CARE HOMES FOR OLDER PEOPLE
Roundham Court Roundham Court 22 Cliff Road Paignton Devon TQ4 6DG Lead Inspector
Judy Cooper Unannounced Inspection 15th February 2006 09:00 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 Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 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. Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Roundham Court Address Roundham Court 22 Cliff Road Paignton Devon TQ4 6DG 01803 528024 01803 528024 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) Mrs Jill Wakeham Mrs Sally Brazier Vacancy Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Females over the age of 60 may be admitted within the OP category Date of last inspection 18th October 2005 Brief Description of the Service: Roundham Court provides care for up to thirty-five older people. It is a large Victorian house, situated in Paignton near the harbour, set in wellmaintained grounds that overlook Torbay. There is a terraced area to the front and side of the home, which allows residents to have excellent views whilst sitting outside. There is also parking and level access to the Home. The Home has 31 single bedrooms, 29 of which are en-suite, 1 double en-suite bedroom and 2 rooms without an en-suite facility, a dining room, large hall area with seating, office, kitchen, laundry, lounge and a conservatory. There is an assisted bathroom and 2 assisted shower rooms. A shaft lift and wide stairs lead to the first floor. Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on a Tuesday between 9.00a.m. and 4.00p.m. Opportunity was taken to tour the premises, examine some records and policies and talk with the acting manager, who was present throughout, and both of the owners, who were present during some of the inspection. The majority of residents were spoken with as well as the staff on duty during the inspection. Staff on duty were also observed, whilst in the course of undertaking their daily duties. Two visitors to the home were also asked for general feedback as to the care they felt their friends/relatives receive at Roundham Court. All of the required core standards were inspected at the last inspection in October 2005. Those inspected on this occasion concentrated on resident welfare on a day to day basis as well as discussing the progress made in relation to the few shortfalls identified at the last inspection. Information from these observations/discussions has been used in the writing of this report. What the service does well:
The home’s environment continues to provide residents with a homely, bright, comfortable, very well maintained environment. Residents, again, were seen to benefit from a “community spirit” within the home and remain encouraged and enabled to socialise with each other, as desired, as well as make individual personal friendships. The management and staff continue to enable residents to maintain links with the nearby local community and visitors are encouraged and welcomed into the home. The result of this is that residents both benefit from companionship with each other, and continue to feel part of the local community. The current staff group, have helped maintain a feeling of stability for the residents, by some long serving staff remaining in post. Staff remain aware of the residents’ individual needs and endeavour to meet them effectively, and the residents themselves confirmed this to be the case.
Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 6 The acting manger stated that he felt it was very important to appoint new staff members only if he considers they have the both right approach to the care required by the residents at the home, and that he feels will fit in with and become part of the already strong staff team. To this end the current staff team work well together and are supportive of one another. The recently appointed new manager has brought a sense of enthusiasm and commitment to the home, which was reflected in the many positive comments received in respect of the manger’s role within the home from both residents and staff spoken with. The Court Group have also recently identified a health and safety officer, from within the current staff team, who will take on responsibility for ensuring that all matters of health and safety are both undertaken and maintained as required across the Court Group homes, including Roundham Court. A monthly inspection will be undertaken and a report will be issued with any shortfalls noted, so that the responsible person/manager of each home can ensure that residents’ health and safety is maintained, at all times, to the highest level. New laundry equipment has recently been provided within the home to ensure that the residents’ laundry needs can be most effectivly met. What has improved since the last inspection?
The registered provider now ensures that the homes’ fire precautions are maintained in accordance with the reccomendations of the local fire and rescue service by ensuring that door wedges are not used to hold open any fire door within the home. The registered provider has increased the care staffing levels within the home to allow sufficient staff to be available to attend to residents’ needs. The acting manager has ensured that those residents, who have requested that they be so, are now involved in the monthly review of their care plan. The acting manager has tried to ensure residents are more involved in the menu planning processes within the home and continues to work on improving this participation. The acting manager has ensured that a satisfactory recruitment process is adhered to, regarding the appointment of any new staff member, including the obtaining of two written references and ensuring an enhanced CRB check is applied for.
Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 7 The registered provider is now ready to submit the acting manager’s application to this Commission, in respect of him undergoing the fit person process with this Commission, which, if successful, will allow him to become the registered manager of the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected on this occasion. EVIDENCE: Standard 3 was met at the last inspection, undertaken in October 2005. The home does not offer intermediate care Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Residents’ health and personal care needs are documented and known. Residents continue to be treated with dignity and respect and their individuality and independence maintained. EVIDENCE: Two random care plans were inspected which related to two residents who had recently been admitted to the home. The care plans were concise and detailed and contained all relevant information appertaining to providing for the individual resident’s care, and included any medical needs of each resident. The care plans had been undertaken with each resident, which was evidenced by the individual residents signing to say that they agreed with the care plan. One of the residents was quite clear as to her involvement with her plan of care whilst the other had chosen to let her family have more involvement in her overall needs and continued residency at the home. The manager and staff also liaise with other professionals as required.
Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 11 Staff receive training from the pharmacist regarding the allocation of medication and only named experienced staff are allowed to administer medication. The home’s records regarding this were inspected and seen to be in order. Several residents self medicate and there were risk assessments in relatio0n to this as well as resident disclaimer forms, which clearly allowed the resident5 to know that they were responsible for the accurate allocation of medication if they chose to do this. It was pleasing to note the sensitive way the manger was dealing with a resident who was showing signs of losing the ability to self medicate safely and how he was closely monitoring the situation to ensure the resident’s welfare and safety was upheld in this aspect. One resident stated that, although her medications were subject to regular change following reviews by a consultant, the staff were always aware of these changes and ensured she received the correct dosage at all times. Resident feedback, overall, was very positive about the care received, with the majority of residents saying that they felt well looked after and that the staff treated them well and were kind to them. They also stated that they felt they were treated with respect and supported to follow their own chosen lifestyle. Two visitors spoken with during the inspection also stated that they found this to be the case. One was the relative of a newly admitted resident and they stated that they felt their relative had been made to feel welcome and was comfortable, which was also verified by the resident. Another visitor sated that she didn’t feel her friend “could be in a better place”. Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 Residents continue to enjoy a varied, yet peaceful life at the home, with visitors encouraged and welcomed. Choices are made available to residents regarding their day to day living and these are respected and upheld by the management and staff. EVIDENCE: Residents continue to be enabled to have contact with the local community as they so desire and there are always several visitors to the home in a course of a day. The routines within the home remain flexible to ensure that residents can choose how they spend their time. Some had chosen to spend their time in the communal areas of the home, whilst others had chosen to spend their time in their rooms. One newly admitted resident said that at the moment, whilst she was settling in, she preferred to spend more time in her room, which the manager and staff were facilitating. In time though she felt she would enjoy visiting the communal areas of the home, but was pleased that she could make this choice as she wished and in her own time. Resident meetings are regularly held, and the senior management of the home visits monthly and always seeks out residents points of view. This allows
Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 13 residents to give their views and thoughts on the day to day running of the home. Although the standard regarding meals was not inspected in full on this occasion it was noted, that following the last inspection, some residents stated that they wished to have greater consultations with the newly appointed home’s chef to ensure that the menus continue to be to their liking. The manager and chef have since offered these meetings and some ideas for changes/variations have been both put forward and acted upon, with some residents stating that there had been some improvement since then and a few stating that they enjoyed all their meals. However, during the inspection, several other residents continued to say that they still felt there was room for improvement. This was discussed with the manger at the time of the inspection and he will again endeavour to provide an anonymous means to allow all residents the opportunity to be very specific about what they currently find to be good and how exactly they feel the menus/ meals provided can be improved upon/changed for the better. Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected on this occasion. EVIDENCE: Although none of these standards were inspected, it should be noted that the CSCI home has not received any complaints, since the last inspection undertaken in October last year. An outstanding complaint at that time made directly to the CSCI, about a discharge of a resident to another home, has now been closed. Although the complaint ultimately remained unresolved, the acting manager and the complainant were both able to put over their points of view which helped facilitate communication from both sides and consequently an understanding of what each party had expected and why certain actions had been taken. Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Roundham Court remains very comfortable, well appointed, clean, warm and well maintained. EVIDENCE: The home presented as very comfortable, clean, pleasant and welcoming. The tour of the building evidenced that the registered provider continues to undertake any required routine upgrading within the home to ensure that an excellent standard of accommodation is provided throughout. One recently vacated room was to have new carpeting, which is the policy of the Court Group when a room becomes vacant and before a new occupant is takes over the room. Bedrooms continue to be personalised as desired and residents can bring in personal items with them if they wish to. The manager, in conjunction with the newly appointed Court Group’s health and safety representative, undertakes all required routine health and safety management including fire awareness, and the home’s fire log book was
Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 16 inspected and seen to be in order. This ensures that residents are protected by living in a safe environment. The owners will provide a suitable lock if requested by a resident, but they are not provided as standard on admission. This is documented within the home’s statement of purpose. The laundering needs of the residents are met appropriately with new improved laundry equipment having recently been provided which ensures that all residents’ laundry needs can be undertaken as effectively as possible. All areas of the home were odour free and staff were noted as observing routine health and safety procedures which helps prevent any unnecessary cross infection within the home. Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 Staff at the home presented well in both appearance and manner and are employed in sufficient numbers to meet the current residents’ needs. The home’s recruitment processes are in order and therefore protect residents. EVIDENCE: On the day of inspection there were thirty two residents in the home, several of which are relatively independent. Since the last inspection the registered provider has increased staffing within the home by an extra carer in the afternoons and at weekends. A senior care staff member spoken with confirmed that this had been appreciated by the staff within the home and helped them to be better able to meet the residents’ needs at all times. On duty on the morning of the inspection, there was the manager and three carers (it should have been four carers but one carer was on annual leave) plus the home’s chef. The home’s daily kitchen assistant has been off for a length period of time, which again has caused a shortfall, but which will be rectified on the return of the post holder. In the meantime all staff were filling in, including the manger and residents continued to receive the care needed, even though the staff felt pushed themselves. In the afternoon there were also four carers including the manager and in the evening three carers from 6.00p.m until 8.00p.m.when the two waking night staff commenced their duties. Residents confirmed that staff are available to help them as necessary. They also stated that the staff group are kind and caring and this was confirmed on
Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 18 the day of inspection by observing staff undertaking their duties. They appeared sensitive,confident, professional and approachable in the way they dealt with residents. Since the last inspection there has been two newly appointed staff members and their recruitment details were seen to be in order. As neither CRB has yet been received back, both are currently working in a supervised capacity. Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,38 The owners remain involved in the day to day running of the home, whilst the day to day management of the home is conducted thoroughly and professionally by the recently appointed manager. Routine health and safety precautions are maintained appropriately, however by not providing regulation of the hot water temperature to residents’ wash hand basins, residents’ remain at risk from scalding. EVIDENCE: Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 20 The manager has been in post for approximately eight months and the registered provider is to commence the registration process to allow him to undergo the fit person process with this Commission. If he is successful in this it will allow him to become the registered manager of the home. The staff and residents again spoke highly of the manager’s ability to manage the home and of his kindness and approachability. A representative from the management of the Court Group continues to undertake a monthly, in depth, quality audit visit where all aspects of the running of the home are examined and reported on, including consultations with the residents. This ensures that all practices within the home are regularly reviewed and that the care continues to be as residents would expect/want. During this inspection both of the owners were available to speak with and it was evident that they, and all senior members of the Court Group, are available to help and support the manager with any queries he may have. Routine health and safety issues are managed appropriately within the home with some requested records being made available and being seen to be up to date, which confirms that residents are cared for in a mostly safe and secure environment. Residents’ hot water, supplying their washbasins, has not yet been regulated to a safe temperature i.e. 43 degrees C, however there are plans in hand to address this, which will eliminate the risk of residents scalding themselves. Hot water is, however, regulated where there is full submersion bathing facilities. A monthly inspection will now be undertaken by the home’ newly appointed health and safety officer and a report will be issued with any shortfalls noted, so that the responsible person/manager of each home can ensure that residents’ health and safety is maintained at all times to the highest level. The health and safety officer was due at Roundham Court at the end of this week to ensure all staff are up to date with the latest guidance issued from the fire authority about what action to take in the event of a fire. Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 21 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 x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 4 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x x x 2 Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 22 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 OP25 Regulation 15 Requirement The registered provider must ensure that all residents hand wash basins are risk assessed and subsequently fitted with valves to provide hot water to 43 degrees Centigrade. (previous timescale of 18/04/06 not yet expired). Timescale for action 18/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Roundham Court DS0000018420.V272186.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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