CARE HOMES FOR OLDER PEOPLE
Roxburgh House Roxburgh Street Bootle Liverpool Merseyside L20 9PS Lead Inspector
Mrs Trish Thomas Unannounced Inspection 10:00 1 August 2006
st 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 Roxburgh House DS0000005417.V295396.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. Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Roxburgh House Address Roxburgh Street Bootle Liverpool Merseyside L20 9PS 0151 525 7547 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) Southern Cross Home Properties Limited Mrs Ruth Jane Baggs Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Service users to include up to 38 OP. The service should employ a suitably qualified and experienced Manager who is registered with the CSCI. The service to accommodate one named resident under pensionable age. 28th February 2006 Date of last inspection Brief Description of the Service: Roxburgh House is a care home for 38 older people. The registered provider is Southern Cross Properties Limited, and the registered manager is Mrs. Ruth Baggs. The home is purpose-built, situated in a quiet residential street, close to main roads, shops and bus routes. Roxburgh House is set in gardens, with a car park at the front of the property. The home is staffed throughout the day and night, and provides personal care, full board, laundry and single accommodation. All residents are registered with a G.P. and supported by staff in accessing health and paramedical services. Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The methods used in the inspection were, discussion with eleven residents, the manager, Mrs. Ruth Baggs and discussion with seven members of staff. Records maintained in the home regarding care, health & safety and staffing were referred to and a sample of quality assurance questionnaires was read. A tour of the grounds and premises was carried out. What the service does well: What has improved since the last inspection?
Requirements from the last inspection relating to assessments and care planning have been addressed. As stated in the relevant section of this report, some requirements regarding the condition of the grounds have not been met. The progress of action taken so far is that the services of a contract gardener have been arranged, and quotations for construction of a bin store have been obtained.
Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 6 Blinds are to be fitted in the bedrooms and work to fit non-slip flooring in bathrooms was in progress during the inspection. What they could do better:
The home is not registered to provide a dementia service, or admit residents who are assessed with dementia. Some of those living in the home have become mentally and physically frail with age. Their presenting behaviour is monitored in care plan reviews, to ensure that the home is meeting their needs. In order to have the skills to support residents, whose needs may be within the early stages of dementia, a recommendation was given in the last inspection, (February 2006), that staff receive relevant training. Two members of staff who were spoken with during this inspection had not received training in dementia. The manager said the training has been arranged. To ensure that the home is meeting residents’ need, and in respect for their diversity, the recommendation regarding training is repeated in this report. During the inspection, two residents made negative comments regarding staff conduct. A letter to the Commission for Social Care Inspection from a visitor to the home expressed similar a concern, and quoted a breach of confidentiality. The manager must ensure that residents are treated respectfully at all times and their confidentiality is maintained, by addressing with all staff during supervision sessions, best practice in the treatment of residents, and the confidentiality of information held about them. The home’s policies and procedure will assist in the process. The menu posted for the day, did not give full details of the content of the main meal. To ensure that residents’ preferences are respected, is advised that the vegetables of the day are made known to residents and an alternative may be chosen if necessary. To ensure that residents who are frail and/or diabetic are well nourished, it is advised that the content of diets for diabetics and those who are frail and have a poor appetite is recorded daily. The building was generally clean and free of odours at the time of inspection. Some areas of the kitchen and food stores were in need of cleaning, the following being observed. The shelves were dusty, the fly-screen door, thresholds and skirting boards and floors were caked in grime. Cleaning materials, (mop, water and bucket) were dirty. To protect the residents against the risk of eating contaminated food, these areas must be maintained to the highest standards of hygiene. In order to ensure that staffing levels are maintained, the manager is advised to recruit the vacant night staff post without delay. Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 7 The fire door from the kitchen to the dining room was wedged open. Two members of staff said that this was done regularly when taking the food to the dining room to be served. For practical reasons, there must be access from the kitchen to the dining room when transporting meals through this door, but there was no meal in progress at the time the door was seen to be wedged open. Staff appeared not to fully appreciate the risks posed by failing to protect residents from smoke inhalation and fire by use of fire doors between areas, such as the kitchen where fires could start, and those used by residents. 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. Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4 The quality of this outcome was good. This judgement has been made using available evidence, including a visit to the service. No prospective resident moves into the home without having his/her needs assessed and being assured these will be met. EVIDENCE: Three care files were read and each resident’s needs had been assessed prior to admission to Roxburgh House by social workers. In addition, staff follow a standard assessment document for each prospective resident referred to the home. The home’s assessments, which were read had been dated and signed by the member of staff who had carried out the assessment. The home is not registered to provide a dementia service, or to admit any individual who is assessed with dementia. Some of those living in the home have become mentally and physically frail with age. Their presenting behaviour is monitored in care plan reviews, to ensure that the home is meeting their needs. In order to have the skills to support residents, whose needs may be within the early stages of dementia/confusion, a recommendation was given in the last inspection, (February 2006) that staff
Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 10 receive relevant training. Two members of staff who were spoken with during the inspection had not received training in dementia. Ruth Baggs, registered manager, said this training has been arranged. As staff had not received the training at the time of this inspection, the recommendation is repeated in this report. Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality of this outcome was adequate. This judgement has been made using available evidence, including a visit to the service. Residents’ health and personal care needs are set out in a plan of care. Not all residents felt their right to privacy and dignity is respected by staff. EVIDENCE: A sample of three care plans was tracked. Individual plans were in place to address personal care and there were risk assessments for pressure care, moving & handling, nutrition and falls. Monthly evaluations had been carried out and action plans adjusted where changes in need had been identified. Support for independence was evident in records of the self-management by residents of some aspects of care, and support as needed for other aspects. Residents’ diversity was acknowledged through records of their beliefs, social preferences and support needs. All residents are registered with a G.P. Medical, district nursing and chiropody/dentistry/optical referrals are recorded on professional visits diaries. There was evidence regular health care input for the residents whose care plans were read. The manager said that the residents receive good support from local G.P.s. For those whose families are unable to
Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 12 attend, staff escort residents for hospital appointments on a voluntary basis on their days off if necessary. A relative’s quality assurance questionnaire dated March 06 stated, “I cannot praise the staff highly enough for their hard work and caring attitude.” There is a system in place for managing residents’ medication including the option for residents to self-medicate, subject to risk assessment. There is a secure storage area for medication and records and management were satisfactory at this time. With regards to respect for privacy and dignity, residents were spoken with regarding staff conduct towards them. The majority of comments were favourable, one residents said, “The staff are terrific”. Two residents had reservations. One said, “It depends who is on duty.” Another resident said that one member of staff is abrupt in manner. The member of staff was not named. A visitor to Roxburgh wrote to the Commission for Social Care Inspection. The letter describes a clear breach of confidentiality by staff regarding a resident’s personal affairs and also expresses concerns about the conduct of some staff. As no names were given, a requirement is made that the manager addresses with all staff during supervision sessions, conduct towards residents and the confidentiality of information held about them. Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 13 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, 15 The quality of this outcome was good. This judgement has been made using available evidence, including a visit to the service. There is ongoing consultation with residents to ensure that lifestyle experienced in the home is in accordance with their preferences and expectations. EVIDENCE: The home employs a part time activities co-ordinator during the afternoon, who arranges daily events for the residents and whose post is supernumerary to care hours. During the afternoon, a group of residents was observed enjoying music and dancing in the lounge. Some of the residents in the lounge, did not choose to take part, others were in their bedrooms. One lady said she prefers her own company, “I don’t like crowds or noise. I have all I need in my room and………(a resident whose bedroom is close by)…visits me every evening.” A relative’s quality assurance questionnaire dated March 06 states, “There is not enough outside contact and trips out. There should be more encouragement to participate whilst respecting residents’ choices to decline.” The manager said that there is ongoing consultation with residents regarding activities through meetings and social profiling. She said some residents don’t want to get involved whilst others enjoy the contact and stimulation. Reference was made to the minutes of the meeting 11/4/06 (attended by the residents and two of their relatives), where it is stated that
Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 14 outings to Knowsley Safari Park, Blackpool and tea dances had been discussed and would be arranged. There are weekly aromatherapy sessions and a calendar of popular seasonal activities, bingo and film shows. Transport for shopping trips and visits to local places of interest are by disabled taxi, for those who have poor mobility. One resident said he goes out to the shopping precinct by taxi or walks to the paper shop. He said, “Friends and family visit all the time. I’ve made new friends in Roxburgh House and I join in whatever is arranged for us”. Residents’ beliefs are recorded on their care plans and religious ministers visit accordingly. Ten of the residents who commented said they have regular visitors and they are made welcome by the staff. A visitor, whose relative had lived in Roxburgh House for some years and has recently died, continues to call in on the home to keep in contact with the residents and staff. The home continues to maintain links with a local football club and the manager is in the process of establishing contact with local schools to arrange visits by the children. Residents said that a children’s dance group had recently visited to entertain them. There were photos of the event, which they said they enjoyed very much. The manager said that alternative menus have been established and the home does everything possible to accommodate residents’ choice and preference. The menu of the day is written on the notice board and alternatives to the main menu are offered accordingly. It was observed that the main meal was stated as, “Mince, potatoes and vegetables”. It is advised that the vegetables of the day are made known to residents so that an alternative may be chosen if necessary. It is also advised that the content of diets for diabetics and those who are frail and who may have a poor appetite is recorded daily. Residents made no adverse comments on food, one saying said, “The food is excellent.” A quality assurance questionnaire (March 06), had requested more vegetables and there were plenty of fresh vegetables and fruit in the store in addition to a choice of cereals and drinks. Good stocks of chilled and frozen foods were also observed. Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The quality of this outcome was good. This judgement has been made using available evidence, including a visit to the service. The home has systems in place to ensure that residents’ complaints are listened to, taken seriously and acted upon, and to protect them from abuse. EVIDENCE: The home has a complaints procedure, which is supplied to residents and their relatives on admission. A copy of the procedure was observed on the notice board in the hallway. The home maintains a record of complaints and any remedial action taken in response to outcomes. The home’s guide on Protection of Vulnerable Adults and the procedure were read. A member of staff on duty, who was asked, said she has recently received the relevant training in adult protection. Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 16 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 The quality of this outcome was adequate. This judgement has been made using available evidence, including a visit to the service. The interior of the building (other than the kitchen) is clean and suitable for the purpose and the manager has taken action to improve standards in the grounds. Conditions in the kitchen pose a risk of cross contamination. EVIDENCE: The building is well maintained and comfortable internally and refurbishment is ongoing. New flooring was being fitted in the bathrooms at the time of this inspection. Aids to mobility and pressure care such as grab rails, hoists and pressure relieving equipment, are provided for residents in accordance with individual assessment. There is a choice of three communal seating areas and a pleasant dining room, which is well presented. Residents said they are comfortable and they appeared relaxed and at ease. One resident said, “I like my bedroom and the en-suite is appreciated.” The home is let down by the condition of the grounds and the first impression presented to visitors. The sign is in need of repair and there is litter in the car park and grassed areas.
Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 17 The residents’ seating area was pleasant and well tended. The building is secure but grounds are not, and the manager said that the noise and nuisance caused by local youths, who visit the grounds at night, are ongoing. She said that in an attempt to make positive links with the local community, she has invited nearby schools to arrange for the children to visit from time to time, to give them more understanding of the need to respect the residents and their home. The manager said the home now has a contract gardener and arrangements have been made for the construction of a bin store to shield the bins from residents and visitors. The home employs domestic staff and supplies protective clothing and training in Control of Substances Hazardous to Health and Infection Control. The building was generally clean and free of odours at the time of inspection. A visit was made to the kitchen where the appliances and surfaces were clean. Areas of the kitchen and food stores were in need of cleaning, the following conditions were observed. The shelves were dusty, the fly-screen door, thresholds and skirting boards and floors were caked in grime. Cleaning materials, (mop and bucket) were dirty. To protect the residents against the risk of eating contaminated food, these areas and cleaning utensils, must be maintained to the highest standards of hygiene. Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The quality of this outcome was good. This judgement has been made using available evidence, including a visit to the service. Staffing levels and ongoing training are maintained to meet the needs of residents and the home’s statement of purpose. EVIDENCE: Reference was made to staff rosters. Staffing levels are maintained in accordance with resident numbers. There were 36 in residence at the time of inspection. On duty were the manager, a deputy manager, four care assistants, two domestics, one kitchen domestic, a cook and a handy person. There was one member of night staff on sick leave and one night staff vacancy (being covered through overtime). The home has a recruitment procedure, which includes advertising posts, interviewing staff and taking up two employers’ references and clearances. All staff are provided with job descriptions and contracts of employment. A sample of three staff files was read and contained information in accordance with Schedule 2 (Care Home Regulations). Criminal Records Bureau and Protection of Vulnerable Adults clearances are obtained for all staff and records held in head office with proof of clearance held in the home. There is an ongoing NVQ and mandatory training programme. The manager said that nine staff have NVQ2 and three staff have NVQ3. Staff on duty said they had received ongoing training including Medication Administration, Food Hygiene, First Aid, NVQ and Protection of Vulnerable Adults. The file of a more
Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 19 recently employed staff member had records of Skills for Care, induction training. Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36, 38 The quality of this outcome was adequate. This judgement has been made using available evidence, including a visit to the service. There are wellmaintained systems in place to ensure the efficient running of the home. A serious health & safety fire risk was observed during the inspection. EVIDENCE: The registered manager, Mrs. Ruth Baggs, holds a management qualification and has several years experience in residential care for older people. Throughout the inspection, she demonstrated a good knowledge of the residents’ needs, best practice in care giving, equal opportunities and diversity. Residents appeared relaxed in her company, and staff said she is approachable and supportive towards them. The home has a quality assurance system and questionnaire from March 06 provided evidence of residents’ and relatives’ views on the home. There was evidence of the action taken to address negative comments, for example :
Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 21 The heating in a bedroom was turned up when a resident said the room was cold and radios were supplied to two residents who asked for them. The manager said that the administrator was absent and she was responsible for personal allowances held on behalf of residents. Records of all such transactions are maintained and are regularly audited by head office. The home does not become involved in residents’ financial affairs and residents’ savings are deposited in personal bank accounts. Staff on duty said they receive regular formal supervision in the form of a confidential one-to-one meeting with a senior member of staff. They said this was “good”, “useful”, “helpful”. The home has a range of staffing policies and procedures in place, including grievance and disciplinary procedures. Health and safety certification was in date. Electrical Safety Certificate 27/6/06 Landlord’s Gas Certificate 6/6/06 Fire Alarm maintenance 3/2/06 Hoisting Equipment March 06 Portable Appliance Test March 06 Legionella 8/4/06 Fire Systems Test 31/7/06 Fire Drill 25/5/06 Fire Doors 25/7/06 Emergency Lights 29/7/06. Radiator covers have been fitted throughout the building to protect residents from burns. There is an access panel on each radiator, which allows the heat to be regulated. The fire door from the kitchen to the dining room was wedged open. Two members of staff said that this was done regularly when taking the food to the dining room to be served. There was no meal in being served at this time. Staff appeared not to fully appreciate the risks posed by failing to protect residents from smoke inhalation and fire by correct use of fire doors between areas, such as the kitchen where fires could start, and those used by residents. Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 22 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
ENVIRONMENT CHOICE OF HOME Standard No Score 1 2 3 4 5 6 Standard No 19 20 21 22 23 24 25 26 Score X X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 1 Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 23 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 OP10 Regulation 12 (4) Requirement The registered person must address in supervision sessions with all staff, the requirement to respect residents’ privacy and dignity in the handling of information, and in their treatment of residents. The registered person must make arrangements for the grounds be made secure from intruders by fitting fencing and gates by the date stated. This requirement is outstanding from the last two inspections and an extended time limit is given. Timescale for action 01/09/06 2. OP19 23 (o) 14/09/06 3. OP19 23 (o) The registered person must 14/09/06 make arrangements for the grounds to be maintained to a good standard by increasing staff hours, or employing the services of a gardener. This requirement is outstanding from the last two inspections. A contract gardener has been employed but the entrance was not well maintained. An extended time limit is given. Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 24 4. OP38 23 (4) The registered person must ensure that residents’ safety is maintained by keeping fire doors closed. The registered person must ensure that staff who use the kitchen receive updates in fire safety instruction. 01/09/06 5. OP38 23 (4) 01/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP4 Good Practice Recommendations The registered person should arrange for care staff to receive training in dementia care. (Outstanding from last inspection). The registered person should ensure that the full content of the daily menu is made known to residents, including which vegetables are to be served. The registered person should arrange for diabetic diets and those who are frail and may have a poor appetite to be recorded daily. The registered person should contact the fire safety officer regarding any risks to access and means of escape, which may be posed by provision of gates/fencing to the grounds. The registered person should recruit the vacant post on nights without delay. 2. 3. OP15 OP15 4. OP19 5. OP27 Roxburgh House DS0000005417.V295396.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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