Inspection on 11/02/08 for Roxburgh House

This inspection was carried out on 11th February 2008.

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

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

Other inspections for this house

Roxburgh House 27/01/09

Roxburgh House 29/08/07

Roxburgh House 03/01/07

Roxburgh House 12/01/06

Roxburgh House 18/08/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Roxburgh House 29 Roxburgh Road Westgate-On-Sea Kent CT8 8RX Lead Inspector Christine Grafton Unannounced Inspection 08:30 11 February 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Roxburgh House DS0000062994.V352857.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 DS0000062994.V352857.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roxburgh House Address 29 Roxburgh Road Westgate-On-Sea Kent CT8 8RX 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) 01843 832022 roxburgh_house@yahoo.co.uk Discovery Care Ltd t/a Roxburgh House Post Vacant Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (16), Physical disability (6) of places Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The residents with physical disabilities shall be aged 35 years and over. 29th August 2007 Date of last inspection Brief Description of the Service: Roxburgh House provides care and support for 22 older people including some people with physical disabilities. The home is a large detached property with accommodation on four floors, including a basement level, ground and first floor that are all accessible via a shaft lift. There are two bedrooms on the second floor and the occupants of those rooms need to be able to walk up one flight of stairs. There are a total of seventeen bedrooms, twelve of which are singles and five doubles. The home is situated in a small, slightly privately sectioned area, close to the railway, local shops and within walking distance of the sea front. The frontage of the home is on level ground and gives access for wheelchair users. This paved frontage area has seating arranged for service users to enjoy during good weather. There is on street parking available. The home is staffed by a manager and team of carers who work a rota that includes two staff on waking duty at night. There are also catering staff and a part-time domestic. The fees are determined according to the needs of the individual. On 11th February 2008, the provider stated that the fees ranged between £312.00 and £569.00 per week. Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. This report takes account of information received since the last inspection, including a visit to the home. The last inspection that took place in August 2007 identified a number of areas for improvement and ten requirements were made where the home was not meeting regulations. This inspection looks at the key standards and those requirements. An unannounced visit took place on 11th February 2008 between 08:30 am and 16:45 pm. The visit included talking to residents, care staff, the acting manager and the registered providers. Some records were looked at and a tour of the home was made. Observations of the home routines, activities and staff practices have also informed judgements made in this report. At the time of the visit there were fifteen residents living at the home. The providers sent us their annual quality assurance assessment by the date it was due, in September 2007, following the last inspection. They also sent us their improvement plan in December 2007. What the service does well: Each resident is treated as an individual and they are encouraged to do what they want and pursue their own interests. They also have opportunities to take part in some group activities within the home. During this inspection, a number of residents were enjoying an exercise activity. A resident said how much this had stimulated them and that the “the exercise lady” comes in every week. Residents’ religious needs are supported and community contact is being developed. Contacts with families, friends and advocates are encouraged. Residents again expressed that the food is good, that they have choices and the meals are well presented. Mealtimes are leisurely occasions, with residents being given plenty of time to eat and chat with each other, making it a pleasurable time. Residents expressed that they are comfortable to approach any of the staff if they have a problem or request. Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 6 Bedrooms are individualised with residents’ own personal possessions, giving them a sense of ownership. The majority of staff have achieved a qualification in care. Residents said that the staff are nice and always helpful. What has improved since the last inspection? The providers have worked hard to address the areas requiring attention identified at the last inspection. The requirements set have now either been met or almost met. Improvements have been made to the way the home assesses a prospective resident to make sure it can meet their needs. The new process provides more information, identifies any risks and shows how the home will care for the person. Care plans now provide most of the information for staff to support residents in a way that meets their needs. Staff are using the care plans and they understand residents’ needs. This helps make sure that residents receive consistent care. The home is being better maintained. The new ‘wet room’ shower facility has been completed to a good standard and provides more choice for residents. More radiator guards have been fitted to reduce the risk of burns. Work is due to start soon to level the floor of the sun lounge to make it more accessible for people using wheelchairs. A new washing machine has been installed and better methods introduced for dealing with soiled items, so that residents and staff are better protected from the risk of spread of infection within the home Staffing levels have been reviewed and some minor changes made so that staff have a bit more time to spend with some residents to take them out once a week. A resident said how much they had enjoyed going to the shops the previous week. New staff now have better induction training and they do not start work at the home until all the necessary recruitment checks have been completed. Several staff have also attended training courses, since the last inspection, to better equip them to do their jobs. Residents can therefore be confident that staff are suitable to care for them and that they receive the relevant training. The providers have improved the way they monitor the service they provide to make sure that residents’ best interests are promoted and protected. They have carried out regular monthly visits to do their own assessment of the service and have acted upon the things identified for improvement. Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 7 The providers have made sure that the environment is safer for people and that staff follow the right health and safety practices. 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. The summary of this inspection report can be made available in other formats on request. Roxburgh House DS0000062994.V352857.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 DS0000062994.V352857.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People considering moving into the home have an assessment, which has been developed since the last inspection, to tell staff enough about them and the support they need. They can therefore be confident that their needs can be met upon moving into the home. People who stay at the home for respite and intermediate care have an assessment and care plan to support them in returning home. EVIDENCE: Since the last inspection, a new assessment document has been developed to meet the requirement set in relation to standard three, that a full assessment of needs is undertaken. There are three sections to the new document, including an initial screening document that provides sufficient information to decide whether the home might be suitable. If it is felt that the home might Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 10 be able to meet the person’s needs, a full assessment is completed. The providers gave an example whereby this screening process had been used in one instance that had highlighted the person had needs the home would not be able to meet and the referral was refused. The documentation used to assess a new resident, admitted since the last inspection, was looked at as part of the case tracking. This provides a good level of information to make a decision about whether the home can meet the person’s needs. The assessment contained all the relevant details, including a social profile, health and personal care needs, mental state and overall dependency. A copy of the care management assessment had also been obtained and all the information had been used to develop a comprehensive care plan. The new resident said that they like the home and that their admission process had been a positive experience. The home provides respite care and the new assessment tool is used to identify the needs of people admitted for short stays. Staff on duty at the time of this visit were competent and knowledgeable about residents’ needs. However, the numbers of staff on duty each shift have not been changed since the last inspection, when staff did not have enough time to promote independence (see Staffing Section). Staffing numbers will therefore need to be closely monitored to take account of residents’ changing needs. Overall, there has been a significant improvement in the outcomes for people choosing this home. Roxburgh House DS0000062994.V352857.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can be confident that the home’s care planning system now provides staff with most of the information needed to meet their needs. Residents are adequately protected by the home’s procedures and practices for managing their medication. EVIDENCE: Since the last inspection, Mrs Isiakpere, registered provider and responsible individual of the company, has been working with the acting manager in reviewing all the care plans. Five care plans were looked at and as well as talking to those residents, we discussed their needs with the acting manager and provider. The care plans cover aspects of daily living, such as: personal hygiene, skin integrity, continence, mobility, any health care issues, Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 12 medication, diet and weight. They contain clear guidelines on how best to assist residents to meet their needs. The provider confirmed that all the care plans are now being kept at the home. At the last inspection, some had been taken off the premises and were not available to look at on the two separate visits that we made. The acting manager and care staff now have the information available to them so that they can provide the right care for residents. Care plans cover a standard format, with specific plans for each need identified. Any other needs identified that do not fit into this format have been recorded separately with the guidance for staff. There were a few elements that were missing, or need to be expanded, such as making sure that each plan is dated, that all the relevant information from the old care plans and assessments is transferred to the new document and expanding the guidance on how to manage individual moving and handling risks. Care plans contain details of contacts with healthcare professionals, such as doctors, community nurses and the chiropodist. Daily records now link to the care plan needs identified. The provider has recognised that some of these records are better than others and has already identified this as a staff training need. One resident spoke about their health care needs and the care plan showed how these complex needs were being managed. The resident described how their choice to keep and administer one of their medicines is supported. A care plan showed how risks associated with diabetes are being managed. The staff actions to reduce the risk of complications were clearly recorded. However, when talking to the resident it became clear that not all staff were following the instructions to record when they witness the insulin being given, together with the dose. Upon further discussion with the acting manager it was clear that this had not had a detrimental effect, but this inconsistency in the record keeping means that signs of any developing complications might be missed. The provider said this would be