Inspection on 04/09/07 for Roby House Care Centre

This inspection was carried out on 4th September 2007.

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

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

Other inspections for this house

Roby House Care Centre 24/07/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Roby House Care Centre Tarbock Road Huyton Liverpool Merseyside L36 5XW Lead Inspector Daniel Hamilton Unannounced Inspection 09:30 4 & 5 September 2007 th 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.V348222.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.V348222.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.V348222.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. 15th November 2006 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 snoozelum – a room fitted out with sensory equipment which provides a soothing environment for residents. 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. Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 5 Care Home Fees range from £327.47 to £450.00 per week. Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days and lasted approximately 13 hours. A partial tour of the premises took place and observations were made. A selection of care, staff and service records were viewed and the Registered 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 home. All the key standards were assessed and progress / action taken in response to the previous requirements and recommendations from the last Key Inspection in November 2006 and the Random Inspection in January 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 very good standard of accommodation. The people living in the home were observed to receive appropriate support and supervision from the care staff during the two days of the inspection and overall, feedback received from residents and their representatives confirmed the residents received the care and support they required and were treated with respect. Comments included; “I am well cared for by the staff who work here”; “We have some nice carers who are very kind” and “The manager and senior staff take a real interest in the care provided to residents.” Likewise, the relative of one resident reported: “My mother was very frail on arrival 3 months ago and has improved a great deal physically. They [staff] have at times a very difficult job which they do well.” An assessment and care planning system had been developed and each resident was registered with a General Practitioner. The manager and staff demonstrated a good awareness of the diverse needs of the people living in the home and residents reported that they had access to health care services as required. Records were available to confirm the outcome of appointments with various health care professionals. Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 7 Residents were observed to follow their preferred routines during the day and receive visits from family members / friends. Meals were well managed and menus showed that the people living in the home received a choice of wholesome and nutritious meals. Comments received from residents included; “The food has improved greatly”; “The meals are always very nice” and “We get a good choice of food”. A complaints procedure had been developed to enable residents to formally express their concerns and records showed that complaints had been acted upon by the manager. Feedback from two residents included; “I have no issues that concern me. If I did I would speak to Pam (The manager) or one of the senior staff” and “I have no complaints. The staff are helpful and deal with problems quickly.” Likewise, the relative of one resident reported: “The manageress and senior carers have always been sympathetic to any issues I have brought up and attended to them thoroughly and promptly”. Systems had been established to protect the financial interests of the people living in the home and to ensure residents were consulted about the quality of care provided at Roby House. What has improved since the last inspection? Medication Administration Records (MAR) had been completed to account for medication administered to the people living in the home. A second medication administration round had also been established, to ensure medication was administered to residents at the correct times and guidance issued by the Royal Pharmaceutical Society of Great Britain had been obtained for staff to reference. Records showed that Complaints received by the home had been acted upon by the Registered Manager to ensure compliance with the Organisation’s Complaints procedure. Arrangements had been made to ensure the home was staffed in accordance with the staffing levels detailed in the Statement of Purpose for Roby House. Staff recruitment files (available for inspection) showed that staff had been correctly recruited, to protect the welfare of the people living in the home. Care Plans had been kept under monthly review, to demonstrate the needs of residents were being monitored. The widespread locking of doors on the dementia care unit had stopped, to enable residents to have unrestricted access to their rooms. A fire and building risk assessment had been developed to ensure actual / potential risks were identified and planned for. Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 8 What they could do better: Medication stocks were not being appropriately monitored or maintained for some residents. Sufficient stocks of medication must be available in the home, to ensure residents receive their medication in accordance with the prescribed instructions. Furthermore, medication boxes should be dated upon opening to provide an audit trail and the manager should undertake an assessment of competency for staff responsible for administering medication, to ensure best practice. Recruitment / employment records were not in place for all staff working in the home. These records must be kept in the home and available for inspection. Some incidents and accidents that had occurred in the home had not been notified to the Commission for Social care Inspection. This matter must be addressed, to ensure the welfare of the people living in the care home is safeguarded and to ensure compliance with Regulation 37 of the Care Home Regulations 2001. An- up-to-date Fire Alarm Service Certificate could not be located and there was no record to confirm the fire alarm system had been tested on a weekly basis. These issues must be addressed to ensure the health and safety of residents is protected. A copy of the home’s Statement of Purpose and Service User Guide was not being displayed in the home. A copy should be available to provide current and prospective residents and / or their representatives with information on the service. Furthermore, each resident should be issued with a Statement of Terms and Conditions of Residency on admission to the home, so that they understand their rights and obligations. One file viewed did not contain an assessment of need and some care plans lacked information on how the mental and / or health care needs of residents were to be met. These issues should be addressed to ensure the needs of residents are identified and appropriately planned for. A number of residents and their representatives continued to express concerns regarding the range and frequency of activities in the home. Action should be taken to ensure the activities in the home reflect the recreational needs and preferences of all residents. Staff spoken with during the visit lacked awareness of the different types of abuse and reporting procedures, despite having completed training in the Protection of Vulnerable Adults from Abuse. Refresher training should be arranged so that staff understand how to recognise and respond to abuse. As noted at the last visit, a number of chairs on the dementia care unit were stained and dirty. Arrangements should be made to ensure the chairs are kept Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 9 clean and hygienic, to maintain the comfort and dignity of the people living in the home. Progress logs / checklists were not available on some staff files to provide evidence that staff had completed an induction that was compliant with the Skills for Care – Common Induction Standards. Furthermore, records showed that some staff had not completed training in all Safe Working Practice topics and / or dementia awareness. Action should be taken to monitor and address the outstanding learning needs of staff, to provide evidence that staff are trained and competent for their roles. 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.V348222.R01.S.doc Version 5.2 Page 10 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.V348222.R01.S.doc Version 5.2 Page 11 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. Information on the home has been developed but residents have not always received terms of conditions of residency, to ensure they understand their rights and obligations. EVIDENCE: The Organisation had developed a Statement of Purpose and Service User Guide for Roby House. The manager agreed to display a copy of the documents in the reception area of the home, as they were not available for residents and / or their representatives to view. Overall, feedback received via Care Home Surveys and / or discussion with residents and their representatives confirmed that people had received information on the service and a copy of the previous inspection record was available in the reception area at the home. The Annual Quality Assurance Assessment for the service and the previous inspection records confirmed that the Organisation had developed Policies and Procedures for referral and admission. Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 12 The files of six residents were viewed during the visit. Five of the six files contained evidence that an assessment of need had been completed and information on diversity issues / needs had also been obtained. Copies of social work assessments and care plans were also on file for residents referred via social services. The manager confirmed that assessment information was used to develop individual plans of care for each resident. Previous inspection records confirm that the Organisation had developed a Contract / Statement of Terms and Conditions. Feedback received from some residents and / or their representatives via Care Home Survey forms and / or discussion revealed that some people had not received a Contract and some files viewed did not contain a copy of a Contract. Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 13 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. Medication systems and practice need to be improved, to ensure the health and personal care of residents is fully safeguarded. EVIDENCE: The Annual Quality Assurance Assessment for the service and previous inspection records confirmed that the Organisation has developed Policies and Procedures for Individual Planning, Review and the Control, Storage, Disposal, Recording and Administration of Medication. The files of six residents were examined during the visit. Each file contained a Care Plan the outlined the individual needs, action required and details of who was responsible for delivering the care. Plans had been signed by residents / representatives and staff, and had been kept under monthly review. One care plan viewed lacked information on how the dementia care needs of a resident were to be met. The manager was also advised to include more information on how the health care needs of residents were to be met. Supporting documentation including; declaration of wishes in relation to the administration of medication, monthly weight charts, risk assessments, daily Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 14 reports, personal property / inventories and personal care, health care and activity reports were also in place. A new recording system had also been introduced for night staff to record their observations / findings. 