Inspection on 02/07/08 for Roxburgh House

This inspection was carried out on 2nd July 2008.

CSCI found this care home to be providing an Adequate service.

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 02/07/07

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 30/01/2009.

CARE HOMES FOR OLDER PEOPLE Roxburgh House Warwick Road Kineton Warwickshire CV35 0HW Lead Inspector Lesley Beadsworth 2 nd Unannounced Inspection July and 30th July 2008 11:50 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 DS0000064118.V367395.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.V367395.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 wolston@pinnaclecare.co.uk Pinnacle Care Ltd Manager post vacant 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.V367395.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. An upgrade of the homes décor is planned and implemented within 18 months, (31st October 2006) 2nd July 2007 Date of last inspection Brief Description of the Service: Roxburgh House is in Kineton, which is a village on the public transport route to Stratford-upon-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. An extension has recently been added but is not yet registered or in use. 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 quoted in the Service User Guide to be £518.00 but this varies if the resident is referred by social services or continuing care. Outings, hairdressing and chiropody services are extra to this. Roxburgh House DS0000064118.V367395.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 the people who use this service experience adequate quality outcomes. The inspection included a visit to Roxburgh House. As part of the inspection process the manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), although this was not returned by the initial date requested. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers and is a legal requirement. It informs us about how providers are meeting outcomes for people using their service. Information contained within this, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. The pharmacy inspector visited the home prior to the link inspector to assess the medication system. 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 over two visits between 11:50 and 8pm on 2nd July and between 4pm and 5.30pm on 30th July. What the service does well: Residents had care plans that give care staff the information they require to meet their individual needs. Audits of medication by the pharmacy inspector indicated that the medicines had been administered prescribed by the GP. Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 6 Residents are given choices about meals, when they go to bed and get up and whether to join activities. The food looked very well presented and tasty. Two residents told us that the food was always very good. Staff were observed interacting with residents while they served meals or assisted them to eat. Terms of preferred address is recorded and used by staff. Residents were cared for in a respectful manner ensuring that their dignity and self-esteem were maintained. The majority of the staff had attended recent Protection of Vulnerable Adults (safeguarding) training. All recruitment practices safeguard residents from the employment of unsuitable people. The financial interests of residents are safeguarded. The hairdressing room was located off the main lounge and is well planned, providing plenty of space for wheelchairs and walking aids. The bedrooms were clean, comfortable, and free from unpleasant smells and personalised with the occupants’ belongings. 75 of the care staff had achieved National Vocational Qualification (NVQ) Level 2 in Care. This shows that staff have been assessed as competent to carry out their role. The home has a Quality Assurance system. This indicates that the home is monitoring the service in order to enable growth and improvement. What has improved since the last inspection? The Statement of Purpose had been updated to include recent information for residents and prospective residents. This included information to explain the difference between price list charges for hairdressing and chiropody and the amount invoiced by the organisation. Care plan formats had been revised and were easier to access than previously. The care plans were the responsibility of the resident’s key worker (known at Roxburgh as ‘best friend’). The home was free of unpleasant smells due to the increase in staff at the home since the last inspection. Fire extinguishers had been serviced. Cutlery was being stored hygienically. Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 7 All staff have received training in the safe handling of medicines and training related to health and safety issues. All residents seen were wearing appropriate footwear. The building work had been completed and an attractively laid out enclosed garden area had been provided between the extension and the car park. Residents were seen to be using this during the visits and the paths provide good walkways for them. A water feature added sensory interest. The laundry was much better organised and clean. Suitable laundry equipment was provided and laundry was drying appropriately. Training undertaken in the past year included that related to safeguarding adults (protection of vulnerable adults), First Aid, fire safety, infection control, moving and handling and health and safety. What they could do better: There were some differences between information in the Statement of Purpose and the Service User Guide; this needs to be addressed to avoid confusion. There were two copies of the same care plans for each resident – one kept in the office and a second kept in the bedrooms. There were some difference in the information and this may cause confusion. Night care has not been properly assessed resulting in the same care and actions being taken by staff. This does not ensure individual care. Care plans had not been reviewed monthly in a consistent manner. Not reviewing at least monthly has the potential for changes not being made in the care plans and as a result needs not being met. Concern was raised at the practice of medication being carried around the home in open pots as there was nowhere for the staff to secure these medicines in the event of the emergency. The controlled drugs cabinet did not comply with the misuse of Drugs Regulations 1973. Controlled drug entries were recorded in the register but not all entries were witnessed by a second person, which is required. The medicine charts were printed by the home and there is no system to check the prescription before they are dispensed by the chemist or to check the medicines received into the home against the prescription. Medication reviews are undertaken by the GP but many had not been documented in the records. Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 8 Medication administration took a long time after lunch, this needs to be assessed and actions taken to improve this. There were differing pieces of information in the Service User Guide and Statement of Purpose with regard to, for example visiting, these should be revised so that both documents contain the same information. The home does not have an activity organiser or an activity programme, depending mainly on care staff to provide the activity to give the residents the stimulation and occupation that they require. Due to the dependency levels of the people living at the home and the number of care and ancillary staff available this is not practicable. Fresh food was being delivered to the home after lunch and involved several trips through the lounge to the kitchen as the kitchen was no longer accessible from the rear of the kitchen due to the new extension. Apart from the health and safety aspect this seemed disruptive to people living at the home. Some of the clothing in wardrobes was creased, did not look well cared for and was incorrectly named or not named at all and therefore relied on staff to remember to whom they belonged. This is an unreliable way of ensuring that people have their own clothes returned to them and fails to show a respect for their belongings. A risk assessment needs to be in place, and any appropriate action taken, for the battery operated air freshener in the lounge as this can affect those people with breathing problems. A small room on the first floor that had originally been a second office was being used as a storeroom and some archived paperwork was stored there. This room needs to be locked for reasons of confidentiality and health and safety. A cupboard in the hairdressing room stored large bottles of toiletries, which implies that these were for communal use. Apart from this not being personal to individuals’ wishes there is a risk of cross infection when toiletries are shared. One of the bedrooms viewed had pretty, pink lampshades that had been provided, along with several other identical ones, by the organisation for specific rooms. There was no evidence that the occupants of these rooms had been consulted or given a choice. Bedroom door signs (name of occupant) had been handwritten and pasted to the doors as residents had removed previous versions that had been made by staff. These were not attractive or easy to read. Whilst there were some signs on toilets and bathrooms there were no directional signs for the people living at the home for example to direct them to the toilets, bathrooms, lounge or Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 9 dining room. Purpose made signage that is permanently fixed should be provided to assist people with limited understanding. The doors to the original lift, which is no longer in use, serviced or inspected, need to be secured. This lift must not be used, even in an emergency, unless there is a lift inspection certificate to show that it is safe. The organisation continues not to use disposable towels and have introduced a ‘single use’ flannel sized towel that are meant to be put to the laundry after use. The flannels are kept at the side of the washbasins. This practice is difficult and time consuming to maintain and it is likely that there is still a high risk of contamination. One resident continues to use the kitchen on occasions. Residents should not be allowed into the kitchen unless they wash their hands and wear suitable clothing to protect food from contamination. This includes even if food is not being prepared, as precautions need to be taken to stop contamination of surfaces, especially where the residents have dementia and are incontinent. Fly screens continue not to be in use in the kitchen. Staff have instructions to close the windows and doors whilst food is being prepared these are open at other times there remains a high risk of work surfaces, equipment and utensils becoming contaminated by flying insects. The skirting boards edges of the kitchen floor were very dirty and were in need of a deep clean to remove the build up of dirt. The manager said that plans were in place for this but in the meantime creates a source of infection. The kitchen door was propped open, which would prevent it from closing automatically in the event of a fire and this and the adjacent lounge door were without intumescent strips. These strips prevent the passage of smoke by sealing the door edges in the event of a fire. However the manager advised that these were on order for all the doors in the home and were due to be fitted. The broken floor tiles in the laundry were in need of repair or replacement to ensure that the floor can be easily cleaned and infection control is maintained. Considering the size of the home, the number of residents and the level of support needed by them there seemed to be insufficient staff in the home at any given time. Lack of care of laundry and limited activity and occupation available to residents would further indicate that this was the case. Whilst the majority of staff had undertaken training related to care of people with dementia there were only two members of staff that had undertaken this since 2004 and two members of staff had not had relevant training since 1999. This training needs updating particularly considering that the home specialises in caring for this client group. Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 10 Although in post for over a year the manager was not registered with us. The application for registration began following this inspection. 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.V367395.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.V367395.