addressed in the planned staff training. The breakfast time medication round was observed. The senior carer carried this out in a competent way. Medications are supplied in a monitored dosage system and stored in a purpose made trolley that is kept in the staff room. Medication records contain photographs and other useful information to support the correct administration of medication. Medication administration (MAR) sheets had been appropriately signed. Medications that require cold storage are now kept in a separate refrigerator in the staff room. The senior carer and second carer on duty both confirmed they had done medication-training. The acting manager and senior carer have also attended Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 13 specific training on the administration of insulin. We discussed that all staff would benefit from training on this, plus diabetes awareness as a whole. The provider said she would look into this. Residents spoken to felt that staff treat them with respect. Observations of the interactions between residents and staff supported this. Staff had a friendly approach and encouraged residents to participate in the inspection. Conversations with staff confirmed that they are using the care plans and they understand residents’ needs. A resident said they have one regular bath day a week and they knew they could ask for another bath if they wished. Choice of bath times was discussed at the last inspection in relation to staffing levels. The numbers of care staff on duty each shift have remained at two, but at this visit it was seen that the overall resident dependencies were lower than last time. Also, the providers have made some changes to shift patterns to allow key workers an extra hour each week to spend with their ‘key’ individual residents. Therefore there has been an improvement in relation to standard 10. Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 14 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from having opportunities to take part in activities that suit their needs and from being able to keep in contact with families and friends. They are encouraged to lead their lives the way that they want. Residents benefit from the relaxed mealtimes and enjoy their food and the choices available to them. EVIDENCE: During the morning of the visit, a group of residents were seen participating in an exercise activity in the lounge. Residents said that “the exercise lady” comes in every week and they do armchair exercises to music. This activity was seen to be very much a fun activity that also involved use of a colourful parachute. There were approximately eight people joining in, plus others were smiling as they were watching and tapping their hands and feet. Two residents said how much they had enjoyed the activity. Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 15 One resident said, “It stimulates me and makes me feel good. We have a laugh”. Another resident spoke of their enjoyment from reading and said how much they appreciated the mobile library service at the home so that they could choose from a variety of large print books. Religious needs are identified in the care plans. Two clergymen of different denominations regularly visit the home and once a month a communion service is held. A resident said how important their religion is to them and spoke of how they are supported to attend religious services in the local community. The provider stated that they have started arranging an hour extra once a week for a staff member to take a resident out. This will usually be the resident’s key worker, who takes them out in a wheelchair for a walk in the local community, or to visit the shops. This was confirmed in conversation with a resident, who said, “The other day the staff took me out in a wheelchair and we went up the shops – I really enjoyed that”. Residents said that their friends and families are welcomed and spoke about their visitors and of relatives taking them out. Wheelchair users are encouraged to move about independently, but those wishing to access the sun lounge have to negotiate a step, so are reliant on staff assistance. This is currently being addressed with plans to level the floor of the sun lounge. (See Environment section). All residents spoken to at this visit again said that the food is good and that they have a choice at every mealtime. The breakfast time meal was observed and seen to be a leisurely occasion. Residents had a choice of cereals, porridge, toast and a cooked breakfast. Staff were ready to offer assistance in eating where necessary and there was lots of lighthearted chat with each other. Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 16 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their complaints will be listened to and acted on. Residents are adequately protected by the home’s procedures and practices to safeguard them from abuse. EVIDENCE: There have been no complaints received since the last inspection. Residents spoken to were content with their lifestyle at the home. All six residents said they had no complaints and knew who to talk to if they had a concern about anything. They said that all staff are approachable, and knew who was “in charge”. One resident said, “I’m happy here”. Another resident was clearly developing a good relationship with their key worker. This was evident from observing the rapport between them and reading the informative personal profile that shows insight and understanding. The home has a policy and procedure to protect residents from abuse. The staff-training matrix indicates that seven staff have attended adult protection training, including two new staff that completed it in January 2008. Three staff have also attended training on managing challenging behaviours. There have Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 17 been some staff changes since the last inspection and some new staff employed. The providers indicated their aim that all staff will receive adult protection training as part of their development plan. Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22, 25 & 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable environment and benefit from the improved practices to maintain hygiene and prevent the spread of infection within the home. These now provide them with adequate protection from risk of harm. EVIDENCE: The tour of the home indicated that a number of the things identified at the last inspection have been, or are being addressed. The new ‘wet room’ shower facility has been completed and also has a ‘blow and dry’ toilet. The room has been finished to a good standard, with attractive tiling, non-slip flooring, grab rails and shower seat. Hand washing facilities consist of a hand wash dispenser, warm air drier and alcohol gel. This will help Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 19 to ensure that residents are protected from the spread of infection. However, the room was cold and does not have any form of heating, so this will need to be closely monitored and any necessary action taken to ensure residents’ comfort. At the last inspection, a requirement was made for the premises to be assessed by a suitably qualified occupational therapist, to see if any adaptations to the environment and any disability equipment are needed to maximise the independence of people with disabilities. Evidence was seen that the providers have made contact with an occupational therapist for advice, but a visit has not yet been arranged. They made an undertaking to pursue this and the supporting paperwork seen indicates their commitment to this. They have also contacted a health and safety officer for advice about the fitting of ramps. Action has been taken to make the sun lounge more accessible for people in wheelchairs and a contract agreed for work to be started soon to level the floor. It has been decided to make the sun lounge the room specified where residents may smoke. The providers stated that following advice from the health and safety officer, they intend putting in an extractor and sealing the doors to the main lounge to protect those people who do not smoke. The programme to fit radiator guards to reduce the risk of burns is well under way, with sixteen guards fitted throughout the home, including the hallway, corridors and a number of bedrooms. More guards have been ordered and are due to be fitted in order of assessed risk. Since the last inspection, the providers have responded to meet the requirement made to ensure suitable arrangements are in place to prevent infection, toxic conditions and the spread of infection within the home. This has included: installing alcohol hand gel dispensers in every bedroom and bathrooms, plus anti bacterial hand soap dispensers in the bathrooms and paper hand towel dispenser in the laundry room and bathrooms. A new washing machine has been installed in the laundry that is designed to handle soiled articles and has the recommended sluicing cycle. The laundry room was cleaner and tidier than at the last inspection. The providers spoke of their intentions to upgrade the laundry room and fit new units, which they plan to include in their development plan for the coming year. This is important, as there is an area of the wall where the paint has flaked off so that it may not be impervious and the drawer handles are missing on a drawer unit. Also there is no separate hand washbasin so staff have to wash their hands in the sink that is sometimes used to wash dirty articles. The home now has a waste management contract that includes supplies of category E bags and the appropriate clinical waste bin. Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 20 Most areas of the home seen were clean and fresh smelling. There were odours in two bedrooms, where there were particular continence problems. The providers said that care plans are in place to address this, but they indicated that if shampooing of the carpet does not work, they would replace the carpets. The flooring around the bottom of the hoist in the first floor bathroom is coming away and shows the floor boards beneath, so is no longer impervious and needs attention. Overall there was a marked improvement in the standard of environment and actions taken have helped to improve safety for residents. Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 21 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can be confident that they will be supported by competent and qualified staff, and protected by the home’s recruitment procedures. However, they would benefit if the numbers of staff on duty at all times is regularly reviewed, so that additional staff are provided when residents’ needs change. EVIDENCE: At the start of the visit, there were two carers on duty, plus a cleaner and a cook. Both registered providers and the manager arrived later in the morning. The carers on duty were seen going about their work competently. Staff morale was good and there was a relaxed atmosphere in the home throughout the day. This is a significant improvement to the last inspection, when staff morale had been poor, staff were task orientated and saying they did not have enough time to care for residents the way they wanted. All of the residents spoken to on this occasion felt that they receive the support they need from staff and they had confidence in the staff. One resident commented, “staff are okay, sometimes there could be more staff on duty, but Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 22 they’re all very helpful”. Another commented that they like the staff who are very good. Another said, “The staff are very nice but have to work very hard. There are usually enough staff on duty.” The staff rota was discussed with the providers who stated that there have been some staff changes since the last inspection. Three carers, plus the new part-time cook have left. Two new carers have started and one more has been recruited, but they are waiting for the return of the criminal records bureau (CRB) check before the person starts work. A new cook has also been recruited and is waiting for the return of the CRB so that a start date can be agreed. The rota still only shows two carers on duty each shift, plus a cleaner on weekday mornings. The providers stated that the cleaner has got their National Vocational Qualification (NVQ) in care level 2 and can step in for care if needed. Also since the last inspection, key workers have been allocated an extra hour each week to take their resident out. (See Daily Life & Social