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 the residents were supported to attend appointments with various health care practitioners, dependent upon their needs, wellbeing and wishes. Records examined on the day of visit showed that residents had seen district nurses, doctors, dentists, chiropodist, physiotherapist, optician and / or hospital staff. The home continued to use 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 for reference. A copy of guidance issued by the Royal Pharmaceutical Society of Great Britain had been obtained since the last inspection. The manager reported that all staff responsible for the administration of medication had completed medication training and that a second medication round had been introduced since the last visit, to reduce the potential for error and to ensure residents received their medication at the correct times. Medication was checked with the manager during the inspection. Systems had been established for the storage, disposal, recording and administration of medication. Overall, Medication Administration Records had been correctly completed but some major shortfalls were noted. For example, the Medication Administration Record (MAR) for one resident identified that 4.5 Lorazepam 1m/g tablets had been received on the 28/08/07. The prescribed instructions detailed that half a tablet should be administered in the morning and half at teatime. The MAR detailed that the medication had been administered / signed by staff on 10 occasions. This would have required a balance of 5 tablets originally and there was no supply in the home for the resident on the day of the visit. The manager was advised to record the date that boxes of medication were opened and to ensure that all hand written MAR sheets were checked and signed by another suitably trained member of staff. Furthermore, the manager was recommended to formally assess the competency of all staff responsible for medication, to ensure best practice. Records were in place to account for medication returned to the pharmacist. Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 15 Staff spoken with during the visit demonstrated knowledge and understanding of the principles of good care practice and were observed to offer appropriate support to residents throughout the day. Staff confirmed they had received training in this subject as part of their induction and policies and procedures has been produced by Meridian Healthcare for staff to reference. Overall, feedback received from residents and their representatives confirmed the people living in the home were treated with privacy and dignity. Comments received included; “I am well cared for by staff who work here”; “We have some nice carers who are very kind” and “The manager and senior staff take a real interest in the care provided to residents.” Likewise, the relative of one resident reported: “My mother was very frail on arrival 3 months ago and has improved a great deal physically. They [staff] have at times a very difficult job which they do well.” The record of complaints for Roby House showed that some concerns had been expressed by the relatives of residents regarding poor personal care. The manager reported that the issues raised were being closely monitored to ensure the privacy and dignity of residents was safeguarded. Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. The range and frequency of social activities is limited and does not satisfy the recreational needs and expectations of some residents. EVIDENCE: A programme of activities had been developed for residents which was updated on a monthly basis. At the time of the visit, the programme was not being displayed for residents to view. The programme for August 2007 detailed that the following activities were on offer. Monday (Quiz night): Tuesday (Reminiscence): Wednesday (Arts and Crafts): Thursday (Bingo) and Friday (Board Games). The Birthdays of residents during the month of August had also been recorded. A number of residents and relatives continued to express concern via survey forms and through discussion regarding the range and frequency of activities provided. For example, two residents reported; “There are very few activities. It can get boring” and “I’d like more activities and the chance to get out.” Likewise, the relative of a resident stated; “I feel the residents would benefit from more activities.” Activity reports viewed also showed that residents had participated in a limited range of activities. Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 17 Similar issues had been noted at the previous visit and in the results of the annual residents / representatives survey for Roby House during October 2006. This issue should be given priority attention to ensure the recreational needs and preferences of residents are addressed. A volunteer continued to offer assistance with activities on a Wednesday and Thursday each week and representatives from the local Roman Catholic and Church of England churches visited the home regularly to offer communion. Knowsley library also visit the home to supply a range of books & audio books for residents and an outside entertainer (Banjo man) had visited the home. 