Inspection on 02/07/07 for Roxburgh House

This inspection was carried out on 2nd July 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Roxburgh House 02/07/08

Roxburgh House 06/06/06

Roxburgh House 23/02/06

Roxburgh House 27/09/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Roxburgh House Warwick Road Kineton Warwickshire CV35 0HW Lead Inspector Lesley Beadsworth Key Unannounced Inspection 2nd July 2007 09:30 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 DS0000064118.V334613.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 DS0000064118.V334613.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roxburgh House Address Warwick Road Kineton Warwickshire CV35 0HW 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) 01926 640296 0871 9940289 Pinnacle Care Ltd Vacant post Care Home 32 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (32) of places Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. An upgrade of the homes décor is planned and implemented within 18 months, (31st October 2006) Stephanie Robson must complete the Registered Managers Award by 31st December 2006 6th June 2006 Date of last inspection Brief Description of the Service: Roxburgh House is in Kineton, which is a village on the ‘bus route to Stratfordupon-Avon and Leamington Spa. The original building dates back over 150 years. Accommodation is provided on two floors and there is a passenger lift. The home has 22 single bedrooms, nine of which have ensuite facilities, and five double rooms one of which has ensuite facilities. The home has gardens to the front and rear and car parking to the side. It is within easy walking distance of local amenities such as churches, doctors’ surgeries, the post office, pubs, banks and shops. The home is registered to provide specialist care to elderly people who have dementia. It does not provide nursing care, but residents have access to the community nursing service, as they would if they were living in their own homes. Fees are currently from £408.00 to £508.00 per week per person. Outings, hairdressing and chiropody services are extra. Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection included a visit to Roxburgh House. As part of the inspection process the registered manager of the home completed and returned a PreInspection Questionnaire containing further information about the home. Surveys provided by us were completed and returned by five visitors and one GP. Some of the information contained within the pre-inspection questionnaire and surveys has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between 09.30am and 07.00pm. What the service does well: Pre-admission assessments are carried out by senior staff to ascertain if a prospective resident’s needs can be met. Records examined and discussion with residents and staff showed that people living at the home have access to health professionals outside of the home, which includes GP, chiropodist, District Nurses and opticians. Preventative measures such as pressure relieving mattresses and cushions were seen to be in use for those residents with a risk of developing pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area). Lunch outings take place with different residents on a weekly basis and other activities include, movement to music, a monthly visit by an organist and local church visits. Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 6 Visitors spoken with said that they were made to feel welcome when they came to the home and residents confirmed this. One relative said that residents are able to have visitors at any time. Visitors and staff seemed to have a comfortable rapport. Staff interacted well with residents and cared for them for in a respectful manner. There are two adjacent and spacious sitting areas and two adjoining dining rooms on the ground floor that have been recently refurbished offering comfortable and attractive surroundings for the people living there. Residents spoken with said that they had choices in their daily lives, for example they could get up and go to bed when they wished. Choices were also available at mealtimes. Residents with limited understanding were shown plated choices to assist them in making a decision about what the wanted to eat. Food likes and dislikes are also recorded in the residents’ care plans. The menus looked at offered varied and nutritious meals. On the day of the visit residents were choosing between minted lamb chops and cottage pie, with a variety of vegetables and a choice of trifle, ice cream or jam and coconut pudding for dessert. Assistance was offered as required in a sensitive and patient manner and the mealtime was a pleasant and social time, taken in two adjoining dining areas that were attractively decorated and had good quality furniture. The home had appropriate policies and procedures for complaints and adult protection to safeguard residents. Five people completing our surveys answered, “yes” to the question, “Do you know how to make a complaint? Four out of five answered, “always” to the question, “Has the care service responded appropriately if you or the person using the service has raised concerns about their care?” The fifth person answered, “usually”. These responses suggest that the home takes complaints seriously and that people can expect to be listened to when they raise concerns. The greater majority of the staff have attended training related to Vulnerable Adults giving them the knowledge required to be able to identify and protect residents from abuse. Over 60 of the care staff have achieved National Vocational Qualification (NVQ) Level 2 in Care and three others are working towards NVQ Level 2 in Care or NVQ Level 3 in Care. This qualification shows that they have been assessed as having the knowledge and skills to do their job. The manager demonstrated a good understanding of the home, staff and residents and of what the strengths and weaknesses of the service were. What has improved since the last inspection? Some requirements from the last inspection had been met. Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 7 • Boxed medication that had been superseded by blister packs had been appropriately returned to the pharmacist. • Dosages were clearly detailed as to how many tablets had been given thereby protecting residents. • All medication in stock was counted and recorded at each time medication administration to maintain a running audit. • The home had a ramp to the garden to enable easier access to the garden for people using a wheelchair. The home had made further improvements in the physical environment. The whole home had been redecorated offering attractive surroundings for the people living at the home. Comments in surveys returned to us regarding improvements included, “It seems that one improvement is already taking place – the building of a conservatory. I think this will enhance the lives of the residents who cannot go out. They can sit and look out at the garden.” “As the inside has all been refurbished it is all looking much improved.” “There have been great improvements since Pinnacle Care took over Roxburgh House and not just structurally but particularly in the cleanliness of the place.” Training that has been undertaken by staff at the home since the last inspection includes, Food Hygiene, First Aid, fire training, infection control, Health and Safety and Moving and Handling. This training enables staff to work safely and meet the need of residents. Those members of staff responsible for medication have also undertaken relevant training. Other non-mandatory training undertaken by some staff includes report writing, Dementia, Conflicting behaviour, Medical Conditions, Stress Management, Risk Assessment, Diabetes and Changes to Food Safety Law. This training gives staff further knowledge and skills to meet the needs of the residents and the service. What they could do better: The home was difficult to find on the first visit, as there is no name or number outside to indicate that it is there. Whilst this is frustrating and irritating for anyone visiting the home it is of more concern that emergency services could have the same difficulty. Not all pre-admission assessment forms had been signed by the assessor and one did not have the signature page. All records need to be signed and dated in order to validate them. Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 8 Needs were not clearly identified in the assessment/care plan form and therefore there was the risk that not all needs would be met. Plans looked at had not been reviewed for several months and therefore there was a risk that they were not up to date, further creating the risk of needs not being met. Risk assessments related to pressure sores, nutrition and falls had not been reviewed in recent months, creating the risk of changes in circumstances not being considered. There were several concerns related to medication that had the potential of putting residents’ well being at risk, as follows• The room where medication is stored is in a vulnerable location and the lock is not totally secure. • Medication is stored in open fronted shelves in the room further reducing medication security. • The controlled drug cabinet is a wooden single cupboard with a hasp and staple with a padlock, which is not adequate for the storage of controlled drugs. • The medication fridge is a domestic one rather than a medication fridge and therefore does not have a lock to kept contents secure. • There are risks to residents involved in the manner in which medication is administered. There was a box of unnamed slippers in the laundry that staff advised were ‘lost property’. This could suggest that there is disrespect for residents’ belongings. The manager advised, when asked about staffing levels, that the post of activity organiser had been made redundant and therefore the activities and pastimes for residents is the responsibility of care staff. This creates the risk of staff trying to meet conflicting needs of residents. Care staff was preparing tea in the kitchen, as there are no cooks designated to be on duty at this time. Three care staff were preparing the meal and one agency care assistant was with the residents, although two of these returned to residents once the manager was aware of the situation. There continue to be some windows that are rotting and therefore in need of replacement. One window in the dining room had a slight leak. The bedroom doors are without any means of identification for residents to be able to find their own room, which would be particularly useful for those with dementia, and whilst the non-functional letterbox, alongside the doorknocker, on each door is attractive, and is aimed to provide some domesticity they could be misleading for those with limited understanding. Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 9 The bedrooms of those residents case tracked were viewed. One ensuite was without sufficient storage for all the toiletries and these were stored on top of the toilet cistern. There were concerns regarding infection control. Whilst it is understood the need and desire to maintain a homely and domestic environment there are risks to health, safety and welfare of people living at the home when preventative measures have not been implemented. These concerns were as follows – • There were some areas of the home that had an offensive odour. Two surveys returned to us also included comments about a smell of urine in the home. • The laundry was quite shabby with some areas of the floor looking as though it was not water-resistant and therefore not easy to keep clean and free from infection. The boiler area of the laundry and the tops of machines were dirty and dusty creating a further potential for infection. • A trolley in the kitchen had very worn shelving with the laminate coating completely worn away in parts and chipboard exposed. This therefore could not be cleaned properly and was a source of cross infection. • The lack of fly screens on open windows and doors in the kitchen adds to the risk of contamination when doors or windows of the kitchen are left open. • Disposable towels were stored on a shelf rather than in a dispenser and thereby were a source of cross infection. The walk-in shower/toilet did not have any soap dispenser or towels for staff or residents to be able to wash their hands. • Some bins used for disposing of paper towels were without lids. • The sluice on the ground floor was used for washing commodes and the pad disposal bin was kept there. The sluice was also being used to store a vacuum cleaner, carpet cleaner, vases and an out of order television, which could become contaminated. • One bathroom had a number of unnamed toiletries in an unlocked bathroom cabinet. Apart from the chance of these being used as communal items and therefore being a cross infection risk, they may be hazardous to residents with limited understanding. There were some concerns related to health and safety – • Most of the fire extinguishers checked had not been serviced since 2003 although one was serviced in 2004. The recently appointed manager attended to this immediately, and confirmed after the visit that this had been carried out. This equipment needs to be services annually to safeguard people living and working at the home in the event of a fire. • Extinguishers, and other items, were being used to keep doors open. If doors are to be kept open this must be by a device that is linked to the fire alarm system, closes automatically when the fire alarm sounds and that meets the approval of the Fire Service. Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 10 • It was noticed that many of the edges of the fire doors did not have intumescent strips to prevent the passage of smoke in the event of a fire and advice regarding this should be sought from the Fire Service. • A cupboard on the first floor which stored COSHH (Control of substances hazardous to health) items was found to be unlocked creating the risk of harm to residents, particularly those with limited understanding. • A television, vacuum cleaner and carpet cleaner were stored in the ground floor sluice. There could be a health and safety risk by storing electrical items where water is regularly in use. • Several residents were walking around the home without footwear creating the risk of injury. Staff were unable to give a reason for this. It was noted that some of the charges for hairdressing on the organisation’s invoices were higher than the hairdressing price list in the home. The registered provider needs to ensure that this is correct and if so that residents and/or their representatives are clear about the reasons for this. 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 DS0000064118.V334613.R01.S.doc Version 5.2 Page 11 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 DS0000064118.V334613.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is adequate. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met but the amount of detail varies. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Pre-admission assessments are carried out by senior staff to ascertain if a prospective resident’s needs can be met. Evidence of these was available in the care files of the three residents that were case tracked as part of this inspection. Although the format included all the appropriate headings the assessments of those residents that had been in the home for some time only held brief information in the areas where there were concerns, other sections of the form being left blank. One person that was case tracked had an obvious problem that caused a visual impairment but this was not referred to in the assessment. There was no information regarding the strengths or abilities of these residents. The pre-admission assessment of a resident who had been admitted to the home the previous day was more detailed and provided Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 13 information required to assess if that person’s needs could be met by the home. The format for pre-admission assessment consists of tick boxes, for example the assessor is asked to mark one of “Fair/poor/very poor” and although there was also a space for comments these had not been completed for the first two care files. This type of format restricts the amount and type of detail recorded. Not all forms were signed by the assessor and one of the three assessment forms did not include the signature sheet. All records need to be signed and dated in order to validate them. The home asks for completion of a ‘Personal Profile’ form prior to admission, either by the prospective resident or their representative, to give the home information about the person’s life history to assist in meeting their social and emotional needs. Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. There are shortfalls in care plans that carry the risk of residents’ needs not being met. Residents have access to health care professionals and are cared for in a respectful manner but there are concerns around the medication process that could mean risks to residents’ well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the three care files looked as part of the case tracking process contained a format that was an assessment/care plan. Needs were not clearly identified in this tool and therefore there was the risk that not all needs would be met. The form was based on questions with multi choice answers and a resulting score. An example was – Question – “The person has an activity/hobby/interest he/she involves his/herself in?” Answer (Multi choice) and scores – Daily = 0; Once/twice a week= 1; Occasionally = 2; Never = 3. Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 15 There was no indication of what the activity/hobby/interest was or, apart from the frequency, to what level it was taken up. One resident case tracked scored 0 on this section and yet the spouse advised that they liked to listen to a particular classical musical radio station all day, music having been a major part of their lives previously. Plans looked at had not been reviewed for several months and therefore there was a risk that they did not include any change in circumstances, further creating the risk of needs not being met. End of life wishes were recorded in the care plans. All care files included risk assessments for tissue viability, falls, moving and handling and nutrition. These had not been reviewed in recent months, once again creating the risk of changes in circumstances not being considered. Records examined and discussion with residents and staff showed that people living at the home have access to health professionals outside of the home, which includes GP, chiropodist, District Nurses and opticians. A district Nurse and GP visited residents on the day of the inspection visit. Preventative measures such as pressure relieving mattresses and cushions were seen to in use for those residents with a risk of developing pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area). Several residents were walking around the home without footwear creating the risk of injury. Staff were unable to give a reason for this. The majority of the residents were otherwise appropriately dressed and appeared well cared for, although some residents who had difficulty communicating looked as though they would benefit from hairdressing. The home has a medication policy. Medication is dispensed in a bubble packed multi dose system and stored in a designated room. Medication of those residents case tracked was looked at in detail with an audit of their tablets carried out and checked with their Medication Administration Record Sheets. These were in good order with the correct number of tablets remaining in relation to those recorded as having been taken. The staff kept a running total of these on the Medication Administration Record Sheets. Receipt and disposal of medication is checked and amounts recorded. However there were several concerns that had the potential of putting residents’ well being at risk, as follows. • The room where medication is stored is in a vulnerable location and the lock is not totally secure. The window to the room was secure. Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 16 • Medication is stored in insecure open fronted shelves in the room. • The controlled drug cabinet is a wooden single cupboard secured only with a hasp and staple with a padlock, which is not adequate for the storage of controlled drugs. • The administration policy is on display in the medication storage room and reads, “Medication must be administered via each individual resident. e.g. dispense into pill pot and take to the resident one at a time then sign to say , taken; refused; destroyed etc. stock balance record to be kept up to date.” This requires for the pot to be taken to the resident from the medication store room to wherever that person is in the building, requiring the member of staff to leave and return locking and unlocking the door on each occasion. This is time consuming, and creates the potential of risk to residents, for example, some residents may receive their medication late, pots could be dropped and medication lost or spoiled, medication could be given to the wrong person. Although the manager said that staff always administrate safely when she is present the procedure also runs the high risk of even less safe practices being carried out when staff are busy, for example by more than one person’s tablets to be taken out at the same time. Staff spoken to said that the morning tablets take almost two hours • The medication fridge is a domestic one rather than a medication fridge and therefore does not have a lock to keep contents secure. Staff interacted well with residents and cared for them for in a respectful manner. Some of the residents receive their own post, either reading it themselves or with the assistance of a member of staff. There are also arrangements for some residents’ mail to be saved for family to collect and attend to. There was a box of unnamed slippers in the laundry that appeared to be ‘lost property’. This could indicate that there is disrespect for residents’ belongings. Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. Residents were only moderately occupied. Visitors were made welcome and their needs considered. Residents had choices over their daily lives. The people living at the home enjoyed the varied and nutritious meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager advised, when asked about staffing levels, that the post of activity organiser had been made redundant and therefore the activities and pastimes for residents is the responsibility of care staff. This creates the risk of staff trying to meet conflicting needs of residents and of activities having a lower profile. For example on the afternoon of the visit a member of staff was spending time with the residents in one of the lounges with music, a sing along and dancing with some of them. Other care staff were preparing tea. Had any resident needed assistance or personal care at this time this care assistant would have been the only person able to provide it. Lunch outings take place with different residents on a weekly basis and other activities include, movement to music, a monthly visit by an organist and local church visits. Special occasions are also celebrated. Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 18 Visitors spoken with said that they were made to feel welcome when they came to the home and residents spoken with confirmed this, one relative saying that residents are able to have visitors at any time. Visitors and staff seemed to have a comfortable rapport. One relative said that lunch was often offered if they were visiting at that time. Discussion with residents showed that they had choices in their daily lives, for example they could get up and go to bed when they wished and visitors commented in surveys returned to us that, “they (residents) can get up when they are ready to do so –they can sit in the lounge, stay in their room, walk about , socialise if they want to.” “they can have their own personal effects in their room.” “It gives the residents home from home environment and freedom to be themselves. They are not restricted in any way.” Choices were also available at mealtimes. Food was served from a heated trolley outside the dining room and residents with limited understanding were shown plated choices for them to make a decision about what the wanted to eat. Food likes and dislikes are also recorded in the residents’ care plans. The menus looked at offered varied and nutritious meals. On the day of the visit residents were choosing between minted lamb chops and cottage pie, with a variety of vegetables and a choice of trifle, ice cream or jam and coconut pudding for dessert. Although fish should have been on the menu this was changed, as the fish had not been delivered. The meal was attractively presented and served. Assistance was offered as required in a sensitive and patient manner and the mealtime was a pleasant and social time, taken in two adjoining dining areas that were attractively decorated and had good quality furniture. One resident did not want any of the choices available and a member of care staff offered several alternatives until the resident chose to have a sandwich. The kitchen was visited and was clean and in good order, having been recently refurbished. However there were no fly screens to the window and the door. Being a warm day the door was fully open and flies were in evidence. This created a source of infection and every effort needs to be made to reduce the risk. There was also a trolley with worn laminate that could not be cleaned sufficiently enough to prevent cross infection. Care staff was preparing tea, as there are no cooks rotered to be on duty at this time. Three care staff were preparing the meal and one agency care assistant was with the residents, although two of these returned to residents once the manager was aware of the situation. Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. The home has appropriate policies and procedures to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been two anonymous complaints made to us about the staffing at the home. Investigations showed that some regulations were not being met but that this had been addressed by the time of the visit to the home. The home has a complaint policy that is included in the Statement of Purpose and displayed in the home for residents and visitors. One relative said in a survey that, “there is a printed notice giving details of how to make a complaint – if necessary – on the notice board in the corridor.” “the manager and staff are always available if I need to discuss anything with them, and are sympathetic to any questions raised.” Five people completing our surveys answered, “yes” to the question, “Do you know how to make a complaint? Four out of five answered “always” to the question, “Has the care service responded appropriately if you or the person Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 20 using the service has raised concerns about their care?” The fifth person answered, “usually”. These responses suggest that the home takes complaints seriously and that people can expect to be listened to when they raise concerns. The manager advised that there are also resident/relative meetings where there is an opportunity to raise any concerns. There had been one Vulnerable Adult referral since the last key inspection related to medication administration but this was addressed by the introduction of the monitored dose system. The greater majority of the staff have attended training related to Vulnerable Adults giving them the knowledge required to be able to identify and protect residents from abuse. Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is adequate. The home offers the people living there surroundings that look attractive and clean, but the offensive odours impact on the comfort and hygiene for residents. There are risks to the health and safety of the people living and working at the home in the event of a fire. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is difficult to find on the first visit, as there is no name or number outside to indicate that it is there. Whilst this is frustrating and irritating for anyone visiting the home it is of more concern that emergency services could have the same difficulty. It is understood why care home signs can be considered stigmatising or not domestic in nature but as was suggested at the previous inspection a small tasteful sign, as many houses have, would assist finding the home. Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 22 An extension had begun to be built at the time of the visit. This was not infringing on the indoors for residents. The manager advised that this would include a sun lounge and four extra bedrooms. Those people with whom this was discussed made positive comments about the improvements the extension would bring, and several people said how much the environment had improved since the home belonged to the present organisation. Comments in surveys returned to us included, “It seems that one improvement is already taking place – the building of a conservatory. I think this will enhance the lives of the residents who cannot go out. They can sit and look out at the garden.” “As the inside has all been refurbished it is all looking much improved.” “There have been great improvements since Pinnacle Care took over Roxburgh House and not just structurally but particularly in the cleanliness of the place.” Entrance to the home is at the rear of the property and this is where the building contractors are currently working. A tour of the home was made. The pre-inspection questionnaire and the manager advised that the home had been completely redecorated and residents and visitors spoken with were very pleased with the results. There had also been a new passenger lift installed in a different locality in the home giving all residents access to all parts of the home. The old lift was no longer in use. Doors to the old lift are still in place and whilst locked and safe they may be confusing for people living at the home. There is wheelchair access to the garden by means of a ramp at the end of the lounge area. There are two adjacent and spacious sitting areas and two adjoining dining rooms on the ground floor that have been recently refurbished offering comfortable and attractive surroundings for the people living there. The office, laundry and medication rooms are also on this floor. The manager advised that the floor covering is relatively new in the communal areas but that in the lounges and dining rooms had a busy pattern and this is not considered appropriate for people with dementia. There continue to be some windows that are rotting and therefore in need of replacement. One window in the dining room had a slight leak. A cupboard on the first floor which stored COSHH (Control of substances hazardous to health) items was found to be unlocked creating the risk of harm to residents, particularly those with limited understanding. The bedroom doors are without any means of identification for residents to be able to find their own room, which would be particularly useful for those with Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 23 dementia, and whilst the non-functional letterbox, alongside the doorknocker, on each door, was attractive and aimed to provide some domesticity they could be misleading for those with limited understanding. There was little other signage in the home in order to assist those residents with dementia. The home has 22 single bedrooms, nine of which have ensuite facilities, and five double rooms one of which has ensuite facilities. The bedrooms of those residents case tracked were viewed and had been personalised by the occupant or their relatives, with pictures, ornaments, plants and radios and televisions. One ensuite was without sufficient storage for toiletries and many items were stored on top of the toilet cistern. Another bedroom had a faint smell of urine, although it had been recently redecorated and carpeted. The room was clean apart from the radiator guard, which was very dirty. The room was also quite small with space for walking at the end of and by the side of the bed. This area of the carpet looked very well trodden, causing a new carpet to look quite old. Apart from the bedroom already mentioned there was an offensive odour in and around the main office. The manager advised that this had been caused by inappropriate voiding of urine by a resident and despite cleaning the office carpet they had been unable to remove the odour. Two surveys returned to us by visitors also commented on the smell of urine in the home. The organisation has a policy that covers basic infection control related to hand washing and the use of protective clothing. There were concerns regarding infection control. Whilst it is understood the need and desire to maintain a homely and domestic environment there are some risks to health, safety and welfare of people living at the home when preventative measures have not been implemented. The laundry area had the appropriate machines that had suitable programmes. This room was quite shabby with some areas of the floor looking as though it was not water-resistant and therefore not easy to keep clean and free from infection. The room housed the boiler in an open alcove and this area and the tops of the washing machine and tumble drier were dirty and very dusty. This would create a source of infection. A further risk of cross infection was created by the absence of disposable towels for hand washing purposes. A trolley in the kitchen had very worn shelves with the laminate coating completely worn away in parts and chipboard exposed. This therefore could not be cleaned properly and was a source of cross infection, particularly as it was used for transporting food. The lack of fly screens on open windows and doors in the kitchen adds to the risk of contamination. The kitchen door was wide open when tea was being prepared. Some communal hand washing areas had soap dispensers and disposable towels but the towels were stored unwrapped on a shelf rather than in a Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 24 dispenser and thereby were a source of cross infection, both from airborne germs and from people contaminating the pack when taking a towel. The walkin shower/toilet did