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): 1,3 Quality in this outcome area is adequate. Information required to make a decision about choice of home is not always accurate. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Service User Guide had been revised in order to incorporate the reason for the difference between the cost of hairdressing and chiropody as given to the resident and as charged by the organisation to whoever is responsible for the resident’s finances. It states, “For all charges made by the visiting Chiropodist and Hairdresser there will be a £1.00 levy charge to cover costs such as water, electric and laundering of towels”. The organisation should consider if these extra charges are appropriate as residents are already paying for these utilities/facilities in their fees. The manager informed us before this report was made public that this has now been reassessed and the £1.00 charge has been removed. Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 13 The Statement of Purpose and Service User Guide documents had been devised by the organisation and were comprehensive. They provided prospective and current residents with information about the home and the services provided. However there were some differences between statements in these documents and the practices in the home including training undertaken by staff related to the needs that can be met by the home, opportunities for pursuing past hobbies and activities and the use of signage for people with dementia. These are discussed in the appropriate sections of this report. Whilst the Statement of Purpose gave the qualifications of the registered provider and the expected qualification and experience of any manager of Roxburgh House it did not give the qualifications and experience of the current manager. Three care files were looked as part of the case tracking. All files contained a pre admission assessment of each person’s needs and abilities. These were carried out using a format that included all the necessary headings and sufficient detail to decide if the home could meet the person’s needs or not. A care plan had been devised from these assessments. Roxburgh House DS0000064118.V367395.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 some care plans and the regularity of reviews 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. The medicine management was good but a new system must be installed for taking the medicines to the residents in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each care file looked as part of the case tracking process included a care plan based on the assessment of need. A new format was in use, which made it easier to access the information. The plans were of sufficient detail for care staff to have the information they required to meet the needs of the person and reflected the needs identified in the assessment. Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 15 There were two sets of care plans for each resident – one kept in the office and a second kept in the bedrooms. Both versions contained similar information, but there were areas that were different. One copy of the care plans was copy kept in the bedrooms and had been introduced by the registered provider so that night staff could show that they had carried out routine checks by completing the daily records in the residents’ bedrooms. The manager advised that the majority of residents were to be checked every two hours during the night. Residents need to be assessed individually as to how often they are checked and the purpose of this to ensure that they receive person centred care. Care plans had not been reviewed monthly. Although some revisions had been made in the care plans as changes had occurred, others had not been recorded. It was noted that in one part of the Statement of Purpose there is reference to care plans being reviewed at six weekly intervals and in another part to them being reviewed at three monthly intervals. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician and chiropodist being identified in care files looked at. Records for falls, pressure areas, and weight, were in place within the files looked at. Completed risk assessments for nutritional risk screening and a manual handling risk assessment were also in place. These would help to minimise any risk. A care plan of a resident with a minor pressure sore (a break in the skin due to pressure, which reduces the blood supply to the area) was looked at and appropriate detail was included giving instruction of the care required. The district nurse had been involved in the treatment of this and the appropriate pressure relieving equipment provided. The pharmacist inspection took place on the 18th July 2008 and lasted just under three hours. Four residents medicines were looked at together with the care plans and daily records. One member of staff was spoken with during the inspection and all feedback was given to the manager and area manager. All the medicines were stored in open shelves in the medication room. Staff prepared the medication for each resident and then took to him or her in open pots each resident in the home. Concern was raised at this practice as there was nowhere for the staff to secure these medicines in the event of the emergency. The drug round was completed by the start of the inspection at 09:30 despite the lengthy procedure they had in place and the number of residents in the home. Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 16 Medication was being administered following lunch. Considering that there were far less people requiring medication at lunch than at breakfast and in the evenings, this took approximately three quarters of an hour, with the manager going back and forth through the lounge carrying medication for one person at a time. The controlled drugs cabinet did not comply with the misuse of drugs regulations 1973 and so the controlled drugs were not safely stored. All controlled drug entries were recorded in the register but not all entries were witnessed. The medicine charts were printed by the home. Currently they do not have a system to check the prescription before they are sent to the pharmacist for dispensing or to check the medicines received into the home against a copy of the prescription. The majority of the medicines were dispensed in a “monitored dosage system” which were provided by the dispensing doctors on a weekly basis. The home has a lengthy process of recording what they have received and did not record this information on the current medicine chart. Audits indicated that the medicines had been administered as dispensed. The care assistant and manager both had a good knowledge of the clinical conditions and what the medicines were for but the care plans did not record this. For example one resident was diabetic but the care plans did not support any special diet that would be required. One antifungal cream had been prescribed but it was unclear why the doctor had been called out in the first place. Another resident was prone to urinary tract infections resulting in seizures. There was no care plans in place to prevent possible urinary tract infections. One resident could not communicate verbally if they were in pain. The care assistant spoken with was able to tell us how they knew if they needed additional pain relieving medicines but again this information had not been recorded. Medication reviews are undertaken by the doctor but many had not been documented in the records to record these had taken place. All staff have received training in the safe handling of medicines. Roxburgh House DS0000064118.V367395.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 not sufficiently occupied or stimulated. Visitors were made welcome and their needs considered but there were shortfalls in informing them of the visiting policy. Residents had choices and some control over their daily lives. Residents enjoyed the nutritious and varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does not have a designated activity organiser and no activity programme was made available although the notice board displayed some planned contracted entertainment including a visiting musician, music to movement and reminiscence sessions. The manager and the Statement of Purpose advised that the care staff would organise social and recreational activities. However observations showed that care staff were fully occupied with other areas of care required by the people currently living at the home and no activities were seen to be taking place. The service should assess the activity needs of the residents and how these needs can be met. Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 18 Visitors spoken with said that they were always made welcome and spoke highly of the care given by staff. One visitor expressed their gratitude for the way staff responded to requests to prepare their relative for an outing when visiting. The Service User Guide says that there is unrestricted visiting but the Statement of Purpose that had been updated in May 2008 states that the visiting policy had recently been amended and, “Visitors are now requested to telephone if visiting after 8pm”. There was no notice in the home in relation to this and it was not clear how visitors would be informed about the new policy. Neither was it clear whether the visitors would be allowed in if they arrived after 8pm if they had not phoned first. The Statement of Purpose says that visitors need to let themselves be known to staff so that their visit can be recorded but in practice this is time consuming for staff, especially if they are anxious to return to a task or a resident they have left to answer the door. It was seen that in practice this does not happen. The registered provider does not want a visiting book available for visitors to complete as they feel this is institutional. This record would ensure that there is a record of who is in the building for health and safety purposes. The manager told us before this report was made public that the policy in relation to this is being revised. Observations made and discussion with residents showed that people living and staying at the home had some opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. Assistance and support in eating was available to residents as required. Although this was mainly individual, unhurried and sensitively given, one member of staff was struggling to feed two residents at the same time until another member of staff was asked to assist. This is not acceptable for the residents’ well being or their dignity. Staff were observed interacting with residents while they served meals or assisted them to eat. The menus are devised by the organisation to be used by all their homes rather than by and for each individual home. This gives less opportunity for the menus to reflect likes, dislikes and choices of the people who live at Roxburgh. However the advised that there was some flexibility for this. The menus were varied and nutritious. Residents and visitors said that there were always choices of what to eat. This was also observed throughout lunch and tea times when residents were asked which of the choices they wanted. Lunch consisted of three course and choices offered at each course. The food looked very well presented and tasty and two residents who were able to respond said that the food was always very good. However the first resident was taken to the dining room in a wheelchair at 12.15pm but lunch was not served until 1pm. This is a Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 19 long time for anyone to be sat unoccupied and with no way of independently moving away from the table. Fresh vegetables were being delivered soon after lunch, which had been collected by the organisation’s driver. This was carried through the home, including the main lounge, by hand and on a trolley over several trips. This delivery is made twice a week and seemed quite disruptive. The new extension prevented easy access via the rear of the kitchen. Terms of preferred address were on the resident’s care plan and heard to be used by staff. Residents were cared for in a respectful manner ensuring that their dignity and self-esteem were maintained. Residents were well groomed and clothes being worn were suitable and clean. All residents seen were wearing appropriate footwear. Some of the clothing in wardrobes were creased and did not look well cared for. Several garments did not bear the correct name of the person occupying the room, which would indicate that they are not wearing their own clothes. Some clothing was marked with the number of the room rather than the name of the occupant of the room. Many garments, particularly underwear, in several bedrooms were without any name and therefore relied on staff to remember to whom they belonged. This is an unreliable way of ensuring that people have their own clothes returned to them and fails to show a respect for their belongings. There were no designated laundry staff at the home and the care of residents’ clothing and other laundry is the responsibility of domestic and care staff. Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 20 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: The home has a complaints procedure that has appropriately set timescales. This is accessible to residents and family in the Statement of Purpose and displayed on the notice board for residents and visitors. Records are maintained but there have been no complaints since the one that was being addressed in the last random inspection. This concern was about the service, which included the care of residents, the odour in the home and that residents were not assisted appropriately during meal times. It was found that most of those concerns raised were appropriate and that actions were required to ensure that people living at the home have good outcomes. Most of these concerns were because of insufficient care and ancillary staff. This has mostly been resolved. The home had an organisational policy related to adult protection based on the ‘No Secrets’ document. The home did not have a Local Authority policy but the manager said that she would request a copy. The manager showed that she was knowledgeable about the subject. The majority of the staff had attended recent relevant training. Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 21 The residents are therefore safeguarded from abuse and staff had the knowledge and skills to identify or prevent abuse. There had been no adult protection referrals since the last inspection. All recruitment practices safeguard residents from the employment of unsuitable people. The financial interests of residents are safeguarded. Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 22 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): 19,20,21,22,24,26 Quality in this outcome area is adequate. The home offers the people living there comfortable surroundings, which are clean, free of offensive odour but with some shortfalls related to health and safety and infection control. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Apart from a faint odour of urine on entering the home there were no unpleasant smells in the home. The faint odour was not apparent on the second visit. The manager said that staff had worked very hard to eliminate odours and that the organisation had provided staff to assist in this. There was a battery driven air freshener in the main lounge that has the potential to affect breathing. A risk assessment should be carried out to ensure that none of the people living at the home are affected by it and any necessary action identified should be taken. Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 23 The building work had been completed and an attractively laid out enclosed garden area had been provided between the extension and the car park. Residents were seen to be using this garden during the visits and the paths provide interesting walkways for them. A water feature added sensory interest. The living space in this extension was not yet in use whilst awaiting application for registration. The entrance to the home is at the rear of the building and a lobby area leads to bedrooms and a bathroom to one side and further bedrooms and the office and communal areas to the other. The office is small and cluttered with office equipment and paperwork. There is no space to meet with visitors, staff or other professionals. The manager said that the dining room is used for this purpose. The lounge areas are decorated and furnished to a good standard. There continue to be busily patterned carpets but research shows that these are not appropriate for people with dementia. There are limited pictures, cushions, ornaments and other knick-knacks that would make these areas more homely. Patio doors lead from the main lounge to the new garden. The lounge door leading to the kitchen corridor continued to be without the intumescent strip that seals a closed door from smoke in the event of a fire. As the kitchen door is also mainly wedged open there is a high risk to the safety of people in the lounge, and the rest of the home, if a fire occurred in the kitchen. The manager advised that the organisation had planned to provide the intumescent strips in the near future but was unable to be more specific. The hairdressing room was located off the main lounge and was in use at the time of the visit. This is well planned and provides plenty of space for wheelchairs and walking aids. A cupboard in this room was storing large bottles of toiletries. Before this report was made public the manager stated that these were stored there and were to be used on the ‘shops trolley’ for residents to purchase if needed. Six bedrooms were viewed. Each of these was clean, comfortable and personalised with the occupants’ belongings. One of the bedrooms viewed had a pretty, pink lampshade that had been provided, along with several other identical ones, by the organisation for specific rooms. The manager said that she had been told where to put these shades when they were provided and there was no indication that the man, or any of the others with this type of shade, had been given any choice. Directions and doors throughout the home were not all appropriately signed. Research of long standing has shown that different coloured doors and good Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 24 signage can assist people to fid their way. Signage in use had been made at the home, some of which were difficult to read. In order to minimise the odour in a bedroom where the occupant had continence needs a chart for domestic staff to complete at two hourly intervals had been put in place. The manager advised that this helped to ensure the room stayed clean and odour free. The home provides