of guidance issued by the Royal Pharmaceutical Society of Great Britain and a medication policy were available for reference. Despite the above safeguards, the Commission had received notification since the last visit of a medication dispensing error. The acting manager was advised to undertake an assessment of competency for each employee designated with responsibility for administering medication. This will help to confirm new staff are competent to administer medication for the first time and to also review the practice and knowledge of existing staff. Medication was checked with the deputy manager during the inspection. Alert cards had been placed on file for residents on warfarin, antibiotics and / or allergies. This was considered good practice. Overall, Medication Administration Records viewed had been correctly completed however there was no audit trail for one record examined. Furthermore, advice was given regarding handwritten medication charts as one example viewed did not clearly indicate that the prescribed instructions had been checked against the prescription by another suitably trained member of staff. Advice was also given on some administration and ordering issues. For example, records showed that one resident had not been administered a Donepezil 10mg tablet on one occasion and a resident’s stock of Co-dydramol PRN 10mg/500mg had run out of stock. Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 14 Staff spoken with during the visit demonstrated limited knowledge and understanding of the principles of good care practice and equality and diversity issues. Feedback received from the residents and / or their representatives via Care Home Survey forms and discussion highlighted different levels of satisfaction regarding the standard of care provided. Some residents and relatives complimented the care provided. For example, comments included; “I have no concerns about the care I receive” and “Staff are very nice and very busy but will help when I ask them.” A number of concerns were received via surveys and discussion. For example, one relative spoken with reported that he had observed a resident who had been expected to wait nearly an hour before being supported with a request for assistance with a personal care matter, despite the carer being reminded several times that support was needed. Likewise, examples of other comments received included: “Requests for assistance are often ‘forgotten’ or perhaps ignored” and “Telephone calls to the home quite often go unanswered at varying times. Request from callers to give a message are not always conveyed.” Other examples were discussed with the manager during the visit so that appropriate action could be taken. Roby House Care Centre DS0000067698.V368766.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Social activities and meals are in need of ongoing development and review in order to satisfy the recreational and dietary needs, expectations and preferences of the people using the service. EVIDENCE: Since the last visit, a 20-hour activity coordinator’s role had been created. The post was being covered by a senior carer as additional hours. Examination of the activity record book for Roby House and discussion with residents and relatives highlighted that the range and frequency of activities was limited and that there was still potential for improvement. A programme of activities could not be located for July 2008 and residents spoken with were not clear about the range of activities on offer. Furthermore, feedback received from residents and / or their representatives highlighted that there continued to be a number of people who were dissatisfied with the range of activities on offer. Similar concerns / issues were noted at the previous visit and the results of the annual residents / representatives survey for Roby House during September Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 16 2007 highlighted that the feedback for social activities and events was not as positive as other sections of the survey. Comments received included: “Activities are few and far between. There would seem to be a great degree of discomfort amongst residents at the lack of stimulation. This results in total boredom and residents staring into space or sleeping their lives away”; “Very rarely any activities. Carers are too busy doing other chores. TV on in lounge and no-one looks at it and no encouragement for anyone to speak to each other” and “My mother is limited in what she can participate in, but in my visiting experience I have seen very little evidence of any activities taking place.” Records showed that the Activities Coordinator had introduced some new activities since the last visit including: ‘Sonas’ – a sensory programme to improve communication for people with dementia related conditions’; external trips to Knowsley Safari Park, Anfield, National Flower and Garden Centres and walks to the local pub and shops. Residents reported that they had very much enjoyed the trips and expressed a desire for similar opportunities to be organised. A volunteer also offered assistance with activities on a Wednesday and Thursday each week and representatives from the local Roman Catholic and Church of England churches visited Roby House regularly to offer communion, subject to the individual wishes of the people using the service. The knowsley library service and an outside entertainer continued to visit the care centre. The personal experience of choice and control over each resident’s daily life is a difficult balance to achieve, given the lack of mental capacity of some of the people living in the home. Nevertheless, the general atmosphere of the home continued to be warm and friendly and residents were observed to follow their preferred routines and receive visits from their family and friends throughout the day. Rooms viewed had been personalised by residents and contained personal possessions including pictures and