Activities section). Resident numbers and dependency levels were discussed and it was evident that these had changed since the last inspection. However, the providers have not been using the recommended guidance from the Department of Health to calculate the numbers of staff on duty needs to meet residents’ assessed needs. This is important, as if used regularly it makes sure that adjustments can be made to take account of residents’ changing needs. The layout of the home on three floors was discussed, as the providers stated in their improvement plan that it does not necessitate extra staff on duty for observation purposes. This is because, during the day, most of the residents spend their time in the lounge, except those who prefer to stay in their rooms. However, this can be reflected in the above staffing calculation tool, as the impact of the environment might have an effect on the outcomes for residents if their needs change. Discussion with the providers and viewing the staff training matrix indicates that nine staff have completed their NVQ in care level 2 or above and new staff are enrolled to commence it at the end of their probationary period. Two staff files were checked and seen to contain documentation indicating full recruitment checks are completed before staff start working at the home. The induction records for a new carer had been completed over a four week period. Although this still does not fully meet the Skills for Care specification, it is an improvement since the last inspection, when staff had spoken of completing their induction in one day. Also, since the last inspection a number of staff have completed some short courses and others are planned for February and March. Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 23 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, 32, 33, 36, 37 & 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Improvements in the way the home has been managed since the last inspection have benefited residents, so that their health and safety is protected and their best interests are promoted. EVIDENCE: At the last inspection, management practices did not ensure that residents’ best interests were being safeguarded and promoted. Significant improvements have been made since then, as has already been seen in this report. Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 24 The acting manager has been appointed as manager and now works thirty-five hours a week. The manager works on shift as one of the two carers on duty for the majority of her time, with some supernumerary hours to complete management tasks. She is supported by one of the registered providers (Mr Isiakpere) who is at the home most days and provides support with non-care related management tasks. The responsible individual (Mrs Isiakpere) has care management skills and qualifications and has been providing a lot of support to the manager with care management issues. The manager has an NVQ level 3 in care and is working towards her NVQ level 4 in care and management. The manager and providers indicated that an application for registration would be made by 1st April 2008. Care staff spoken to on this occasion felt supported by the manager and providers. Staff are now receiving formal staff supervision that is being done by the responsible individual. The providers have ensured that regular monthly quality monitoring visits have been made, during which the views of residents and staff have been sought on how the home is being run and the quality of the service provided. Other regular quality monitoring audits have included a kitchen audit and room check lists. Two fire drills have taken place in January and good records of evaluation were seen. Fire doors are closed unless fitted with magnetic closures that allow them to shut in the event of a fire. Since the last inspection, six staff have done first aid training and eleven staff have attended health and safety training. Other courses have been planned during February and March to include: infection control, food hygiene, fire safety and moving and handling. All of these things have improved residents’ safety and the management now need to show that they can sustain the changes they have made and continue to develop the service taking account of residents’ views. Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 25 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 3 2 x 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 2 3 2 X X 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 x x 2 2 2 Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 26 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 OP31 Regulation 8(1) Requirement As the registered provider is an organisation, the individual appointed to manage the home and be in day-to-day charge must make an application to be registered to be in compliance with Section 11 of the Care Standards Act 2000. The manager must be qualified, competent and experienced to run the home to meet its stated aims and objectives. (Previous requirement 29/08/07) Timescale for action 01/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations That all care staff receive training on care planning and DS0000062994.V352857.R01.S.doc Version 5.2 Page 27 Roxburgh House that they are involved in writing and reviewing the care plans. 2 3 4 OP9 OP18 OP25 That all staff attend specific training on diabetes awareness and the administration of insulin. That all staff attend training on the protection of vulnerable adults. To monitor the temperature in the new ‘wet room’ shower facility and to provide suitable heating as may be necessary for residents’ comfort. That the planned upgrade of the laundry room goes ahead and that a separate hand washbasin is added. That the guidance recommended by the Department of Health is used to review staffing levels and calculate the numbers of staff on duty to meet residents’ needs, taking account of the layout of the home. That the home’s induction and foundation training programme meets the Skills for Care specification. 5 6 OP26 OP27 7 OP30 Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Roxburgh House DS0000062994.V352857.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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