accommodation on two floors and a passenger lift gives residents access to both floors. The knobs used to operate the lift were both labelled ‘1’ as the contractors did not have the correct replacement for the ‘ground’ floor knob. This would be confusing for anyone using the lift. There is a second passenger lift that is no longer serviced or routinely inspected and was not in use. The doors to this lift should be bolted or permanently secured. This lift must not be used, even in an emergency, unless there is a lift inspection certificate to show that it is safe. The manager said that she was not aware of any plans to remove the lift or to secure the doors. Although most of the home was accessible by all residents there were some areas on the first floor that could not be reached without negotiating several steps. The organisation now uses individual flannel-sized ‘single use’ towels that are put in the laundry after each use as part of their infection control practices. Charts kept to show that these are changed were only completed in the mornings during the domestic assistant’s hours and there was no evidence that they continued to be changed during the rest of the day and night. The manager advised that there was only one resident continued to use the kitchen but that this was becoming an increasingly rare occurrence. Staff supervise this person during their time in the kitchen and a risk assessment was in place. Residents should not be allowed into the kitchen unless they wash their hands and wear suitable clothing to protect food from contamination even if food is not being prepared. The skirting boards edges of the kitchen floor were very dirty creating a source of infection, and were in need of a deep clean to remove the build up of dirt. The manager said that plans were in place for this. The previous worn cutlery storage had been removed. Laundry facilities were inspected and found to be better organised and cleaner than previously. The broken floor tiles need to be repaired or replaced to ensure that infection control is maintained. Suitable laundry equipment was provided and laundry was drying appropriately. Disposable aprons and gloves were provided for staff in order to maintain infection control. Roxburgh House DS0000064118.V367395.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 on the rota to meet the needs of the residents but absences and low numbers of ancillary staff impact on this. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of induction and mandatory training has been recognised but there are shortfalls in specialised training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussion with staff and the manager and looking at staff rotas showed that there had been an improvement in staffing ratios since the previous inspection. The rotas showed two waking care staff on duty during the night and four during the day. However there were several occasions when the manager had needed to act as a care assistant when absences brought the number of care staff on duty below this. Due to a vacancy there were only three care staff available on the day of the visit. The organisation needs to ensure that there are strategies that can be followed if there are insufficient permanent staff available to cover absences. In addition to care staff the rotas showed that there was one cook each day working 8am to 2pm and one domestic assistant from 8.30am to 1.30pm each day. Domestic and catering tasks that are conducted outside of these times are Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 26 done by care staff, which takes them away from time with residents. Limited activity and occupation available to residents would suggest that the management should assess the hours required to meet all the residents’ needs, including activities and daily occupation. 75 of the care staff had achieved National Vocational Qualification (NVQ) Level 2 in Care, exceeding the required 50 . This qualification shows that staff have been assessed as competent to carry out their care role. Three staff files were looked at and contained all the required information to safeguard residents from the employment of unsuitable people. References and employment history had been verified to further ensure this. New staff undertake induction training, which was evidenced in staff files. Other training undertaken in the past year included that related to safeguarding adults (protection of vulnerable adults), First Aid, fire safety, infection control, moving and handling and health and safety. Whilst the majority of staff had undertaken training related to care of people with dementia there were only two members of staff that had undertaken this since 2004 and two members of staff had not had relevant training since 1999. This training needs updating particularly considering that the home specialises in caring for this client group. Roxburgh House DS0000064118.V367395.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): 31,33,35,37,38 Quality in this outcome area is adequate. A person who has completed the appropriate training and who has previous experience in a senior position manages the home. Monitoring and auditing of the service and practices takes place so that all services operate in the best interests of residents. There are concerns about the security of records of past residents that create a risk to confidentiality. There are shortfalls in health and safety practices thereby not protecting residents and staff at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although in post for over a year the manager was not registered with us. The application for registration began following this inspection. She had achieved the Registered Managers Award, which with her previous experience in a senior position in a similar setting gives her the appropriate training and experience for this role. The deputy post was vacant on the second day of the visit, as the Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 28 deputy had chosen to resign from this post after several years, to become a care assistant. Following the inspection visit we were informed that she remained in post until a new deputy was transferred from another home in the organisation. The home has a Quality Assurance system. Monthly inspections