ornaments. The acting manager reported that a three-week rolling menu had recently been introduced following a series of complaints regarding the quality of the catering. The menu had been constructed following consultation with the people living in Roby House and via feedback received from a survey that was distributed in May. Daily menu plans had been developed in large print and copies of the menus were available in a file in each dining room. Alternative choices were listed for each sitting. No recent records of meal choices were available for inspection. The cook on duty reported that the two menu options were prepared in the kitchen and transported to each dining room via hot trolleys for residents to choose their Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 17 preferred meal. Some residents advised that they were not always offered a choice of meal and the manager was therefore advised to ensure that a record of the meals served to each resident was maintained and available for future reference. During the two days of the inspection the dinner-time options were as follows. For day one, lamb jogan rosh with basmati rice or roast ham, new potatoes and green beans. Likewise for day two the options were; cod in butter or parsley sauce, chipped potatoes and garden peas or fried egg, chipped potatoes and garden peas. Meals were served in the dining rooms on each unit. Dining rooms were pleasantly decorated and furnished. Tables were set with napkins, condiments coasters and dried flowers. Staff were present during meals to offer support for residents as required. Additional drinks were served throughout the day and residents were able to eat their meals in the 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. Feedback received from residents and their representatives highlighted different views on the quality of the catering service at Roby House. Examples of positive comments received included: “The meals have improved in the last 6 months”; “I enjoy the meals and I get the opportunity to choose an alternative” and “There is always plenty to eat and the food is OK”. Conversely, a number of people expressed concerns. Feedback included; “Portions too small. Not enough solid food”; “Kitchen issues do not seem to be easily resolved by care staff. The catering staff seem to be autonomous” and “The quality and presentation of food is abysmal…”. The acting manager reported that having examined the training files for the cooks she had noted that they did not have an up-to-date food hygiene certificate on file. Arrangements had been made for the relevant staff to complete food hygiene training during June. The results of the annual residents / representatives survey for Roby House during September 2007 highlighted that the outcome against the question covering food presentation was not as good as previous. Despite a review of the menus and catering service a number of residents and relatives remain concerned about the quality of catering. This matter should therefore be kept under review. Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable the people using the service to express their concerns however some recurring issues have not been adequately addressed to demonstrate that complaints and concerns are effectively acted upon. EVIDENCE: The Registered Provider had developed a corporate complaints procedure, which detailed that written complaints would be responded to within 28 days. Copies of the procedure had been laminated in a standard format and displayed in each resident’s room for reference. Feedback received from the people using the service and their representatives confirmed that people were aware of whom to talk to if they had a problem. The complaints record for Roby House detailed that twelve complaints had been received from relatives / representatives of people living in the home since the last inspection. The complaints concerned a range of issues including; poor communication, missing clothing, failure to administer medication, limited activities, the cleanliness of the home, the conduct / availability of staff and the standard of personal care provided to residents. Records showed that each complaint had been logged and responded to by the acting manager or other senior staff. Similar complaints / concerns have been noted on previous inspections. The Commission for Social Care Inspection had received no formal complaints since the last visit. One person contacted the Commission with concerns Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 19 regarding the standard of care provided to a relative living in Roby House. The relative was advised to refer the issues to the Registered Provider for investigation. Previous inspection records and information received from the manager via the Annual Quality Assurance Survey (AQAA) confirmed the Organisation had developed an Abuse and Whistle blowing policy. A copy of the local authority adult protection procedures was also in place for the staff to reference. The acting manager reported that she had recently completed a ‘Safeguarding Adult’s- Manager’s Response’ course and demonstrated a sound understanding of the different types of abuse and reporting procedures. Likewise, the acting manager advised that the majority of the staff team had completed refresher training in the Protection of Vulnerable Adults from Abuse however staff spoken with displayed a limited understanding of the different categories of abuse and knowledge of how to respond to suspicion or evidence of abuse. Similar issues were noted at the last visit. The Annual Quality Assurance Assessment (AQAA) for the service detailed that there had been one adult protection referral and investigation in the last 12 months. The referral concerned an allegation regarding the conduct of staff on waking night duties. Action was taken by the Registered Provider in response to the incident. A further adult protection referral was made following the completion of the AQAA document. The second referral concerned the conduct of a member of staff on daytime duties. Action was also taken by the Registered Provider in response to this incident, as the manager was awaiting a response from the local authority adult protection team at the time of the inspection. Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is decorated and furnished to a high standard and is modern, safe and well maintained. Some chairs and carpets in the home require more frequent cleaning, to ensure the comfort of residents is not compromised. EVIDENCE: Roby House Care Centre was opened in July 2006 and was purpose built to accommodate 54 people. Overall, the home was decorated and furnished to very high standard, in order to provide a modern, homely and pleasant environment for the people using the service. Since the last visit a part-time maintenance person had been appointed who was responsible for undertaking minor maintenance tasks. The Registered Provider continued to hire contractors as and when necessary to attend to specialised maintenance work and the servicing of equipment. A maintenance book was in place to record jobs in need of attention. Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 21 The home was fully 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 / en-suite, subject to the needs of the 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 the daily life of the residents. Residents had access to personal mobility aids, subject to individual needs. The acting manager reported that no new furniture or equipment had been purchased since the last visit. The Annual Quality Assurance Assessment (AQAA) for the service detailed that more garden furniture was to be ordered and fitted in the near future. A tour of the premises revealed that the chairs and carpets (especially in the lounge on the upper floor) were showing signs of wear and / or were stained. Four chairs in the upper floor lounge area had small holes (due to wear and cigarette burns) and two tables in the residential lounge area were covered in cigarette burn marks. The home employed four part-time domestics and two part-time laundry staff. The AQAA for Roby House confirmed the service had a policy for preventing infection control and that an action plan had been developed for work on infection control management. Records showed that 13 staff had completed infection control training. The laundry was appropriately equipped and sited away from food preparation areas. Feedback received from the majority of residents and / or their relatives confirmed the care centre was kept clean and fresh and overall areas viewed were clean, tidy and hygienic. Concern was noted however regarding the cleanliness of the chairs and the lounge carpets as highlighted above. For example, a relative reported; “Some of the chairs are stained also some carpets in the lounge area. My mother’s room is not as clean as it might be.” This issue should be addressed as a matter of priority as similar issues were noted at the last inspection. Advice was also given to the manager to ensure that shampoos and cleaning products are stored safely as some products had been left in a communal bathroom on the upper floor. This issue was addressed by the manager during the visit. Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Records and systems associated with staff training and development are in need of review, to verify that the people living in the home receive appropriate levels of support from trained and competent staff. EVIDENCE: The Acting manager confirmed that the staffing levels remained the same as at the last visit. Five staff (including an Acting Senior) were based on the upper floor (dementia care unit) and three staff (including a senior) were allocated to work on the ground floor (residential unit) during the day. During the night, three waking night staff were based on the dementia care unit and two carers were based on the residential unit. The acting manager worked supernumerary hours or as required by the service. Examination of rotas highlighted that some variation in staffing levels had taken place due to lower occupancy levels and that some cover had not always been recorded. The manager agreed to ensure that the rotas accurately reflected the staff cover. Since the last visit arrangements had been made to clearly record the lead carer on each night shift. Feedback received from the residents and / or their representatives via Care Home Survey forms and discussion highlighted different levels of satisfaction regarding the standard of care provided. Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 23 A number of concerns were received via survey forms and through discussion with residents and / or their representatives during the visit. Recurring themes which were noted included: requests for care being ignored or forgotten; the standard of catering; lack of social activities; telephone calls not being answered and / or messages not being relayed. These issues were discussed with the manager during the visit so that appropriate action could be taken. Staff observed during the inspection were seen to engage with residents in a positive manner and the people using the service appeared relaxed and comfortable in their home environment. The Annual Quality Assurance Assessment (AQAA) for Roby House confirmed the Registered Provider had developed a corporate policy for recruitment and employment. Furthermore, the document confirmed that all the people who had worked in Roby House in the past twelve months had completed satisfactory pre-employment checks. The Acting manager reported that eleven staff had commenced employment at Roby House since the last visit. This number consisted of seven care staff, two cooks, one domestic and one handyman. The personnel files of the seven care staff were viewed. Each file contained a copy of an application form, recruitment records, two satisfactory references