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. The general atmosphere of the home was warm and friendly. Residents were observed to follow their preferred routines and receive visits from their relatives. Staff spoken with demonstrated a good awareness of the rights and diverse needs of the people living in the home. Rooms viewed had been personalised by residents and contained personal possessions including pictures and ornaments. The home had a four week rolling menu which showed that residents received a selection of wholesome and nutritious meals. Alternative choices had been listed on a separate sheet of paper and the manager confirmed that the menus were kept under review in consultation with residents. A copy of the menu was displayed in each dining room. Meals were served in the dining rooms on each unit. Dining rooms were pleasantly decorated and furnished. Tables were set with placemats, napkins, condiments and coasters. Residents were observed to enjoy their mealtimes which were viewed as a social occasion and unhurried. Staff were present during meals to offer support for residents. 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 via Care Home Surveys and discussion confirmed the people living in the home enjoyed their meals. Comments included: “The food has improved greatly”; “The meals are always very nice” and “We get a good choice of food.” Roby House Care Centre DS0000067698.V348222.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. Some staff lack awareness of the Organisation’s adult protection policies and procedures and do not fully understand how to recognise and respond to suspicion or evidence of abuse. EVIDENCE: The Organisation had developed a corporate complaints procedure, 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. Copies of the procedure had been laminated and displayed in each resident’s home. The complaints record for Roby House detailed that four complaints had been received from different relatives of people living in the home since the last inspection. The complaints all concerned the standard of personal care provided to residents. Records showed that the manager had logged each complaint and acted upon the issues. The Commission for Social Care Inspection had also received one anonymous complaint regarding the misconduct of some of the night staff team. Action is being taken in response to the issues identified and this will be monitored by the Commission. 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. Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 19 Comments received from two residents included: “I have no issues that concern me. If I did I would speak to Pam [The manager] or one of the senior staff” and “I have no complaints. The staff are helpful and deal with problems quickly.” Likewise, the relative of one resident reported: “The manageress and Senior Carers have always been sympathetic to any issues I have brought up and attended to them thoroughly and promptly”. One relative reported that the “Staff listen but do not always act on requests.” This point was brought to the attention of the manager during the visit. Previous inspection records and information received from the manager via the Annual Quality Assurance Survey 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 training matrix for the home was not up-to-date at the time of the visit and showed some staff had not completed training in the protection of vulnerable adults from abuse. The manager was able to provide evidence that she had recently nominated seven staff to attend adult protection training. The manager demonstrated a good understanding of the correct procedures to follow in response to evidence or suspicion of abuse. Staff spoken to during the visit reported that they had completed training in the Protection of Vulnerable Adults from Abuse but showed different levels of understanding regarding the different types of abuse and referral procedures. This was discussed with the manager during the visit, as similar issues were noted at the last key inspection. Roby House Care Centre DS0000067698.V348222.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 in the home require more frequent cleaning, to ensure the comfort of residents is not compromised. EVIDENCE: Roby House Care Centre was purpose built to provide a modern and homely environment for the residents who previously lived in Connaughtons. The care centre opened during July 2006. The manager reported that the home had a vacancy for a part-time handy person and that contractors were hired to look after the grounds and building work as required. Contractors were observed to be on site attending to various maintenance and / or repair tasks on the day of the visit. A maintenance book was in place to record jobs in need of attention. 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 Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 21 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 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. Since the last visit, the floor covering in a bedroom had been replaced. Furthermore, the widespread practice of locking residents’ doors on the dementia care unit had stopped and signage had improved, to assist residents to find their bedrooms more easily. The home employed 4 part-time domestics and 3 part-time laundry staff. The Annual Quality Assurance Assessment 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 only 11 staff had completed infection control training. The laundry was appropriately equipped and sited away from food preparation areas. The home was decorated and furnished to high standard. Feedback received from residents and their representatives confirmed the home was kept tidy and clean and areas viewed during inspection appeared generally fresh and hygienic. A number of seats in the smoking lounge and the main lounge area on the dementia care unit were badly stained and dirty. This issue was discussed with the manager as similar findings were also at the last visit. Roby House Care Centre DS0000067698.V348222.