take place where services are monitored and audited by a senior member of the organisation. Questionnaires are given to people who use the home for respite care and to permanent residents or their representatives annually, social workers, GPs and district nurses. This indicates that the home is enabling growth and improvement. Until now the organisation had collated and analysed this information but the manager advised that this is to be carried out by individual services in the future. Apart from one resident the home does not keep money on behalf of the people living at the home. Any extra purchases such as hairdressing or chiropody are paid by the organisation and invoiced to the resident or the person handling their financial affairs. The one resident signs for all transactions themselves. There are details regarding advocacy services in the Statement of Purpose, enabling residents or their representative to arrange this. A small room on the first floor that had originally been a second office was being used as a storeroom and some archived paperwork, including resident information, was stored there. This room needs to be locked in order to maintain confidentiality and health and safety. Staff have undertaken the mandatory training related to health and safety issues. There was evidence from a random check of records, that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system were up to date, although there were some concerns as mentioned in the Environment section of this report regarding the lack of fire safety with the kitchen and lounge doors. Several areas of health and safety risk were identified during the visits to the home and have been addressed throughout this report. These include, - The need for a risk assessment for the battery operated air freshener appropriate and action to be taken in order to minimise the risk of this affecting a person with breathing difficulties/conditions. - The need for a visitors’ book to be completed so that the service is aware of who is in the building at any given time. Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 29 - The original lift must not be used, even in an emergency, unless it has an up to date inspection certificate to show that it is safe to use. The doors to this lift need to be made secure. - Fire doors need intumescent strips in order to prevent the passage of smoke in the event of a fire. - Fire doors should not be wedged open other than by an open door device that is linked to the fire alarm system. The registered persons should seek advice from the fire service with regard to this. Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 30 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 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 2 3 2 3 x x 2 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x 2 2 Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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. 2. Standard OP7 Regulation 12 Requirement The information in the two sets of care plans must be the same, up to date and accurate to prevent confusion. This will ensure that needs are met in a person centred and consistent way. Staff must transport medicines throughout the home in a safe manner and all medicines must be able to be securely held in a locked facility in the event of an emergency A system must be installed to check the prescription prior to dispensing and to check the dispensed medication and the medicine charts against the prescription for accuracy. The quantity of all medicines received and any balances carried over from previous cycles must be recorded to enable audits to take place to demonstrate the medicines are administered as prescribed Timescale for action 15/09/08 3. OP9 13(2) 15/09/08 4. OP9 13(2) 15/09/08 Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 32 . OP26 16(2)(j) Consultation with Environmental 15/09/08 Health must take place regarding infection control measures related to hand washing facilities, access to the kitchen by residents, the cleanliness of the kitchen and the floor covering in the laundry. This will ensure that satisfactory infection control is in place in order to protect the welfare of residents and staff. There must be appropriate strategies in place to enable management to cover staff absences. This will ensure that the needs of the service and the residents are met. All staff must have up to date training related to dementia. This will ensure that they have the skills and knowledge to meet these specialist needs. All records of current and past residents must be stored in a secure location. This will safeguard their confidentiality. Risk assessments need to be in place where a possible hazard presents, including for the battery operated air freshener, for fire doors and for the out of use lift. 30/09/08 . OP27 18 . OP30 18 30/11/08 . OP37 17(1) 15/09/08 . OP38 13(4) 15/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 33 No. 1. 2. 3. 4. 5. 6. 7. 8. Refer to Standard OP1 OP12 OP13 OP19 OP21 OP22 OP27 OP38 Good Practice Recommendations The Statement of Purpose and Service User Guide should give the same information to prevent confusion and should be kept up to date. Activities should suit the individual’s wishes, needs and abilities. Visitors should be clear about the visiting policy. Consideration should be given to providing improved office facilities. The lampshades provided for private accommodation should the choice of the individual occupying the room. There should be appropriate signage in the home so that people with dementia can find there around the building. The service should demonstrate that they have assessed the number of hours required to meet all the needs of the people who live there. Appropriate fire safety measures must be in place, following advice from the fire service. This will protect the health and safety of the people living and working in the home. Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 (COMMISSION FOR SOCIAL CARE INSPECTION) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of COMMISSION FOR SOCIAL CARE INSPECTION ******************** Roxburgh House DS0000064118.V367395.R01.S.doc Version 5.2 Page 35 - 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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