and evidence that a Protection of Vulnerable Adult (POVA) and /or Criminal Record Bureau (CRB) had been undertaken. The acting manager reported that the home employed 35 care staff. Documentary evidence was available to confirm that 13 staff (37.14 ) had completed a National Vocational Qualification (NVQ) at level 2 or above in Care. A further 5 staff (14.29 ) had completed a NVQ at level 2 or above and were waiting to receive certificates from the training provider. Two staff (5.71 ) were working towards the award at the time of the visit. Once the remaining employees have completed their inductions, (57.14 ) of the care staff will have completed a National Vocational Qualification. Corporate Induction / Foundation workbooks had been developed by the Registered Provider for newly appointed staff to complete. Only two of the seven new care staff had an induction record on file for reference and these had not been signed off or dated by senior staff. The acting manager was advised to check that the induction package was fully compliant with the Skills for Care Induction Standards and to ensure that induction records were signed off to confirm staff were competent and ‘safe to leave.’ The acting manager reported she had requested all new and existing staff to complete induction booklets as some copies had been lost or mislaid. A copy of a letter was viewed which confirmed that all booklets were due to be returned by the end of July. Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 24 A training matrix had not been completed to provide an overview of the training completed by staff. Furthermore, staff files viewed did not contain an up-to-date record of training completed or were incomplete. Staff spoken with during the visit confirmed they had received an induction booklet, training opportunities and formal supervision from senior staff. Examination of training records i.e. certificates highlighted that a number of staff had not completed all the necessary safe working practice and / or care specific training for their roles. Similar issues were also noted at the last inspection. It is essential that the training records for staff employed in Roby House are updated in order that an accurate assessment of the training needs and competency of staff can be made. For example, the training record for a carer designated with ‘lead’ responsibilities on waking nights detailed that the employee had completed only manual handling and fire procedure training. Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of recurring complaints and concerns is in need of attention, to ensure the ongoing development of a person-centred service. EVIDENCE: Since the last inspection the Registered Manager of the home (Mrs Pamela Case) has left the service. A new acting manager (Sarah Malloy) has been appointed as the acting manager and is due to register with the Commission for Social Care Inspection in the near future. The acting manager has worked for Meridian Healthcare Ltd for approximately three years and has acquired approximately nine years experience as a Registered Manager, specialising in the residential care of older people. Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 26 The acting manager reported that she had completed the National Vocational Qualification (NVQ) level 4 RMA award (Adults) and that she was in the process of completing the NVQ 4 award in Health and Social Care. It was not possible to assess all of the training completed by the manager, as some certificates and / or a training record were not available for inspection. Documentary evidence available for inspection confirmed that the acting manager had completed a range of training that was relevant to her role and responsibilities, however some safe working practice training was in need of review. Residents and staff spoken with confirmed the acting manager was supportive and approachable. The manager demonstrated a commitment to developing the service at Roby House and to promoting open and transparent management processes. Discussion with staff and examination of records confirmed that some staff had started to receive formal supervision sessions from senior staff. The Operations Manager continued to undertake monthly visits on behalf of the Registered Provider in accordance with Regulation 26 of the Care Home Regulations 2001 and records of monthly visits were available for inspection in the home. Copies had also been forwarded to the Commission each month. Records showed that the acting manager had organised two residents’ meeting since the last visit, in order to improve consultation processes with the people using the service. Meetings had also been coordinated with staff. An annual residents / representative survey was undertaken and a summary of results for September 2007 was displayed in the reception area of the home. The findings were well presented and provided useful information for current and prospective residents, their representatives and other interested parties to view. Social activities and events was not as positive as other sections of the survey and the outcome against the question covering food presentation was not as good as previous. Similar issues / concerns were noted during the inspection (see link to daily life and activities section). Quality audits were also completed on a bi-annual basis. The Annual Quality Assurance Assessment (AQAA) for the service detailed that policies and procedures on the Management of Services Users’ Money, Valuables and Financial Affairs had been developed for staff to reference. The acting manager reported that arrangements had been made for Knowsley Social Services to act as an appointee for two people who used the service. The remaining residents were encouraged to manage their personal finances independently or with support from family members or personal representatives. Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 27 Systems had been established by the Registered Provider for issuing invoices to residents or their representatives for fees and to enable payments to be made via standing order. At the time of the visit the Acting Manager was responsible for the safe storage and management of personal spending money for 42 residents. Systems had been established to ensure money was not pooled and written records of all financial transactions, receipts and cash balances were maintained. Previous inspection records detail that the Registered Provider had developed Health and Safety policies and procedures and examination of the AQAA confirmed the relevant policies and procedures had been kept under review. Records confirmed that test, maintenance and / or associated records were in place and up-to-date for all key areas with the exception of soiled waste disposal. The manager reported that the Organisation had recently changed to a new service provider and that the contract was at head office. Fire log and service records were checked during the visit. A service certificate was in place which confirmed the fire alarm, emergency lighting, and nurse call system had been serviced during May 2008. Furthermore, a certificate of inspection for the fire extinguishers was available for inspection, which confirmed the appliances had been serviced during July 2008. Records showed that the fire alarm system, panel, means of escape, emergency lighting and fire extinguishers and hose reels had been tested or visually inspected in accordance with the recommended intervals. The fire alarm was tested during the inspection by the maintenance person and a record of fire drills and training was available for reference. A fire risk assessment had been developed and a building / catering risk assessment was in place. Some staff required training in Safe Working Practice Topics as identified in the ‘Staffing’ section of this report. The Commission for Social Care Inspection had received notifications of significant incidents in the home since the last inspection in compliance with Regulation 37 of the Care Home Regulations 2001. Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 28 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 2 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 3 15 2 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 3 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 3 X 3 Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 Sufficient stocks of medication must be maintained in the home, to ensure residents receive their medication in accordance with the prescribed instructions. [Previous timescale of 17/10/07 not met]. An up-to-date record of all training undertaken, including induction training must be maintained and available for each member of staff employed at Roby House, to provide evidence that the people using the service are supported by trained and competent staff Timescale for action 25/08/08 2. OP30 17 (2) 25/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations A copy of the Statement of Purpose and Service User DS0000067698.V368766.R01.S.doc Version 5.2 Page 30 Roby House Care Centre 2. 3. 4. OP2 OP3 OP9 5. 6. OP9 OP9 7 OP9 7. OP12 8. OP15 9. OP16 10. OP26 11. OP30 Guide should be available at Roby House in alternative formats e.g. large print to enable people with a visual impairment to read the information more easily. Residents should be issued with terms and conditions of residency or standard contracts on admission to the home, so that they understand their rights and obligations. The date and details of the staff responsible for undertaking pre-admission assessments should be recorded to provide a clear audit trail. The Controlled Drugs Cabinet should be secured to the wall using the correct method of fixing, to ensure compliance with the Misuse of Drugs (Safe Custody) Regulations 1973 as amended. Action should be taken to ensure medication is not stored in any area where the temperature exceeds 25°C. The manager should develop a detailed tool for assessing the competency of staff responsible for administering medication, to ensure staff understand the arrangements for recording, handling, safekeeping, safe administering, and disposal of medicines. Handwritten Medication Administration Records should be checked and witnessed by another suitably trained member of staff to confirm the prescribed instructions are identical to the prescription. The range and frequency of activities in the home should be further developed in consultation with the people using the service. This will help to ensure the recreational needs and preferences all residents are accommodated. The catering service in the home should be closely monitored in consultation with the people using the service and a record of the meals served to each resident should be maintained. This will help to improve satisfaction levels and provide information on meal choices / dietary intake. Action should be take to fully address recurring complaints and concerns in order to demonstrate that the views of the people using the service and / or their relatives are fully acted upon. Arrangements should be made to ensure the seats and carpets in the lounge areas are repaired or cleaned (where necessary) in order to maintain the comfort and dignity of the people living at Roby House. Action should be taken to ensure all care staff complete training and / or refresher training in safe working practice and care related subjects. This will help staff to fully understand and demonstrate competence in: the principles of best care practice; equality and diversity issues; how to recognise and respond to abuse; the care needs of older DS0000067698.V368766.R01.S.doc Version 5.2 Page 31 Roby House Care Centre people and those with dementia and how to promote and safeguard health and safety. Roby House Care Centre DS0000067698.V368766.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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