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. Some staffing records were not available in the home to provide evidence that all staff were appropriately recruited and inducted and some employees had not completed all the necessary training to ensure competence in their role. EVIDENCE: Discussion with the manager and staff, direct observation and examination of rotas confirmed the home was staffed with eight care staff and one senior carer during the day. Three of the care staff were allocated to work downstairs on the residential unit and five staff, including a senior, worked upstairs on the dementia care unit. During the night, three waking night staff were based on the dementia care unit and two carers worked on the residential unit. The manager worked Monday to Friday each week or as required by the service. The lead carer for waking night duties had not been clearly recorded on the rotas and this was discussed with the manager during the visit. Feedback received from the residents and / or their representatives via Care Home Survey forms and discussion confirmed the care staff were generally available when needed and that they received the care and support they required. One person expressed concern regarding the time taken at night to respond to personal care issues and this was discussed with the manager. The Annual Quality Assurance Assessment for the home detailed that policies and procedures had been developed for recruitment and employment. At the Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 23 time of the visit, the service had vacancies for a part-time Handyperson, Cook and two Care Staff. The Manager reported that eleven care and two ancillary staff commenced employment in the home since the last visit. The personnel files of six 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. Two additional personnel files were requested to view during the visit. These were not available in the home for inspection as required under the Care Home Regulations 2001. The manager reported that the files had been taken off-site by senior managers. The manager reported that the home employed 33 care staff. Examination of training certificates confirmed that 11 staff (33.33 ) had completed a National Vocational Qualification (NVQ) at level 2 or above in Care. Previous inspection records confirmed that the Organisation had developed corporate induction booklets for new employees. Only two of the six personnel files viewed contained an induction checklist to provide evidence that staff had completed an induction. The manager was recommended to review the induction package, to confirm the corporate induction is compliant with the requirements of the ‘Skills for Care’ Common Induction Standards. Staff spoken with during the visit confirmed they had received induction, training opportunities and formal supervision from senior staff. The training matrix was not up to date at the time of the visit and did not identify the dates that training had been completed. Each personnel file viewed contained an individual training record and certificates had been obtained, to ensure documentary evidence was in place for the majority of training completed. Records show that some staff required training in various Safe Working Topics and / or care related training e.g. dementia awareness and the Protection of Vulnerable Adults. The manager was able to provide evidence that she had nominated 16 staff for first aid, 8 staff for infection control, 4 staff for medication, 7 staff for Protection of Vulnerable Adults, 12 staff for Mental Health Awareness and 8 staff for challenging Behaviour training during August 2007. Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 24 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 and administration of some key records is in need of attention, to confirm the welfare of residents is safeguarded. 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 and had previously gained 10 years experience as the manager of Connaughtons, prior to the closure of the home by the Registered Provider. Mrs Case had attained the National Vocational Qualification (NVQ) level 4 Registered Managers Award and reported that she had recently completed a NVQ Level 4 in Health and Social Care (awaiting verification / certification). Records showed that the manager had completed Protection of Vulnerable Adult and Mental Capacity Act training since the last visit. Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 25 It was not possible to assess all of the training completed by the manager, as some certificates / a training record were not available for inspection as noted at the last visit. Feedback received from the residents and staff confirmed the manager was approachable and promoted an open, positive and inclusive atmosphere. The operations manager was responsible for undertaking monthly visits in accordance with regulation 26 of the Care Home Regulations 2001. Records of monthly visits were available for inspection in the home and copies had been forwarded to the commission each month. Records showed that one residents’ meeting had been coordinated since the last visit during February 2007. An annual residents / representative survey had been undertaken and a summary of results for October 2006 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 fell outside the general level of satisfaction (see link to daily life and activities section). Policies