not have any soap dispenser or towels for staff or residents to be able to wash their hands. Some bins used for disposing of paper towels were without lids, also creating a risk of cross infection. Protective clothing was readily available, aprons in sluices and gloves in toilets, supplied for staff to use in order to minimise cross infection. However the sluice on the ground floor was said by staff to be used for washing commodes and the pad disposal bin was kept there. The sluice was also being used to store a vacuum cleaner, carpet cleaner, vases and an out of order television. There is therefore the risk of contamination and cross infection, particularly from spillage and airborne germs from commodes and pads, onto the stored items, including the aprons used to minimise cross infection. There could also be a health and safety risk by storing electrical items where water is regularly in use. One bathroom had a number of unnamed toiletries in an unlocked bathroom cabinet. Apart from the chance of these being used as communal items and therefore being a cross infection risk, they may be hazardous to residents with limited understanding. Most of the fire extinguishers checked had not been serviced since 2003 with one serviced in 2004. The manager attended to this immediately, and confirmed after the visit that a full service had been carried out. However this equipment needs to be serviced annually to safeguard people living and working at the home in the event of a fire. Furthermore extinguishers, and other items, were being used to keep doors open. If doors are to be kept open this must be by a device that is linked to the fire alarm system, closes automatically when the fire alarm sounds and that meets the approval of the Fire Service. Evidence of any approval for alternative ways of keeping doors open must be made available for inspection. It was noticed that many of the edges of the fire doors did not have intumescent strips to prevent the passage of smoke in the event of a fire and advice regarding this should be sought from the Fire Service. The home has a smoking policy that was implemented this month and that enables residents to smoke in a designated area. The organisation has decided that this will be the resident’s bedroom. This increases the need for adequate fire prevention. Signage was in place denoting that staff and visitors could not smoke on the premises. Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. There are sufficient care staff available to meet the needs of the residents but the low numbers of ancillary staff may have an impact on this. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager provided rotas at the time of the visit and with the pre-inspection questionnaire in April. There were two anonymous complaints made to us before the inspection visit regarding there being insufficient staff on duty. Discussion with the manager and examination of rotas worked showed that whilst there had been a period of time when there were staff shortages this had been addressed by the use of agency staff. The names of the agency staff need to be recorded on the rotas so that it clear who is on duty. However there continued, on some occasions, to be only three care staff in the home in addition to the person in charge and a student on work placement. There is a domestic assistant on the rota but on some days is recorded as being a care assistant. There is no cook available after 2pm. On the day of the visit care staff were working in the kitchen preparing and cooking tea. They also carried out laundry tasks throughout the day. This is all time taken away from giving direct care and attention to the residents. As there are 26 out the 29 residents with dementia or who have limited understanding, 25 with continence needs and at least two residents with high physical dependency, further consideration Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 26 should be given to ensure that there are sufficient staff available to meet the needs of the residents at all times. Over 60 of the care staff have achieved National Vocational Qualification (NVQ) Level 2 in Care and three others are working towards NVQ Level 2 in Care or NVQ Level 3 in Care. This qualification shows that staff have been assessed as having the knowledge and skills to do their job. Three staff files were looked at. One of these was of a recently appointed member of staff and all paperwork required and evidence of induction training was included, demonstrating suitable recruitment procedures were in place in order to ensure that inappropriate people are not employed. The other files were belonging to members of staff who had been at the home for many years when old recruitment methods were in use. All three files showed evidence that satisfactory Criminal Records Bureau disclosure had been received, further safeguarding residents from being cared for by inappropriate employees. Training that has been undertaken by staff at the home since the last inspection includes, Food Hygiene, First Aid, fire training, infection control, Health and Safety and Moving and Handling. This training enables staff to work safely and meet the need of residents. Those members of staff responsible for medication have also undertaken relevant training. Other non-mandatory training undertaken by some staff includes report writing, Dementia, Conflicting behaviour, Medical Conditions, Stress Management, Risk Assessment, Diabetes and Changes to Food Safety Law. This training gives staff further knowledge and skills to meet the needs of the residents and the service. Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. The manager does not yet have the appropriate qualification or registration. There are shortfalls in health and safety practice thereby not protecting people living and working at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The person managing the home had only been in post for four weeks but had worked for the organisation for four and a half years. She had almost completed the Registered Managers Award. The manager is in the process of applying for registration with us. Since the time of her appointment she has had to act as care assistant on many occasions due to staff shortages, although is meant to be supernumerary Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 28 to the rota. However she demonstrated a good understanding of the home, staff and residents and of what the strengths and weaknesses of the service were. There is no administrative assistant at the home and therefore she attends to this. Two deputy managers, one of whom has been at the home a long time and the other who was newly appointed, support her. The manager said that they balance each other well to meet the needs of the service. There was further senior support from three team leaders. Quality Assurance audits are carried out by the organisation but these were not inspected on this occasion. Regulation 26 visits are made by the organisation and reports are forwarded to us and a copy kept in the home. There is no money or record of transactions kept in the home on behalf of residents. Any costs incurred for hairdressing or chiropody for example are invoiced to the organisation who then invoice the residents or their representative. Transactions for recent weeks for the residents who were case tracked were forwarded via head office later for inspection. It was noted that some of the charges for hairdressing on the organisation’s invoices were higher than the hairdressing price list in the home. The registered provider needs to ensure that this is correct and if so that residents and/or their representatives are clear about the reasons. There were several concerns related to infection control and fire safety that are discussed in more detail in the Environment section of this report. There were also risks to the welfare of residents due to some medication practices that are detailed in the Health and Personal Care section of this report. Fire alarm checks, drills and training were satisfactory and there was evidence that other servicing and maintenance of equipment such as hoists and other lifting equipment, central heating and call bell system, was in order. Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 29 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 2 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 2 X 3 X 3 X X 2 Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? 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 OP7 Regulation 14,15 Requirement Care plans must be reviewed at least monthly and as circumstances change. This will ensure that residents’ needs are identified and met. The previous timescale of 01/04/07 was not met. Care plans must clearly identify in sufficient detail the care required. This will ensure that all residents’ needs are met. Risk assessments must be reviewed and kept up to date. This will ensure the welfare, health and safety of the residents is protected. Medication must be administered and stored in a safe and efficient manner. This will ensure that residents’ welfare and the security of the medication are protected The home must provide suitable and appropriate signage. This will ensure that the relevant needs of residents with dementia are met. The home must be free of offensive odour. This will DS0000064118.V334613.R01.S.doc Timescale for action 15/08/07 2. OP8 14 15/08/07 3. OP9 13(2) 15/08/07 4. OP22 23(2) 30/08/07 5. OP26 16(2)(k) 15/08/07 Roxburgh House Version 5.2 Page 31 6. OP26 16 7. OP27 18 8. OP35 13 9. OP38 13 10. OP38 23 improve the hygiene of the premises and the comfort of people living at the home. The home must have adequate infection control measures in place. This will protect the welfare of residents and staff. The home must have at all times sufficient staff in both number and skill mix that are appropriate to needs of the service. This will ensure that the needs of the residents are met. Residents and/or their representative must be made aware of the details of any purchase charges made to them. This will ensure that residents’ finances are safeguarded. Substances hazardous to health must be stored in a secure location. This will ensure that residents’ are safeguarded. Appropriate fire safety measures must be in place. This will protect the health and safety of the people living and working in the home. The previous timescale of 01/04/07 was not met. 30/08/07 30/08/07 15/08/07 15/08/07 30/08/07 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. 2. Refer to Standard OP3 OP9 Good Practice Recommendations Pre-admission assessments and other records should be signed and dated in order to validate them. Medication must be administered in an efficient and timely DS0000064118.V334613.R01.S.doc Version 5.2 Page 32 Roxburgh House 3. 4. 5. 6. 7. OP10 OP19 OP19 OP24 OP38 manner. This will ensure that residents’ welfare is protected. The home should implement a system that protects residents’ belongings so that they are returned to them. Rotting and leaking window frames should be replaced. The name of the home should be displayed, to help visitors, and emergency services to locate the service. The home should provide residents with adequate storage in their private accommodation. The home should identify the reason when residents are without footwear and take action to minimise the risk of injury. Roxburgh House DS0000064118.V334613.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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