CARE HOMES FOR OLDER PEOPLE
Roxburgh House 29 Roxburgh Road Westgate-On-Sea Kent CT8 8RX Lead Inspector
Brenda Pears Unannounced Inspection 12th January 2006 10:00 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 Roxburgh House DS0000062994.V273692.R01.S.doc Version 5.0 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.V273692.R01.S.doc Version 5.0 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) 0207 639 1421 Discovery Care Ltd t/a Roxburgh House 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.V273692.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The residents with physical disabilities shall be aged 35 years and over. Date of last inspection Brief Description of the Service: The Home provides care and support for 22 older people including some people with physical disabilities. The Home is a large property that is situated in a small, slightly privately sectioned area, close to local shops and is 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 also ample on street parking available. Roxburgh House DS0000062994.V273692.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken with a focus on the well being, safety and quality of life of service users living in the home. The methods of inspecting the home included speaking to service users, management and staff, sampling records and observations of the building. The first part of this inspection was conducted with the care staff on duty, who displayed a thorough knowledge of service user needs and health care developments. The manager later arrived to participate in this inspection and the proprietor was present during this inspection. The home was found to be clean and bright with a warm and welcoming environment. Service users spoken to at this time stated their needs are met and the staff are caring. One particular service user was experiencing a difficult time following a recent bereavement and stated staff and other service users were being very supportive and understanding. What the service does well:
Independence and mobility are encouraged and promoted with hobbies or activities that are enjoyed being fully supported. Those staying at Roxburgh House for intermediate care are appropriately supported by health care professionals, any specific equipment is obtained and individuals are encouraged to become independent and mobile. The home continues to provide support and care in a safe, relaxed and well maintained environment. The home provides a relaxed and happy environment with service users being at the centre of care provision. Staff support service users to enjoy and be part of the local community. Staff and management maintain contact with family/advocates to keep them fully informed at all times and to forge good relationships. Roxburgh House DS0000062994.V273692.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Roxburgh House DS0000062994.V273692.R01.S.doc Version 5.0 Page 7 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.V273692.R01.S.doc Version 5.0 Page 8 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): 6 Intermediate care is undertaken with correct equipment and appropriate support is provided to maintain and promote independence. EVIDENCE: All intermediate care and rehabilitation is undertaking using appropriate equipment, appropriate support from care staff and healthcare professionals. All care is to ensure a complete recovery and return to independence is achieved. Roxburgh House DS0000062994.V273692.R01.S.doc Version 5.0 Page 9 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, 9 While care plans are developed for each service user, these have not been regularly reviewed, resulting in some care plans not currently being up to date. This does not support service users fully or appropriately. New policies and procedures have been developed to ensure the safe administration of medication, supporting the safety and well being of service users. EVIDENCE: Care plans are currently being reviewed but this process has not yet been fully completed. Regular reviews of all care plans must be carried out to ensure individual support and goals are current and appropriate. A new policy and procedure has been developed for the safe storage and return of duplicated/refused medication. A medicine trolley has been purchased to ensure the appropriate storage of medication and this is in the process of being affixed to the wall in the storage
Roxburgh House DS0000062994.V273692.R01.S.doc Version 5.0 Page 10 area. The medication trolley enables staff to take medication to all areas of the home and support service users. Roxburgh House DS0000062994.V273692.R01.S.doc Version 5.0 Page 11 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 Service user needs are met by the home and family, friends or advocates are encouraged to maintain contact. Choice and autonomy are supported and encouraged. EVIDENCE: Choice and autonomy is supported and encouraged through regular meetings and through informal discussions each day. All aspects of religious, social and leisure activities are fully supported in the home. Service users talked about trips to the local shops and enjoying walks to the beach in the warmer months. Discussions at this time and at previous inspections confirm that staff encourage family and friends to maintain regular contact with service users. Roxburgh House DS0000062994.V273692.R01.S.doc Version 5.0 Page 12 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): 18 A new policy has been developed on protection from abuse, but current and approved training needs to be undertaken by all staff to fully protect and support service users at all times. EVIDENCE: A new policy regarding the protection of service users from abuse has been developed. However, current training is also required in this and other areas, to ensure staff are aware of all areas of abuse and the correct actions to take in such circumstances.. The proprietor stated that training is currently being reviewed to ensure staff do undertake all core training, but adult protection training has not been identified to date. Small amounts of money are retained in a secure area at the request of service users. All receipts are supported by 2 signatures at all times with balances being recorded at each transaction. Roxburgh House DS0000062994.V273692.R01.S.doc Version 5.0 Page 13 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 home was found to be clean and pleasant at the time of the inspection, providing service users with an attractive and comfortable environment. EVIDENCE: The building and service user rooms are regularly maintained in a good state of repair. Rooms are individual and comfortably furnished with bedside lights available. Some rooms have been redecorated with matching linen and curtains enabling service users to feel their room is individual and personal. Roxburgh House DS0000062994.V273692.R01.S.doc Version 5.0 Page 14 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, 30 Some training has been undertaken but there are still areas of essential training that must be addressed to ensure staff skills are current and appropriate to meet service user needs. Staff are caring and consider the dignity of service users but staffing levels must be appropriate, particularly at busier times of the day. EVIDENCE: There were 2 care staff and the cook on duty at this time plus the proprietor. It is noted that the proprietor is regularly in the building and the acting manager is also on duty from 8 to 3pm. While staff stated they feel they are able to meet the needs of service users, attention must be paid to ensure staffing levels are sufficient at all times. Considering there are 4 service users needing assistance when using the bathroom, there must be some delay during the busier periods in the home if the acting manager is not on duty. Discussions regarding training were undertaken with the proprietor at this time. Some training that has been undertaken consists of diabetes and insulin and food hygiene with fire safety and first aid training booked during February 2006. All core skills are to be considered when training is being booked to ensure all care practices are current and appropriate. Roxburgh House DS0000062994.V273692.R01.S.doc Version 5.0 Page 15 Any staff that do not currently have qualifications at NVQ level 2 have been identified and are to start their level 2 studies as soon as possible. Roxburgh House DS0000062994.V273692.R01.S.doc Version 5.0 Page 16 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 registered manager is competent and able to undertake her duties in the home. Service users benefit from a safe environment and well run home and the systems of consultation are good. EVIDENCE: The registered manager has many years of experience with the current service user group and is a suitable and fit person to manage Roxburgh House. Roxburgh House provides a safe, relaxed and well maintained environment. Service users stated they feel happy and well cared for and were seen to be comfortable while enjoying chatting with staff and the inspector.
Roxburgh House DS0000062994.V273692.R01.S.doc Version 5.0 Page 17 Roxburgh House DS0000062994.V273692.R01.S.doc Version 5.0 Page 18 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 3 Roxburgh House DS0000062994.V273692.R01.S.doc Version 5.0 Page 19 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. 2. Standard OP7 OP18 Regulation 14 12 & 13 Requirement All care plans to be regularly reviewed, dated and signed. That approved training regarding abuse and protection is undertaken. - Action plan to CSCI by the date stated. Staff training to be up to date and appropriate in all areas with an ongoing training programme and refresher courses booked as required. - Action plan to CSCI by the date stated. Staffing levels must be appropriate to meet the assessed needs of service users at all times. Timescale for action 31/01/06 31/01/06 3 OP30 18 & 19 31/01/06 4 OP27 18 31/01/06 Roxburgh House DS0000062994.V273692.R01.S.doc Version 5.0 Page 20 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 Roxburgh House DS0000062994.V273692.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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