and procedures on the Management of Services Users’ Money, Valuables and Financial Affairs had been developed for staff to reference. The Organisation was responsible for issuing invoices to residents or their representatives for fees and a system was in place to enable payments to be made via standing order. The manager acted as an appointee for two of the people living in the home and residents were encouraged to manage their personal finances independently or with support from family members or personal representatives. The manager demonstrated a good awareness of how to safeguard the financial interests of residents. Systems had been established to ensure money was not pooled and written records all financial transactions, receipts and cash balances were maintained. The Annual Quality Assurance Assessment for the service detailed that staff had access to Health and Safety policies and procedures and that test, maintenance and / or associated records were in place for all key areas with the exception of the emergency call and soiled waste disposal. The manager reported that the Organisation has a contract with Knowsley Borough Council for waste disposal and that the certificate was held at head office. Fire log and service records were checked during the visit. Records showed that the fire alarm panel had been checked on a daily basis and a weekly inspection of the means of escape and emergency lighting had been completed. Monthly inspections of the extinguishers and hose reels had also been undertaken but a record of weekly tests of the fire alarm system could Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 26 not be located for the period since 09/02/07. Furthermore, an up to date fire alarm service certificate could not be found. A record of fire drills and training was available for reference. Furthermore, a fire and building risk assessment had been developed since the last visit. Some accidents and / or incidents that had occurred in the house since the last key inspection had not been formally notified and / or without delay to the Commission for Social Care Inspection in accordance with Regulation 37 of the Care Home Regulations 2001. This issue was discussed with the Registered Manager during the visit and has also been raised as an issue of concern with representatives from the Organisations Operational Management team. Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 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 3 X 3 X 3 3 2 2 Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 28 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. The Registered Person must identify a named, suitably qualified, competent and experienced person to oversee the care provided on the dementia care unit at all times. [Previous timescale of 16/02/07 not met] Records of all persons employed in the care home must be kept in Roby House and available for inspection, to provide information on all employees. The Commission for Social Care Inspection must be notified, without delay, of any event in the care home which affects the wellbeing or safety of any service user, so that the welfare of the people living in the care home is monitored and safeguarded. An up-to-date service certificate for the Fire Alarm System must DS0000067698.V348222.R01.S.doc Timescale for action 17/10/07 2. OP27 18 (1) a 17/10/07 3. OP29 17 (2) Schedule 4 37 (1) e&g 17/10/07 4. OP37 17/10/07 5. OP38 23 (4) C 31/10/07 Roby House Care Centre Version 5.2 Page 29 be obtained and a copy forwarded to the Commission, to provide evidence that the fire equipment in the home is being maintained. 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 Guide should be displayed in the home, to provide information for the residents, their representatives and visitors. 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. Assessments should be completed for all residents and kept under regular review, to ensure the changing needs of residents are identified and planned for. Care plans should include more information on how the mental and / or health care needs of residents are to be met. Medication boxes should be dated upon opening, to provide an audit trail 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. The range of activities should be increased for the people living in the home, including residents with dementia / cognitive impairments, to satisfy the recreational needs and interests of all residents. Staff should receive refresher training in the Protection of Vulnerable Adults of Abuse so that they fully understand how to recognise and respond to suspicion or evidence of abuse. Arrangements should be made to ensure the seats in the smoking and main lounge on the dementia care unit are kept clean as a matter of priority, to maintain the comfort DS0000067698.V348222.R01.S.doc Version 5.2 Page 30 2. 3. 4. 5. 6. OP2 OP3 OP7 OP9 OP9 7. OP12 8. OP18 9. OP26 Roby House Care Centre 10. 11. 12. 13. OP27 OP30 OP30 OP38 and dignity of the people living in the home. The lead night carer should be clearly recorded on the rota to improve record keeping. Induction records / checklists should be stored on the staff files, to confirm staff have been inducted in accordance with the Skills for Care – Common Induction Standards. All staff should complete training in Safe Working Practice topics and dementia awareness to develop staff competence. A record of the weekly testing of the Fire Alarm System should be in place to provide evidence that the home is testing the fire equipment on a weekly basis. Roby House Care Centre DS0000067698.V348222.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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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